Mid-Thoracic Vertebral Compression Fracture after Mini-Trampoline Exercise: A Case Series of Seven Patients.

Background and Objectives: Home-based training exercise gained popularity during the coronavirus disease 2019 pandemic era. Mini-trampoline exercise (MTE) is a home-based exercise that utilizes rebound force generated from the trampoline net and the motion of the joints of the lower extremities. It is known to be beneficial for improving postural balance, stability, muscle strength and coordination, bone strength, and overall health. However, we encountered several patients with mid-thoracic vertebral compression fractures (VCFs) following regular MTE, which was never reported previously, despite having no history of definite trauma. This study aims to report mid-thoracic VCFs after regular MTE and arouse public attention regarding this spinal injury and the necessity of appropriate prior instructions about the correct posture. Patients and Methods: All consecutive patients diagnosed with acute VCFs following regular MTE were included. We collected data on patient demographics, history of MTE, characteristics of symptoms, and radiological findings such as the location of fractures and anterior vertebral body compression percentage. Results: Seven patients (one man and six women) and ten fractures (T5 = 1, T6 = 3, T7 = 2, and T8 = 4) were identified. Symptoms started 2.57 ± 1.13 weeks after the beginning of regular MTE. All patients reported that they were never properly instructed on the correct posture. They also stated that they were exercising with a hunchback posture and insufficient joint motion of the lower extremities while holding the safety bar with both hands, which resulted in increased peak vertical force along the gravity z-axis in the mid-thoracic area and consequent mid-thoracic VCFs. Conclusions: Mid-thoracic VCFs can occur following regular MTE even without high-energy trauma in case of improper posture during exercise. Therefore, public attention on mid-thoracic VCFs following MTE and the appropriate prior instructions are imperative.

Percutaneous transpedicular intracorporeal cage grafting for Kümmell disease.

BACKGROUND: Osteonecrosis with progressive collapse and segmental kyphosis can lead to intersegmental instability in some osteoporotic vertebral compression fractures (OVCFs). These conditions are known as Kümmell's disease and often require anterior column reconstruction in elderly patients. METHODS: We attempted anterior column reconstruction by percutaneous transpedicular intracorporeal cage grafting (PTICG) with short-segment pedicle screw fixation and described the steps, with discussions on the surgical indications and pros and cons. CONCLUSION: PTICG is expected to be an alternative to vertebral anterior column reconstruction, which can preserve the thoracolumbar posterior arch and paravertebral musculature.

Biportal Endoscopic Technique for Transforaminal Lumbar Interbody Fusion: Review of Current Research.

BACKGROUND: There are many types of minimally invasive lumbar interbody fusion procedures. Among them is the recently introduced biportal endoscopic lumbar interbody fusion surgery. Biportal endoscopic transforaminal lumbar interbody fusion (TLIF) might combine the advantages of minimally invasive TLIF and endoscopic spine approaches. However, clinical evidence in support of biportal endoscopic TLIF remains insufficient. METHODS: A comprehensive review of English-language literature on biportal endoscopic lumbar interbody fusion was performed. Articles on biportal endoscopic TLIF in PubMed, the Cochrane Library, and Web of Science were searched using the terms "unilateral biportal endoscopy," "biportal endoscopic spine surgery," "transforaminal," and "lumbar interbody fusion" as well as their combinations. The clinical and radiological outcomes of biportal endoscopic TLIF were analyzed and are summarized here. The biportal endoscopic lumbar interbody fusion surgical techniques are then described. RESULTS: There are 3 biportal endoscopic TLIF techniques. In the available literature, the postoperative 1-year outcomes of biportal endoscopic TLIF were comparable to those of posterior lumbar interbody fusion (PLIF) and minimally invasive (MIS)-TLIF. Clinical parameters were significantly improved after biportal endoscopic TLIF. Compared to PLIF or MIS-TLIF, biportal endoscopic-TLIF may have the advantage of a faster recovery. Biportal endoscopic TLIF showed no inferiority in fusion rates compared to PLIF or MIS-TLIF. The postoperative complications were usually minor. CONCLUSIONS: The postoperative 1-year clinical and radiological outcomes of biportal endoscopic TLIF were favorable compared to those of PLIF and MIS-TLIF. However, long-term outcomes should be investigated through prospective, randomized controlled trials in the future. CLINICAL RELEVANCE: This review article outlines the most current evidence-based medicine with regard to spinal surgery with an aim to introduce a new technique.

Evaluation of Muscular Atrophy and Fatty Infiltration Using Time-zero Magnetic Resonance Imaging as Baseline Data, After Rotator Cuff Repair.

BACKGROUND: This study evaluated postoperative changes in the supraspinatus from time-zero to 6 months, using magnetic resonance imaging (MRI). We hypothesized that restoration of the musculotendinous unit of the rotator cuff by tendon repair immediately improves the rotator cuff muscle status, and maintains it months after surgery. METHODS: Totally, 76 patients (29 men, 47 women) with rotator cuff tears involving the supraspinatus tendon who underwent arthroscopic rotator cuff repairs were examined. MRI evaluation showed complete repair with intact integrity of the torn tendon at both time-zero and at 6 months follow-up. All patients underwent standardized MRI at our institution preoperatively, at 1 or 2 days postoperative, and at 6 months after surgery. Supraspinatus muscular (SSP) atrophy (Thomazeau grade) and fatty infiltrations (Goutallier stage) were evaluated by MRI. The cross-sectional area of SSP in the fossa was also measured. RESULTS: As determined by MRI, the cross-sectional area of SSP significantly decreased 11.41% from time-zero (immediate repair) to 6 months post-surgery, whereas the Goutallier stage and Thomazeau grade showed no significant changes (p < 0.01). Furthermore, compared to the preoperative MRI, the postoperative MRI at 6 months showed a no statistically significant increase of 8.03% in the cross-sectional area. In addition, morphological improvements were observed in patients with high grade Goutallier and Thomazeau at time-zero, whereas morphology of patients with low grade factors were almost similar to before surgery. CONCLUSIONS: Our results indicate that cross-sectional area of the initial repair appears to decrease after a few months postoperatively, possibly due to medial retraction or strained muscle.