Percutaneous kyphoplasty assisted by three dimensional printing percutaneous guide plate for the treatment of osteoporotic vertebral compression fractures / 中国骨伤

OBJECTIVE@#To verify the safety of three dimensional printing percutaneous guide plate assisted percutaneous kyphoplasty(PKP) in the treatment of osteoporotic vertebral compression fractures(OVCFs).@*METHODS@#The clinical data of 60 patients with OVCFs treated by PKP from November 2020 to August 2021 were retrospectively analyzed. There were 24 males and 36 females, aged from 72 to 86 years old with an average of (76.5±7.9) years. Routine percutaneous kyphoplasty was performed in 30 cases (conventional group) and three dimensional printing percutaneous guide plate assisted PKP was performed in 30 cases (guide plate group). Intraoperative pedicle puncture time (puncture needle to posterior vertebral body edge) and number of fluoroscopy, total operation time, total number of fluoroscopy, amount of bone cement injection, and complication (spinal canal leakage of bone cement) were observed. The visual analogue scale (VAS) and the anterior edge compression rate of the injured vertebra were compared before operation and 3 days after operation between two groups.@*RESULTS@#All 60 patients were successfully operated without complication of spinal canal leakage of bone cement. In the guide plate group, the pedicle puncture time was(10.23±3.15) min and the number of fluoroscopy was(4.77±1.07) times, the total operation time was (33.83±4.21) min, the total number of fluoroscopy was(12.27±2.61) times;and in the conventional group, the pedicle puncture time was (22.83±3.09) min and the number of fluoroscopy was (10.93±1.62) times, the total operation time was(44.33±3.57) min, the total number of fluoroscopy was(19.20±2.67) times. There were statistically significant differences in the pedicle puncture time, intraoperative number of fluoroscopy, the total operation time, and the total number of fluoroscopy between the two groups(P<0.05). There was no significant difference in amount of bone cement injection between the two groups(P>0.05). There were no significant differences in VAS and the anterior edge compression rate of the injured vertebra at 3 days after operation between two groups(P>0.05).@*CONCLUSION@#Three dimensional printing percutaneous guide plate assisted percutaneous kyphoplasty is safe and reliable, which can reduce the number of fluoroscopy, shorten the operation time, and decrease the radiation exposure of patients and medical staff, and conforms to the concept of precise orthopaedic management.

Spinal deformity index and quality of life of patients with a densitometric diagnosis of osteoporosis / índice de deformidade espinal e qualidade de vida de pacientes com diagnóstico densitométrico de osteoporose / índice de deformidad espinal y calidad de vida de pacientes con diagnóstico densitométrico de osteoporosis

ABSTRACT Objective: To evaluate the existence of a possible significant correlation between the quality of life of outpatients with osteoporosis and the Spinal Deformity Index (SDI), a radiographic method for semiquantitative assessment of the spine that enables the identification of prevalent and incident fractures. Methods: A cross-sectional observational study carried out with female patients, Caucasians, over 50 years of age, with a densitometric diagnosis of osteoporosis and in an outpatient follow-up, who were submitted to the Oswestry Disability Index (ODI) and SF-36 questionnaires to measure the direct and indirect damage of vertebral fragility fractures on quality of life. The scores obtained in these questionnaires were correlated with the SDI scores, calculated from the radiographs of the lumbar and thoracic spine. Results: 48 patients completed the study, with a mean age of 69.6±6.7 years, mean body mass index (BMI) of 25.4±3.4 kg/m2, mean ODI of 25.1±17.9%, mean SF- 36 of 428.7±192.4 and mean SDI of 4.3±3. For the statistical analysis, Spearman's coefficient was used (p ≤ 0.05). Conclusion: There is no statistically significant correlation between the SDI and the scores obtained on the ODI and SF-36 quality of life questionnaires. Level of evidence: III. Study of non-consecutive patients, without gold standard, applied uniformly.

RESUMO Objetivo: Avaliar a existência de uma possível correlação significativa entre a qualidade de vida de pacientes ambulatoriais com osteoporose e o Spinal Deformity Index (SDI, Índice de Deformidade Espinal), método radiográfico de avaliação semiquantitativa da coluna vertebral que permite identificar fraturas prevalentes e incidentes. Métodos: Estudo observacional transversal realizado com pacientes do sexo feminino, caucasianas, com mais de 50 anos de idade, diagnóstico densitométrico de osteoporose e em seguimento ambulatorial, as quais foram submetidas aos questionários Oswestry Disability Index (ODI) e SF-36 para dimensionar o dano direto e indireto das fraturas por fragilidade vertebral na qualidade de vida. A pontuação obtida nestes questionários foi correlacionada com os escores do SDI, calculados a partir das radiografias da coluna vertebral lombar e torácica. Resultados: Concluíram o estudo 48 pacientes, com média de idade de 69,6 ± 6,7 anos, índice de massa corporal (IMC) médio de 25,4 ± 3,4 kg/m2, ODI médio de 25,1 ± 17,9%, SF-36 médio de 428,7 ± 192,4 e SDI médio de 4,3 ± 3. Para a análise estatística empregou-se o coeficiente de Spearman (p ≤ 0,05). Conclusões: Não há correlação estatística significativa entre o SDI e a pontuação obtida nos questionários de qualidade de vida ODI e SF-36. Nível de evidência: III; Estudo de pacientes não consecutivos, sem padrão ouro, aplicados uniformemente.

RESUMEN Objetivo: Evaluar la existencia de una posible correlación significativa entre la calidad de vida de los pacientes ambulatorios con osteoporosis y el Spinal Deformity Index (SDI, Índice de Deformidad Espinal), un método radiográfico de evaluación semicuantitativa de la columna vertebral que permite identificar fracturas prevalentes e incidentes. Métodos: Estudio observacional transversal realizado con pacientes del sexo femenino, caucásicas, mayores de 50 años, con diagnóstico densitométrico de osteoporosis y en seguimiento ambulatorio, a las que se les aplicaron los cuestionarios Oswestry Disability Index (ODI) y SF-36 para medir el daño directo e indirecto de las fracturas por fragilidad vertebral en la calidad de vida. Las puntuaciones obtenidas en estos cuestionarios se correlacionaron con las puntuaciones del SDI, calculadas a partir de las radiografías de la columna lumbar y torácica. Resultados: Un total de 48 pacientes completaron el estudio, con una edad promedio de 69,6 ± 6,7 años, índice de masa corporal (IMC) promedio de 25,4 ± 3,4 kg / m2, ODI promedio de 25,1 ± 17,9%, SF-36 promedio de 428,7 ± 192,4 y un SDI promedio de 4,3 ± 3. Para el análisis estadístico se utilizó el coeficiente de Spearman (p ≤ 0,05). Conclusiones: No existe una correlación estadísticamente significativa entre el SDI y la puntuación obtenida en los cuestionarios de calidad de vida ODI y SF-36. Nivel de evidencia: III; Estudio de pacientes no consecutivos, sin padrón oro, aplicados uniformemente.

Effect of Sarcopenia on the Efficacy of Percutaneous Kyphoplasty in the Treatment of Osteoporotic Spinal Compression Fractures in Elderly Patients / 中国医学科学院学报

Objective To investigate the effect of sarcopenia on the efficacy of percutaneous kyphoplasty(PKP)in the treatment of osteoporotic spinal compression fracture(OSCF)in elderly patients. Methods From February 2017 to June 2018,a total of 77 elderly patients who met the inclusion and exclusion criteria were included in this study.Grip strength of dominant hand was measured by an electronic grip dynamometer with cut-off values of 27 kg for males and 16 kg for females.The cross-sectional area of the pedicle level muscle of the 12th thoracic vertebra(T12)was measured by chest CT.The skeletal muscle index(SMI)was calculated by dividing the T12 pedicle level muscle cross-sectional area by the square of body height.The SMI cut-off value used to diagnose sarcopenia was 42.6 cm

Ex-vivo evaluation of the three-column concept in canine thoracolumbar fractures / [Avaliação em ex-vivo do conceito dos três compartimentos em fraturas toracolombares da coluna]

Traumatic events such as a motor vehicle accident or falling from heights are very common in veterinary medicine and often lead to vertebral fracture-luxation with concomitant spinal cord injuries, mostly in the thoracolumbar spine. The purpose of this cadaveric biomechanical study was to determine the feasibility of the three-column concept in canine thoracolumbar segments with induced fractures. Eighteen Functional Spinal Units (FSU) of the thoracolumbar segments (T12-L2) were collected from 18 medium-sized adult dog cadavers and were subjected to flexion-extension and lateral bending tests so that range of motion (ROM) was recorded with a goniometer. Fractures were induced by compressive loads applied by a universal testing machine (EMIC®). After this, specimens were screened using computed tomography (CT) and the fractures were graded as affecting one, two or three columns, and divided into groups A, B, and C, respectively. Post-fracture range of motion (ROM) was compared with the previous results. Groups B and C (with fractures in two or three columns) had instability in the two axes evaluated (P<0.05). The outcomes of this study support the applicability of the three-column theory to thoracolumbar spines of dogs, as the FSUs that suffered fractures in two or more columns showed axial instability.(AU)

Eventos traumáticos, como acidentes automobilísticos ou quedas, são muito comuns na medicina veterinária e, frequentemente, levam a fraturas ou luxações vertebrais, associadas a lesões medulares concomitantes, mais frequentemente na coluna toracolombar. O propósito deste estudo biomecânico em cadáveres foi determinar a viabilidade da teoria dos três compartimentos em fraturas induzidas em segmentos toracolombares de cães. Dezoito unidades espinhais funcionais (UEF) de segmentos toracolombares (T12-L2) foram coletadas de 18 cadáveres de cães adultos de médio porte e submetidas a testes de flexão-extensão e curvamento lateral, de modo que a amplitude de movimento (ADM) foi registrada com um goniômetro. Fraturas foram induzidas por meio de cargas compressivas aplicadas por uma máquina universal de ensaios (EMIC®). As amostras foram submetidas à tomografia computadorizada (TC), e as fraturas foram classificadas como afetando um, dois ou três compartimentos e divididas nos grupos A, B e C, respectivamente. A ADM pós-fratura foi comparada com os resultados prévios. Os grupos B e C (com fraturas em dois ou três compartimentos) apresentaram instabilidade nos dois eixos avaliados (P<0,05). Os resultados deste estudo corroboram a aplicabilidade da teoria dos três compartimentos para segmentos de coluna toracolombar em cães, uma vez que as UEF que sofreram as fraturas em dois ou mais compartimentos apresentaram instabilidade axial.(AU)

Risk factors of recurrent kyphosis in thoracolumbar burst fracture patients treated by short segmental pedicle screw fixation / 北京大学学报(医学版)

OBJECTIVE@#To analyze the risk factors of recurrent kyphosis after removal of short segmental pedicle screw fixation in patients with thoracolumbar burst fractures.@*METHODS@#Retrospective analysis was conducted of 144 cases of thoracolumbar burst fractures without neurological impairment treated in Peking University Third Hospital from January 2010 to December 2017. There were 74 males and 70 females, with an average age of (39.1±13.2) years. The distribution of the injured vertebrae was T12: 42, L1: 72 and L2: 30, with fracture types of A3: 90, B1: 25 and B2: 29. The patients were divided into two groups: Recurrent kyphosis group (n=92) and non-recurrent kyphosis group (n=52). SPSS 26.0 software was used for univariate analysis and Logistic regression analysis.@*RESULTS@#The average follow-up time was 28 (20-113) months. The imaging indexes of pre-operation, 3 days post-operation, 12 months post-operation and the last follow-up were measured and compared. Anterior vertebral body height, segmental kyphosis, vertebral wadge angle and Gardner deformity were significantly improved after operation (P < 0.05), and there were some degrees of loss in the 1-year follow-up; anterior vertebral body height and vertebral wadge angle were no longer changed after the removal of the screws; however, segmental kyphosis and Gardner deformity were still aggravated after the removal of the screws (P < 0.05). There were some degrees of collapse of the height of the upper and lower discs during the follow-up. Univariate analysis showed that there were statistically significant differences (P < 0.05) between the two groups in gender, age (36.9 years vs. 43.0 years), upper disc injury, CT value (174 vs. 160), segmental kyphosis (16.6° vs. 13.3°), vertebral wadge angle (16.7° vs. 13.6°), Gardner deformity (19.1° vs. 15.2°) and ratio of anterior vertebral body height (0.65 vs. 0.71). Logistic regression analysis showed that male (OR: 2.88, 95%CI: 1.196-6.933), upper disc injury (OR: 2.962, 95%CI: 1.062-8.258) and injured vertebral wedge angle were risk factors of recurrent kyphosis after removal of internal fixation for thoracolumbar burst fracture (P < 0.05).@*CONCLUSION@#The patients with thoracolumbar burst fracture can obtain satisfactory effect immediately after posterior short segmental pedicle screw fixation, however, there may be some degree of loss during the follow-up. Male, upper disc injury and injured vertebral wedge angle are the risk factors of recurrent kyphosis after removal of internal fixation for thoracolumbar burst fracture.

Minimally Invasive versus Conventional Open Surgery for Fixation of Spinal Fracture in Ankylosed Spine

@#Introduction: This was a retrospective study aimed to investigate the perioperative outcomes of long construct minimally invasive spinal stabilisation (MISt) using percutaneous pedicle screws (PPS) versus conventional open spinal surgery in the treatment of spinal fracture in ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH). Material and Methods: Twenty-one patients with AS and DISH who were surgically treated between 2009 and 2017 were recruited. Outcomes of interest included operative time, intra-operative blood loss, complications, duration of hospital stay and fracture union rate. Results: Mean age was 69.2 ± 9.9 years. Seven patients had AS and 14 patients had DISH. 17 patients sustained AO type B3 fracture and 4 patients had type B1 fracture. Spinal trauma among these patients mostly involved thoracic spine (61.9%), followed by lumbar (28.6%) and cervical spine (9.5%). MISt using PPS was performed in 14 patients (66.7%) whereas open surgery in 7 patients (33.3%). Mean number of instrumentation level was 7.9 ± 1.6. Mean operative time in MISt and open group was 179.3 ± 42.3 minutes and 253.6 ± 98.7 minutes, respectively (p=0.028). Mean intra-operative blood loss in MISt and open group was 185.7 ± 86.4ml and 885.7 ± 338.8ml, respectively (p<0.001). Complications and union rate were comparable between both groups. Conclusion: MISt using PPS lowers the operative time and reduces intra-operative blood loss in vertebral fractures in ankylosed disorders. However, it does not reduce the perioperative complication rate due to the premorbid status of the patients. There was no significant difference in the union rate between MISt and open surgery.

Comparison of percutaneous vertebroplasty and percutaneous curved vertebroplasty for osteoporotic vertebral compression fractures: Distribution and leakage rate of injected bone cement / 中国组织工程研究

BACKGROUND: Percutaneous curved vertebroplasty is a modified surgical method of percutaneous vertebroplasty; the most prominent feature of which is that it can make the bone cement distributed symmetrically and balance the strength on both sides of the vertebral body. In theory, it can ensure the distribution of bone cement in the vertebral body, and solve the problem that the uneven distribution of bone cement in the traditional percutaneous vertebroplasty and single injection leads to poor pain relief effect in the fracture area. OBJECTIVE: To compare the clinical efficacy of percutaneous curved vertebroplasty and percutaneous vertebroplasty bone cement injection in the treatment of osteoporotic vertebral compression fractures, and to discuss the value of percutaneous curved vertebroplasty in clinical application. METHODS: Seventy patients with single vertebral osteoporotic vertebral compression fractures from the Third Affiliated Hospital of AnHui Medical University between 2017 and 2018 were selected. The patients were randomly divided into two groups. Percutaneous curved vertebroplasty group (n=35) received treatment with percutaneous curved vertebroplasty. Percutaneous vertebroplasty group (n=35) received treatment with percutaneous vertebroplasty. Distribution and leakage of bone cement were observed in the two groups. Visual analogue scale score and Oswestry disability index were assessed preoperatively and 1 day postoperatively. Postoperative follow-up was conducted for 1 year to observe the recovery of the height of the anterior edge of the injured vertebra and the occurrence of adjacent vertebral fractures. The trial was approved by the Ethics Committee of the Third Affiliated Hospital of Anhui Medical University. RESULTS AND CONCLUSION: (1) Compared with the percutaneous vertebroplasty group, the distribution of bone cement was more uniform and satisfactory (P0.05). (4) There was no significant difference in the incidence of adjacent vertebral fractures between the two groups (P>0.05). (5) The results showed that compared with the treatment of percutaneous vertebroplasty, the treatment of osteoporotic vertebral body compression fractures by percutaneous curved vertebroplasty can reduce the rate of bone cement leakage and improve the quality of life of patients.

Prophylactic of stress fractures of vertebrae adjacent to transpedicular screw fixation for osteoporosis / Profilaxia das fraturas por estresse de vértebras adjacentes à fixação com parafuso transpedicular em osteoporose / Profilaxia de las fracturas por estrés de vértebras adyacentes a la fijación de tornillo transpedicular en osteoporosis

ABSTRACT Objective: To assess the efficacy and use of vertebroplasty as a prophylactic measure to prevent stress fractures of vertebrae adjacent to transpedicular screw fixation with augmentation for osteoporosis. Methods: An experimental cadaveric study was performed to assess the overall strength of 10 cadaveric blocks of T10-L4 vertebral segments with simulation of L1 fracture and T12-L2 transpedicular 4-screw system with augmentation. T11 and L2 vertebroplasty cranial and caudal to the transpedicular system was performed in 5 blocks in the main group. Stress testing of the blocks was performed by placing them under a vertically directed load until destruction. Results: Vertically directed load on the blocks in the main group (0.84 ± 0.39831 kN) resulted in T11 vertebrae fractures. Vertebrae with augmentation were resistant to the load in the main group. T10 vertebrae fractures in the blocks of the main group occurred at a load of 1.91 ± 0.40566 kN. Conclusion: 1. The adjacent T11 vertebra is the weakest vertebra in the anatomical blocks of T10-L4 vertebral segments with simulation of L1 fracture (type A according to the AO/Magerl classification) and the T12-L2 4-screw transpedicular system with augmentation. 2. Bone cement injection into the T11 cranial vertebra adjacent to the level of fixation increases the overall strength of the blocks 3. Vertebroplasty of the overlying vertebra is an effective way to prevent its fracture and in case of osteoporosis. 4. Prophylactic vertebroplasty of the vertebra caudal to the level of fixation is unnecessary due to the insignificant risk of a fracture. Level of Evidence III; Experimental - Quasi experiments

RESUMO Objetivo: Avaliar a eficácia e o uso da vertebroplastia como medida profilática para prevenir fraturas por estresse das vértebras adjacentes à fixação com parafuso transpedicular com o aumento da osteoporose. Métodos: Foi realizado um estudo cadavérico experimental para avaliar a resistência global de 10 blocos cadavéricos dos segmentos T10-L4 com simulação de fratura de L1 e sistema com 4 parafusos transpediculares em T12-L2 com aumento. A vertebroplastia de T11-L2 cranial e caudal ao sistema transpedicular foi realizada em 5 blocos no grupo principal. Os testes de estresse nos blocos foram realizados aplicando-se carga vertical até ocorrência de fratura. Resultados: A carga vertical sobre os blocos no grupo principal (0,84 ± 0,39831 kN) resultou em fratura da vértebra T11. As vértebras com aumento foram resistentes à carga no grupo principal. As fraturas da vértebra T10 nos blocos do grupo principal ocorreram com carga de 1,91 ± 0,40566 kN. Conclusão: 1. A vértebra adjacente à T11 é a mais fraca nos blocos anatômicos dos segmentos vertebrais T10-L4 com simulação de fratura de L1 (tipo A de acordo com a classificação AO/Magerl) e do sistema transpedicular com 4 parafusos T12-L2 com aumento. 2. A injeção de cimento ósseo na vértebra adjacente à T11 em sentido cranial ao nível de fixação aumenta a resistência global dos blocos. 3. A vertebroplastia da vértebra sobrejacente é uma forma eficaz de prevenir a fratura nos casos de osteoporose. 4. A vertebroplastia profilática da vértebra caudal ao nível de fixação é desnecessária devido ao risco insignificante de fratura. Nível de Evidência III; Experimental - Quase experimentos.

RESUMEN Objetivo: Evaluar la eficacia y el uso de la vertebroplastia como medida profiláctica para prevenir fracturas por estrés de las vértebras adyacentes a la fijación con tornillo transpedicular con aumento de la osteoporosis. Métodos: Se realizó un estudio cadavérico experimental para evaluar la resistencia global de 10 bloques cadavéricos de los segmentos T10-L4 con simulación de fractura de L1 y sistema con 4 tornillos transpediculares en Th12-L2 con aumento. La vertebroplastia de T11-L2 craneal y caudal al sistema transpedicular se realizó en 5 bloques en el grupo principal. Los tests de estrés en los bloques fueron realizados aplicándose carga vertical hasta la ocurrencia de fractura. Resultados: La carga vertical sobre los bloques en el grupo principal (0,84 ± 0,39831 kN) resultó en fractura de la vértebra T11. Las vértebras con aumento fueron resistentes a la carga en el grupo principal. Las fracturas de la vértebra T10 en los bloques del grupo principal ocurrieron con carga de 1,91 ± 0,40566 kN. Conclusión: 1. La vértebra adyacente a T11 es la más débil en los bloques anatómicos de los segmentos vertebrales T10-L4 con simulación de fractura de L1 (tipo A según la clasificación AO/Magerl) y del sistema transpedicular con 4 tornillos T12-L2 con aumento. 2. La inyección de cemento óseo en la vértebra adyacente a la T11 em sentido craneal al nivel de fijación aumenta la resistencia global de los bloques 3. La vertebroplastia de la vértebra suprayacente es una forma efectiva de prevenir la fractura en los casos de osteoporosis. 4. La vertebroplastia profiláctica de la vértebra caudal al nivel de fijación es innecesaria debido al riesgo no significativo de fractura. Nivel de evidencia III; Experimental - Cuasi experimentos.

Comparative study of the clinical application of TLICS and AO-TLICS scores / 国际外科学杂志

Objective To evaluate the reliability of the TLICS and AO-TLICS scoring system for the thoracolumbar fracture and the effectiveness of the final treatment scheme.Methods The clinical data of 56 adult patients with acute traumatic thoracolumbar fracture diagnosed in Department of Orthopedics,Chui Yang Liu Hospital Affiliated to Tsinghua University from June 2015 to June 2017 were analyzed retrospectively.There were 35 males and 21 females,aged (32.3 ± 9.8) years,with an age range of 21-53 years.Two senior deputy chief orthopaedic physicians retrospective analyzed DR plain films,CT,MRI images and clinical records of thoracolumbar spine by independent blind method.According to TLICS and AO-TLICS scoring system (include injury morphology,neurologic status,posterior ligament complex (PLC) damage or M1 modifier,the severity scores of thoracolumbar fracture were classified and calculated.The score was divided into TLICS score group and AO-TLICS score group,each group of scores was the above 56 patients.Three months later,the two physicians repeated the above analysis process and compared the consistency of the scores between the observer and the observer's own control.The consistency of the two groups was compared,and the accuracy,sensitivity and specificity of the final treatment were compared.Cohen kappa test was used for consistency comparison according to the score and the mean value was taken.Measurement data were expressed as mean ± standard deviation (Mean ± SD),and t test was used for inter-group comparison.Results In the TLICS score group,the Cohen kappa coefficients of the observer's own control in fracture type,neurological status assessment,and PLC injury were 0.810,0.966,and 0.698,respectively,and the total scores were consistent (k=0.727).Cohen kappa coefficients between the observers in fracture morphology,neurological status assessment,and PLC injury were 0.725,0.931,and 0.594,respectively,and the total scores were consistent (k =0.615).In the AO-TLICS score group,the Cohen kappa coefficients of the observer's own control in terms of fracture type,neurological status assessment,and M1 correction factor were 0.760,0.892,and 0.711,respectively,and the total scores were consistent (k =0.666).Cohen kappa coefficients of the observers in terms of fracture type,neurological status assessment and M1 correction factor were 0.707,0.836 and 0.604,respectively,and the total score was consistent (k =0.592).According to the TLICS score,the correct rate of treatment was (84.2 ± 2.8) ％,the sensitivity was (84.1 ±2.1)％,and the specificity was (85.9 ± 6.5)％.According to the AO-TLICS score,the correct rate of treatment was (89.0 ± 2.6) ％,the sensitivity was (88.3 ± 3.5) ％,and the specificity was (89.6 ± 2.4) ％.There was a statistically significant difference in the rate of correct rate (t =2.485,P =0.047).Conclusion The advantage of TLICS score is better consistency in interobservers or intraobservers,but the AO-TLICS score system is more comprehensive,and the choice of treatment plan is more instructive.

Relationship between the Progression of Kyphosis in Thoracolumbar Osteoporotic Vertebral Compression Fractures and Magnetic Resonance Imaging Findings / 대한정형외과학회잡지

PURPOSE: To examine the relationship between the progression of a kyphotic deformity and the magnetic resonance imaging (MRI) findings in conservatively treated osteoporotic thoracolumbar compression fracture patients. MATERIALS AND METHODS: This study categorized the patients who underwent conservative treatment among those patients who underwent treatment under the suspicion of a thoracolumbar compression fracture from January 2007 to March 2016. Among them, this retrospective study included eighty-nine patients with osteoporosis and osteopenia with a bone density of less than −2.0 and single vertebral body fracture. This study examined the MRI of anterior longitudinal ligament or posterior longitudinal ligament injury, superior or inferior endplate disruption, superior of inferior intravertebral disc injury, the presence of low signal intensity on T2-weighted images, and bone edema of intravertebral bodies in fractured intravertebral bodies. RESULTS: In cases where the superior endplate was disrupted or the level of bone edema of the intravertebral bodies was high, the kyphotic angle, wedge angle, and anterior vertebral compression showed remarkably progression. In the case of damage to the anterior longitudinal ligament or the superior disc, only the kyphotic angle was markedly prominent. On the T2-weighted images, low signal intensity lesions showed a high wedge angle and high anterior vertebral compression. On the other hand, there were no significant correlations among the posterior longitudinal ligament injury, inferior endplate disruption, inferior disc injury, and the progression of kyphotic deformity and vertebral compression. The risk factors that increase the kyphotic angle by more than 5° include the presence of injuries to the anterior longitudinal ligament, superior endplate disruption, and superior disc injury, and the risk factors were 21.3, 5.1, and 8.5 times higher than those of the uninjured case, and the risk differed according to the level of bone edema. CONCLUSION: An osteoporotic thoracolumbar compression fracture in osteoporotic or osteopenic patients, anterior longitudinal ligament injury, superior endplate and intravertebral disc injury, and high level of edema in the MRI were critical factors that increases the risk of kyphotic deformity.

Anterior fixation of odontoid fractures: results / Fixação anterior de fraturas do processo odontoide: resultados

ABSTRACT Objective: To evaluate the clinical and radiological outcomes of the surgical treatment in patients diagnosed with odontoid fracture who underwent open reduction and internal fixation (ORIF) with screws. Methods: This was a retrospective study with nine patients. Pain (visual analog scale [VAS]) and neurological status (Frankel scale) were assessed. The neck disability index (NDI) and the post-operative cervical range of motion were calculated. The cervical spine was radiologically evaluated (X-ray and CT) pre- and postoperatively. Results: The mean age of patients was 70 years. All patients presented type IIb (Grauer classification) fractures, with a mean deviation of 2.95 mm. Two patients had subaxial lesions. The mean follow-up was 30 months. The mean time from trauma to surgery was seven days. The pre-operative Frankel score was E in all except one patient (B), in whom a post-operative improvement from B to D was observed. Post-operative pain was 2/10 (VAS). A total of 77% of patients presented a mild or moderate disability (NDI). Six patients regained full range of cervical movement, and bone union required approximately 14 weeks. Pseudarthrosis complications were observed in two patients (77% union rate), one patient presented screw repositioning and one case, dysphonia. Conclusion: Delayed diagnosis is still an issue in the treatment of odontoid fractures, especially in elderly patients. Concomitant lesions, especially in younger patients, are not uncommon. The literature presents high fusion rates with ORIF (≥80%), which was also observed in the present study. However, surgical success depends on proper patient selection and strict knowledge of the technique. This pathology presents a reserved functional prognosis in the medium-term, especially in the elderly.

RESUMO Objetivo: Avaliar os resultados clínicos e radiológicos do tratamento cirúrgico em pacientes com diagnóstico de fratura do processo odontoide submetidos a redução aberta e fixação interna (RAFI) com parafusos. Métodos: Estudo retrospectivo com nove pacientes. Avaliada a dor (escala visual analógica [EVA]) e o estado neurológico (escala de Frankel). O Neck Disability Index (NDI) e a amplitude de movimento cervical pós-operatória foram calculados. A coluna cervical foi avaliada radiologicamente (raios X e TC) nos períodos pré- e pós-operatório. Resultados: A idade média dos pacientes foi de 70 anos. Todos apresentaram fraturas do tipo IIb (classificação de Grauer), com desvio médio de 2,95 mm. Dois apresentaram lesões subaxiais. O seguimento médio foi de 30 meses. O tempo médio entre trauma e cirurgia foi de sete dias. O escore pré-operatório de Frankel foi E em todos, exceto em um paciente (B), no qual se observou uma melhoria pós-operatória de B para D. A dor pós-operatória foi 2/10 (EVA). Apresentaram incapacidade leve ou moderada (NDI) 77% pacientes. Seis pacientes recuperaram toda a amplitude de movimento cervical; a consolidação óssea levou aproximadamente 14 semanas. Foram observadas complicações de pseudartrose em dois pacientes (taxa de consolidação: 77%), um paciente necessitou reposicionamento do parafuso e um paciente, disfonia. Conclusão: O diagnóstico tardio ainda é um problema no tratamento de fraturas do odontoide, especialmente em pacientes idosos. As lesões concomitantes, especialmente em pacientes mais jovens, não são incomuns. A literatura apresenta altas taxas de consolidação com RAFI (≥ 80%), o que também foi observado no presente estudo. No entanto, o sucesso cirúrgico depende da seleção adequada do paciente e do conhecimento rigoroso da técnica. Essa patologia apresenta um prognóstico funcional reservado em médio prazo, especialmente em idosos.

Vertebroplastia percutánea guiada por tomografía para el manejo del dolor en pacientes con fractura del cuerpo vertebral / CT-guided Vertebroplasty for Painful Vertebral Fractures

Objetivo Describir la técnica y resultados en cuanto a la mejoría del dolor y complicaciones al realizar este procedimiento mediante guía por tomografía computada. Materiales y Métodos Estudio observacional descriptivo de una serie de 108 pacientes a quienes se les realizó vertebroplastia percutánea guiada por tomografía computada realizadas en dos hospitales universitarios, entre mayo 2007 y mayo 2017. Todos los procedimientos se realizaron de forma ambulatoria con anestesia local y se valoró el dolor mediante la escala visual análoga. Resultados Se realizaron 125 vertebroplastias, en el 87,9% de los pacientes (n = 95) se realizó el procedimiento en un cuerpo vertebral, en el 8,3% (n = 9) y 3,7% (n = 4) de los pacientes se cementaron 2 y 3 vertebras respectivamente. El rango de dolor según la escala visual análoga (EVA) previo al tratamiento varió entre 5 y 10, donde un 94% (n = 102) de los pacientes manifestaban una intensidad 10/10. En el postratamiento el rango de dolor varió entre 0a7dondeel 98% de la población reportó un valor menor o igual a 3. Se presentaron 3 complicaciones: tromboembolismo pulmonar por metil-metacrilato, extravasación al plexo de Batson y extravasación al espacio interdiscal, cada una en tres pacientes diferentes. Conclusión La vertebroplastia percutánea guiada por TC ofrece una indiscutible mejora inmediata del dolor en pacientes con fractura de uno o más cuerpos vertebrales, con una baja tasa de complicaciones.

Objetive Describe the technique, results in terms of pain improvement and complications to perform this procedure by computed tomography. Materials and Methods A descriptive observational study of a 108 cases series of percutaneous vertebroplasty guided by computed tomography performed in two university hospitals between May 2007 and May 2017. All procedures were performed with local anesthesia on an outpatient basis, pain was assessed by means of the Visual analogue scale (VAS). Results A total of 125vertebroplasties were performed. In 87.9% (n = 95) of the patients, the procedure was performed in one vertebral body, in 8.3% (n = 9) and 3.7% (n = 4) of the patientshad two or three vertebrae cemented respectively. The range of pain according to VAS prior to treatment varied between 5 and 10, where 94% (n = 102) of the patients manifested a 10/10 intensity; after treatment, the range of pain varied between 0 to 7 where 98% of the population reported a value less than or equal to 3. Three complications were reported, one pulmonary thromboembolism due to methylmethacrylate, one extravasation in to the Batson plexus and one extravasation of cement to the interdiscal space. Conclusion CT-guided percutaneous vertebroplasty offers an undeniable immediate improvement of pain in patients with fracture of one or more vertebral bodies, with a low rate of complications.

Application of midazolam combined with remifentanil in anesthesia of spinal fractures / 中国生化药物杂志

Objective To study the clinical application of midazolam combined with remifentanil in spinal anesthesia.Methods80 cases of vertebral fractures in Jiaxing hospital, Zhejiang armed police corps from February 2014 to December 2016 were selected as the research object in this study.They were randomly divided into two groups: control group and experimental group, each group had a total of 40 cases.Patients in the control group were treated with midazolam anesthesia, the experimental group was treated with midazolam combined with remifentanil anesthesia.Comparative analysis of the experimental group and control group of patients with vital signs and anesthesia recovery time and anesthetic effect indicators.ResultsAfter the corresponding anesthesia, the respiratory frequency and heart rate of the experimental group were significantly higher than those of the control group, with statistical difference (P<0.05).There was no significant difference between the control group and the experimental group, no statistical significance.The recovery time, the time of open eyes and extubation time of the experimental group were significantly lower than those of the control group (P<0.05).The excellent rate of anesthesia in the experimental group was 95.0%, and the excellent rate of anesthesia in the control group was 75.0%.As a result, the excellent rate of anesthesia in the control group was significantly lower than that in the experimental group, the OAAS score of the experimental group was significantly higher than that of the control group, with statistical difference (P<0.05).ConclusionThe application of midazolam combined with remifentanil in anesthesia of spinal fracture surgery, anesthesia effect is good, the patient's recovery time is faster, with the clinical significance of further promotion and application.

Inj ury mechanism and imaging features of ankylosing spondylitis with spinal fracture in patients at middle-late stage / 实用放射学杂志

Objective To explore injury mechanism and imaging manifestations of ankylosing spondylitis (AS)with spinal frac-ture so as to reduce missed diagnosis and misdiagnosis.Methods Imaging and clinical data of 1 5 patients with AS in combination with spinal fracture as well as 37 patients with common spinal fracture were reviewed retrospectively and analyzed subsequently.Results Among the patients with AS,1 1 had explicit trauma history,9 had three column fracture on images,7 had spinal canal compression or spinal cord inj ury,and 6 had fracture lines across the intervertebral disk.Among the patients with common spinal fracture,the corresponding number were 36,4,5 and 0 in sequence.There were significant differences between AS fracture group and common fracture group in trauma history (χ2=4.565,P<0.05),three column fracture (χ2=11.274,P<0.05),spinal canal compression or spinal cord injury (χ2=4.873,P<0.05)and fracture across the intervertebral disk (χ2=13.041,P<0.05).Conclusion There are obvious differences between AS with spinal fracture and common spinal fracture in injury mechanism.X-ray,CT and MRI have different advantages in the diagnosis of AS with spinal fracture,and choosing appropriate imaging techniques may reduce missed diagnosis and misdiagnosis.

Value of MRI in predicting intradiscal cemment leakage during percutaneous vertebral augmentation / 中国医学影像技术

Objective To assess the value of preoperative MRI in predicting the incidence of cement leakage into adjacent discs during percutaneous vertebral augmentation (PVA) for osteoporotic vertebral compression fracture (OVCF).Methods Clinical and radiological characteristics of 127 patients who were treated with PVA for OVCF were analyzed retrospec tively.The following clinical data of these patients were analyzed,including gender,age,location of treated vertebral body and surgical approach.The image features of endplate injury,fracture line extended to the endplate,adjacent intervertebral dick injury and intravertebral cleft were evaluated on the preoperative MRI.The incidence of cement leakage into the adjacent disc were compared for the above factors with statistical methods.Results Totally 127 patients were enrolled in our study,including 179 treated vertebral bodies,358 endplates and 341 adjacent intervertebral discs.The incidence of intradiscal cement leakage was 57.73％ (56/97) in endplate injury sign,60.98％ (25/41) in fracture line extended to endplate sign,35.91％(51/142) in adjacent discs injury sign and 55.56％(20/36) inintravertebral cleft sign.The differences were statistically significant on preoperative MRI in patients with the above signs compared to those who had not (P＜0.05).The incidence of intradiscal cement leakage in percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP) were 26.67％(16/60) and 42.86％(51/119),respectively,which was significant different (P=0.035).For bone cement volume ≤ 5 ml vertebral bodies,the incidence of intradiscal cement leakage was 31.19 ％ (34/109),lower than bone cement volume ＞ 5 ml vertebral bodies (47.14％ [33/70],P=0.031).There was no statistically significant association between intradiscal cement leakage and age,gender and location of treated vertebral body (P＞0.05).Conclusion Preoperative MRI can predict the leakage of bone cement into adjacent discs effectively during PVA.The PKP and the lower volume of bone cement injection can reduce the risk of intradiscal cement leakage.

Minimally invasive pedicle screw fixation for the treatment of thoracolumbar spine fracture / 局解手术学杂志

Objective To explore the effect of minimally invasive pedicle screw fixation for the treatment of thoracolumbar spine fracture.Methods Totally 80 patients with thoracolumbar spinal fracture accepted pedicle screw internal fixation in our hospital from January 2012 to December 2015 were selected as the observation object.According to the operation mode,they were equally divided into minimally invasive surgery group and open surgery group.The operation effect,quality of life and the incidence of complications of the two groups were compared.Results The operation time of the two groups had no significant difference.The amount of blood loss and postoperative drainage volume in minimally invasive surgery group were less than those in open surgery group(P ＜ 0.05).The anterior and posterior Cobb's angles of the two groups had no significant difference.The anterior and posterior Cobb's angles of the two groups both decreased 3 months after operation,and it decreased more significantly in the minimally invasive surgery group compared with the open surgery group with statistically significant difference(P ＜0.05).The VAS and ODI scores between the two groups had no significant difference before operation.And the scores of the two groups all decreased 3 months after operation,but the reduction in the minimally invasive surgery group was more significant (P ＜ 0.05).The incidence rate of complications of the two groups had no significant difference (P ＞ 0.05).The quality of life of the two groups had no difference before surgery,and it increased 3 months after the operation both in the two groups,and the minimally invasive surgery group increased more significantly (P ＜ 0.05).Conclusion The minimally invasive pedicle screw internal fixation for thoracolumbar spine fracture has a better therapeutic effect,which can significantly improve the patients clinical symptoms,signs,and their quality of life.

Acute Epidural Hematoma Following Cervical Spinal Fracture in a Patient with Ankylosing Spondylitis

STUDY DESIGN: Case report. OBJECTIVES: To report a case of epidural hematoma following cervical spinal fracture in a patient with ankylosing spondylitis. SUMMARY OF LITERATURE REVIEW: An early surgical intervention for acute epidural hematoma following cervical spinal fracture led to improvements in the patient's neurological deficits. MATERIALS AND METHODS: A 76-year-old male with ankylosing spondylitis presented with neck pain and motor weakness of both upper and lower extremities after falling. He sustained fractures of the C7 body and the spinous processes of C5 and C6. Magnetic resonance imaging showed an extensive epidural hematoma from C7 to T5. The authors performed decompression from C6 to T2, and posterior instrumentation and fusion from C4 to T3. RESULTS: An urgent surgical intervention was performed, and a good result was obtained. CONCLUSIONS: The authors describe an early surgical intervention in a case of acute epidural hematoma following cervical spinal fracture in a patient with ankylosing spondylitis.

Traumatic Spinal Cord Injury: Long-Term Motor, Sensory, and Urinary Outcomes

STUDY DESIGN: Retrospective study. PURPOSE: To evaluate how motor, sensory, and urinary outcomes of spinal cord injury (SCI) patients were influenced in the long term. OVERVIEW OF LITERATURE: SCI is a potentially disabling and devastating neurological outcome that can occur because of spinal column fractures. Most studies have not evaluated or have failed to show the influence of different surgical approaches and other parameters on neurological recovery. METHODS: A thorough history regarding sensory, motor, and urinary complaints was taken from 103 patients with SCI due to vertebral fracture; patients were followed by a thorough neurological examination. Subsequently, all medical records of patients, including neurological state after trauma, trauma mechanism, treatment protocol, surgical protocol, and imaging findings, were evaluated. RESULTS: Of the 103 patients, 73.8% were survivors of a major earthquake and 26.2% were victims of vehicle accidents; 92.2% patients were surgically treated, while 7.8% underwent conservative management. The mean follow-up duration was 10.3 years. In follow-up visits, 67.0%, 12.6%, 13.6%, and 6.8% patients showed no, partial, substantial, and complete motor improvement, respectively; 68.0%, 26.2%, and 5.8% showed no, mild, and substantial sensory improvement, respectively; and 73.8%, 17.5%, and 8.7% showed no, substantial, and complete urinary improvement, respectively. Logistic regression analysis showed that sex, age at injury time, follow-up duration, trauma mechanism, and stem cell therapy had no effect on motor, sensory, and urinary improvement. Higher initial scores on the American Spinal Injury Association (ASIA) classification, lumbar fracture level, and performance of laminectomy improved motor outcome; higher initial ASIA scores improved urinary and sensory outcomes. CONCLUSIONS: The initial ASIA score is the most important factor for prognosticating motor, sensory, and urinary improvement in SCI patients. Lumbar (L3–L5) and thoracic (T1–T10) fractures have the best and worst prognosis, respectively, in terms of motor recovery. Laminectomy during surgery improves motor function.

Discrimination between Malignant and Benign Vertebral Fractures Using Magnetic Resonance Imaging

STUDY DESIGN: Retrospective analysis using magnetic resonance imaging (MRI). PURPOSE: To identify MRI features that could discriminate benign from malignant vertebral fractures. OVERVIEW OF LITERATURE: Discrimination between benign and malignant vertebral fractures remains challenging, particularly in patients with osteoporosis and cancer. Presently, the most sensitive means of detecting and assessing fracture etiology is MRI. However, published reports have focused on only one or a few discriminators. METHODS: Totally, 106 patients were assessed by MRI within six weeks of sustaining 114 thoracic and/or lumbar vertebral fractures (benign, n=65; malignant, n=49). The fractures were pathologically confirmed if malignant or clinically diagnosed if benign and were followed up for a minimum of six months. Seventeen features were analyzed in all fractures' magnetic resonance images. Single parameters were analyzed using the chi-square test; a logit model was established using multivariate logistic regression analysis. RESULTS: The chi-square test revealed 11 malignant and 4 benign parameters. Multivariate logistic regression analysis selected (i) posterior wall diffuse protrusion (odds ratio [OR], 48; 95% confidence interval [CI], 4.2–548; p=0.002), (ii) pedicle involvement (OR, 21; 95% CI, 2.0–229; p=0.01), (iii) posterior involvement (OR, 21; 95% CI, 1.5–21; p=0.02), and (iv) band pattern (OR, 0.047; 95% CI, 0.0005–4.7; p=0.19). The logit model was expressed as P=1/[1+exp (x)], x=−3.88×(i)−3.05×(ii)−3.02×(iii)+3.05×(iv)+5.00, where P is the probability of malignancy. The total predictive value was 97.3%. The only exception was multiple myeloma with features of a benign fracture. CONCLUSIONS: Although each MRI feature had a different meaning with a variable differentiation power, combining them led to an accurate diagnosis. This study identified the most relevant MRI features that would be helpful in discriminating benign from malignant vertebral fractures.

Delayed Neurological Deficits after Osteoporotic Vertebral Fractures: Clinical Outcomes after Surgery

STUDY DESIGN: Retrospective cohort. PURPOSE: To review the clinical presentation of operated patients with delayed neurological deficits after osteoporotic vertebral fractures (OVFs). OVERVIEW OF LITERATURE: Delayed neurological deficits can occur from 1 week to 5.7 months after OVFs. Baba has reported 78% good-to-excellent improvement (i.e., ≥50%) after 20 posterior (Cotrel-Dubousset) and 7 anterior (Kaneda in 4, Zielke ventral derotational spondylodesis in 2, and un-instrumented anterior fusion in 1) fusions. Predictive factors for neurological deficits include burst type, vacuum sign, kyphosis, angular instability, and retropulsion. METHODS: Patients with neurological deficits after OVF who received spinal operations between 2000 and 2016 were included. RESULTS: Totally, 28 patients with a mean age of 77 years underwent surgery. Neurological deficits occurred at an average of 5.4 weeks after the onset of back pain. The most common site was L1. Burst fracture was present in 14 patients and vacuum sign in seven. Surgery was performed within an average of 3.9 days of the onset of neurological deficit. Baba's score improved significantly from 5.96 to 9.81, with good-to-excellent improvement in 18 (64%) patients. Better outcomes based on Baba's scores (improvement>60% [median]) were associated with compression fractures, preoperative retropulsion of 16%. Poor improvement in Baba's scores ( < 25%) was associated with surgical complications and burst fracture type. Twenty-two patients (79%) regained walking ability, and seven of 15 (47%) patients demonstrated improved sphincter control at the latest follow-up. Six Frankel grade B patients did not achieve neurological recovery, four of whom exhibited postoperative surgical complications and died at 2 years because of medical problems. Implant migration occurred in six patients, albeit this was of no clinical significance. CONCLUSIONS: Although OVFs are commonly considered benign, delayed neurological deficits can occur. The significant improvement in clinical function after surgery for neurological deficits is associated with compression (and not burst) fractures, lack of surgical complications, and optimal restoration of retropulsion.