Rider sitting position widens lumbar intervertebral distance: a prospective observational study

Abstract Background: Reduced lumbar lordosis may make the process of identifying the intervertebral distance easier. The primary aim of this study was to measure the L3-L4 intervertebral space in the same patients undergoing spinal anesthesia in three different sitting positions, including the classic sitting position (CSP), hamstring stretch position (HSP) and rider sitting position (RSP). The secondary aim was to compare ultrasonographic measurements of the depth of the ligamentum flavum and intrathecal space in these three defined positions. Methods: This study is a single-blinded, prospective, randomized study. Ninety patients were included in final analysis. the patients were positioned on the operating table in three different positions to perform ultrasonographic measurements of the spinal canal. The intervertebral distance (IVD), the distance between the skin and the ligamentum flavum (DBSLF) and the intrathecal space (IS) were measured in the L3 -L4 intervertebral space in three different positions. Results: The RSP produced the largest mean distance between the spinous processes. The RSP yielded a significantly larger IVD than did the CSP (p < 0.001) and HSP (p < 0.001). The DBSP was larger in the CSP than in the HSP (p = 0.001). The DBSLF was significantly larger in the RSP than in the HSP (p = 0.009). Conclusions: Positioning the patient in the RSP significantly increased the intervertebral distance between L3 -L4 vertebrae compared to the CSP and HSP, suggesting easier performance of lumbar neuraxial block.

Morphometrics of T11-L5 Vertebrae in Jordanian Population: CT Scan-Based Study / Morfometría de las Vértebras T11-L5 en una Población Jordana: Estudio Basado en Tomografía Computarizada

SUMMARY: The study will provide information on the morphometrics of the vertebrae, which can be used to guide clinicians on the appropriate size of transpedicular screws to use in spine interventions among the Jordanian population and for comparative studies with other races. A retrospective analysis of normal CT scans of the lumbar and thoracolumbar areas was done. Linear and angular measurements of 336 vertebrae were collected for 25 males and 23 females. The results were compared between right and left and between both sexes. The L5 has the longest AVBH and the shortest PVBH in both sexes, it also, had the shortest and widest pedicle in both males and females. ratio of the AVBH to PVBH showed progressive increase in both sexes from T11 to L5. Similarly, the VBW increased progressively from the top to the bottom in both sexes, but it was significantly different between both sexes. The L1 was the most cranially oriented vertebrae in males while the L2 showed the most cranial orientation in females. Both sexes L5 was the most caudally oriented vertebrae. This study provides a database for vertebral morphometrics in the Jordanian population, there are slight differences between the right and left side in the upper studied vertebrae (T11-L2) and some measurement showed significant differences between males and females. These findings need to be taken into consideration when inserting pedicle screws.

Este estudio proporciona información sobre la morfometría de las vértebras, la cual puede ser utilizada por los médicos oara determinar el tamaño adecuado de los tornillos transpediculares a utilizar en intervenciones de columna en la población jordana y para estudios comparativos con otras grupos. Se realizó un análisis retrospectivo de tomografías computarizadas normales de las áreas lumbar y toracolumbar. Se recogieron medidas lineales y angulares de 336 vértebras de 25 hombres y 23 mujeres. Los resultados se compararon entre vértebras derechas e izquierdas y entre ambos sexos. La L5 tiene el AVBH más largo y el PVBH más corto en ambos sexos, también tenía el pedículo más corto y más ancho tanto en hombres como en mujeres. La relación de AVBH a PVBH mostró un aumento progresivo en ambos sexos de T11 a L5. De manera similar, el VBW aumentó progresivamente de arriba hacia abajo en ambos sexos, pero fue significativamente diferente entre ambos sexos. La L1 fue la vértebra más orientada cranealmente en los hombres, mientras que la L2 mostró la orientación más craneal en las mujeres. En ambos sexos L5 fue la vértebra más orientada caudalmente. Este estudio proporciona una base de datos para la morfometría vertebral en la población jordana, donde existen ligeras diferencias entre el lado derecho e izquierdo en las vértebras superiores estudiadas (T11-L2). Algunas mediciones mostraron diferencias significativas entre hombres y mujeres. Estos hallazgos deben tenerse en cuenta al insertar tornillos pediculares.

Relationship between the gross motor function classification system and hip and lumbar spine development in children with spastic cerebral palsy / 中国骨伤

OBJECTIVE@#To investigate the relationship among the gross motor function classification system (GMFCS)and the development of hip joint and lumbar spine in children with spastic cerebral palsy.@*METHODS@#The clinical data of 125 children with spastic cerebral palsy admitted from January 2018 to July 2021 were retrospectively analyzed. There were 85 males and 40 females, aged from 4 to 12 years old with an average of (8.4±2.9) years. According to GMFCS, the patients were divided into gradeⅠ, Ⅱ, Ⅲ and Ⅳ groups. There were 27 cases in gradeⅠgroup, 40 cases in gradeⅡgroup, 35 cases in grade Ⅲ group and 23 cases in grade Ⅳ group. The migration percentage(MP), central edge angle(CE), neck-shaft angle(NSA), acetabular index(AI) were measured by the radiograph of pelvis, abnormal parameters were selected to evaluate the relationship between different GMFCS grades and hip joint development. Lumbar sagittal Cobb angle, lumbar sacral angle, lumbar lordosis index and apical distance were measured by lateral lumbar radiographs to evaluate the relationship between different GMFCS grades and lumbar spine development.@*RESULTS@#①Among the 125 spastic cerebral palsy children, there were 119 cases of pelvic radiographs that met the measurement standards. In the four groups with gradeⅠ, Ⅱ, Ⅲ, Ⅳ, MP was (22.72±3.88), (26.53±4.36), (33.84±4.99), and (49.54±7.87)%, CE was(30.10±6.99) °, ( 22.92±4.19) °, ( 17.91±5.50) °, and (-0.70±17.33)°, AI was (16.41±2.77) °, (20.46±4.63) °, (23.76±5.10) °, and ( 29.15±7.35)°, respectively, there were significant differences between the two comparisons (P<0.05). And the higher GMFCS grade, the greater MP and AI, and the smaller CE.The NSA was(142.74±10.03) °, (148.66±9.09) °, (151.66±10.52) °, and (153.70±8.05)° in four groups with gradeⅠ, Ⅱ, Ⅲ, Ⅳ, respectively. The differences between the two comparisons of the GMFCS gradeⅠgroup and the other three groups were statistically significant (P<0.05). NSA of GMFCSⅠgroup was significantly lower than that of the others, there was no significant difference among other groups(P>0.05). ② Among the 125 spastic cerebral palsy children, there were 88 cases of lumbar spine radiographs that met the measurement standards. ③The lumbar sagittal Cobb angle was(32.62±11.10) °, (29.86±9.90) °, (31.70±11.84) °, and (39.69±6.80)° in the four groups with gradeⅠ, Ⅱ, Ⅲ, Ⅳ, respectively;GMFSS of grade Ⅳ group was significantly higher than that of other three groups, there was significant difference between the two comparisons (P<0.05);there were no significant differences between other groups (P>0.05). In the four groups with gradeⅠ, Ⅱ, Ⅲ, Ⅳ, the lumbosacral angle was (31.02±9.91) °, ( 26.57±9.41) °, (28.08±8.56) °, and ( 27.31±11.50)°, the lumbar lordosis index was (4.14±12.89), (8.83±13.53), (13.00±11.78), and (10.76±9.97) mm, the arch apex distance was (9.50±6.80), (6.68±3.20), (7.16±4.94), and (6.62±4.13) mm, respectively, there were no significant differences between the two comparisons(P>0.05).@*CONCLUSION@#①In children with GMFCS gradeⅠ-Ⅳ, the higher the GMFCS grade, the worse the hip develops. ② Children with GMFCS grade Ⅲ-Ⅳ may be at greater risk for lumbar kyphosis.

Study on anatomical parameters of adult lumbar intervertebral disc and endplate based on CT / 中国骨伤

OBJECTIVE@#To provide basic data for clinical application and individualized design of lumbar disc prostheses by measuring the anatomical parameters of lumbar intervertebral discs and endplates in healthy adults with CT three-dimensional reconstruction technology.@*METHODS@#A retrospective analysis was performed on 200 males and 200 females with normal lumbar spine who were admitted to the imaging center or outpatient department of the Second Affiliated Hospital of Xinjiang Medical University from September 2019 to December 2020. The age ranged from 20 to 60 years old, with an average of (40.61±11.22) years old. The measurement segment was L1-S1 intervertebral disc, and the measurement indicators included the axial anteroposterior diameter and transverse diameter of the intervertebral disc, sagittal anterior, middle and posterior height, coronal left and right height, intervertebral space angle, and transverse and anteroposterior diameters of the upper and lower endplates of each vertebral body.@*RESULTS@#①In terms of gender, the anatomical parameters of L1-S1 disc axial diameter, transverse diameter, sagittal anterior, middle and posterior height, left and right coronal height and intervertebral space angle were all higher in males than in females(P<0.05), and the anatomical parameters of upper and lower endplates of L1-S1 vertebral body were higher in males than in females(P<0.001). ②In comparison of sagittal height of anterior, middle and posterior intervertebral discs, the sagittal height of L1-L5 intervertebral discs was middle-high > anterior-high > posterior-high(P<0.001), while that of L5S1 intervertebral disc was anterior-high > middle-high > posterior-high (P<0.001). ③In the comparison of left and right coronal height, there was no statistical significance in the left and right coronal height of L1-S1 disc between male and female(P>0.05). ④The L1-S1 intervertebral spaces angle between male and female increased with the increase of vertebral body segments. ⑤The anterior and posterior diameters and transverse diameters of upper and lower of L1-S1 vertebral bodies endplates were height in males than in females(P<0.001).@*CONCLUSION@#The results suggest that gender differences should be considered in the design of adult lumbar disc prostheses. The anatomical parameters of the lumbar intervertebral disc varied with the increase of the vertebral body sequence, suggesting that different anatomical parameters of the intervertebral disc should be considered in the design of the artificial intervertebral disc, and the changes in the height of the sagittal position suggest that the design of the intervertebral disc should be wedge-shaped.

Effect of morphological changes in the sagittal plane of vertebrae and discs on degenerative kyphodeformity / 中国骨伤

OBJECTIVE@#To explore the effects of morphological changes such as vertebral wedge deformation and disc degeneration (collapse) on adult thoracolumbar/lumbar degenerative kyphosis(TL/LDK) deformity.@*METHODS@#A retrospective analysis of 32 patients with spinal TL/LDK deformity admitted from August 2015 to December 2020, including 8 males and 24 females, aged 48 to 75(60.3±12.4) years old. On the long-cassette standing upright lateral radiographs, the coronal Cobb angle, sagittal thoracic lumbar/lumbar kyphosis angle(KA) of spine were measured, and the height and wedge parameters of apex vertebral(AV) and two vertebrae(AV-1, AV-2, AV+1, AV+2) above and below AV and the intervertebrae and the intervertebral disc(AV-1D, AV-2D, AV+1D, AV+2D) were evaluated, involving anterior vertebral body height(AVH), posterior vertebral body height(PVH), vertebral wedge angle(VWA), ratio of vertebral wedging(RVW), anterior disc height(ADH), posterior disc height(PDH), disc wedge angle(DWA), ratio of disc wedging(RDW), and DWA/KA.@*RESULTS@#The average angle of kyphosis was (44.2±19.1)°. A significant decrease in anterior height of vertebral was observed compared to the posterior height of vertebral(P<0.005). There was no significant difference in anterior and posterior height of discs. The vertebral wedging ratio/contribution ratio:AV-2(14.98±10.95)%/(14.21±8.08)%, AV-1(21.08±12.39)%/(18.09±7.38)%, AV(26.94±11.94)%/(25.52±8.64)%, AV+1(24.19±8.42)%/(20.82±8.69)%, AV+2(20.56±7.80)%/(15.60±9.71)%, total contribution(94.23±22.25)%, the disc wedging ratio/contribution ratio:AV-2D(2.88±2.57)%/(5.27±4.11)%, AV-1D(1.98±1.41)%/(2.29±2.16)%, AV+1D(-5.54±3.75)%/(-0.57±0.46)%, AV+2D(-8.27±4.62)%/(-1.22±1.11)%, total contribution (5.77±4.79)%. And the contribution rate of AV was significantly higher than that of adjacent vertebral(P<0.05).@*CONCLUSION@#The vertebral body and intervertebral disc shape both have influence on thoracolumbar kyphosis. However, the contribution of vertebral morphometry to the angle of TL/LDK deformity is relatively more important than the disc. The contribution of the wedge change of the AV to the TL/LDK deformity is particularly significant.

Correlation between spinous process deviation and lumbar disc herniation in young patients / 中国骨伤

OBJECTIVE@#To explore the relationship between spinous process deviation and lumbar disc herniation in young patients.@*METHODS@#From March 2015 to January 2022, 30 treated young (under the age of 30) patients with lumbar disc herniation were included as the young group. In addition 30 middle-aged patients (quinquagenarian group) with lumbar disc herniation and 30 patients with non-degenerative spinal diseases (young non-degenerative group) were selected as control groups. The angle of the spinous process deviation was measured on CT and statistically analyzed by various groups. All the data were measured twice and the average value was taken and recorded.@*RESULTS@#The average angle of spinous process deviation in the degenerative lumbar vertebra of young patients were (3.89±3.77) degrees, similar to the (3.72±2.98) degrees of quinquagenarian patients(P=0.851). The average angle of s spinous process deviation young non-degenerative group were (2.20±2.28) degrees, significantly less than young group(P=0.040). The spinous process deviation angle of the superior vertebral of the degenerative lumbar in the young group was (4.10±3.44) degrees, which similar to the (3.47±2.87) degrees in the quinquagenarian group (P=0.447). A total of 19 young patients had the opposite deviation direction of the spinous process of the degenerative lumbar vertebra and upper vertebra, while only 7 quinquagenarian patients had this condition(P=0.02). The type of lumbar disc herniation in young patients had no significant relationship with the direction of spinous process deflection of the degenerative or upper lumbar vertebra (P>0.05).@*CONCLUSION@#Spinous process deviation is a risk factor of young lumbar disc herniation patients. If the deviation directions of adjacent lumbar spinous processes are opposite, it will increase the incidence of lumbar disc herniation in young patients. There was no significant correlation between the type of disc herniation and the deviation direction of the spinous process of the degenerative or upper lumbar vertebra. People with such anatomical variation can strengthen the stability of spine and prevent lumbar disc herniation through reasonable exercise.

Treatment of sciatica by lumbar nerve root canal injection under X-ray angiography / 中国骨伤

OBJECTIVE@#To investigate the short-term clinical effect of lumbar nerve root canal injection under X-ray angiography in the treatment of sciatica.@*METHODS@#The clincal data of 78 patients with sciatica underwent lumbar nerve root canal injection under X-ray angiography from December 2017 to February 2020 was retrospectively analyzed. Including 31 males and 47 females, aged from 22 to 88 years old with a median of 65 years. There were 55 cases of lumbar disc herniation and 23 cases of lumbar spinal stenosis, the course of disease ranged from 1 to 8 weeks with a median of 3 weeks. There were 71 cases of single segment disc herniation or stenosis, including L3,4 of 5 cases, L4,5 of 61 cases, L5S1 of 5 cases, and 7 cases of multisegment herniation or stenosis. The pain visual analogue scale (VAS) was recorded and Macnab was used to evaluate the clinical effect.@*RESULTS@#All patients completed standardized treatment without serious adverse reactions. VAS were (3.21±0.76) scores immediately after treatment, (2.89±0.33) scores 1 hour after treatment, (1.80±0.27) scores 6 hours after treatment, (1.10±0.20) scores 24 hours after treatment, (2.53±0.35) scores 1 week after treatment and (4.27±0.36) scores 1 month after treatment. There were significant differences in VAS between before treatment(7.83±0.56) and each time period after treatment(P<0.05). According to Macnab low back pain evaluation standard, 42 cases were effective, 34 cases were markedly effective and 2 cases were ineffective within 24 hours after treatment, with an effective rate of 97.4%;38 cases were effective, 25 cases were markedly effective, 15 cases were ineffective within one week after treatment, the effective rate was 80.0%;32 cases were effective, 22 cases were markedly effective, 24 cases were ineffective within one month after treatment, the effective rate was 69.2%.@*CONCLUSION@#The short-term clinical effect of nerve root canal injection under X-ray radiography in the treatment of sciatica is good and it is an effective method to relieve sciatica.

Artrodesis lumbosacra en trabajadores de la construcción. Reinserción laboral / Lumbosacral arthrodesis in construction workers. Return to work

Resumen La enfermedad degenerativa del raquis es la causa más frecuente de lumbalgia y ciática en la población general provocando ausentismo, lo que incrementa el gasto en salud de los distintos subsistemas, así como el gasto del empleador quien deberá suplantar al trabajador. Su incidencia aumenta en personas sometidas a tareas de sobrecarga del raquis, como el caso de obreros de la construcción. La artrodesis instrumentada es una práctica frecuente y con resultados satisfactorios para su resolución. No hemos encon trado publicaciones con datos estadísticos locales sobre este tema. El objetivo fue evaluar el impacto laboral que genera la artrodesis lumbosacra instrumentada en trabajadores de la construcción. Realizamos un estudio retrospectivo, descriptivo, comparativo y monocéntrico, entre enero de 2005 y agosto de 2018, de trabajadores de la construcción con artrodesis del segmento lumbosacro por lumbalgia de origen degenerativo con evaluación y seguimiento clínico e imagenológico por un periodo de 18 a 24 meses, utilizando el Índice de Discapacidad de Oswestry (IDO) y la Escala Visual Analógica del Dolor (EVA). Se analizó la muestra en grupos según las funciones al momento del retorno laboral, jubilación o despido. Se evaluaron 139 pacientes (mediana 42 años). El 66.9% de la muestra no tuvo complicaciones postoperatorias y retomó la misma actividad prequirúrgica. Los puntajes de IDO y EVA postquirúrgicos fueron peores en los pacientes despedidos, jubilados y/o recalificados. Los menores de 42 años, sin complicaciones postoperatorias que mejoran más de 1 categoría del Oswestry retomaron sus tareas habituales con resultados satisfactorios a mediano y largo plazo.

Abstract Degenerative spinal disease is the leading cause of low back pain and sciatica in the general population. It is an important cause of absenteeism and increased expenses. Its incidence increases in people subjected to tasks that overload the spine, such as construction workers. Instrumented arthrodesis is a frequent practice with satisfactory results for its resolution. To date, in our country, we haven´t found statistical data on this group of work-related patients. Our objective was to evaluate laboral impact generated by instrumented lumbosacral arthrodesis in construction workers. We did a retrospective, descriptive, comparative and monocentric study. Construction workers' patients with degenerative low back pain and instrumented lumbar or lumbosacral arthrodesis who were operated between January 2005 to August 2018 were included. Clinical and imaging evaluation and follow-up for a period of 18 to 24 months. Assessed with the Oswestry Disability Index (IDO) and the Visual Analog Pain Scale (VAS). The sample was analyzed in groups according to the functions at the time of returning to work, retirement or dismissal. We evaluated 139 patients. Mean age 42 years, degenerative spinal disease of the lumbosacral segment, 66.9% of the sample without postoperative complications resumed the same pre-surgical activity. Post-surgical IDO and VAS scores were worse in patients discharged, retired, and/or requalified. Patients under 42 years of age, without postoperative complications who improved more than 1 Oswestry category, returned to their usual tasks with satisfactory results in the medium and long term.

Value of magnetic resonance combined with dual-source spectral computed tomography in improving the clinical diagnosis and treatment efficiency of lumbar disk herniation

SUMMARY OBJECTIVE: This study aims to investigate the value of magnetic resonance combined with dual-source spectral computed tomography in improving the clinical diagnosis and treatment efficiency of lumbar disk herniation. METHODS: Two hundred patients with lumbar disk herniation were enrolled. Magnetic resonance and dual-source spectral computed tomography were used to perform the diagnosis. The treatment efficiency and effectiveness of different diagnostic methods were determined. Results: Eighty cases of lumbar disk herniation, 40 cases of prolapse, 33 cases of bulge, 27 cases of sequestration, and 20 cases of nodules were diagnosed based on pathologic evaluation. magnetic resonance detected lumbar disk herniation in 172 cases, with a detection rate of 86.00%. Dual-source spectral computed tomography detected 171 cases, with a detection rate of 85.50%. Magnetic resonance combined with dual-source spectral computed tomography detected 195 cases, with a detection rate of 97.50%. There was no significant difference between magnetic resonance and dual-source spectral computed tomography (p>0.05), but compared with the combined detection, there was a significant difference (p<0.05). One hundred and two cases of calcification, 83 cases of spinal cord deformity, 70 cases of intervertebral disk degeneration, 121 cases of intervertebral disk gas, 85 cases of dural sac compression, and 78 cases of nerve root compression were surgically demonstrated. The detection rate of diagnostic signs based on imaging by magnetic resonance or dual-source spectral computed tomography alone was lower than that of combined detection (p<0.05). Conclusion: Magnetic resonance combined with dual-source spectral computed tomography can improve the diagnosis and treatment efficiency and effectiveness of lumbar disk herniation.

Comparison of two endoscopic spine surgical techniques

SUMMARY OBJECTIVE: The objective of this study is to compare the clinical outcome among patients who are surgically treated for lumbar disc herniation by transforaminal and interlaminar endoscopy techniques. METHODS: For the treatment of lumbar disc herniation, 31 patients were assigned to undergo the interlaminar technique and 24 patients the transforaminal technique. They were evaluated using visual analog scale and Oswestry disability index in the preoperative period, in the first postoperative period, and in the 12th month after the procedure. The clinical results between the two techniques were then compared. RESULTS: Overall, 89.1% of the patients obtained good results, with 12.5% complications in the transforaminal technique and 9.6% in the interlaminar technique. CONCLUSION: Although both the endoscopic techniques, compared in this study, are safe and effective for the surgical treatment of lumbar herniated disc, the interlaminar technique presented significantly better results and lower rates of complications than the transforaminal technique.

Correlation analysis between degenerative spondylolisthesis and T2WI hyperintensity on MRI of interspinous ligament / 中国骨伤

OBJECTIVE@#To explore the relationship between lumbar degenerative spondylolisthesis and T2WI high signal in the interspinous ligament in MRI in order to improve the understanding of the signal changes of the interspinous ligament.@*METHODS@#The clinical data of 43 patients with clinically diagnosed lumbar degenerative spondylolisthesis were collected from March 2018 to March 2020, there were 19 males and 24 females, aged 50 to 92 years with an average of 69 years old. Using picture archiving and communication systems (PACS) to access images and record the distribution and incidence of T2WI high signal in the interspinous ligament between the slipped and non-slipped segments. Using Spearman correlation analysis to explore the relationshipbetween the T2WI high signal of the interspinous ligament and the degree of lumbar spondylolisthesis.@*RESULTS@#Except for 8 ligaments that were not included in the statistical results due to poor image quality, 43 patients with a total of 207 lumbar vertebrae and interspinous ligaments were included in the study. According to the Meyerding classification method, 43 patients had a total of 48 segments with spondylolisthesis, 41 segments in grade Ⅰ and 7 segments in grade Ⅱ. There were 30 cases of MRI T2WI high signal in the interspinous ligament corresponding to spondylolisthesis segment, including 3 cases on L@*CONCLUSION@#In patients with degenerative lumbar spondylolisthesis, the MRI T2WI hyperintensity is more common in the interspinous ligament. The occurrence of T2WI high signal is positively correlated with the degree of spondylolisthesis, which should be payed enough attention in imaging diagnosis.

Quantitative evaluation of lumbar spine osteoporosis by apparent diffusion coefficient and signal intensity ratio of magnetic resonance diffusion-weighted magnetic resonance imaging / 中国骨伤

OBJECTIVE@#To investigate the application value of apparent diffusion coefficient (ADC) and signal intensity ratio (SIR) of MR diffusion-weighted imaging (DWI) in quantitative evaluation of lumbar spine osteoporosis.@*METHODS@#A total of 175 patients with lumbar spine diseases who received dualenergy X-ray absorption (DXA) bone mineral density (BMD), routine MRI and DWI of the lumbar spine from May 2017 to October 2019 were selected. According to the T-value of DXA, the patients were divided into osteoporosis group (64 cases), osteopenia group (53 cases) and normal bone mass group (58 cases). The ADC and SIR values of L@*RESULTS@#There were statistically significant differences in ADC and SIR values among three groups (@*CONCLUSION@#ADC and SIR can better reflect the BMD of patients with lumbar diseases, and can quantitatively evaluate the vertebral body of osteoporosis, which play an important role in the diagnosis of lumbar osteoporosis.

Sex and stature estimation from adult lumbar vertebrae in a Thai population based on image analysis / Estimación de sexo y estatura de vértebras lumbares adultas en una población Tailandesa basada en análisis de imagen

SUMMARY: Although molecular techniques evolved considerably in last years, anthropological methods of assessing skeletal remains, continues to be an important tool in the identification process in medico legal investigations. The objective of this study was to develop a discriminant function equation for estimating sex and stature using several measurements of lumbar vertebrae in a Thai population. We studied 150 lumbar columns (75 male and 75 female) age range of 22 to 89 years from the Forensic Osteology Research Center, Chiang Mai University, Thailand. The quantitative variables with sex were analyzed by the discriminant function analysis and that with stature were calculated using linear regression. The pixel density of the major axis of the trabecular surface of superior endplate of the first lumbar vertebra had the most accuracy in sex determination. The regression equation with quantitative variables in stature estimation described 32.3 % of the total variance with standard error of estimate of 7.736 cm. Lumbar vertebrae can be used as part of the stature and sex quantitatively and qualitatively estimating in Thais incomplete skeletal remains.

RESUMEN: Los métodos antropológicos de evaluación del esqueleto siguen siendo una herramienta importante en el proceso de identificación en las investigaciones médico-legales. El objetivo de este estudio fue desarrollar una ecuación de función discriminante para estimar el sexo y la estatura utilizando varias medidas de las vértebras lumbares en una población tailandesa. Se estudiaron 150 columnas lumbares (75 hombres y 75 mujeres) con un rango etario de 22 a 89 años del Centro de Investigación de Osteología Forense, Universidad de Chiang Mai, Tailandia. Las variables cuantitativas de sexo se analizaron mediante el análisis de función discriminante y la estatura fue calculada mediante regresión lineal. En cuanto a la determinación de sexo, la densidad de píxeles del eje mayor de superficie trabecular de la placa terminal superior de la primera vértebra lumbar fue de mayor precisión. La ecuación de regresión con variables cuantitativas en la estimación de la estatura describió el 32,3 % de la varianza total con el error estándar de estimación de 7,736 cm. Las vértebras lumbares se pueden utilizar como parte de la estatura y el sexo, estimando cuantitativa y cualitativamente los restos esqueléticos incompletos en sujetos tailandeses.

Resultados y complicaciones de la enfermedad del segmento adyacente tratada mediante artrodesis intersomática lateral mínimamente invasiva / Results and complications of adjacent segment disease treated by minimally invasive lateral intersomatic arthrodesis

Resumen: Introducción: Se ha realizado un estudio clínico comparativo sobre los pacientes intervenidos mediante artrodesis intersomática lateral para tratamiento de la enfermedad del segmento adyacente utilizando dispositivos intersomáticos de titanio y de PEEK. Material y métodos: Se han analizado y comparado los resultados clínicos (EVA y oswestry disability index ODI) y radiológicos (alineamiento y fusión), las complicaciones (mayores y menores) y la calidad de vida (EQ5D) de 32 pacientes intervenidos desde Septiembre de 2015 hasta Septiembre de 2018, con un seguimiento medio de 25 meses (46-18). La edad media en la cirugía fue de 66 años (39-89) y 68% de los pacientes fueron mujeres. El segmento intervenido con más frecuencia fue L3-L4 (62%) abordaje retroperitoneal derecho 86%. La EVA lumbar mejoró de 6.2 ± 2.12 a 4.1 ± 1.71 (p = 0.028). La EVA de la pierna descendió de 5.3 ± 2.26 a 1.9 ± 1.58 (p = 0.02). La escala ODI mejoró de 50.2 ± 18.9 a 33.3 ± 10.2 (p = 0.025) y la EQ5D pasó de 0.52 a 0.73 (p = 0.039) sin diferencias estadísticamente significativas entre los grupos (ODI p = 0.18, EQ5D p = 0.293). Radiológicamente aumentó la altura intervertebral, la lordosis lumbar y segmentaria, disminuyó el ángulo de Cobb y la tasa de fusión global fue de 84.3% (88% Ti/82% PEEK), sin diferencias entre los grupos. Conclusiones: La artrodesis intersomática lumbar lateral Lateral Lumbar Interbody Fusion es un método eficaz para el tratamiento de la enfermedad del segmento adyacente con resultados clínicos-radiológicos y complicaciones similares a la literatura. No se han encontrado diferencias entre los implantes de Ti y de PEEK.

Abstract: Introduction: A comparative clinical study has been conducted on patients involved using lateral intersomatic arthrodesis for the treatment of adjacent segment disease using titanium and PEEK intersomatic devices. Material and methods: Clinical (EVA and oswestry disability index ODI) and radiological (alignment and fusion), complications (major and minor) and quality of life (EQ5D) of 32 patients intervened from September 2015 to September 2018 have been analyzed and compared, with an average follow-up of 25 months (46-18). The average age in surgery was 66 years (39-89) and 68% of patients were women. Results: The most common segment involved was L3-L4 (62%) right retroperitoneal approach 86%. Lumbar EVA improved from 6.2 ± 2.12 to 4.1 ± 1.71 (p = 0.028). The LEG EVA descended from 5.3 ± 2.26 to 1.9 ± 1.58 (p = 0.02). The ODI scales improved from 50.2 ± 18.9 to 33.3 ± 10.2 (p = 0.025) and the EQ5D went from 0.52 to 0.73 (p = 0.039) with no statistically significant differences between the groups (ODI p = 0.18, EQ5D p = 0.293). Radiologically increased intervertebral height, lumbar and segmental lordosis, decreased Cobb's angle and the overall melting rate was 84.3% (88% Ti/82% PEEK), with no differences between the groups. Conclusion: Lateral lumbar interbody fusion is an effective method for treating adjacent segment disease with clinical-radiological results and literature-like complications. No differences have been found between Ti and PEEK implants.

A rare cause of vertebral osteomyelitis: the first case report of rat-bite fever in Portugal

Abstract Rat-bite fever is a rarely diagnosed illness caused by Streptobacillus moniliformis . Although this disease is distributed worldwide, there have been few cases reported in Europe. Here, we report a case of vertebral osteomyelitis and sternoclavicular septic arthritis caused by S. moniliformis in a Portuguese patient previously bitten by a rat. Laboratory diagnosis was performed using molecular identification. This is the first case report of rat-bite fever in Portugal. The case described here serves as a reminder for physicians to consider this diagnosis in patients who have developed fever syndromes after being in contact with rodents.

Association of bone mineral density with bone texture attributes extracted using routine magnetic resonance imaging

OBJECTIVE: Dual-energy X-ray absorptiometry (DXA)-derived bone mineral density (BMD) often fails to predict fragility fractures. Quantitative textural analysis using magnetic resonance imaging (MRI) may potentially yield useful radiomic features to predict fractures. We aimed to investigate the correlation between BMD and texture attributes (TAs) extracted from MRI scans and the interobserver reproducibility of the analysis. METHODS: Forty-nine volunteers underwent lumbar spine 1.5-T MRI and DXA. Three-dimensional (3-D) gray-level co-occurrence matrices were measured from routine sagittal T2 fast spin-echo images using the IBEX software. Twenty-two TAs were extracted from 3-D segmented L3 vertebrae. The estimated concordance coefficient was calculated using linear regression analysis. A Pearson correlation coefficient analysis was performed to evaluate the correlation between BMD and the TAs. Interobserver reproducibility was assessed with the concordance coefficient described by Lin. RESULTS: The results revealed a fair-to-moderate significant correlation between BMD and 13 TAs (r=−0.20 to 0.39; p<0.05). Eight TAs (autocorrelation, energy, homogeneity 1, homogeneity 1.1, maximum probability, sum average, sum variance, and inverse difference normalized) negatively correlated with BMD (r=−0.20 to −0.38; p<0.05), whereas five TAs (dissimilarity, difference entropy, entropy, sum entropy, and information measure corr 1) positively correlated with BMD (r=0.29-0.39; p<0.05). The interobserver agreement was almost perfect for all significant TAs (95% confidence interval, 0.92-1.00; p<0.05). CONCLUSION: Specific TAs could be reliably extracted from routine MRI and correlated with BMD. Our results encourage future evaluation of the potential usefulness of quantitative texture measurements from MRI scans for predicting fragility fractures.

Radiological features of traumatic vertebral endplate fracture: an analysis of 194 cases with 263 vertebral fractures / 中华医学杂志(英文版)

BACKGROUND@#The importance of identifying osteoporotic vertebral endplate or/and cortex fracture (ECF), which primarily includes endplate fracture (EPF) and vertebral anterior cortex buckling, has been recognized. However, some old traumatic ECFs with healing process in the elderly may be mistaken as osteoporotic. This study analyzes the radiological features of traumatic EPF.@*METHODS@#This was a retrospective analysis of 194 spine trauma patients with 263 vertebral fractures (mean age: 42.11 ± 9.82 years, 118 males and 76 females). All patients had traumatic EPF identified by X-ray/CT/MRI.@*RESULTS@#The involved vertebra was mostly L1 (29.7%), followed by T12 and L2. Except EPFs involved both superior and inferior endplates (12.6%), only 1.9% involved inferior endplate alone, with the majority involved superior endplate. If each endplate was divided into five segments of equal lengths (from anterior to posterior: a1, a2, m, p2, p1), the most depressed point of superior EPFs was mostly at segment-a2 (approximately 45%), followed by segment-a1 (approximately 20%) or segment-m (approximately 20%), and very rarely at segment-p1. The upper 1/3 of anterior vertebral wall was more likely to fracture, followed by middle 1/3 of anterior wall. For posterior vertebral wall fracture, 68.5% broke the bony wall surrounding the basivertebral vain. 58.6%, 30.0%, and 11.4% of vertebral fractures had 1/3 vertebral body height loss. As the extent of vertebral height loss increased, the chance of having both superior and inferior EPFs also increased; however, the chance of having inferior EPF alone did not increase.@*CONCLUSION@#Traumatic EPF features are characterized, which may help the differentiation of traumatic and osteoporotic EPFs.

Sex Estimation of Typical Adult Vertebrae Morphology in Central China Based on CT Technique / 法医学杂志

Objective The morphological data of the second thoracic vertebra and the third lumbar vertebra were measured by computerized tomography （CT）. The sex differences were analyzed and the discrimination equation was obtained. Methods The data of 274 adults （203 cases from experimental group and 69 cases from validation group） from central China were collected. Four linear data （maximum transverse length of vertebral body, maximum longitudinal length of vertebral body, maximum transverse length of vertebral foramen, maximum longitudinal length of vertebral foramen）, one angle data （angle between spinous processes） and two area （vertebral foramen area, total cross-sectional area of vertebral body） data of the second thoracic vertebra and the third lumbar vertebra were collected, respectively. Then three ratios ［maximum transverse length/　maximum longitudinal length of vertebral body, maximum transverse length/ maximum longitudinal length of vertebral foramen, vertebral foramen area/ （total cross-sectional area of vertebral body-vertebral foramen area）］ and one angle （angle between spinous processes） were obtained. The discriminant equation was established for sexual discriminant analysis. Results The morphology of the second thoracic vertebra and the third lumbar vertebra was related with gender. Four single index discriminant formulae and eleven multi-index discriminant formulae were established. The 69 validation group samples were substituted into the formula for testing, and the maximum discriminant accuracy rate of the single-index discriminant formula was 75%. The maximum discriminant accuracy rate of multi-index discriminant formula was 83%. Conclusion It is feasible to conduct individual sex analysis by the morphological indexes of second thoracic vertebra and the third lumbar vertebra. The indexes have important application values in practice.

Does height catch-up in schoolchildren have an effect on bone mass in adolescents? Analysis in a Brazilian birth cohort / Catch-up de estatura em escolares tem efeito sobre massa óssea em adolescentes? Análise em uma coorte brasileira de nascimento

Abstract Objective: To analyze the effect of height catch-up at school age on the bone mass of adolescents of a Brazilian birth cohort. Methods: A cohort study using data obtained from the three moments (birth, 7/9 years and 18/19 years of age) of the Cohorts-RPS study. Height catch-up was defined based on the difference between the schoolchild's z-score and birth z-score. The adolescents' bone mineral mass was analyzed using the z-score index for the lumbar spine measured by dual emission X-ray absorptiometry. A theoretical model was developed for the proposed analysis using directed acyclic graphs paired through the nearest-neighbor matching propensity score using the STATA software, version 14.0. The level of significance was set at 5%. Results: Of the 297 studied children, 24.5% achieved height catch-up. The bone mass below the expected for age was observed in 5.39% of the subjects. The mean lumbar spine z-score was −0.34 (±1.01). After the adjustment, no effect was observed between height catch-up at school age and bone mass in adolescents (Coeff = 0.598; 95% CI −0.117 to 1.313; p = 0.101). Conclusion: Even using the directed acyclic graphs and the causal inference method by adjusting the propensity score, the height catch-up did not seem to affect bone mass in adolescents, a result perhaps related to the sample size.

Resumo: Objetivo: Analisar o efeito do catch-up de estatura na idade escolar na massa óssea em adolescentes em uma coorte brasileira de nascimento. Métodos: Estudo de coorte, utilizando dados dos três momentos (nascimento, aos 7/9 anos e 18/19 anos) da pesquisa Coortes-RPS. Catch-up de estatura foi definida a partir da diferença entre o Z-score do escolar e Z-score do nascimento. Para a análise da massa óssea em adolescentes foi utilizado o índice Z-score da coluna lombar medido pela densitometria por dupla emissão de raio X. Para análise proposta, foi construído modelo teórico usando os gráficos acíclicos direcionados e pareado por escore de propensão do tipo vizinho mais próximo utilizando o software STATA versão 14.0. O nível de significância adotado foi de 5%. Resultados: Das 297 crianças, 24,58% realizaram o catch-up estatural. Massa óssea abaixo do esperado para a idade foi de 5,39%. O Z-score médio da coluna lombar foi −0,34 (± 1,01). Após ajuste, não foi observado efeito entre catch-up de estatura na idade escolar e massa óssea no adolescente (Coef = 0,598; IC 95% −0,117-1,313; p = 0,101). Conclusão: Mesmo com os gráficos acíclicos direcionados e o método de inferência causal por ajuste do escore de propensão, o catch-up de estatura parece não afetar a massa óssea em adolescentes, resultado talvez relacionado ao tamanho da amostra.

Método não ionizante de rastreamento da escoliose idiopática do adolescente em escolares / Non-ionizing method of screening adolescent idiopathic scoliosis in schoolchildren

Resumo Escoliose idiopática do adolescente (EIA) atinge de 2% a 4% de jovens no Brasil. Repetidas exposições aos exames radiológicos, no acompanhamento desta deformidade, podem ser danosos à saúde. O objetivo deste estudo é apresentar um protocolo de fotogrametria, como método não ionizante para quantificação da escoliose, e relacioná-lo ao método radiológico de Cobb. Dezesseis indivíduos portadores de escoliose idiopática (21,4 ± 6,1 anos de idade e 19,8±0,2 de índice de massa corporal) foram submetidos à radiografia posteroanterior do tronco, de pé e, posteriormente, fotografia do tronco posterior, após receberem marcadores anatômicos nos processos espinhosos das vértebras C7 até L5. As imagens foram encaminhadas para análise independente de dois examinadores treinados na quantificação da escoliose para o tipo de imagem recebida. A média angular torácica de Cobb e de fotogrametria foram 36,14° e 36,43°, respectivamente. A diferença média entre os métodos foi de 4,1°. Não houve diferença estatisticamente significante (p-valor < 5%) entre eles. A fotogrametria, por ser não ionizante, ter baixo custo e ser portátil, poderá representar uma alternativa ao método radiológico. Novos estudos são necessários no aprimoramento das técnicas não ionizantes no rastreamento da EIA.

Abstract Adolescent idiopathic scoliosis (AIS) affects 2% to 4% of young people in Brazil. Repeated exposures to radiation used in the monitoring of the deformity can be harmful to the health. This study aimed to present a photogrammetry protocol as a non-ionizing method to quantify scoliosis and relate it to the Cobb radiological method. Sixteen individuals with idiopathic scoliosis (age: 21.4 ± 6.1 years, body mass index: 19.8 ± 0.2 kg/m2) underwent standing posteroanterior X-ray examination of the trunk. Additionally, markers were placed on the spinal processes of the C7 to L5 vertebrae, and posterior trunk photographs were taken. All images were sent for independent analysis by two examiners who were trained in the quantification of scoliosis. The average of the thoracic curvature evaluated through the photogrammetry and Cobb methods were 36.43° and 36.14°, respectively. With an average difference of 4.1°, the methods were not statistically different (p < 0.05). As a non-ionizing method that is low cost and portable, photogrammetry may represent a suitable alternative to the radiological method. Further studies are needed for the improvement of non-ionizing techniques in AIS screening.