Case report: Thoracic vertebral abscess caused by Salmonella via diagnosed next-generation sequencing.

The genus Salmonella consists of Gram-negative bacteria with various serotypes. It commonly causes bacterial infections that affect the intestines. Infection can occur in humans and animals through the ingestion of contaminated food or water, or through contact with infected animals or environments. Complications commonly include intestinal hemorrhage and perforation, though vertebral osteomyelitis is rarely observed. Therefore, in patients with spinal cord abscesses, The genus Salmonella is typically not considered a likely pathogen, especially in the absence of typical symptoms. In this case, the limited information provided by traditional cultivation methods, particularly under the influence of antibiotics. However, next-generation sequencing (NGS) unexpectedly detected Salmonella, which assisted in formulating the final treatment plan. This underscores the role and clinical value of NGS in pathogen identification.

Virtual modelling of the impact of torsional loading on osteoporotic vertebrae buckling.

Purpose: This study aimed to evaluate the biomechanical response or load transfer on the osteoporotic L1 vertebra under torsional loading. Methods: To achieve this goal, a numerical model of osteoporotic vertebra in various trabecular bone degenerations was developed and tested. The mechanical behavior of the model was represented taking into account the anisotropic properties of the cancellous bone, which provided a more realistic mechanical picture of the biological subsystem. To ensure the reliability of osteoporotic degradation, the thinning of cortical bone and the appearance of gaps between trabecular bone and cortical bone were also taken into account when creating the models. Results: Finite element (FE) analysis showed that the deformations of cortical bone thinning and detachment of the cortical bone from the trabecular tissue lead to local instability of the vertebra. As a result, the cortical bone of a vertebra loses its load-bearing capacity, even if the strength limit is not reached. Conclusions: The results obtained allow us to state that taking into account the thinning of the trabeculae, which creates voids, is extremely important for load-bearing capacity of osteoporotic vertebrae. However, a limitation of this study is the lack of experimental data to ensure consistency with the computer simulation results.

Automated 3D Cobb Angle Measurement Using U-Net in CT Images of Preoperative Scoliosis Patients.

To propose a deep learning framework "SpineCurve-net" for automated measuring the 3D Cobb angles from computed tomography (CT) images of presurgical scoliosis patients. A total of 116 scoliosis patients were analyzed, divided into a training set of 89 patients (average age 32.4 ± 24.5 years) and a validation set of 27 patients (average age 17.3 ± 5.8 years). Vertebral identification and curve fitting were achieved through U-net and NURBS-net and resulted in a Non-Uniform Rational B-Spline (NURBS) curve of the spine. The 3D Cobb angles were measured in two ways: the predicted 3D Cobb angle (PRED-3D-CA), which is the maximum value in the smoothed angle map derived from the NURBS curve, and the 2D mapping Cobb angle (MAP-2D-CA), which is the maximal angle formed by the tangent vectors along the projected 2D spinal curve. The model segmented spinal masks effectively, capturing easily missed vertebral bodies. Spoke kernel filtering distinguished vertebral regions, centralizing spinal curves. The SpineCurve Network method's Cobb angle (PRED-3D-CA and MAP-2D-CA) measurements correlated strongly with the surgeons' annotated Cobb angle (ground truth, GT) based on 2D radiographs, revealing high Pearson correlation coefficients of 0.983 and 0.934, respectively. This paper proposed an automated technique for calculating the 3D Cobb angle in preoperative scoliosis patients, yielding results that are highly correlated with traditional 2D Cobb angle measurements. Given its capacity to accurately represent the three-dimensional nature of spinal deformities, this method shows potential in aiding physicians to develop more precise surgical strategies in upcoming cases.

Radiological assessment of the dissection area in supraomohyoid neck dissection.

PURPOSE: The current supraomohyoid neck dissection (SOHND) is performed above the omohyoid muscle to dissect levels I, II, and III in the levels of cervical lymph nodes. However, the anatomical boundary between levels III and IV is the inferior border of the cricoid cartilage. We investigated the anatomical relationship between the omohyoid muscle and cricoid cartilage using contrast-enhanced CT (CE-CT) images to assess the validity of the current SOHND. METHODS: CE-CT images of the head and neck regions in patients were reviewed. The patients were divided into two groups: "malignant tumors" and "others". The vertebral levels corresponding to the positions of anatomical structures such as the intersection of the omohyoid muscle and internal jugular vein (OM-IJ), and the inferior border of the cricoid cartilage (CC), were recorded. RESULTS: The OM-IJ was located around the seventh cervical to the first thoracic vertebra. There was a significant difference between the malignant tumor and others groups in females (p = 0.036). The CC was located around the sixth to seventh cervical vertebrae. There was a significant sex difference in each group (malignant tumor: p < 0.0001; others: p = 0.008). Both sexes tended to have lower OM-IJ than CC, and females had significantly lower OM-IJ than males. CONCLUSION: This study provides clear anatomical evidence showing the difference between the SOHND dissection area and levels I, II, and III. It could be considered that in most cases SOHND invades level IV, not just levels I, II, and III, especially in female patients.

Excessive posterior placement of upper instrumented vertebra relative to lower instrumented vertebra as a predictor of proximal junction kyphosis after selective spinal fusion for adolescent idiopathic scoliosis Lenke type 5C curves.

PURPOSE: We defined sagittal S-line tilt (SSLT) as the tilt of the line connecting the upper instrumented vertebra and the lower instrumented vertebra. This study aimed to: (1) examine the correlation between SSLT and proximal junctional angle (PJA) change values, and (2) determine the cut-off value of SSLT with respect to proximal junctional kyphosis (PJK) occurrence. METHODS: Eighty-six consecutive patients (81 female and 5 male; mean age: 15.8 years) with Lenke 5C AIS who underwent posterior selective spinal fusion. Pearson's correlation coefficients were used to examine the relationship between preoperative SSLT and changes in PJA from preoperative to 2 years postoperative. The impact of SSLT on PJK at 2 years after surgery was assessed using a receiver operating characteristic (ROC) curve. RESULTS: We observed a moderate positive correlation between preoperative SSLT and change in PJA (R = 0.541, P < 0.001). We identified 18 patients (21%) with PJK at 2 years postoperative. Mean preoperative SSLT in the PJK group and the non-PJK group differed significantly at 23.3 ± 4.1° and 16.1 ± 5.0°, respectively (P < 0.001). The cut-off value of preoperative SSLT for PJK at 2 years postoperative was 18° in ROC curve analysis, with a sensitivity of 94%, specificity of 68%, and area under the ROC curve of 0.868. CONCLUSION: In selective lumbar fusion for AIS Lenke type 5C curves, preoperative SSLT was significantly correlated with PJA change from preoperative to 2 years postoperative. SSLT was a predictor of PJK occurrence, with a cut-off value of 18°.

Morphometric analysis of atlas lateral mass in Down syndrome cases with relevance to surgical intervention.

PURPOSE: Surgical stabilization of the Atlas vertebrae is indicated for severe atlantoaxial instability (AAI) in patients with Down syndrome (DS). This study aims to evaluate the morphological characteristics of the Atlas lateral mass (ALM) in patients with DS with regard to safe instrumentation for surgical stabilization and to compare them with non-syndromic group. METHODS: This multicenter, retrospective, case-control study included age- and sex-matched patients with and without DS aged > 7 years with a cervical computed tomography (CT) scan. After three-dimensional CT reconstruction, nine parameters were evaluated for both groups. All included measurements were performed by a neuroradiologist who was blinded to clinical data. RESULTS: Forty-three of 3,275 patients with DS were included in this study. Matching number of consecutive patients without DS were identified (mean age: 16 years). Patients with DS were significantly shorter than those without DS. Seven of nine parameters related to ALM were significantly lower in patients with DS than in those in the control group, including anterior wall height (AH), posterior wall height (PH), their ratio, and arch-ALM angle. On adjusting data for patient height, patients with DS had a smaller PH, lower PH/AH ratio, and steeper arch-ALM angle than the control group. CONCLUSIONS: Patients with DS had a smaller posterior ALM wall and a steeper arch-ALM angle than the control group without DS. This information is important for surgical planning of safe posterior ALM exposure and safe instrumentation for surgical stabilization in patients with DS.

Identifying and exploring the favorable factors that help to slow the progression of disease in patients with mild cervical spondylotic myelopathy.

To explore the favorable factors that help slow the progression of disease in patients with mild Cervical Spondylotic Myelopathy (CSM). A retrospective analysis was conducted, involving the enrollment of 115 CSM patients. The categorization of patients into two groups was based on the duration of symptoms, assessments using the mJOA scale and Health Transition (HT) scores: mild-slow group and severe-rapid group. We found that the patients in both groups had similar degrees of spinal cord compression, but mild-slow group were older and had smaller C2-C7 cobb angle (Flexion) (CL(F)), C2-C7 cobb angle (Range of motion) (CL(ROM)), Transverse area (TA), Normal-TA, Compressive spinal canal area (CSCA), Normal-Spinal canal area (Normal-SCA) and lower Spinal cord increased signal intensity (ISI) Grade than the severe-rapid group. A binary logistic regression analysis showed that CL(ROM) and Normal-TA are favorable factors to help slow the progression of disease patients with mild CSM. Through ROC curves, we found that when CL(ROM) < 39.1° and Normal-TA < 80.5mm2, the progression of disease in CSM patients may be slower. Meanwhile, we obtained a prediction formula by introducing joint prediction factor: L = CL(ROM) + 2.175 * Normal-TA. And found that when L < 213.0, the disease progression of patients may be slower which was superior to calculate CL(ROM) and Normal-TA separately.

Biomechanical Analysis of Pedicle Screw Reinsertion Along the Same Trajectory in a Validated 3D Printed Synthetic Bone Model.

OBJECTIVE: To investigate the biomechanical properties of pedicle screw reinsertion along the same trajectory in a previously validated synthetic bone model. METHODS: Twenty identical acrylonitrile butadiene styrene models of a lumbar vertebrae were 3D-printed. Screws were placed in the standard fashion into each pedicle. Models were separated into two equal groups, control and experimental. Experimental group screws were completely removed from their testing block and reinserted once. All screws in both groups were then forcibly removed. Continuous torque monitoring was collected on screw insertion (IT), removal (RT), and reinsertion (RIT). Pullout strength (PO), screw stiffness (STI), and strain energy (STR) were calculated. RESULTS: There was no significant difference between control and experimental groups for PO (p = 0.26), STI (p = 0.55), STR (p = 0.50), or IT (p = 0.24). There was a significant decrease in RIT (54.5 N-cm ± 8.2 N-cm) from control IT (62.9 N-cm ± 8.4 N-cm, p = 0.045) and experimental IT (67.5 N-cm ± 7.6 N-cm, p = 0.0026). Strong correlations (Pearson's r > 0.80) were seen between control IT against STR and PO, between each of the experimental torque measurements, and between experimental PO and STI. CONCLUSION: Despite a significant decrease in insertion torque, there is no significant loss of pedicle screw performance when a screw is removed and reinserted along the same trajectory.

Digital anatomical features of morphological development in C2-C7 neurocentral synchondrosis in children aged 1-6 years: a retrospective study of CT images.

BACKGROUND: With the continuous improvement of diagnosis and treatment technology for cervical spine-related diseases in children at home and abroad, the demand for exploring the developmental anatomy and function of children's cervical spine of different ages is increasing. So the aim of this study was to investigate the changes of anatomical indicators in neurocentral synchondrosis (NCS) of C2-C7 with age and the developmental characteristics of different vertebrae in children aged 1-6 years old. METHOD: A retrospective collection of 160 cases of normal cervical spine CT images of children aged 1-6 years old in provincial tertiary hospitals, according to the age group of 1-year-old into 6 groups. The original data of continuously scanned cervical spine tomography images were imported into Mimics16.0 software, under the two-dimensional image window, selected the measurement tool under the Measurements toolbar to measure and statistically analyzed the anatomical indicators such as cross diameter, sagittal diameter, height, perimeter and area of NCS in the C2-C7 segment of the cervical spine on the coronal plane and cross-section. RESULTS: There was no significant difference in the anatomical indexes of cervical spine NCS in children compared with the left and right sides of the same vertebrae (P > 0.05). The same cervical spine generally had differences between the age groups of 1-4 years old and 5-6 years old (P < 0.05).The transverse diameter and circumference gradually decreased with age; the sagittal diameter and height showed a slight increase trend; there was a maximum area at 2 years of age. In different cervical vertebrae of the same age group, the NCS values of C3, C4, and C5 varied greatly, which showed that the ossification process of cervical cartilage was faster than that at the upper and lower ends. There were obvious differences between C2 and the rest of the cervical vertebral segments' NCS ossification process. C7 was also very different from the rest of the cervical vertebrae segments, presumably more similar to the thoracic spine. CONCLUSIONS: The anatomical indexes of C2-C7 NCS in children have obvious developmental regularities at different ages, and there are also regularities between cervical segments.

[Repeated Bow hunter's stroke by artery-to-artery embolism from the vertebral artery dissecting aneurysm formed by head rotation: A case report].

A 55-year-old woman suffered from diplopia and occipital pain after shoveling snow. She was diagnosed with the right vertebral artery dissecting aneurysm at the level of the axial vertebra and repeatedly had cerebral infarctions in the posterior circulation. She had subluxation of the atlantoaxial vertebra as an underlying disease. Right vertebral angiogram with the head rotated to the left showed the right vertebral artery occlusion and left vertebral angiogram with the head rotated to the right showed stenosis at the C1-C2 level, leading to the diagnosis of Bow hunter's stroke. After wearing a cervical collar and taking 100 |mg of aspirin, she had no recurrence of cerebral infarction and later underwent C1-C2 posterior fusion to prevent the recurrence of cerebral infarction. She finished taking aspirin 6 months after the surgery, and there has been no recurrence of cerebral infarction. We report here a case of Bow hunter's stroke, a rare disease, with good clinical outcomes after C1-C2 posterior fusion.

Echo-planar DWI variants: A comparative study in vertebral marrow pathology.

PURPOSE: Single-shot echo-planar imaging (ss-EPI) has limited application in vertebral column imaging due to numerous artifacts. Therefore, we aimed to compare readout-segmented echo-planar imaging (rs-EPI) to ss-EPI and assess its value in the differential diagnosis of vertebral infectious, tumoral infiltrative, and degenerative disorders. MATERIALS AND METHODS: Sixty-six adult patients with spondylodiscitis (SD, n = 26), tumoral infiltration (TI, n = 20), or Modic type I degeneration (DE, n = 20) findings on spinal magnetic resonance imaging (MRI) included in this retrospective study. Two radiologists scored images for quality on a 4-point scale (image resolution, degree of geometric distortion, lesion selectivity, and diagnostic reliability) and measured signal intensity (SI), apparent diffusion coefficient (ADC), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). DE and SD groups also united to form the benign group. RESULTS: In all groups, rs-EPI performed better than ss-EPI in image quality, SNR, and CNR (p < .05). The difference between mean pathological ADC (ADCP) in the two sequences was statistically significant (p < .05). There was no significant difference between the groups in terms of ADCP in rs-EPI (p = .229), unlike ss-EPI (p = .025). Pathological SI (SIP) and CNR in rs-EPI were significantly higher in the malignant group than benign group (p = .002, p < .001). In rs-EPI, no significant difference was found between malignant and benign groups' ADCP (p = .13). CONCLUSION: The rs-EPI is a diffusion-weighted imaging (DWI) method with higher image quality that diminishes motion-induced phase errors and increases resolution through phase corrections. However, the distinction of malignant and benign vertebral bone marrow pathologies is unsatisfactory for rs-EPI compared with ss-EPI.

Mechanical consequences to the annulus fibrosus following rapid internal pressurization and endplate fracture under restrained-expansion conditions.

Intervertebral disc herniation is not a common injury in the adolescent population, but the correlation between trauma and herniation warrants concern. Previous research demonstrated the capacity for rapid internal pressurization to reduce the mechanical integrity of the intervertebral disc's annulus fibrosus, even in the absence of fracture. The purpose of this study was to modify previous internal pressurization procedures towards a more transferable injury model, then investigate the capacity for these procedures to damage the mechanical integrity of the annulus fibrosus. Porcine cervical motion segments with intact facet joints were confined between a vice and force plate under 300 N of static compression, then a single, manual, rapid internal pressurization was delivered. Posterolateral annulus samples were extracted and situated in a 180° peel test configuration, exposing the interlamellar matrix of samples to separations of 0.5 mm/s, until complete separation of the sample occurred. Multilayer tensile testing was performed on superficial and mid-span samples of annulus by applying uniaxial tension of 1 %/s to 50 % strain. Compared to unpressurized controls, rapid pressurization causing fracture resulted in reduced lamellar adhesion and increased toe-region stress and strain properties in the annulus. Morphological assessment reported similar fracture patterns between endplate fractures achieved in the present experiment and endplate fractures documented in human patients. Mechanical plus morphological results suggest that rapid internal pressurization resulting in endplate fracture may represent a potent mechanism for subsequent damage to the intervertebral disc.

Does ponticulus posticus affect vertebral artery diameter.

PURPOSE: Ponticulus Posticus, atlantooccipital ligament ossification-induced anomaly, surrounds the vertebral artery and the first cervical nerve root. It is believed to wrap around the first cervical nerve root and the vertebral artery, causing compression. We hypothesized that it would also reduce the diameter of the vertebral artery. METHODS: Between January 1, 2022, and December 31, 2022, cervical spine CT scans taken for any reason were retrospectively reviewed. The images of 1365 patients suitable for evaluation were evaluated by two expert radiologists in 3 dimensions. Among patients with PP, those who underwent cervical angiography were identified for vertebral artery diameter measurement. RESULTS: The average age of the 1365 individuals included in the study (732 males, 633 females) was 55.78 (± 18.85) with an age range of 1-96. Among this group, PP was detected in 288 individuals, resulting in a total prevalence of 21.1%. Right and left vertebral artery diameters were significantly lower in patients with complete PP compared to the absent group (p < 0,001, p < 0,001, respectively). Additionally, it was observed that width and height diameters and artery diameters were positively correlated in patients with Complete PP. CONCLUSIONS: Ponticulus posticus can cause vertebrobasilar insufficiency by reducing the diameter of the vertebral artery. Therefore, imaging and detailed evaluation of this region are important in symptomatic patients.

The Optimal Lowest Instrumented Vertebra to Prevent the Distal Adding-On Phenomenon in Patients Undergoing Selective Thoracic Fusion for Adolescent Idiopathic Scoliosis with Lenke Type 1A and 1B Curves: Comparison of Nine Selection Criteria.

Background/Objectives: There is no solid consensus regarding which lowest instrumented vertebra (LIV) selection criterion is best to prevent distal adding-on (DA) after adolescent idiopathic scoliosis (AIS) surgery. This study aims to search out the LIV selection criteria in the literature and to compare the ability of each LIV selection criterion to prevent DA in patients with AIS. Methods: Patients who underwent thoracic fusion for AIS of Lenke type 1A or 1B were included in this study. Nine criteria for LIV selection were found in a literature review. For each patient, whether the postoperative actual location of LIV was met with the suggested locations of the LIV was assessed. The preventive ability of nine criteria against DA was evaluated using logistic regression analysis. The patients who met the LIV selection criteria but developed DA were investigated. Results: The study cohort consisted of 145 consecutive patients with a mean age of 14.8 years. The criteria of Suk (OR = 0.267), Parisini (OR = 0.230), Wang (OR = 0.289), and Qin (OR = 0.210) showed a significantly decreased risk of DA if the LIV selection criterion was chosen at each suggested landmark. As the additional levels were fused, there was no statistically significant benefit in further reducing the risk of DA. Among the patients who met each criterion, the incidence of DA was lower in criteria by Takahashi (5.9%), Qin (7.1%), and King (7.4%) than the others. Conclusions: Qin's criterion, using the substantially touching vertebra concept, has the highest preventive ability against DA development. Extending the instrumentation further distal to this suggested LIV criterion did not add further benefit.

Sex Determination via the Second Cervical Vertebra and Odontoid Process: A Case Report and a Review of the Literature.

Determining an individual's sex is crucial in several fields, such as forensic anthropology, archaeology, and medicine. Accurate sex estimation, alongside the estimation of age at death, stature, and ancestry, is of paramount importance for creating a biological profile. This profile helps narrow the potential pool of missing persons and aids identification. Our research focuses on the second cervical vertebra and odontoid process, which is particularly valuable due to their high sexual dimorphism. This brief research is structured as follows: we provide an overview of morphometric analysis of the second cervical vertebra for accurate sex estimation in forensic anthropology. We then delve into a case report to explore sexual dimorphism of the C2 vertebrae. Moreover, we discuss some of these studies that showed a significant correlation between the dimensions of the second cervical vertebrae and height, suggesting that the C2 can be used as a reliable indicator for stature estimation. The high accuracy rate of sex estimation using the second cervical vertebrae suggests that this method is a valuable tool for forensic anthropologists. Its practical application can significantly contribute to identifying and profiling individuals in a forensic context, thereby aiding in the identification process.

Bipolar hybrid posterior instrumentation tecnique for the correction of Scheuermann's kyphosis.

Scheuermann´s kyphosis (SK) is the most common cause of painful and progressive structural hyperkyphosis in adolescents. Surgical treatment should be considered in cases of refractory pain or progressive deformities. We present the clinical and radiological results obtained using a bipolar, hybrid posterior instrumentation tecnique. We analysed 12 males and 6 females, with mean age of 15.8 years. Minimum follow-up was 2 years. We used transverse process hooks at the cranial level and polyaxial screws for the remaining levels. We did not instrument the periapical segment. We used the sagittal stable vertebra (SSV) as the lower instrumented vertebra (LIV) in most cases, the "barely touched SSV" if the above disc space is lordotic. The mean preoperative kyphosis was 73.6º, mean postoperative kyphosis 44.7º, and mean correction of 28.9º (p = 0.0002). The mean reduction in lumbar lordosis (LL) was 8.9º (p = 0.0018). There were no significant differences in the spinopelvic parameters or sagittal balance. The mean number of instrumented levels was 8.9. Type II osteotomies were necessary in only three patients. Three patients had a cranial sagittal angle greater than 10°, all of them asymptomatic. Postoperatively, all patients had VAS scores less than 2 and SRS-22 scores greater than 4. Hybrid bipolar posterior instrumentation offers adequate curve correction, less operative time, implant density, bleeding, material protrusion and risk of spinal cord injury, leaving a large periapical bed for graft supply. We propose to measure the flexibility of the curve in MRI. In flexible curves (those that correct at least 20% in the supine decubitus position), wide facetectomies offer adequate correction of the deformity.

C1-C2 Transarticular Anterior Fixation for the Treatment of Atlantoaxial Traumatic Dislocation: A Clinical Case.

Fractures of the odontoid apophysis are one of the most frequent lesions in the elderly population, and an increasingly preponderant problem with the progressive aging of the world population. In the present work, we report a clinical case of an 88-year-old male patient who suffered a fall resulting in a type-II fracture of the odontoid apophysis on the Anderson-D'Alonzo classification. Given the age and comorbidities of the patient, we decided to perform osteosynthesis of the fracture through anterior fixation with a transarticular screw in combination with fixation with an odontoid screw. This technique enables the necessary stability for the consolidation of Anderson-D'Alonzo's type II odontoid apophysis fracture, with the advantage of the lower levels of dissection of the cervical extensor musculature and hemorrhage resulting from this aggression when compared with the posterior approach; moreover, it is a readily-available technique that yields clear benefits in the treatment of this pathology in the geriatric population.

Usefulness of modified S-line for upper instrumented vertebra selection in adolescent idiopathic scoliosis Lenke type 1C curve.

PURPOSE: Determine the effect of using the modified S-line vertebra (MSLV) as the upper instrumented vertebra (UIV) on postoperative trunk balance, L4 tilt, and clinical outcomes in selective thoracic fusion (STF) for adolescent idiopathic scoliosis (AIS) Lenke type 1C curve. METHODS: Twenty-eight consecutive patients (all female; mean age: 15.4±2.0 years) with AIS Lenke type 1C curve were retrospectively enrolled. Primary outcome measures were coronal balance (absolute distance between C7 and the center of the sacral vertical line), L4 tilt, and Scoliosis Research Society (SRS)-22r scores at 2 years postoperatively. The group with the MSLV at the UIV was designated as the MSLV group (18 patients), and the group with the MSLV proximal (12 patients) or distal (4 patients) to the UIV was defined as the non-MSLV group. RESULTS: We observed no significant differences between the groups regarding age, LIV and stable vertebra positioning, or preoperative X-ray parameters. Postoperative coronal balance was significantly better in the MSLV group (0.39±0.08 vs. 1.34±0.22 cm; P.