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1.
Mymensingh Med J ; 30(2): 485-492, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33830133

RESUMO

Stabilization procedures for the treatment of thoracolumbar burst fractures remain controversial. Traditional stabilization procedures include short and long segment stabilization. Nowadays short-segment including fracture vertebrae stabilization is one of the modalities of treatment. This study aimed to analyze the radiological and functional outcome of the Short-segment fixation with the inclusion of the fracture level (SSFIFL) for the treatment of unstable thoracolumbar fractures. In this prospective study, 40 cases of thoracolumbar burst fractures with incomplete spinal cord injury were operated by SSFIFL from Jan 2016 to Jan 2019 in NITOR, Dhaka, Bangladesh. The mean follow-up period was 18 months. Pre-operative and post-operative radiological parameters were the kyphotic angle, kyphotic deformation, Beck index, and clinical parameters include ASIA impairment scale, Visual Analogue Scale (VAS), and Oswestry Disability Index (ODI). Mean age was 32.30±11.85 years, among whom 80% (32) were male in this study. Fall from height (85%) was the main cause and occurs mostly in day labors (45%). Most common skeletal level was L1 (52.5%) followed by L2 (32.5%). Most cases operated between 10-15 days with mean duration of 119.58±19.93 minutes and mean blood loss of 350.38±31.26ml. The pre-operative kyphotic angle was 22.75±4.53° and 9.13±3.04° at final follow-up with correction loss of 5.15±2.54° (p<0.05). Most of the patients were in ASIA-C grade (57.5%) pre-operatively and ASIA-E (67.5%) at final follow-up after surgery (p=0.001). ODI improved from 67.20±12.90 to 25.08±11.36 and VAS form 60.25±8.91 to 21.50±8.33 (p<0.05). Main complication was superficial infection (5 cases) followed by bent rod and CSF leakage in 2 cases each. Good radiological and clinical outcome can be achieved by inclusion of fracture level in a short-segment fixation for unstable thoracolumbar fractures. Finally, this technique may allow us to save two or more segments of vertebral motion.


Assuntos
Parafusos Pediculares , Fraturas da Coluna Vertebral , Adulto , Bangladesh , Fixação Interna de Fraturas , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/lesões , Vértebras Lombares/cirurgia , Masculino , Estudos Prospectivos , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia , Resultado do Tratamento , Adulto Jovem
2.
Medicine (Baltimore) ; 100(16): e25588, 2021 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-33879718

RESUMO

RATIONALE: A case of traumatic atlanto-axial rotatory subluxation (AARS), dens fracture, rupture of transverse atlantal ligament (TAL), and subaxial spinal cord injury without radiographic abnormality (SCIWORA) of Brown-Sequard syndrome has never been reported in a child. PATIENT CONCERNS: A 7-year-old boy presented to hospital with torticollis, neck pain, and limited neck rotation after a seat-belt injury sustained during a car accident. Neurologic examination revealed right-side motor weakness and left-side sensory abnormality, known as Brown-Sequard syndrome. DIAGNOSIS: Radiologic examinations revealed type II AARS (Fielding and Hawkins classification), increased atlanto-dental interval (ADI) of 4.5 mm due to a type 1B TAL rupture (Dickman classification), a displaced transverse dens fracture along with an ossiculum terminale, and an intramedullary hemorrhage on the right side of the spinal cord at C3-4. INTERVENTIONS: The patient immediately received methylprednisolone, and his motor weakness and sensory abnormality gradually improved. At the same time, the patient underwent initial halter traction for 2 weeks, but he failed to achieve successful reduction and required manual reduction under general anesthesia. OUTCOMES: At the 7-month follow-up visit, radiologic examinations showed a corrected type II AARS that was well maintained and normalization of the ADI to 2 mm. The reduced transverse dens fracture was well maintained but still not united. All clinical symptoms were significantly improved, except the remaining motor weakness of the right upper extremity. LESSONS: To the best of our knowledge, this is the first report of traumatic AARS, dens fracture, TAL rupture, and subaxial SCIWORA of Brown-Sequard syndrome in a child. Appropriate diagnosis and careful treatment strategy are required for successful management of complex cervical injuries in a child.


Assuntos
Articulação Atlantoaxial/lesões , Síndrome de Brown-Séquard/diagnóstico por imagem , Luxações Articulares/diagnóstico por imagem , Traumatismos da Medula Espinal/diagnóstico por imagem , Fraturas da Coluna Vertebral/diagnóstico por imagem , Acidentes de Trânsito , Articulação Atlantoaxial/diagnóstico por imagem , Síndrome de Brown-Séquard/etiologia , Vértebras Cervicais/lesões , Criança , Humanos , Luxações Articulares/etiologia , Ligamentos Articulares/diagnóstico por imagem , Ligamentos Articulares/lesões , Masculino , Lesões do Pescoço/diagnóstico por imagem , Lesões do Pescoço/etiologia , Cervicalgia/diagnóstico por imagem , Cervicalgia/etiologia , Radiografia , Ruptura , Traumatismos da Medula Espinal/etiologia , Fraturas da Coluna Vertebral/etiologia , Torcicolo/diagnóstico por imagem , Torcicolo/etiologia
3.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(4): 464-470, 2021 Apr 15.
Artigo em Chinês | MEDLINE | ID: mdl-33855831

RESUMO

Objective: To report an improved classification system of Kümmell's disease and its clinical application. Methods: Based on CT and MRI, an improved classification system of Kümmell's disease was proposed in terms of the integrity of sagittal endplate, the integrity of posterior wall of vertebral body, and the degree of vertebral compression. Between January 2011 and March 2018, the improved classification system was used to evaluate and guide the treatment of 78 patients with Kümmell's disease. There were 13 males and 65 females. The mean age was 69.1 years (range, 54-85 years). The mean disease duration was 4.0 months (range, 1-8 months). The mean T value of bone mineral density was -3.66 (range, -3.86- -3.34).The fractures located at thoracic vertebrae in 47 cases and lumbar vertebrae in 31 cases. According to the modified classification system of Kümmell's disease, there were 11 cases of type A1, 13 cases of type A2, 2 cases of type A3, 10 cases of type B1, 18 cases of type B2, 4 cases of type B3, 4 cases of type C1, 5 cases of type C2, and 11 cases of type C3. According to the classification results, the patients of types A and B were treated with percutaneous kyphoplasty (PKP), while the patients of type C were treated with PKP or intra- vertebral fixation according to the degree of vertebral reduction. Visual analogue scale (VAS) score and Oswestry Disability Index (ODI) were used to evaluate clinical efficacy. The heights of the anterior, middle, and posterior edges of the vertebrae and the Cobb angle were measured to evaluate the reduction of the injured vertebrae and the improvement of kyphosis deformity. The complications were recorded. Results: The statistical analysis showed that the improved classification system has good consistency. All patients were followed up 12-36 months (mean, 24.3 months). The heights of anterior, middle, and posterior edges of the vertebrae, Cobb angle, VAS score, and ODI of all types of patients at last follow-up showed significant differences when compared with those before operation ( P<0.05). After operation, 4 patients of type A2 had different degree of vertebral height loss; 2 patients of type B2, 3 patients of type C1, and 2 patients of type C2 developed asymptomatic bone cement leakage during PKP; 2 patients of type B3 and 3 patients of type C2 underwent percutaneous internal fixation and vertebral augmentation due to bone cement loosening. Conclusion: The modified classification system of Kümmell's disease can be used to guide treatment of Kümmell's disease, but the number of clinical application cases is limited, and further application and observation are needed.


Assuntos
Fraturas por Compressão , Cifoplastia , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Idoso , Cimentos para Ossos , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Resultado do Tratamento
4.
Neurol Neurochir Pol ; 55(2): 227-229, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33687730

RESUMO

BACKGROUND: Type II odontoid fractures are mostly encountered in the elderly. Due to a high risk of non-union fractures in the case of conservative treatment, surgical fixation is widely recommended. Anterior odontoid screw fixation (AOSF) is a method that allows for a wide range of cervical mobility, and it is a relatively safe procedure that is recommended as the method of choice, although rare complications can be fatal when it leads to life-threatening oesophageal perforation. PURPOSE: The aim of this study is to present potential risk factors which lead to these rare complications, and possible methods of treatment. METHODS: This article presents the case of a patient hospitalised in the Neurosurgery Department of St Lukas Hosital in Tarnów in 2016. A literature review was performed using PubMed; search criteria included the phrases 'odontoid fracture perforation' and 'anterior cervical spine perforation'. The search returned 235 articles, of which 55 publications were in line with the subject of this paper, with only 12 deemed appropriate for consideration. RESULT: The authors present the case of an elderly patient with a history of odontoid fracture. Ten weeks after primary AOSF, the patient came to the Neurosurgery Department due to expectorating screws. This implied the need for further examination and even oesophageal reconstructive surgery or another spinal surgery. In laryngological examination and in gastroscopy there were no signs of fistula. In this case conservative treatment was proceeded. Due to odontoid fracture, non-union cervical posterior stabilisation was necessary. CONCLUSION: Patients with oesophageal perforation should be treated with special care.


Assuntos
Perfuração Esofágica , Processo Odontoide , Fraturas da Coluna Vertebral , Idoso , Parafusos Ósseos , Perfuração Esofágica/diagnóstico por imagem , Perfuração Esofágica/etiologia , Perfuração Esofágica/cirurgia , Fixação Interna de Fraturas , Humanos , Processo Odontoide/diagnóstico por imagem , Processo Odontoide/lesões , Processo Odontoide/cirurgia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Resultado do Tratamento
5.
Bone Joint J ; 103-B(3): 462-468, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33641427

RESUMO

AIMS: Minimally invasive fixation of pelvic fragility fractures is recommended to reduce pain and allow early mobilization. The purpose of this study was to evaluate the outcome of two different stabilization techniques in bilateral fragility fractures of the sacrum (BFFS). METHODS: A non-randomized, prospective study was carried out in a level 1 trauma centre. BFFS in 61 patients (mean age 80 years (SD 10); four male, 57 female) were treated surgically with bisegmental transsacral stablization (BTS; n = 41) versus spinopelvic fixation (SP; n = 20). Postoperative full weightbearing was allowed. The outcome was evaluated at two timepoints: discharge from inpatient treatment (TP1; Fitbit tracking, Zebris stance analysis), and ≥ six months (TP2; Fitbit tracking, Zebris analysis, based on modified Oswestry Disability Index (ODI), Majeed Score (MS), and the 12-Item Short Form Survey 12 (SF-12). Fracture healing was assessed by CT. The primary outcome parameter of functional recovery was the per-day step count; the secondary parameter was the subjective outcome assessed by questionnaires. RESULTS: Overall, no baseline differences were observed between the BTS and SP cohorts. In total, 58 (BTS = 19; SP = 39) and 37 patients (BTS = 14; SP = 23) could be recruited at TP1 and TP2, respectively. Mean steps per day at TP1 were median 308 (248 to 434) in the BTS group and 254 (196 to 446) in the SP group. At TP2, median steps per day were 3,759 (2,551 to 3,926) in the BTS group and 3,191 (2,872 to 3,679) in the SP group, each with no significant difference. A significant improvement was observed in each group (p < 0.001) between timepoints. BTS patients obtained better results than SP patients in ODI (p < 0.030), MS (p = 0.007), and SF-12 physical status (p = 0.006). In all cases, CT showed sufficient fracture healing of the posterior ring. CONCLUSION: Both groups showed significant outcome improvement and sufficient fracture healing. Both techniques can be recommended for BFFS, although BTS was superior with respect to subjective outcome. Step-count tracking represents a reliable method to evaluate the mobility level. Cite this article: Bone Joint J 2021;103-B(3):462-468.


Assuntos
Fixação Interna de Fraturas/métodos , Sacro , Fraturas da Coluna Vertebral/cirurgia , Idoso de 80 Anos ou mais , Parafusos Ósseos , Estudos de Casos e Controles , Avaliação da Deficiência , Feminino , Fixação Interna de Fraturas/instrumentação , Consolidação da Fratura , Humanos , Masculino , Estudos Prospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/fisiopatologia , Suporte de Carga
6.
Arch Osteoporos ; 16(1): 37, 2021 02 22.
Artigo em Inglês | MEDLINE | ID: mdl-33619589

RESUMO

This study examines changes in bone density and strength in the spine over the year after hip fracture to see if there are differences in the changes between men and women. Results show losses in the spine that may increase the risk of subsequent vertebral fractures, particularly for women. PURPOSE: Compare changes over the first year post-hip fracture in vertebral bone mineral density (BMD) and compressive strength, measured from quantitative computed tomography (QCT) scans of the spine (T12-L1), between women and men. METHODS: QCT scans were performed on 37 participants (21 men and 16 women) at 2 and 12 months post-hip fracture as part of an ancillary observational study of hip fracture recovery in older community-dwelling men and women. Vertebral BMD and compressive strength were calculated using VirtuOst® (O.N. Diagnostics, Berkeley, CA). Unpaired t-tests were used to compare men and women with respect to baseline demographics, measurements of BMD and bone strength for the whole vertebra and the cortical and trabecular compartments, and any changes in these parameters between months 2 and 12. RESULTS: At 2 months post-fracture, there were no significant sex differences in any measurements of vertebral strength or BMD. Between months 2 and 12, vertebral strength decreased significantly in women (- 3.8%, p < 0.05) but not in men (- 2.3%, p < 0.20), vertebral trabecular BMD decreased similarly in both sexes (- 5.7% women; - 6.0% men), but cortical BMD did not change for either sex. CONCLUSION: Despite the small sample size, these findings suggest that appreciable loss of vertebral trabecular bone can occur for both sexes in the year following hip fracture, which may increase the risk of subsequent vertebral fracture, particularly for women.


Assuntos
Fraturas do Quadril , Fraturas da Coluna Vertebral , Idoso , Densidade Óssea , Feminino , Fraturas do Quadril/diagnóstico por imagem , Fraturas do Quadril/epidemiologia , Humanos , Masculino , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/epidemiologia , Coluna Vertebral , Tomografia Computadorizada por Raios X
7.
Medicine (Baltimore) ; 100(3): e24396, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33546083

RESUMO

RATIONALE: Traumatic atlantoaxial anteroinferior subluxation associated with a dens fracture and a Hangman fracture is a very rare and complex injury. Therefore, appropriate surgical strategy is not established. PATIENT CONCERNS: An 85-year-old female presented with posterior neck pain and atypical neck position caused after rolling down a hill. Although neurological examinations for motor, sensory, gait, and reflex tests were normal, the patient complained of an abnormal neck posture. DIAGNOSES: Radiological examinations revealed an atlantoaxial anteroinferior subluxation with kyphosis, a type IIA dens fracture (Anderson and D'Alonzo classification) with an anterolateral rotatory angulation of type IIA dens fracture fragment, and a type I Hangman fracture (Levine and Edwards classification). Nevertheless, the transverse atlantal ligament was intact. INTERVENTIONS: We considered that the intact transverse atlantal ligament and kinking of the type IIA dens fracture fragment into the left lateral mass of C1 prevented a spinal cord injury by blocking a further displacement of C1 to C2. Due to the patient's osteoporosis and the anterolateral rotatory angulated type IIA dens fracture fragment, a forceful reduction of the atlantoaxial anteroinferior subluxation with kyphosis could pose a high risk of fixation failure and spinal cord injury. Therefore, we performed in-situ posterior C1-2 fusion using a C1 lateral mass screw and C2 lamina screw fixations. OUTCOMES: At 1 year after surgery, the bone union of all fractures was achieved in the kyphosis state. Furthermore, the patient's clinical symptoms were improved with no neurological deficit. LESSONS: A thorough radiological examination and appropriate surgical strategy are important for successful diagnosis and treatment of a complex C1-2 injury.


Assuntos
Articulação Atlantoaxial/lesões , Luxações Articulares/etiologia , Fraturas da Coluna Vertebral/etiologia , Acidentes por Quedas , Idoso de 80 Anos ou mais , Articulação Atlantoaxial/diagnóstico por imagem , Feminino , Humanos , Luxações Articulares/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Cervicalgia/etiologia , Cervicalgia/psicologia , Fraturas da Coluna Vertebral/diagnóstico por imagem
8.
Arch Osteoporos ; 16(1): 20, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33523344

RESUMO

This study demonstrated that number of three specific radiological risk factors (MR T2WI confined high-intensity pattern and diffuse low-intensity pattern, thoracolumbar vertebrae involvement, middle column injury) added prognostic information for delayed union, kyphotic deformity, and prolonged pain. PURPOSE: Delayed union after osteoporotic vertebral fracture (OVF) causes prolonged pain, QOL impairment, progression of collapse, kyphotic deformity, and neurologic impairment. Some specific radiological findings can be useful for predicting delayed union. We aimed to explore the prevalence and concomitance of various types of radiological risk factors for delayed union after osteoporotic vertebral fracture (OVF) and to assess the impact of risk factor number on clinical outcomes. METHODS: A total of 508 patients with fresh OVF from 25 institutes were evaluated. All patients were treated conservatively without surgical interventions. At the 6-month follow-up, the patients were classified into bone union and delayed union groups based on plain X-ray findings. We examined the presence and absence of three specific radiological risk factors (MR T2WI confined high-intensity pattern and diffuse low-intensity pattern, thoracolumbar vertebrae involvement, middle column injury) and analyzed clinical outcomes according to numbers of radiological risk factors. RESULTS: Delayed union was observed in 101 patients (19.9%) at the 6-month follow-up. The most common radiological risk factor was thoracolumbar vertebrae involvement (73.8%), followed by middle column injury (33.9%) and specific MRI findings (T2WI confined high-intensity pattern and diffuse low-intensity pattern) (29.7%). Overall, 85 (16.7%) patients had zero radiological risk factors, 212 (42.7%) had one, 137 (27.0%) had two, and 69 (13.6%) had three. When assessing the number of radiographic risk factors which included the MRI findings (the 3-risk factor method), the odds ratio for delayed union after acute OVF was 5.8 in the 2/3-risk factor group and 13.1 in the 3/3-risk factor group. Even when assessing the number of radiographic risk factors without MRI findings (2-risk factor method), the odds ratio was 3.2 in the 1/2-risk factor group and 10.2 in the 2/2-risk factor group. CONCLUSION: Number of radiological risk factors added prognostic information for delayed union, kyphotic deformity, and prolonged pain.


Assuntos
Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Humanos , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/epidemiologia , Qualidade de Vida , Fatores de Risco , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/epidemiologia , Coluna Vertebral
9.
Arch Osteoporos ; 16(1): 36, 2021 02 21.
Artigo em Inglês | MEDLINE | ID: mdl-33611644

RESUMO

OBJECTIVE: The incidence of fractures in pregnancy and lactation-associated osteoporosis (PLO) is very low. Some fracture cases of PLO are associated with vertebral compression fractures, while malleolar fractures in patients with PLO are rarely reported before. CASE REPORT: A 31-year-old Han Chinese patient presented with a malleolar fracture 3 months after delivery, while she was still breastfeeding. Temporary closed reduction and plaster external fixation were performed in the emergency room. Then the patient was admitted to the orthopedic trauma ward for surgery and diagnosed as PLO by dual-energy X-ray absorptiometry (DEXA). After preoperative evaluation, the patient underwent open reduction and internal fixation. With the diagnosis of PLO, the patient was treated with weaning, bisphosphonate, and supplementation of calcium carbonate and vitamin D. During the 12-month follow-up period, the results of DEXA and laboratory examination improved gradually, and the internal fixation was removed 12 months after surgery. CONCLUSION: Orthopedic doctors should not ignore the possibility of PLO to avoid misdiagnosis of perinatal women with fractures. Improvement of functional recovery of fractures can be achieved with accurate diagnosis and individual treatment.


Assuntos
Fraturas por Compressão , Osteoporose , Complicações na Gravidez , Fraturas da Coluna Vertebral , Absorciometria de Fóton , Adulto , Densidade Óssea , Aleitamento Materno , Feminino , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/etiologia , Fraturas por Compressão/cirurgia , Humanos , Lactação , Osteoporose/diagnóstico por imagem , Gravidez , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/cirurgia
10.
BMC Musculoskelet Disord ; 22(1): 87, 2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33461525

RESUMO

BACKGROUND: Percutaneous anterior odontoid screw fixation for odontoid fractures remains challenging due to the complex anatomy of the craniocervical junction. We designed a new guide instrument to help with the placement of guide wire, which have achieved satisfying surgical results. The objective of this study is to evaluate the safety and efficacy of this new tool in percutaneous anterior odontoid screw fixation. METHODS: Twenty-nine patients with odontoid fracture were retrospectively evaluated. All patients underwent percutaneous anterior odontoid screw fixation with the traditional guide instrument (n = 13) or the new guide instrument we designed (n = 16). The following clinical outcomes were compared between the two groups: operation time, radiograph times, incision length, blood loss, postoperative hospitalization, postoperative complications, bony union, fixation failure, and reoperation. Radiographs or CT scans were performed at 3, 6 and 12 months after surgery. RESULTS: There were no significant differences in preoperative demographic data between the two groups. The operation time (56.62 ± 8.32 Vs 49.63 ± 7.47, P = 0.025) and radiograph times (26.54 ± 6.94 Vs 20.50 ± 5.02, P = 0.011) of the designed guide instrument group were significantly lower than those of the traditional guide instrument group. There were no significant differences in incision length (16.08 ± 3.07 Vs 15.69 ± 2.73, P = 0.720), blood loss (16.08 ± 4.96 Vs 17.88 ± 5.98, P = 0.393), postoperative hospitalization (7.15 ± 1.91 Vs 6.88 ± 2.36, P = 0.734), postoperative complications (7.7% Vs 12.5%, P = 1), and bony union (92.3% Vs 93.8%, P = 1) between the two groups. No fixation failure or reoperation occurred in either group. CONCLUSIONS: The top of our designed guide instrument is a wedge-shaped tip with 30° inclination, which has a large contact area with the anterior surface of the cervical vertebra. According to our retrospective study, the guide instrument can reduce the operation time and radiograph times. It has potential clinical value, which needs further testing with a higher level of research design.


Assuntos
Fixação Interna de Fraturas , Processo Odontoide , Fraturas da Coluna Vertebral , Adulto , Parafusos Ósseos , Humanos , Pessoa de Meia-Idade , Processo Odontoide/diagnóstico por imagem , Processo Odontoide/cirurgia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Resultado do Tratamento
11.
Br J Radiol ; 94(1119): 20200234, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33417486

RESUMO

OBJECTIVES: To analyze vertebral fractures risk in patients with chest scans by evaluating vertebral hydroxyapatite concentration measured on spectral CT compared to trabecular attenuation value measured on conventional CT. METHODS: Our retrospective study reviewed CT of 216 patients. Analysis of vertebral (T11 - L1) hydroxyapatite concentration by spectral imaging and trabecular attenuation value by conventional CT imaging were performed in patients with chest CT examinations. Specificity, sensitivity, negative predictive value (NPV), and positive predictive value (PPV) were performed by using receiver operating characteristic (ROC) curves in patients with and without vertebral fractures. RESULTS: In male patients, vertebral hydroxyapatite concentration had high area under the ROC curve (0.916), by using the optimal threshold of 72.27 mg/cm3, specificity, sensitivity, NPV, and PPV were 91.7, 80.2, 36.7, and 98.7%, respectively. In female patients, vertebral hydroxyapatite concentration also had high area under the ROC curve (0.870), by using the optimal threshold of 74.79 mg/cm3, specificity, sensitivity, NPV, and PPV were 100.0, 77.8, 47.4, and 100.0%, respectively. Area under the ROC curve was significantly different between spectral CT-measured bone hydroxyapatite concentration and conventional CT-measured attenuation value in distinguishing vertebral fractures (p = 0.007 for males; p = 0.005 for females). CONCLUSIONS: Quantitative assessment with spectral CT may appear as higher accuracy than that of conventional CT imaging to analyze risk of vertebral fractures. Hydroxyapatite concentration measured with chest spectral CT may be used to evaluate risk of bone fractures. ADVANCES IN KNOWLEDGE: Hydroxyapatite concentration measured with chest spectral CT may be used to evaluate risk of bone fractures.


Assuntos
Durapatita/metabolismo , Radiografia Torácica/métodos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Idoso , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/lesões , Vértebras Lombares/metabolismo , Masculino , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Sensibilidade e Especificidade , Fatores Sexuais , Fraturas da Coluna Vertebral/metabolismo , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/lesões
13.
Medicine (Baltimore) ; 100(2): e24099, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33466177

RESUMO

BACKGROUND: To explore the ideal trajectory of lumbar cortical bone trajectory screws and provide the optimal placement scheme in clinical applications. METHODS: Lumbar computed tomography (CT) data of 40 patients in our hospital were selected, and the cortical vertebral bone contour model was reconstructed in three dimensions (3D). Depending on the different regions of the screw through the entrance and exit of the pedicle, 9 trajectories were obtained through combinational design: T-Aa, T-Ab, T-Ac, T-Ba, T-Bb, T-Bc, T-Ca, T-Cb, and T-Cc. Cortical bone trajectory (CBT) screws with appropriate diameters were selected to simulate screw placement and measure the parameters corresponding to each trajectory (screw path diameter, screw trajectory length, cephalad angle, and lateral angle), and then determine the optimal screw according to the screw parameters and screw safety. Then, 23 patients in our hospital were selected, and the navigation template was designed based on the ideal trajectory before operation, CBT screws were placed during the operation to further verify the safety and feasibility of the ideal trajectory. RESULTS: T-Bc and T-Bb are the ideal screw trajectories for L1-L2 and L3-L5, respectively. The screw placement point is located at the intersection of the inner 1/3 vertical line of the superior facet joint and the bottom 1/3 horizontal line of the outer crest of the vertebral lamina (i.e., 2-4 mm inward at the bottom 1/3 of the outer crest of the vertebral lamina). CBT screws were successfully placed based on the ideal screw trajectory in clinical practice. During the operation or the follow-up period, there were no adverse events. CONCLUSION: CBT screw placement based on the ideal screw trajectory is a safe and reliable method for achieving effective fixation and satisfactory postoperative effects.


Assuntos
Osso Cortical/lesões , Fixação de Fratura/instrumentação , Vértebras Lombares/lesões , Parafusos Pediculares , Fraturas da Coluna Vertebral/cirurgia , Simulação por Computador , Osso Cortical/diagnóstico por imagem , Osso Cortical/cirurgia , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Modelos Anatômicos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Articulação Zigapofisária/diagnóstico por imagem , Articulação Zigapofisária/cirurgia
14.
Arch Osteoporos ; 16(1): 2, 2021 01 03.
Artigo em Inglês | MEDLINE | ID: mdl-33389230

RESUMO

We investigated the effect of paravertebral muscle (PVM) on poor prognosis in osteoporotic vertebral fracture (OVF) and remaining lower back pain (LBP) in the thoracolumbar and lower lumbar regions. Additional OVF occurrence in the thoracolumbar and remaining LBP in the lumbar region was significantly related to PVM fat infiltration percentage. PURPOSE: Paravertebral muscle (PVM) is an important component of the spinal column. However, its role in the healing process after osteoporotic vertebral fracture (OVF) is unclear. This study aimed to clarify the effect of PVM in thoracolumbar and lower lumbar regions on OVF clinical and radiological outcomes. METHODS: This was a multicenter prospective cohort study from 2012 to 2015. Patients ≥ 65 years old who presented within 2 weeks after fracture onset were followed up for 6 months. PVM was measured at the upper edge of the L1 and L5 vertebral body in the magnetic resonance imaging (MRI) T2-axial position at registration. The cross-sectional area (CSA), relative CSA (rCSA), and fat infiltration percentage (FI%) were measured. Severe vertebral compression, delayed union, new OVF, and remaining low back pain (LBP) were analyzed. RESULTS: Among 153 patients who were followed up for 6 months, 117 with measurable PVM were analyzed. Their average age was 79.1 ± 7.2 years, and 94 were women (80.3%). There were 48 cases of severe vertebral compression, 21 delayed unions, 11 new OVF, and 27 remaining LBP. Among all poor prognoses, only the FI% of the PVM was significantly associated with new OVF (p = 0.047) in the thoracolumbar region and remaining LBP (p = 0.042) in the lumbar region. CONCLUSION: The occurrence of additional OVF in the thoracolumbar region and remaining LBP in the lumbar region was significantly related to the FI% of the PVM. Physicians should be aware that patients with such fatty degeneration shown in acute MRI may require stronger treatment.


Assuntos
Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Região Lombossacral , Imagem por Ressonância Magnética , Músculos , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/epidemiologia , Estudos Prospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/epidemiologia , Coluna Vertebral
15.
Arch Osteoporos ; 16(1): 5, 2021 01 05.
Artigo em Inglês | MEDLINE | ID: mdl-33399996

RESUMO

The aim was to compare the National Osteoporosis Foundation (NOF) and the UK National Osteoporosis Guideline Group (NOGG) guidelines for the detection of vertebral fractures in postmenopausal Chinese women. The NOF guidelines had higher accuracy than the UK guidelines for spinal radiography examination. PURPOSE: To compare the National Osteoporosis Foundation (NOF) and the UK National Osteoporosis Guideline Group (NOGG) guidelines for the detection of vertebral fractures in postmenopausal Chinese women. METHODS: A cross-sectional study on 255 community-dwelling postmenopausal women was conducted in Hunan province in 2017. Demographic and clinical characteristics and risk factors were recorded through questionnaires. Height and weight were measured using standard methods, and bone mineral density (BMD) was measured with dual-energy X-ray absorptiometry. Vertebral fractures were diagnosed by radiography using semi-quantitative morphometry. RESULTS: The prevalence of vertebral fractures was 9.4%. Women with vertebral fractures were significantly older and shorter, had higher years-since menopause and height loss values and lower BMD and T-scores at the femoral neck and total hip, and were more likely to have a history of previous fractures. The sensitivity and specificity of the NOF guidelines were 91.7% and 39.8%, respectively, while the NOGG guidelines had lower sensitivity (87.5%) and specificity (32.5%). However, a higher percentage had indications for radiography in the 50-64 years age group according to the NOGG guidelines, while a higher percentage had indications for radiography in the ≥ 65 year group according to the NOF guidelines. CONCLUSIONS: The NOF guidelines were better than the NOGG guidelines for spinal radiography examination in the Chinese postmenopausal women.


Assuntos
Osteoporose Pós-Menopausa , Osteoporose , Fraturas da Coluna Vertebral , Absorciometria de Fóton , Densidade Óssea , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Osteoporose Pós-Menopausa/diagnóstico por imagem , Osteoporose Pós-Menopausa/epidemiologia , Pós-Menopausa , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/epidemiologia
16.
Osteoporos Int ; 32(3): 399-411, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33475820

RESUMO

Vertebral fractures are independent risk factors for vertebral and nonvertebral fractures. Since vertebral fractures are often missed, the relatively new introduction of vertebral fracture assessment (VFA) for imaging of the lateral spine during DXA-measurement of the spine and hips may contribute to detect vertebral fractures. We advocate performing a VFA in all patients with a recent fracture visiting a fracture liaison service (FLS). Fracture liaison services (FLS) are important service models for delivering secondary fracture prevention for older adults presenting with a fragility fracture. While commonly age, clinical risk factors (including fracture site and number of prior fracture) and BMD play a crucial role in determining fracture risk and indications for treatment with antiosteoporosis medications, prevalent vertebral fractures usually remain undetected. However, vertebral fractures are important independent risk factors for future vertebral and nonvertebral fractures. A development of the DXA technology, vertebral fracture assessment (VFA), allows for assessment of the lateral spine during the regular DXA bone mineral density measurement of the lumbar spine and hips. Recent approaches to the stratification of antiosteoporosis medication type according to baseline fracture risk, and differences by age in the indication for treatment by prior fracture mean that additional information from VFA may influence initiation and type of treatment. Furthermore, knowledge of baseline vertebral fractures allows reliable definition of incident vertebral fracture events during treatment, which may modify the approach to therapy. In this manuscript, we will discuss the epidemiology and clinical significance of vertebral fractures, the different methods of detecting vertebral fractures, and the rationale for, and implications of, use of VFA routinely in FLS. • Vertebral fracture assessment is a tool available on modern DXA instruments and has proven ability to detect vertebral fractures, the majority of which occur without a fall and without the signs and symptoms of an acute fracture. • Most osteoporosis guidelines internationally suggest that treatment with antiosteoporosis medications should be considered for older individuals (e.g., 65 years +) with a recent low trauma fracture without the need for DXA. • Younger individuals postfracture may be risk-assessed on the basis of FRAX® probability including DXA and associated treatment thresholds. • Future fracture risk is markedly influenced by both site, number, severity, and recency of prior fracture; awareness of baseline vertebral fractures facilitates definition of true incident vertebral fracture events occurring during antiosteoporosis treatment. • Detection of previously clinically silent vertebral fractures, defining site of prior fracture, might alter treatment decisions in younger or older FLS patients, consistent with recent IOF-ESCEO guidance on baseline-risk-stratified therapy, and provides a reliable baseline from which to define new, potentially therapy-altering, vertebral fracture events.


Assuntos
Osteoporose , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Absorciometria de Fóton , Idoso , Densidade Óssea , Humanos , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/etiologia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/etiologia
17.
BMC Surg ; 21(1): 22, 2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33407356

RESUMO

BACKGROUND: Symptomatic osteoporotic vertebral compression fractures (OVCF) are increasing, as are acute and chronic pain episodes and progressive spinal deformities. However, there are no clear surgical treatment criteria for patients with these different symptoms. Therefore, this study aims to explore the surgical approaches for the treatment of OVCF with different symptoms and evaluate the feasibility of these surgical approaches. METHODS: We retrospectively analyzed 238 symptomatic OVCF patients who entered our hospital from June 2013 to 2016. According to clinical characteristics and imaging examinations, these patients were divided into I-V grades and their corresponding surgical methods were developed. I, old vertebral fracture with no apparent instability, vertebral augmentation; II, old vertebral fracture with local instability, posterior reduction fusion internal fixation; III, old fractures with spinal stenosis, posterior decompression and reduction fusion and internal fixation; IV, old vertebral fracture with kyphosis, posterior osteotomy with internal fixation and fusion; V, a mixture of the above types, posterior osteotomy (decompression) with internal fixation and fusion. Postoperative visual analog score (VAS), oswestry disability index (ODI) scores, sagittal index (SI) and ASIA grades of neurological function were observed. RESULTS: All 238 patients were followed up for 12-38 months, with an average follow-up of 18.5 months. After graded surgery, the VAS score, ODI score, and vertebral sagittal index SI of 238 patients were significantly improved, and the difference between the last follow-up results and the preoperative comparison was statistically significant (P ˂ 0.05). Besides, the postoperative ASIA grades of 16 patients with nerve injury were improved from 14 patients with preoperative grade C, 2 patients with grade D to 4 patients with postoperative grade D and 12 patients with postoperative grade E. CONCLUSION: In this study, we concluded that graded surgery could better treat symptomatic old OVCF and restore spinal stability. This provides clinical reference and guidance for the treatment of symptomatic old OVCF in the future.


Assuntos
Fraturas por Compressão , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Fixação Interna de Fraturas , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/cirurgia , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/cirurgia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Resultado do Tratamento
18.
Tech Vasc Interv Radiol ; 23(4): 100701, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33308580

RESUMO

Vertebral compression fractures (VCFs) result from either trauma or a pathologic process that weakens the bone by conditions such as osteoporosis or tumor. The incidence of VCFs has been rising over the last few decades in accordance with the aging population. These fractures can result in severe pain, physical limitation and disability, as well as increased morbidity and mortality. Patients with VCFs are optimally treated by accurate and early diagnosis and treatment. An effective method to treat these fractures is percutaneous vertebral augmentation, which is a set of minimally invasive procedures that stabilizes osseous fractures, provides immediate pain relief, and improves quality of life. Vertebral augmentation procedures include vertebroplasty, kyphoplasty, and vertebral augmentation with implants. Each of these techniques is described in general terms in this article. The ideal candidate for vertebral augmentation is a patient with a symptomatic fracture seen on cross-sectional imaging in which nonsurgical management has failed and has positive signs on physical examination with no absolute contraindication. This procedure should be done with the appropriate equipment and personnel in a facility designed for this purpose. After the procedure, the patient should undergo the appropriate follow-up to ensure optimal recovery. Additionally, it is essential that the patient receives appropriate therapy for the underlying disorder that predisposed them to the vertebral fracture.


Assuntos
Fraturas por Compressão/cirurgia , Cifoplastia , Radiografia Intervencionista , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia , Tomada de Decisão Clínica , Protocolos Clínicos , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/fisiopatologia , Humanos , Cifoplastia/efeitos adversos , Radiografia Intervencionista/efeitos adversos , Fatores de Risco , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/fisiopatologia , Vertebroplastia/efeitos adversos
19.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 4717-4720, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019045

RESUMO

Traumatic Spinal Cord Injuries (TSCI) have a disastrous effect on the physical and mental health of both the patients and their relatives. Around 15 % of these injuries are caused by burst fractures, a sub-type of compressive fractures of the vertebral body. The transient dynamics of these fracture have been studied through in vitro experiments coupled with numerical simulations, but no direct observation have ever been made of their genesis and evolution and the behaviour of the nucleus pulposus under compressive loading has only been hypothesized. The purpose of this study was to evaluate the interactions between the vertebral body and the nucleus pulposus under dynamic compressive loading using high-speed cineradiography. A radiopaque agent was injected into the nuclei pulposi of 4 young porcine thoraco-lumbar and lumbar cadaveric segments, and a dynamic compressive load was applied to them using a servo-hydraulic bench-test. The compression process was filmed with a custom high-speed fluoroscope. The nucleus pulposus loaded the vertebral endplate up to 14,142 ± 486 N, before fracturing it and diffusing into the vertebral body. Then, internal pressure seemingly built up until an outward projection of the nucleus pulposus, at an antero-posterior velocity up to 2.9 m.s-1, or until retroprojection of bony fragments into the spinal canal. These results directly corroborate the hypotheses previously made by other studies and stress the unprecedented advantages of using high-speed cineradiography for the study of complex fractures genesis and evolution.Clinical Relevance- Methodology and results from this study would provide an unprecedented insight on the genesis and transient evolution of complex spinal fractures.


Assuntos
Núcleo Pulposo , Fraturas da Coluna Vertebral , Animais , Cinerradiografia , Humanos , Vértebras Lombares/diagnóstico por imagem , Pressão , Fraturas da Coluna Vertebral/diagnóstico por imagem , Suínos
20.
Arch Osteoporos ; 15(1): 160, 2020 10 10.
Artigo em Inglês | MEDLINE | ID: mdl-33040188

RESUMO

We introduced a standardised reporting system in the radiology department to highlight vertebral fractures and to signpost fracture prevention services. Our quality improvement project achieved improved fracture reporting, access to the FLS service, bone density assessment and anti-fracture treatment. PURPOSE: Identification of vertebral fragility fractures (VF) provides an opportunity to identify individuals at high risk who might benefit from secondary fracture prevention. We sought to standardise VF reporting and to signpost fracture prevention services. Our aim was to improve rates of VF detection and access to our fracture liaison service (FLS). METHODS: We introduced a standardised reporting tool within the radiology department to flag VFs with signposting for referral for bone densitometry (DXA) and osteoporosis assessment in line with Royal Osteoporosis Society guidelines. We monitored uptake of VF reporting during a quality improvement phase and case identification within the FLS service. RESULTS: Recruitment of individuals with VF to the FLS service increased from a baseline of 63 cases in 2017 (6%) to 95 (8%) in 2018 and 157 (8%) in 2019 and to 102 (12%) in the first 6 months of 2020 (p = 0.001). One hundred fifty-three patients with VFs were identified during the QI period (56 males; 97 females). Use of the terminology 'fracture' increased to 100% (mean age 70 years; SD 13) in computed tomography (n = 110), plain X-ray (n = 37) or magnetic resonance imaging (n = 6) reports within the cohort. Signposting to DXA and osteoporosis assessment was included in all reports (100%). DXA was arranged for 103/153; 12 failed to attend. Diagnostic categories were osteoporosis (31%), osteopenia (36%) or normal bone density (33%). A new prescription for bone protection therapy was issued in 63/153. Twelve of the series died during follow-up. CONCLUSIONS: Standardisation of radiology reporting systems facilitates reporting of prevalent vertebral fractures and supports secondary fracture prevention strategies.


Assuntos
Osteoporose , Fraturas por Osteoporose , Serviço Hospitalar de Radiologia , Fraturas da Coluna Vertebral , Idoso , Feminino , Humanos , Masculino , Osteoporose/diagnóstico por imagem , Osteoporose/epidemiologia , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/prevenção & controle , Estudos Prospectivos , Estudos Retrospectivos , Risco , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/prevenção & controle
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