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1.
Medicine (Baltimore) ; 99(16): e19780, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32311986

RESUMO

Segmental fusion is not necessarily needed in treatment of thoracolumbar unstable burst fracture requiring surgery. Our objective was to report the results of follow-up for at least 10 years in patients with thoracolumbar unstable burst fracture requiring surgery in which fractured segment was healed following temporary posterior instrumentation without fusion, and in whom implants were subsequently removed.Retrospective Cohort Study.Nineteen patients in whom union of fractured vertebra was observed following surgery and in whom implants were removed within an average 12.2 months, and who could be followed up for at least 10 years, were enrolled.At the last follow-up, we evaluated the segmental motions, anterior body height ratio, progress of further kyphotic deformity, Oswestry Disability Index, Rolland Morris Disability Questionnaire and Short Form 36.Results: The follow-up period after implant removal surgery was 151 months on average. The local kyphotic angle was 26.89 ±â€Š6.08 degrees at the time of injury and 10.11 ±â€Š2.22 degrees at the last follow-up. The anterior body height ratio was 0.54 ±â€Š0.16 at the time of injury and 0.89 ±â€Š0.05 at the last follow-up. Thus, the fractured vertebra was significantly reduced after surgery and maintained till last follow-up. The segmental motion was 9.84 ±â€Š3.03, Oswestry Disability Index was 7.95 ±â€Š7.38, Rolland Morris Disability Questionnaire was 2.17 ±â€Š2.67, short form 36 Physical Component Score was 77.50 ±â€Š16.61, and short form 36 Mental Component Score was 79.21 ±â€Š13.32 at last follow-up.We conducted at least 10-year follow-up and found that temporary posterior instrumentation without fusion should be considered one of the useful alternative treatments for thoracolumbar unstable burst fracture in place of the traditional posterior instrumentation and fusion.


Assuntos
Fixação Interna de Fraturas/instrumentação , Vértebras Lombares/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/cirurgia , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Radiografia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Adulto Jovem
2.
Medicine (Baltimore) ; 99(11): e19354, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176057

RESUMO

RATIONALE: Leakage of bone cement is a common complication after percutaneous kyphoplasty. In rare cases, bone cement can leak into the venous system, which can be life threatening, especially when it causes an embolism in the heart. PATIENT CONCERNS: A 79-year-old female patient developed chest pain with chest tightness 3 weeks after the percutaneous kyphoplasty. DIAGNOSES: Initially, negative fluoroscopy results and elevated myocardial enzymes suggested that the patient's chest pain and chest tightness symptoms were manifestations of coronary heart disease. However, in the subsequent computed tomography (CT) examination, foreign bodies in the heart and pulmonary vessels were found. INTERVENTIONS: The patient underwent emergency surgery to remove the bone cement and repair the tricuspid valve. OUTCOMES: The postoperative course was uneventful and the patient was discharged on the 13th day after surgery. LESSONS: If a patient develops chest pain with chest tightness after percutaneous kyphoplasty, the clinicians must be vigilant and take into account the limited sensitivity of fluoroscopy and use chest computer tomography and echocardiogram as the first choice and thereby prevent serious consequences.


Assuntos
Cimentos para Ossos/efeitos adversos , Embolia/etiologia , Embolia/cirurgia , Corpos Estranhos/diagnóstico por imagem , Cifoplastia/efeitos adversos , Fraturas da Coluna Vertebral/cirurgia , Idoso , Cimentos para Ossos/uso terapêutico , Ecocardiografia/métodos , Embolia/diagnóstico por imagem , Feminino , Fluoroscopia/métodos , Seguimentos , Corpos Estranhos/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Humanos , Cifoplastia/métodos , Vértebras Lombares/cirurgia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Resultado do Tratamento
3.
Unfallchirurg ; 123(4): 269-279, 2020 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-32215668

RESUMO

BACKGROUND: Spinal injuries in pediatric patients are overall very rare. Current reference studies including large patient numbers that enable the formulation of evidence-based recommendations on diagnostics and treatment of these injuries do not exist. OBJECTIVE: The aim of the current study was to formulate recommendations on the diagnostics and treatment for injuries of the thoracic and lumbar spine in pediatric patients. MATERIAL AND METHODS: Firstly, a search for primary and secondary literature on the topic of diagnostics and treatment of spinal injuries in children was carried out. From this, a literature database was established and maintained. Secondly, within the framework of 9 meetings in the time period from April 2017 to December 2019 the members of the Pediatric Spinal Trauma Group of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU) documented recommendations on diagnostics and treatment of injuries of the thoracic and lumbar spine in pediatric patients by a consensus process. RESULTS: Recommendations on the diagnostics and treatment of injuries of the thoracic and lumbar spine could be given for 3 age groups (age group I: 0-6 years; age group II: 7-9 years; age group III: 10-16 years). Diagnostic and therapeutic principles known from adult patients suffering from injuries to the thoracic or lumbar spine cannot easily be transferred to pediatric patients. CONCLUSION: Spinal injuries in childhood are rare and should be treated in specialized spine centers. Pediatric patients with a stable cardiopulmonary status should undergo magnetic resonance imaging (MRI) if a spinal trauma is suspected. The basic principles of the treatment of spinal trauma in children is the restoration of spinal stability and correct anatomical parameters as well as the protection of all neural structures. The potential for correction and regeneration of the individual spinal sections depending on the age of the patient must be considered for deciding between operative vs. conservative treatment. Whenever operative treatment is needed, it should be performed by minimally invasive techniques as a sole instrumentation without spondylodesis. An early removal of the screw-rod-system should be performed.


Assuntos
Fraturas da Coluna Vertebral , Fusão Vertebral , Traumatismos da Coluna Vertebral , Parafusos Ósseos , Criança , Humanos , Vértebras Lombares/lesões , Imagem por Ressonância Magnética , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Traumatismos da Coluna Vertebral/cirurgia , Vértebras Torácicas
4.
Medicine (Baltimore) ; 99(7): e19037, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049800

RESUMO

RATIONALE: We present a rare case of a traumatic intradural ruptured disc associated with a mild vertebral body compression fracture along with a review of the relevant medical literature. An intradural ruptured disc often occurs due to chronic degenerative diseases and is rarely due to trauma. It can cause irreversible neurological complications if the appropriate treatment is not planned. PATIENT CONCERNS: A 32-year-old male presented with motor paraparesis (grade 3/5), right ankle dorsiflexion, and great toe dorsiflexion (grade 1/5), along with radiating pain at his right L4 and L5 sensory dermatome following a fall. DIAGNOSES: Computed tomography revealed a compression fracture of the L2 body. Lumbar magnetic resonance imaging showed an intradural mass-like lesion on the ventral side of his spinal cord and an epidural mass-like lesion on the dorsal side of his spinal cord, indicating a hematoma. INTERVENTIONS: An emergency L2 laminectomy was performed to remove the space-occupying lesions and to decompress the cauda equina and nerve root. The mass-like lesion was removed. No other lesions were found in the spinal canal. OUTCOMES: Pathologic examination of the intradural mass lesion revealed fibrocartilage similar to that found in disc material. The patient still continued to experience motor weakness at the 1-year follow-up examination. LESSONS: We report a rare case of a traumatic lumbar disc rupture into the dural sac associated with a mild vertebral body compression fracture. Early diagnosis and prompt surgical intervention are essential, as is performing a magnetic resonance imaging or computed tomography myelogram promptly to evaluate the spinal canal when there are unexplained neurologic symptoms. An intraspinal canal evaluation should be completed before the postural reduction of the vertebral body fracture to prevent any neurological complications.


Assuntos
Fraturas por Compressão/cirurgia , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Acidentes por Quedas , Adulto , Descompressão Cirúrgica , Fraturas por Compressão/diagnóstico por imagem , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Laminectomia , Imagem por Ressonância Magnética , Masculino , Fraturas da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
5.
Medicine (Baltimore) ; 99(6): e19053, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028424

RESUMO

RATIONALE: Traditionally, transpedicular approach was used in the treatment of osteoporotic lumbar compression fracture. In order to avoid the risks of pedicle disruption and spinal canal intrusion, extrapedicular approache has been attempted. The aim of the article is to present the modified extrapedicular kyphoplasty technique for the treatment of osteoporotic lumbar compression fracture. PATIENT CONCERNS: A 62-year-old woman suffered from severe low back pain after an accidental fall 10 days ago. Low back pain was obvious when turning over and getting out of bed. It was not relieved after bed rest and conservative treatment. Visual analog scale (VAS) of low back pain was 8 points and Oswestry disability index score was 80%. DIAGNOSIS: Magnetic resonance imaging showed osteoporotic vertebral compression fracture of L2 and L3. INTERVENTIONS: We performed modified extrapedicular kyphoplasty for the patient. The technique has a standardized operating procedure. The puncture point of skin is determined according to preoperative computer tomography and X-ray. The puncture point of vertebral body is located at the outer upper edge of the pedicle. The puncture direction is from the upper edge of the pedicle to the lower edge of the contralateral pedicle. OUTCOMES: The operation time was 20 minutes. The intraoperative blood loss was 5 mL. The amount of bone cement was 4 mL in L2 and 5 mL in L3. VAS of low back pain was 2 points in 1 day after surgery. Preoperative symptoms were significantly improved. LESSONS: Modified extrapedicular kyphoplasty is a safe and effective technique for the treatment of osteoporotic lumbar compression fracture, which should be promoted and applied.


Assuntos
Fraturas por Compressão/cirurgia , Cifoplastia/métodos , Vértebras Lombares/lesões , Fraturas da Coluna Vertebral/cirurgia , Perda Sanguínea Cirúrgica , Feminino , Fraturas por Compressão/diagnóstico por imagem , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Pessoa de Meia-Idade , Duração da Cirurgia , Radiografia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X
6.
PLoS One ; 15(1): e0228341, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31999783

RESUMO

BACKGROUND: Osteoporotic vertebral compression fractures (OVCFs) often cause local kyphosis. Percutaneous kyphoplasty (PKP) is a common method for the treatment of local kyphosis. However, the influence of kyphoplasty on spino-pelvic alignment and global sagittal balance when performed at specific treatment sites in the spine remains unclear. The purpose of the study is to investigate the influence of different fracture sites and PKP treatment on the spino-pelvic alignment and global sagittal balance in patients with OVCFs. METHODS: 90 patients with OVCF who underwent PKP were included in the retrospective study. According to the site of the fractured vertebrae, all the cases were divided into 3 groups: Main thoracic (MT) group (T1 to T9), Thoracolumbar (TL) group (T10 to L2) and Lumbar (LU) group (L3 to L5). 26 healthy elderly volunteers (aged over 59) were enrolled as the control group. Sagittal spino-pelvic parameters were measured on the full-spine radiographs preoperatively and postoperatively. Information of sagittal spino-pelvic parameters and global sagittal balance was gathered. RESULTS: Compared with the Control group, TL group showed significant differences in almost all parameters, except pelvic incidence (PI) and lumbar lordosis (LL). While only local sagittal parameters (Thoracic kyphosis (TK), Thoracolumbar kyphosis (TLK), LL) were significantly different in MT group. There was no significant difference in almost all of the parameters except for PT and TPA in LU group. Correspondingly, the sagittal parameters of TL group improved best after PKP, except for thoracic kyphosis (TK) and sagittal vertical axis (SVA). In MT group, only TLK was significantly decreased, while in LU group, only local kyphosis Cobb angle and SSA were improved. CONCLUSIONS: OVCF mainly occurs in the thoracolumbar region. Compared with MT group and LU group, OVCF occurred in the thoracolumbar region had greater influence on the spino-pelvic alignment and global sagittal balance. When PKP was performed, the improvement of sagittal balance parameters of TL group was the best in the three groups.


Assuntos
Fraturas por Compressão/cirurgia , Cifoplastia/métodos , Cifose/cirurgia , Osteoporose/complicações , Fraturas da Coluna Vertebral/cirurgia , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Fraturas por Compressão/complicações , Fraturas por Compressão/diagnóstico por imagem , Humanos , Cifose/diagnóstico por imagem , Cifose/etiologia , Masculino , Pessoa de Meia-Idade , Osteoporose/diagnóstico por imagem , Equilíbrio Postural , Radiografia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/cirurgia , Resultado do Tratamento
7.
Nat Med ; 26(1): 77-82, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31932801

RESUMO

Methods for identifying patients at high risk for osteoporotic fractures, including dual-energy X-ray absorptiometry (DXA)1,2 and risk predictors like the Fracture Risk Assessment Tool (FRAX)3-6, are underutilized. We assessed the feasibility of automatic, opportunistic fracture risk evaluation based on routine abdomen or chest computed tomography (CT) scans. A CT-based predictor was created using three automatically generated bone imaging biomarkers (vertebral compression fractures (VCFs), simulated DXA T-scores and lumbar trabecular density) and CT metadata of age and sex. A cohort of 48,227 individuals (51.8% women) aged 50-90 with available CTs before 2012 (index date) were assessed for 5-year fracture risk using FRAX with no bone mineral density (BMD) input (FRAXnb) and the CT-based predictor. Predictions were compared to outcomes of major osteoporotic fractures and hip fractures during 2012-2017 (follow-up period). Compared with FRAXnb, the major osteoporotic fracture CT-based predictor presented better receiver operating characteristic area under curve (AUC), sensitivity and positive predictive value (PPV) (+1.9%, +2.4% and +0.7%, respectively). The AUC, sensitivity and PPV measures of the hip fracture CT-based predictor were noninferior to FRAXnb at a noninferiority margin of 1%. When FRAXnb inputs are not available, the initial evaluation of fracture risk can be done completely automatically based on a single abdomen or chest CT, which is often available for screening candidates7,8.


Assuntos
Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/diagnóstico , Medição de Risco , Tomografia Computadorizada por Raios X , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Automação , Biomarcadores/metabolismo , Calibragem , Feminino , Fraturas por Compressão/diagnóstico , Fraturas por Compressão/diagnóstico por imagem , Fraturas do Quadril/diagnóstico , Fraturas do Quadril/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Fraturas da Coluna Vertebral/diagnóstico , Fraturas da Coluna Vertebral/diagnóstico por imagem
8.
World Neurosurg ; 136: 70-72, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31931243

RESUMO

BACKGROUND: Although instrumented stabilization of pediatric atlanto-occipital dislocation (AOD) has been described in the literature, there is little evidence regarding instrumentation techniques in pediatric patients presenting with both AOD and a cervical fracture. We present a case of a 2-year-old male involved in a motor vehicle collision with an unstable C2 fracture and AOD, treated with an occiput-C4 posterior arthrodesis using a rod, crosslink, and cable construct. CASE DESCRIPTION: This patient suffered a type III C2 fracture and AOD with 4 mm craniocaudal and 3 mm anterior displacement. In the operating room, 2 cobalt chrome connecting rods (3.5 mm) were connected to 1 another with crosslinks at C2 and C4. These were affixed with suboccipital and sublaminar cables at C1, C2, and C4. At 14 months postoperatively, his spine is clinically and radiographically stable. He has spontaneous movement in all 4 extremities, and remains in a persistent vegetative state because of his underlying central nervous system injury. CONCLUSIONS: Although there is a breadth of literature investigating instrumentation approaches to pediatric AOD, there is minimal evidence on outcomes of patients presenting with both AOD and cervical fracture. The technique we describe has proven safe and effective for this patient.


Assuntos
Articulação Atlantoccipital/cirurgia , Vértebra Cervical Áxis/cirurgia , Vértebras Cervicais/cirurgia , Luxações Articulares/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Acidentes de Trânsito , Artrodese , Articulação Atlantoccipital/diagnóstico por imagem , Articulação Atlantoccipital/lesões , Vértebra Cervical Áxis/diagnóstico por imagem , Vértebra Cervical Áxis/lesões , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/lesões , Pré-Escolar , Humanos , Luxações Articulares/complicações , Luxações Articulares/diagnóstico por imagem , Masculino , Estado Vegetativo Persistente , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico por imagem
9.
J Forensic Sci ; 65(1): 144-153, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31503337

RESUMO

Conducted electrical weapons are designed to cause temporary electro-muscular incapacitation (EMI) without significant injury. The objective of this study was to assess the risk and cause of spinal injury due to exposure to a benchtop EMI device. Porcine subjects were exposed to 19 and 40 Hz electrical stimuli for a prolonged duration of 30 sec. X-ray imaging, necropsy, and accelerometry found that lumbosacral spinal fractures occurred in at least 89% of all subjects, regardless of the stimulus group, and were likely caused by musculoskeletal fatigue-related stress in the lumbosacral spine. Spinal fractures occurred in the porcine model at an unusually high rate compared to human. This may be due to both the prolonged duration of electrical stimulation and significant musculoskeletal differences between humans and pigs, which suggests that the porcine model is not a good model of EMI-induced spinal fracture in humans.


Assuntos
Lesões por Armas de Eletrochoque , Vértebras Lombares , Fraturas da Coluna Vertebral , Animais , Lesões por Armas de Eletrochoque/diagnóstico por imagem , Lesões por Armas de Eletrochoque/patologia , Estimulação Elétrica/instrumentação , Medicina Legal , Fraturas Cominutivas/diagnóstico por imagem , Fraturas Cominutivas/patologia , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/lesões , Vértebras Lombares/patologia , Modelos Animais , Radiografia , Sacro/diagnóstico por imagem , Sacro/lesões , Sacro/patologia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/patologia , Suínos
10.
J Bone Miner Metab ; 38(1): 44-53, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31297652

RESUMO

The objective of the present multicenter randomized study was to compare weekly teriparatide with alendronate in their inhibition of vertebral collapse, effects on delayed union, pain relief, and improvement of quality of life (QOL) in women with new osteoporotic vertebral fractures within 1 week after onset of the fracture. Patients were randomly allocated to the teriparatide and alendronate groups. Vertebral collapse, low back pain assessed by a visual analog scale, and QOL assessed by EuroQol 5 dimension at weeks 1, 2, 4, 8, and 12 after the start of the treatment were compared between the groups. Lumbar bone mineral density (BMD) at baseline and week 12 and the rate of delayed union at week 12 were also compared. Each group consisted of 48 subjects. Vertebral collapse progressed over time in both groups, with no significant difference between the groups. Pain on rising up from lying position, turning over in bed, and resting in the lying position improved over time in both groups, with no significant difference between the groups. There were no significant differences in increase in BMD and delayed union. QOL in the teriparatide group showed significant improvement in comparison with that in the alendronate group at week 12. The weekly formulation of teriparatide showed comparable inhibition of vertebral collapse, increase in BMD, promotion of bone union, and improvement of pain and significant improvement of QOL at week 12 in comparison with alendronate in patients with a new osteoporotic vertebral fracture within 1 week after onset of the fracture. The weekly formulation of teriparatide may have improved components of QOL other than pain at week 12.


Assuntos
Alendronato/uso terapêutico , Fraturas da Coluna Vertebral/tratamento farmacológico , Teriparatida/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Alendronato/farmacologia , Densidade Óssea/efeitos dos fármacos , Conservadores da Densidade Óssea/farmacologia , Conservadores da Densidade Óssea/uso terapêutico , Esquema de Medicação , Feminino , Humanos , Qualidade de Vida , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/fisiopatologia , Teriparatida/farmacologia , Escala Visual Analógica
11.
Biomed Res Int ; 2019: 1386510, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31886170

RESUMO

The treatment of traumatic low-degree vertebral compression fracture remains in a wide range between functional treatment, bracing, vertebroplasty, kyphoplasty, and even surgical fixation. The objective was to assess the innovation of instrumented kyphoplasty and to report the early and mid-term functional and radiological results. This study is a retrospective review of patients enrolled from 2012 to 2017. 104 consecutive endovertebral implantations of instrumented kyphoplasty were reviewed for the study. There were 56 women and 48 men. 93 of 104 patients were evaluated, of whom 27 were evaluated only by retrospective medical record review and 66 with follow-up visit. Clinical parameters were the pain rating scale (VAS) and the Oswestry score questionnaire. The radiological parameters were the vertebral kyphosis, vertebral height, lumbar lordosis, and adjacent disc degeneration (UCLA scale). Statistical correlations between before/after surgery/last follow-up were performed. The average follow-up was 26.7 months (3 to 55). The average VAS decreased from 8.2 to 3.2 the day after surgery, allowing immediate standup. The average Oswestry score was 14.6 at follow-up. The average vertebral kyphosis decreased from 12.9° to 6.5° post-op and stabilized at 8.0° at the last follow-up, corresponding to 28% gain on vertebral height. The lumbar lordosis was restored (+6.6°). Adjacent disc degeneration increased by 1 UCLA grade in 17 patients (16.3%) at follow-up. The instrumented kyphoplasty in acute led to immediate and lasting pain relief, with no bracing or bed rest, short stay in hospital, and quick return to daily life including professional activities. The good clinical results were associated to a stable radiological restoration of the vertebral anatomy.


Assuntos
Fraturas por Compressão/cirurgia , Cifoplastia/métodos , Dor/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Idoso , Cimentos para Ossos/uso terapêutico , Doenças Ósseas Metabólicas/tratamento farmacológico , Doenças Ósseas Metabólicas/fisiopatologia , Doenças Ósseas Metabólicas/terapia , Feminino , Fixação Interna de Fraturas/métodos , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/fisiopatologia , Humanos , Cifoplastia/efeitos adversos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/fisiopatologia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Dor/tratamento farmacológico , Dor/fisiopatologia , Medição da Dor/métodos , Radiologia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/fisiopatologia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/fisiopatologia , Vértebras Torácicas/cirurgia , Resultado do Tratamento , Vertebroplastia/métodos
12.
AANA J ; 87(1): 37-42, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31587742

RESUMO

Postoperative vision loss (POVL) after spine surgery is a rare but devastating complication. Because of its rarity (incidence < 0.2%), POVL might not be considered for inclusion in an informed consent by surgeons and anesthesia providers. We present a case of POVL due to posterior ischemic optic neuropathy following prone spine surgery. Posterior ischemic optic neuropathy is characterized by acute painless vison loss that is progressive and irreversible. Our case is atypical because the patient experienced moderate improvement of visual acuity. Increased awareness and understanding of risk factors associated with POVL is an important and timely patient safety topic. In this report we review different pathophysiologies and risk factors for POVL following spine surgery along with recommendations for informed consent and strategies to reduce the incidence of POVL.


Assuntos
Anestesia/efeitos adversos , Neuropatia Óptica Isquêmica/diagnóstico , Fraturas da Coluna Vertebral/cirurgia , Idoso , Neoplasias Ósseas/secundário , Carcinoma de Células Renais/secundário , Diagnóstico Diferencial , Humanos , Neoplasias Renais/patologia , Vértebras Lombares , Imagem por Ressonância Magnética , Masculino , Metástase Neoplásica , Neuropatia Óptica Isquêmica/induzido quimicamente , Complicações Pós-Operatórias/induzido quimicamente , Complicações Pós-Operatórias/diagnóstico , Fraturas da Coluna Vertebral/diagnóstico por imagem
13.
J Coll Physicians Surg Pak ; 29(10): 946-950, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31564267

RESUMO

OBJECTIVE: To compare the efficacies of unilateral and bilateral percutaneous kyphoplasty (PKP) in the treatment of thoracolumbar osteoporotic compression fractures. STUDY DESIGN: Experimental study. PLACE AND DURATION OF STUDY: Department of Orthopedics, Hubei 672 Orthopedics Hospital of Integrated Chinese and Western Medicine, China, from November 2014 to January 2017. METHODOLOGY: One hundred and seventy-eight patients with single-level thoracolumbar osteoporotic compression fractures included in this study. These patients were randomly assigned to unilateral (n=83) and bilateral (n=95) PKP groups. The operation time, bone cement volume, number of X-ray views, preoperative and postoperative pain visual analogue scale scores (VAS), Oswestry Dysfunction Index (ODI), Cobb angle, and vertebral height in both groups were recorded. RESULTS: Operation time, bone cement volume and intraoperative number of X-ray views were significantly different between unilateral and bilateral PKP groups (29.8 ±2.7 vs. 31.5 ±3.9 minutes; 9.3 ±2.6 vs. 11.2 ±3.7 times; 3.1 ±0.7 vs. 3.5 ±1.2 ml, respectively, p <0.05). VAS scores and ODI in both groups were significantly different before and 24 hours, 3 months and 6 months after surgery. The heights of anterior and middle borders of vertebral body and Cobb angle in the two groups were significantly different before and after surgery (p <0.05). CONCLUSION: The short-term efficacy was identical between unilateral and bilateral PKP. The unilateral PKP is characterized by short operation time, low hospital cost, less number of X-ray views and less bone cement volume. The unilateral PKP shows a higher risk of re-fracture of adjacent vertebral body compared with the bilateral PKP.


Assuntos
Cifoplastia/métodos , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Idoso , Idoso de 80 Anos ou mais , Cimentos para Ossos , China , Avaliação da Deficiência , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Duração da Cirurgia , Fraturas por Osteoporose/diagnóstico por imagem , Medição da Dor , Fraturas da Coluna Vertebral/diagnóstico por imagem , Vértebras Torácicas/cirurgia
14.
Eklem Hastalik Cerrahisi ; 30(3): 252-8, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31650922

RESUMO

OBJECTIVES: This study aims to investigate if pelvic mapping is applicable in iliosacral screw fixation to determine screw entry point and screw trajectory. PATIENTS AND METHODS: Clinical files and images of 16 patients (10 males, 6 females; mean age 35 years; range, 20 to 57 years) who underwent iliosacral screw fixation due to sacroiliac joint injury and sacrum fracture were retrospectively reviewed. Pelvic mapping was performed using preoperative tomography images of the patients and appropriate screw entry point and trajectory were determined. Postoperative computed tomography scans of all patients were obtained and these were used to evaluate the accuracy of the screw position. RESULTS: No intraoperative complications occurred. The entry points and trajectory of the screws were compatible for all patients pre- and postoperatively. CONCLUSION: Mapping of the pelvis is a method that can be used for preoperative planning of iliosacral screwing.


Assuntos
Articulação Sacroilíaca/diagnóstico por imagem , Articulação Sacroilíaca/cirurgia , Sacro/diagnóstico por imagem , Sacro/cirurgia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Adulto , Parafusos Ósseos , Feminino , Fixação Interna de Fraturas , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Radiografia , Estudos Retrospectivos , Articulação Sacroilíaca/lesões , Sacro/lesões , Adulto Jovem
15.
Medicine (Baltimore) ; 98(43): e17666, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651894

RESUMO

RATIONALE: Traumatic AOD is rare but highly associated with upper cervical spine injuries. We found no references in the literature of traumatic posterior atlantooccipital dislocation (AOD) combined with type II dens fracture (Anderson-D'Alonzo classification) and C1 anterior arch fracture. PATIENT CONCERNS: The first case was a 93-year-old male patient who was admitted to the Emergency Department complaining of incomplete quadriplegia after a fall from a height. The second was a 53-year-old male patient who visited the emergency department complaining of posterior neck pain following a high-speed motor vehicle collision. DIAGNOSIS: Reconstructed computed tomography (CT) scans clearly demonstrated posterior AOD combined with type II dens fracture and C1 anterior arch fracture. In addition, magnetic resonance imaging (MRI) also revealed type II transverse atlantal ligament injury (Dickman's classification) in the first patient. INTERVENTIONS: The patients chose not to undergo surgery; instead, they were immobilized with a rigid cervical brace. OUTCOMES: The patients were lost to follow-up. LESSONS: A thorough clinical evaluation and radiologic investigation (CT and MRI) on concomitant upper cervical injuries should be evaluated in traumatic AOD patients.


Assuntos
Articulação Atlantoaxial/lesões , Braquetes , Vértebras Cervicais/lesões , Luxações Articulares/terapia , Fraturas da Coluna Vertebral/terapia , Acidentes por Quedas , Acidentes de Trânsito , Idoso de 80 Anos ou mais , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/etiologia , Masculino , Pessoa de Meia-Idade , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/etiologia , Tomografia Computadorizada por Raios X
16.
BMC Musculoskelet Disord ; 20(1): 423, 2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31510985

RESUMO

BACKGROUND: Percutaneous kyphoplasty (PKP) can effectively treat osteoporotic vertebral compression fractures (OVCFs). Although satisfactory clinical outcomes can be achieved, bone cement leakage remains a primary complication of PKP. Previous studies have found many high risk factors for bone cement leakage into the spinal canal; however, less attention to the posterior wall morphologies of different vertebral bodies may be one reason for the leakage. Here, we investigated the effect of posterior vertebral wall morphology in OVCF patients on bone cement leakage into the spinal canal during PKP. METHODS: Ninety-eight OVCF patients with plain computed tomography (CT) scans and three-dimensional (3D) reconstruction images from T6 to L5 were enrolled. 3D-CT and multiplanar reconstructions (MPR) were used to measure the concave posterior vertebral wall depth (PVWCD) and the corresponding midsagittal diameter of the nonfractured vertebral body (VBSD), and the PVWCD/VBSD ratio was calculated. All subjects were divided into the thoracic or lumbar groups based on the location of the measured vertebrae to observe the value and differences in the PVWCD between both groups. The differences in PVWCD and PVWCD/VBSD between the thoracic and lumbar groups were compared. Three hundred fifty-seven patients (548 vertebrae) who underwent PKP within the same period were also divided into the thoracic and lumbar groups. The maximal sagittal diameter (BCSD), the area of the bone cement intrusion into the spinal canal (BCA), and the spinal canal encroachment rate (BCA/SCA × 100%) were measured to investigate the effect of the thoracic and lumbar posterior vertebral wall morphologies on bone cement leakage into the spinal canal through the Batson vein during PKP. RESULTS: The PVWCDs gradually deepened from T6 to T12 (mean, 4.6 mm); however, the values gradually became shallower from L1 to L5 (mean, 0.6 mm). The PVWCD/VBSD ratio was approximately 16% from T6 to T12 and significantly less at 3% from L1 to L5 (P < 0.05). The rate of bone cement leakage into the spinal canal through the Batson vein was 10.1% in the thoracic group and 3.7% in the lumbar group during PKP. In the thoracic group, the BCSD was 3.1 ± 0.5 mm, the BCA was 30.2 ± 3.8 mm2, and the BCA/SCA ratio was 17.2 ± 2.0%. In the lumbar group, the BCSD was 1.4 ± 0.3 mm, the BCA was 14.8 ± 2.2 mm2, and the BCA/SCA ratio was 7.4 ± 1.0%. The BCSD, BCA and BCA/SCA ratio were significantly higher in the thoracic group than in the lumbar group (P < 0.05). CONCLUSIONS: The PVWCD in the middle and lower thoracic vertebrae can help reduce bone cement leakage into the spinal canal by enabling avoiding bone cement distribution over the posterior 1/6 of the vertebral body during PKP. The effect of the difference between the thoracic and lumbar posterior vertebral wall morphology on bone cement leakage into the spinal canal through the Batson vein in OVCF patients during PKP is one reason that the rate of bone cement leakage into the thoracic spinal canal is significantly higher than that into the lumbar spinal canal.


Assuntos
Cimentos para Ossos/efeitos adversos , Corpos Estranhos/epidemiologia , Cifoplastia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Canal Vertebral/lesões , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/etiologia , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/cirurgia , Humanos , Imageamento Tridimensional , Cifoplastia/métodos , Vértebras Lombares/anatomia & histologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Canal Vertebral/irrigação sanguínea , Canal Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/anatomia & histologia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Veias
17.
Medicine (Baltimore) ; 98(36): e17077, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490410

RESUMO

Unilateral sagittal split fracture (USSF) of the C1 lateral mass (LM) has been recently recognized as a rare variant of C1 atlas fracture. To date, there has been no study to investigate whether radiologic criteria can be applied to determine the presence or absence of transverse atlantal ligament (TAL) injury in USSF of the C1 LM.Twenty six consecutive cases of USSF of the C1 LM were included in this study. According to Dickman classification, 16 cases were TAL injury, and 10 cases were TAL intact. Radiologic parameters were measured and compared between the 2 groups.Total LM displacement (LMD) of the 2 sides (5.9 ±â€Š2.0 mm vs 1.2 ±â€Š2.0 mm), unilateral LMD of the fracture side (4.3 ±â€Š1.2 mm vs 1.0 ±â€Š1.1 mm), atlanto-dental interval (ADI) (2.0 ±â€Š0.9 mm vs 1.5 ±â€Š0.4 mm), and fracture gap (6.9 ±â€Š2.7 mm vs 2.1 ±â€Š1.1 mm) were statistically higher in the TAL injury group than the TAL intact group. However, basion-dental interval, clivus canal angle, and atlanto-occipital joint axis angle were not different between the 2 groups. Total LMD and unilateral LMD positively correlated with ADI and fracture gap. The incidence of fracture gap larger than 7 mm was statistically higher in the TAL injury group than the TAL intact group (81% vs 30%).In conclusion, total LMD > 5.9 mm or unilateral LMD > 4.3 mm suggests the presence of TAL injury in USSF of the C1 LM. The possibility of diagnostic error for TAL injury can be further reduced in USSF of the C1 LM by considering the fracture gap larger than 7 mm.


Assuntos
Atlas Cervical/lesões , Ligamentos Articulares/lesões , Fraturas da Coluna Vertebral/diagnóstico por imagem , Adulto , Idoso , Atlas Cervical/diagnóstico por imagem , Feminino , Humanos , Ligamentos Articulares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
18.
J Craniofac Surg ; 30(7): 2065-2068, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31490441

RESUMO

The research aimed at investigating potential correlations between craniofacial morphological measurements and mandibular pericondylar fractures, based on a retrospective study of 380 mandible fractures treated in our department, during 2010 to 2017. Predictors included morphological measurements and features. Primary outcome was presence of pericondylar fracture; 133 pericondylar fractures were found, including subcondylar, condylar neck, and condylar head fractures. Condylar neck fractures showed negative correlations with condylar neck width (5.7 mm versus 6.7 mm sagittaly, and 6.1 mm versus 6.8 mm coronally, respectively). Gonial angle (117.3 degrees versus 128.7), and mandibular length 106.2 mm versus 110.4 mm, respectively) showed negative correlation with all pericondylar fractures. Ramus height correlated positively with pericondylar fractures (53.6 mm versus 51.2 mm, respectively). Thus, our results showed condylar neck width was a predictor for condylar neck fractures. In addition, individuals suffering from pericondylar fractures had significantly smaller gonial angles, longer ramus height, and shorter mandibular length. These morphologic features are characteristic of individuals with decreased anterior facial height. Our results corroborated a previous study we had conducted, which suggested that increased anterior vertical growth correlates with angle fractures.


Assuntos
Mandíbula/diagnóstico por imagem , Fraturas Mandibulares/diagnóstico por imagem , Adolescente , Adulto , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Adulto Jovem
19.
J Orthop Surg Res ; 14(1): 299, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488174

RESUMO

PURPOSE: Our purpose was to combine intravoxel incoherent motion diffusion-weighted MR imaging (IVIM-DWI) and magnetic resonance spectroscopy (MRS) to differentiate osteoporotic fractures from osteolytic metastatic vertebral compression fractures (VCFs). METHODS: A total of 70 patients with VCFs were included and divided into two groups, according to their causes of fractures based on pathological findings or clinical follow-up. All patients underwent conventional sagittal T1WI, T2WI, STIR, IVIM-DWI, and single-voxel MRS. The diffusion coefficient (D), pseudo diffusion (D*), and perfusion fraction (f) parameters from IVIM-DWI and the lipid water ratio (LWR) and fat fraction (FF) parameters from MRS were obtained and compared among groups. Furthermore, the diagnostic performance of MRS, IVIM-DWI, and IVIM-DWI combined with MRS for differentiation between osteoporotic and osteolytic metastatic VCFs was assessed by using receiver operating characteristic (ROC) curve analysis. RESULTS: Compared with the osteoporotic group, the metastatic group had significantly lower values for f, D, and FF, but higher D* (all P < 0.05). The area under the receiver operating characteristic (ROC) curve of MRS, IVIM-DWI, and IVIM-DWI combined with MRS were 0.73, 0.88, and 0.94, respectively. Among these, the IVIM-DWI combined with MRS showed the highest sensitivity, specificity, and accuracy, which are 90.63% (29/32), 97.37 % (37/38), and 94.29% (66/70), respectively. CONCLUSIONS: IVIM-DWI combined with MRS can be more accurate and efficient for differentiation between osteoporotic and osteolytic metastatic VCFs than single MRS or IVIM-DWI.


Assuntos
Imagem de Difusão por Ressonância Magnética/métodos , Fraturas por Compressão/diagnóstico por imagem , Espectroscopia de Ressonância Magnética/métodos , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Idoso , Diagnóstico Diferencial , Imagem de Difusão por Ressonância Magnética/normas , Feminino , Fraturas por Compressão/metabolismo , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/lesões , Vértebras Lombares/metabolismo , Espectroscopia de Ressonância Magnética/normas , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/metabolismo , Fraturas da Coluna Vertebral/metabolismo , Neoplasias da Coluna Vertebral/metabolismo , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/lesões , Vértebras Torácicas/metabolismo
20.
J Pak Med Assoc ; 69(9): 1380-1382, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31511730

RESUMO

Sacral insufficiency fracture is a rare complication of the lumbar spinal surgery. It is normally reported as a late complication of the multi-segment spinal fixation in females with osteoporotic bone. We present the case of an elderly gentleman who suffered this complication spontaneously on the second postoperative day. To the best of our knowledge this has never been reported in Pakistan. Sacral alae are directly in line with weight bearingwhile walking and should be kept in mind when mobilizing a postoperative patient whose previous history indicates such risk factors. Once injury is suspected, CT scan is recommended as x-rays may not always reveal the injury. In literature, these fractures have almost always been treated conservatively.1 Conservative management wasnot tolerated well in our case and we proceeded with surgical management using S2 sacral alar iliac screws (S2 AI screws) to extend the previous lumbosacral fusion construct. S2 AI screws are a novel technique used for bone lumbosacral fusion and studies have shown to have lower rate of screw breakage under stress and need for revision surgery with their use.


Assuntos
Fraturas Espontâneas/diagnóstico por imagem , Fraturas de Estresse/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Sacro/lesões , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fusão Vertebral , Idoso , Repouso em Cama , Tratamento Conservador , Descompressão Cirúrgica , Fixação Interna de Fraturas , Fraturas Espontâneas/cirurgia , Fraturas de Estresse/cirurgia , Humanos , Vértebras Lombares/cirurgia , Masculino , Complicações Pós-Operatórias/cirurgia , Sacro/diagnóstico por imagem , Sacro/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Estenose Espinal/cirurgia , Tomografia Computadorizada por Raios X
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