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1.
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
2.
Arch Osteoporos ; 14(1): 112, 2019 11 23.
Artigo em Inglês | MEDLINE | ID: mdl-31760559

RESUMO

Lower limb muscle mass and grip loss may be risk factors for vertebral compression fractures in women. PURPOSE: We examined the relationship between bone mineral density, bone strength, skeletal muscle mass, grip strength, and skin autofluorescence (SAF) in women with osteoporotic vertebral compression fractures (VCF). METHODS: A total of 1039 women (mean age 73.3 years) were included in our study. These included 222 cases of VCF (mean 77.8 years) and 817 controls (mean 72.0 years). Lumbar and femur BMD were measured for all participants using dual-energy X-ray absorptiometry (DXA). Bone strength surrogates, such as cross-sectional area (CSA) of the proximal femur, were evaluated using Advanced Hip Assessment software. SAF was measured with an autofluorescence reader. We used a bioelectrical impedance analyzer (BIA) to analyze body composition, including appendicular skeletal muscle mass index (SMI; appendicular lean mass (kg)/(height (m))2. We measured bone density, geometric parameters related to bone strength, skeletal muscle mass, grip strength, and SAF in both groups. We also examined factors related to vertebral fracture using multiple logistic regression analysis. RESULTS: Women with vertebral fractures had lower SMI (5.55 vs 5.76 kg/m2, p = 0.0006), smaller femoral cross-sectional area (97.20 vs 100.09, p = 0.014), lower grip strength (16.81 vs 19.16 kg, p < 0.0001), and increased skin autofluorescence (2.38 vs 2.25, p = 0.0002) compared to women without fractures. The prevalence of sarcopenia (SMI < 5.75) was 63.51% in VCF subjects and 52.02% in controls, revealing a high prevalence in VCF (p = 0.002). Skeletal muscle mass and grip strength were not significantly different between patients with acute and old VCF, suggesting that low skeletal muscle mass and muscle weakness may exist before fracture. From the multiple logistic regression analysis, lower femoral density (p = 0.0021), CSA (p = 0.0166), leg muscle mass (p = 0.0127), and left arm grip strength (p = 0.0255) were risk factors for vertebral compression fractures; all were negatively correlated with increased vertebral fractures. CONCLUSIONS: Lower limb muscle mass and grip loss may be closely related to the onset of vertebral compression fracture.


Assuntos
Fraturas por Compressão/etiologia , Força da Mão/fisiologia , Fraturas por Osteoporose/etiologia , Sarcopenia/complicações , Fraturas da Coluna Vertebral/etiologia , Absorciometria de Fóton , Adulto , Idoso , Idoso de 80 Anos ou mais , Composição Corporal/fisiologia , Densidade Óssea/fisiologia , Feminino , Fêmur/patologia , Fêmur/fisiopatologia , Fraturas por Compressão/patologia , Fraturas por Compressão/fisiopatologia , Humanos , Vértebras Lombares/fisiopatologia , Pessoa de Meia-Idade , Músculo Esquelético/patologia , Fraturas por Osteoporose/patologia , Fraturas por Osteoporose/fisiopatologia , Fatores de Risco , Sarcopenia/patologia , Sarcopenia/fisiopatologia , Fraturas da Coluna Vertebral/patologia , Fraturas da Coluna Vertebral/fisiopatologia
3.
Fa Yi Xue Za Zhi ; 35(4): 437-439, 2019 Aug.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-31532153

RESUMO

Abstract: Objective To provide a reference for the assessment of the disability grade of Kümmell's disease cases, through the analysis of the basic situation, the disability grade and the causality of Kümmell's disease cases. Methods Data of appraised individuals in 8 cases of Kümmell's disease from traffic accident spinal injury cases accepted by the Institute from 2015 to 2017 were collected, and the basic situation, vertebral fracture sites and disability grades of the appraised individuals were analyzed. Results Among 8 cases of appraised individuals, there were 2 males and 6 females, the oldest 75 years and the youngest 50 years, with an average age of 62.5 years, all of whom suffered from single vertebral fracture. Among them, 1 patient had thoracic 11 vertebra fracture, 3 thoracic 12 vertebra fracture, 2 lumbar 1 vertebra fracture, 1 lumbar 2 vertebra fracture, and 1 lumbar 4 vertebra fracture, all of whom were assessed as grade 10 disability. Conclusion In the assessment of disability grade of vertebral fracture, dynamic observation of the vertebral fracture and its recovery should be made based on imaging data. If it is suspected that there is Kümmell's disease, it should be differentiated from other diseases. Also, the disability grade will be assessed according to the corresponding standards when the morphology of the injured vertebral body is relatively stable.


Assuntos
Acidentes de Trânsito , Avaliação da Deficiência , Doenças da Coluna Vertebral/patologia , Fraturas da Coluna Vertebral/patologia , Idoso , Feminino , Medicina Legal , Humanos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Doenças da Coluna Vertebral/diagnóstico , Doenças da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/diagnóstico , Vértebras Torácicas
4.
BMC Musculoskelet Disord ; 20(1): 336, 2019 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-31324243

RESUMO

BACKGROUND: The endplate-intervertebral disc (IVD) complex is closely interrelated with the vertebral body (VB) in the structural integrity of the anterior spinal column, including biomechanical and biological functions. Endplate and IVD injuries are usually found in association with vertebral fractures (VFs); however, little is known about their relevance to the healing of osteoporotic VFs (OVFs). The first purpose of this study was to evaluate the incidence and occurrence pattern of endplate and IVD injuries associated with single- and acute-OVFs, and the second was to evaluate the influence of endplate and IVD injuries on the occurrence of delayed union. METHODS: Endplate and IVD injuries associated with single- and acute-OVFs were retrospectively evaluated using magnetic resonance imaging (MRI). Vertebrae of 168 patients were included in the study. The occurrence rate and type of endplate and IVD injuries were radiologically evaluated, and the association between endplate and IVD injuries was statistically analyzed. Vertebrae of 85 patients, who received conservative treatment for acute OVFs, were included in the study and classified into two groups, union and delayed union, at 6 months after injury. To identify factors predicting delayed union, uni- and multivariate statistical analyses were performed. Vertebral MRI signal alternation patterns and endplate and IVD injuries were included as candidate factors in the logistic model. RESULTS: In association with OVFs, endplate injuries were observed in 103 of the 168 vertebrae (61%), and IVDs lesions were observed in 101 of 168 OVFs (60%); the occurrence of both injuries was significantly associated. Although no significant association with endplate and IVD injuries was identified, multivariate analysis demonstrated that intravertebral signal alternation (focal high signal intensity) and posterior wall injury were independent risk factors that predicted delayed union. CONCLUSIONS: The results of this study showed that endplate and IVD injuries were found in approximately 60% of single and acute OVFs. These results suggest that fracture healing of OVFs would be mainly attributed to vertebral factors, including mechanical stress and metabolic status, among the three components of the anterior spinal column.


Assuntos
Consolidação da Fratura , Disco Intervertebral/lesões , Fraturas por Osteoporose/complicações , Fraturas da Coluna Vertebral/complicações , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares , Imagem por Ressonância Magnética , Masculino , Fraturas por Osteoporose/patologia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/patologia , Vértebras Torácicas
5.
World Neurosurg ; 130: e862-e873, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31295605

RESUMO

BACKGROUND: Patients with chronic renal failure undergoing hemodialysis have been shown to have poor overall health, osteoporosis, and altered bone metabolism. However, the impact of hemodialysis on patient outcomes after spinal fusion remains unknown. We sought to assess the effect of dialysis on 30-day perioperative and postoperative outcomes after cervical and lumbar fusion for pathologic compression fractures. METHODS: We queried the National Surgical Quality Improvement Program from 2009 to 2016 for patients undergoing cervical or lumbar fusion for compression fractures. Three-to-one propensity score matching using sex, age, body mass index, and number of operated levels was used to match patients not undergoing dialysis with those undergoing dialysis. Multivariable conditional regression was used to identify the association between dialysis and 30-day clinical outcomes, after adjusting for confounders. RESULTS: A total of 48,492 patients undergoing cervical fusion were identified; 156 (0.32%) of these were on dialysis. On multivariable regression, dialysis dependency was associated with increased operative time (regression coefficient [coef.], 15.93; 95% CI, 0.4-31.5; P = 0.045), length of stay (coef. 6.06; 95% CI, 4.64-7.48; P < 0.001), 30-day readmissions (odds ratio [OR], 1.07; 95% CI, 1.02-1.12; P = 0.009), any complications (OR 1.08; 95% CI, 1.03-1.13; P = 0.002), and serious complications (OR, 1.08; 95% CI, 1.02-1.14; P = 0.012). A total of 25,417 patients undergoing lumbar fusion were identified; 51 of these (0.2%) were on dialysis. On multivariable regression, dialysis dependency was associated with significantly higher length of stay (coef. 2.98; 95% CI, 1.28-4.68; P < 0.001). CONCLUSIONS: Our analyses indicated that dialysis dependency is associated with poor perioperative and postoperative outcomes after cervical/lumbar fusion for pathologic compression fractures.


Assuntos
Sistema de Registros , Diálise Renal/tendências , Fraturas da Coluna Vertebral/patologia , Fraturas da Coluna Vertebral/cirurgia , Fusão Vertebral/tendências , Idoso , Vértebras Cervicais/lesões , Vértebras Cervicais/patologia , Vértebras Cervicais/cirurgia , Estudos de Coortes , Bases de Dados Factuais/tendências , Feminino , Humanos , Tempo de Internação/tendências , Vértebras Lombares/lesões , Vértebras Lombares/patologia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Diálise Renal/efeitos adversos , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
6.
Vet Comp Orthop Traumatol ; 32(6): 492-498, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31242518

RESUMO

OBJECTIVE: The aim of this study was to describe the signalment, clinical presentation, diagnostic findings, medical and surgical treatment and outcome of 22 farm animals diagnosed with a vertebral fracture or luxation. STUDY DESIGN: Medical records of 22 farm animals (7 goats, 6 alpacas, 5 cattle, 3 sheep and 1 deer) were reviewed for signalment, history, presenting clinical signs and neurological examination findings, clinicopathological results, diagnostic imaging, final diagnosis, medical and surgical management, clinical progression and outcome. RESULTS: Animals' age ranged from 1 day to 15 years. Neurological examination findings included decreased motor function (20/22), recumbency (14/22), altered mentation (13/22), cranial nerve deficits (4/22) and lack of nociception (3/22). Lesions were localized to the atlanto-occipital region (2/22), C1 to C5 (7/22), C6 to T2 (4/22), T3 to L3 (3/22), and L4 to S1 (6/22). Diagnoses included vertebral fracture only (4/22), luxation only (5/22) or both vertebral fracture and luxation (13/22). In five cases, no therapy was attempted, while 12 cases were treated medically and five cases were treated surgically. Surgical interventions included manual reduction (n = 1); arthrodesis (n = 2); laminectomy (n = 1); and laminectomy with pin fixation, cerclage wire and polymethylmethacrylate bridging (n = 1). Five of the 22 cases survived to hospital discharge; two of these were treated surgically. CONCLUSION: The cervical region was most commonly affected. Prognosis for these injuries in farm animals is guarded.


Assuntos
Fraturas Ósseas/veterinária , Luxações Articulares/veterinária , Gado/lesões , Fraturas da Coluna Vertebral/veterinária , Animais , Feminino , Fraturas Ósseas/patologia , Fraturas Ósseas/terapia , Luxações Articulares/patologia , Luxações Articulares/terapia , Masculino , Estudos Retrospectivos , Fraturas da Coluna Vertebral/patologia , Fraturas da Coluna Vertebral/terapia , Traumatismos da Coluna Vertebral/patologia , Traumatismos da Coluna Vertebral/terapia , Traumatismos da Coluna Vertebral/veterinária , Resultado do Tratamento
7.
World Neurosurg ; 130: e368-e374, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31229750

RESUMO

OBJECTIVE: The AOSpine Subaxial Cervical Spine Injury Classification System was introduced to improve communication, clinical management, and research. Here, the system was studied in relation to injury severity along with admission and long term neurologic follow-up. METHODS: A retrospective study was performed in subaxial cervical spine injury patients. Morphology was classified using the AOSpine Subaxial Cervical Spine Injury Classification System. Six major morphology subtypes were selected for analysis. The American Spinal Injury Association (ASIA) motor and Abbreviated Injury Severity (AIS) scores were recorded at admission and at follow-up >6 months. Admission intramedullary lesion length (IMLL) on MRI was recorded. RESULTS: In all, 82 patients met criteria for analysis. The mean follow-up time was 11 months (range, 6-33 months). The were 36 patients with morphology subtypes A0, 4 with A1/A2, 9 with A3/A4, 8 with B2, 11 with B3, and 14 with C. The A1/2 subtype had the least severe injuries on admission. The C and A3/A4 subtypes had the most severe injuries. The subtype C had the lowest ASIA Motor Score (AMS) and second highest percentage of complete injuries. A3/A4 patients had the highest percentage of complete injuries on admission. At follow-up, A3/A4 patients had the lowest AMS, and 33% of patients continued to have complete injuries. C subtype injuries all converted to AIS incomplete injuries on follow-up (P = 0.04). IMLL was found to be significantly different compared across multiple morphologic subtypes. Surgical management for each morphology subtype was reported. CONCLUSION: The AOSpine Subaxial Cervical Spine Injury Classification System successfully associated injury morphology with IMLL along with admission and long-term neurologic function and recovery.


Assuntos
Vértebras Cervicais/lesões , Traumatismos da Coluna Vertebral/classificação , Traumatismos da Coluna Vertebral/diagnóstico , Vértebras Cervicais/patologia , Feminino , Hospitalização , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fraturas da Coluna Vertebral/classificação , Fraturas da Coluna Vertebral/diagnóstico , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/patologia , Traumatismos da Coluna Vertebral/epidemiologia , Traumatismos da Coluna Vertebral/patologia
8.
World Neurosurg ; 122: e639-e646, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-31108080

RESUMO

BACKGROUND: Vertebroplasty and kyphoplasty are minimally invasive techniques used to treat vertebral compression fractures. The etiology of vertebral compression fractures varies among patients. Although osteoporosis and trauma are major etiologic factors in patients with a vertebral compression fracture, unexpected results were found in 11 patients in the present study. The aim of the present retrospective study was to determine the incidentally detected pathology results of patients with vertebral fracture treated by vertebroplasty and kyphoplasty. METHODS: From February 2010 to November 2015, 616 patients with a vertebral compression fracture were treated by kyphoplasty and vertebroplasty at our institution. Vertebral biopsies were obtained from 533 patients during a vertebral augmentation technique. The average patient age was 62.4 years. Of the 616 patients, 388 were female and 228 were male. Histological evaluation of the biopsy specimens from the vertebral compression fractures was performed. RESULTS: The biopsy results of 505 patients showed various stages of bone healing. Among these patients, malignancy was identified in 23 patients, and 43 patients had a history of malignancy. In 6 patients, an unsuspected malignancy was found, and 1 patient had Paget's disease. Infection was detected in 4 patients. In our study, the rate of unsuspected malignancy was 1.1%. CONCLUSIONS: Tissue examination is useful and could reveal pathologic fractures. An incidentally detected biopsy result could change the treatment of patients; however, bone biopsy should be reserved for those patients whose preoperative radiological diagnosis raises suspicion of a nonosteoporotic etiology.


Assuntos
Fraturas por Compressão/cirurgia , Achados Incidentais , Cifoplastia , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas por Compressão/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Osteíte Deformante/diagnóstico , Osteíte Deformante/patologia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/patologia , Neoplasias da Coluna Vertebral/diagnóstico , Neoplasias da Coluna Vertebral/patologia , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/patologia , Coluna Vertebral/cirurgia , Adulto Jovem
9.
Spine J ; 19(9): 1490-1497, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31125694

RESUMO

BACKGROUND CONTEXT: Emerging literature has identified the importance of pretreatment health and functional status as influential in the prognostication of survival. A comprehensive, accessible, predictive model for survival following cervical spine fracture has yet to be developed. PURPOSE: To develop an accessible and intuitive predictive model for survival in individuals aged 50 and older treated for cervical spine fractures. STUDY DESIGN: Retrospective review of records from two tertiary care centers (2009-2016). PATIENT SAMPLE: Patients age 50 and older who received operative or nonoperative management for cervical fractures. OUTCOME MEASURES: One-year mortality was the primary outcome with 3-month and 2-year mortality considered secondarily. METHODS: Multivariable logistic regression was used to identify factors independently associated with mortality. The magnitude and precision of the relationship with 1-year mortality for statistically significant variables determined weighting in the scoring system subsequently developed. Score performance was tested through multivariable regression and bootstrap simulation. In a sensitivity test, the performance of the score developed for 1-year mortality was assessed using figures for the 3-month and 2-year time-points. RESULTS: We included 1,758 patients. Mortality rates were 12% at 3 months, 17% at 1 year, and 21% at 2 years. Following multivariable testing age, injury severity score and Glasgow coma scale demonstrated the strongest predictive values for a base score, followed by serum albumin and ambulatory status. The resultant composite score ranged from 0 (base score≤4, albumin≤3.5 g/dL, and dependent/nonambulator at presentation) to a maximum of 4 (base score≥5, albumin>3.5 g/dL, and independent ambulator at presentation). Following multivariable analysis, when compared to patients with a score of 4, significantly increased odds of 1-year mortality were appreciated for those with scores of 3 (odds ratio [OR] 7.35; 95% confidence interval [CI] 3.77, 14.32), 2 (OR 8.43; 95% CI 4.66, 15.25), 1 (OR 17.47; 95% CI 9.81, 31.11), and 0 (OR 26.58; 95% CI 13.87, 50.92). Score performance was unchanged in bootstrap testing and sensitivity analyses. CONCLUSIONS: We have developed a useful prognostic utility capable of informing survival in individuals age 50 and older, following cervical spine fractures. The score can be applied to adjust patient expectations, anticipate outcomes, and as an adjunct to decision-making in the postinjury period.


Assuntos
Escala de Gravidade do Ferimento , Fraturas da Coluna Vertebral/mortalidade , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prognóstico , Fraturas da Coluna Vertebral/patologia , Taxa de Sobrevida
10.
AJR Am J Roentgenol ; 213(2): 427-436, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31039028

RESUMO

OBJECTIVE. We aimed to systematically examine the reliability and validity of different MRI sequences in differentiating benign and malignant vertebral fractures, appropriately select the best MRI sequence to improve the diagnostic accuracy, and compare the diagnostic accuracy of MRI sequences in the context of different study designs or publication date. MATERIALS AND METHODS. Computer and manual retrieval were conducted on studies published between January 1, 2000, and September 31, 2016. Studies relevant to the differential diagnosis of benign and malignant vertebral fractures by MRI and reference standard (histopathologic diagnosis or clinical follow-up examination) were analyzed. RESULTS. Eighteen articles were included. Neither threshold (p = 0.86) nor nonthreshold (p = 0.06) effects were present. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 89% (95% CI, 86-92%), 88% (95% CI, 85-91%), 6.54 (95% CI, 4.44-9.65), 0.14 (95% CI, 0.09-0.21), and 55.76 (95% CI, 37.06-83.89), respectively. The AUC was 0.95. The risk of publication bias was negligible (p = 0.33). CONCLUSION. MRI sequences could provide appreciable diagnostic performance in differentiating benign and malignant vertebral fractures. However, our pooled estimates do not support the superiority of one set of sequences over another, and there is not sufficient evidence to show that prospective or recent studies are obviously better than retrospective or older studies.


Assuntos
Imagem por Ressonância Magnética/métodos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/patologia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/patologia , Diagnóstico Diferencial , Humanos , Reprodutibilidade dos Testes
11.
World Neurosurg ; 127: e1120-e1126, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30980977

RESUMO

OBJECTIVE: Fracture of the odontoid process is a critical injury to diagnose and often treat. The aim of this anatomic study was to present a comprehensive understanding of this part of the C2 vertebra. METHODS: We used 20 C2 vertebrae. Samples underwent imaging (computed tomography [CT] with and without three-dimensional reconstruction, micro-CT, 1.5T magnetic resonance imaging) and sagittal and coronal sectioning using a bone saw. Sectioned specimens were imaged under a digital handheld microscope, and transillumination of the bone was used to highlight its internal trabecular pattern. Three samples underwent infusion of the odontoid process with a hardening substance and were then decalcified. RESULTS: Internal trabecular patterns of the odontoid process of all specimens were discernible. In sagittal and coronal sections, trabecular patterns were highlighted with transillumination, but the patterns were much clearer using the digital microscope. Magnetic resonance imaging and CT provided the least detail of the imaging methods, but the trabecular patterns could be identified. Three-dimensional reconstruction of CT data was the preferred imaging method over magnetic resonance imaging and CT without three-dimensional reconstruction. The most distinct trabecular and cortical patterns were seen using micro-CT. Osteoporosis was seen in 2 specimens (10%). Five specimens (25%) were found to have a subdental synchondrosis. For most specimens, the trabeculae were found throughout the odontoid process. CONCLUSIONS: Improved knowledge of the anatomy, structural composition, and variations within the C2 vertebra may allow for better treatment options and patient care.


Assuntos
Imageamento Tridimensional/métodos , Processo Odontoide/anatomia & histologia , Processo Odontoide/diagnóstico por imagem , Fraturas da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Idoso , Vértebra Cervical Áxis/anatomia & histologia , Vértebra Cervical Áxis/diagnóstico por imagem , Vértebra Cervical Áxis/patologia , Cadáver , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Processo Odontoide/patologia , Fraturas da Coluna Vertebral/patologia
12.
J Int Med Res ; 47(6): 2424-2433, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31007103

RESUMO

OBJECTIVE: To evaluate the clinical efficacy of percutaneous curved vertebroplasty (PCVP) in treating thoracic and lumbar osteoporotic vertebral compression fractures (OVCFs). METHODS: Patients with thoracolumbar OVCFs were recruited and randomly divided into three treatment groups: PCVP, unilateral percutaneous vertebroplasty (PVP) or bilateral PVP. Bone cement dispersion in the fractured vertebrae was observed. Surgery duration, X-ray frequency, bone cement injection volume, bone cement leakage rate and visual analogue scale (VAS) scores were recorded. RESULTS: Among 78 patients included, surgery duration and X-ray frequency were significantly lower in the PCVP and unilateral PVP groups versus bilateral PVP group. Bone cement injection volume was significantly higher in the bilateral PVP group (6.3 ± 1.4 ml) versus unilateral PVP (3.5 ± 1.1 ml) and PCVP groups (4.6 ± 1.2 ml). VAS scores at 24 h and 3 months post-surgery were significantly decreased versus baseline in all groups. The bone cement leakage rate was lowest in the PCVP group (8.8% [3/34 patients]). CONCLUSION: PCVP is associated with reduced trauma, less complicated surgery with shorter duration, fewer X-rays, lower complication rate, and quicker postoperative recovery versus unilateral and bilateral PVP.


Assuntos
Fraturas por Compressão/cirurgia , Vértebras Lombares/cirurgia , Fraturas por Osteoporose/cirurgia , Complicações Pós-Operatórias , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/cirurgia , Vertebroplastia/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Fraturas por Compressão/patologia , Humanos , Vértebras Lombares/patologia , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/patologia , Prognóstico , Estudos Prospectivos , Fraturas da Coluna Vertebral/patologia , Vértebras Torácicas/patologia
13.
Pain Physician ; 22(2): E91-E96, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30921985

RESUMO

BACKGROUND: Unilateral and bilateral percutaneous kyphoplasty (PKP) have been widely adopted to treat osteoporotic vertebral compression fractures (OVCFs). Unilateral PKP has a shorter operation time and less radiation exposure time compared with bilateral PKP, but the anatomical distinctions of unilateral PKP are not identical in all cases. OBJECTIVE: The aim of this study was to examine the significance of age, gender, level, and side in relation to the anatomical distinctions of unilateral PKP for lumbar OVCFs through the transverse process-pedicle approach (TPPA). STUDY DESIGN: This was a retrospective study of 200 patients. SETTING: The research took place at General Hospital of Shenyang Military Area Command of Chinese PLA. METHODS: Researchers examined 1000 lumbar spines (L1-L5) of 200 patients and simulated PKP on the 3D-CT scans through unilateral TPPA. The distance between the entry point and the midline of the vertebral body (DEM), the puncture inclination angle (PIA), the safe range of the inner inclination angles (SRA), and the success rate (SR) of puncture were measured and compared. RESULTS: There were significant differences (P < 0.05) in the mean DEM between men and women, and between the left and right sides. The DEM was significantly larger in men than women and in right than left. The DEM from L1 to L5 was significantly increased (P < 0.05), from 22.4 ± 2.0 mm to 34.1 ± 4.3 mm. The right maximum PIA was significantly larger than the left. The maximum puncture angle and SRA in men was larger than that in women except for L5. The SRA from L1 to L5 was significantly increased (P < 0.05), from 20.1 ± 6.0 mm to 44.2 ± 8.8 mm. The SR from L1 to L5 was significantly increased (P < 0.05), from 88.3% to 100%. The SR in men was significantly higher than that in women for L1 and L2. LIMITATIONS: Sample size was relatively small. CONCLUSIONS: The DEM was 22.4 mm to 34.1 mm according to different levels. There were significant gender, side, and age differences in the DEM and PIA. The values of DEM, PIA, SRA and SR were significantly increased from L1 to L5. KEY WORDS: Lumbar, osteoporotic vertebral compression fracture, unilateral, percutaneous kyphoplasty, transverse process.


Assuntos
Fraturas por Compressão/cirurgia , Cifoplastia/métodos , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Fatores Etários , Idoso , Feminino , Fraturas por Compressão/patologia , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/patologia , Estudos Retrospectivos , Fatores Sexuais , Fraturas da Coluna Vertebral/patologia
14.
Eur Radiol ; 29(9): 4999-5006, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30847590

RESUMO

OBJECTIVE: To investigate the relationship between paraspinal and psoas muscle volumes and acute osteoporotic or low-bone-mass compression fractures of the lumbar spine in postmenopausal women. METHODS: Patient data were retrieved retrospectively for postmenopausal women with L-spine magnetic resonance imaging (MRI) and dual-energy X-ray absorptiometry showing osteoporosis/low bone mass. Group 1 comprised eight women aged 60-80 years with MRI showing a single acute compression fracture. The age-matched group 2a (N = 12) and younger group 2b (N = 12) comprised of women whose MRIs showed no fractures. Cross-sectional MRIs of the paraspinal and psoas muscles and intramuscular fat volume for each muscle group were measured. Operator repeatability and reproducibility were obtained. RESULTS: Group 1 showed significantly smaller lean muscle volume for all muscle groups at L5/S1. Intramuscular fat volume was also smaller in most muscle groups in group 1, though only reaching statistical significance at variable muscle groups and levels. Measurements show both good intrarater repeatability and interrater reproducibility of lean muscle volume estimations (intraclass correlation coefficient (ICC), 0.999 for rater A and 0.997 for rater B; Cronbach's alpha 0.995) and intramuscular fat volume estimations (ICC, 0.995 for rater A and 0.982 for rater B; Cronbach's alpha was 0.981). CONCLUSIONS: This study provides the first quantitative evidence that compression fractures in postmenopausal women with underlying osteoporosis/low bone mass are associated with less paraspinal and psoas muscle volumes. Further longitudinal studies with larger cohorts are needed to verify this relationship. KEY POINTS: • The risk of osteoporotic compression fractures is higher in older women with smaller paraspinal muscle volume. • Older women show smaller paraspinal muscle volume and more intramuscular fat compared to younger controls.


Assuntos
Fraturas por Compressão/patologia , Vértebras Lombares/lesões , Imagem por Ressonância Magnética , Fraturas por Osteoporose/patologia , Músculos Paraespinais/diagnóstico por imagem , Músculos Paraespinais/patologia , Fraturas da Coluna Vertebral/patologia , Absorciometria de Fóton , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Fraturas por Compressão/diagnóstico por imagem , Humanos , Estudos Longitudinais , Vértebras Lombares/diagnóstico por imagem , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa/diagnóstico por imagem , Fraturas por Osteoporose/diagnóstico por imagem , Músculos Psoas/patologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem
15.
J Back Musculoskelet Rehabil ; 32(5): 803-810, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30856101

RESUMO

BACKGROUND: Histological and histochemical analyses of muscle samples were used to determine the intensity of paraspinal muscle injury during open (OPEN) and minimally invasive (MIS) procedures due to spinal trauma. OBJECTIVE: A randomised prospective study design was chosen. According to our hypothesis, OPEN procedures will lead to more intensive microscopic changes than MIS. METHODS: Muscle samples were collected during the primary surgery - fracture surgery (FRS) from the left and during material extraction (EXS) from the right side. Complete samples were acquired from 17 OPEN and 18 MIS subjects. We compared them histochemically and histologically; muscle fibre typing and statistical analysis were performed. RESULTS: We statistically confirmed that the increase in fibrosis in the OPEN EXS sample was significantly higher than in the MIS EXS sample, with p< 0.05 (p= 0.000322453). Fibre types in MIS did not differ almost at all in both samples; the changes were statistically insignificant.In OPEN samples, the number of type I fibres differed significantly. In EXS, it was significantly lower (46.23%) than in FRS (60.63%), at a statistically significant level, p< 0.05 (p= 0.0234375000) especially with the increase of the type IIA fibres, less in IIB fibres. CONCLUSIONS: These microscopic findings provide a statistically significant confirmation that OPEN procedures in spinal fracture lead, in most cases, to significant changes in the structure of the corset muscle at the fracture site and surgical access point than MIS procedures.


Assuntos
Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Músculos Paraespinais/metabolismo , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/cirurgia , Adolescente , Adulto , Idoso , Feminino , Humanos , Vértebras Lombares/lesões , Masculino , Pessoa de Meia-Idade , Músculos Paraespinais/patologia , Estudos Prospectivos , Fraturas da Coluna Vertebral/metabolismo , Fraturas da Coluna Vertebral/patologia , Vértebras Torácicas/lesões , Adulto Jovem
16.
J Int Med Res ; 47(2): 1043-1051, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30618309

RESUMO

Traumatic incarceration of the small bowel accompanied by vertebral fractures and dislocation is rare and usually misdiagnosed until laparotomy. This report presents a rare case of jejunum entrapment between lumbar spine fractures. A 43-year-old man was clamped between two railway tracks on the upper abdomen and lower back. Following ineffective conservative treatment, he underwent a laparotomy due to the development of guarding and rebound tenderness. Loss of vitality of the jejunal loop, which was incarcerated between the L3 and L4 vertebrae, was observed. The necrotic bowel was removed and end-to-end anastomosis was performed. When his condition was stable, anterior and posterior lumbar fixation surgery was performed. The patient had no abdominal complications and lower limb nerve function deficiency during the follow-up period. A review of the literature since 1979 on incarceration of the bowel associated with lumbar fracture and dislocation identified 12 cases: five patients showed persistent neurological symptoms, but none of the patients died as a result of their injuries. It should be borne in mind that patients with hyperextension or flexion-distraction injury of the lumbar spine could show symptoms of intestinal obstruction and bowel incarceration. Enhanced computed tomography or magnetic resonance imaging will be helpful for diagnosis.


Assuntos
Obstrução Intestinal/patologia , Intestino Delgado/patologia , Luxações Articulares/patologia , Vértebras Lombares/patologia , Fraturas da Coluna Vertebral/patologia , Adulto , Humanos , Obstrução Intestinal/cirurgia , Intestino Delgado/cirurgia , Luxações Articulares/cirurgia , Vértebras Lombares/cirurgia , Masculino , Prognóstico , Fraturas da Coluna Vertebral/cirurgia
17.
Korean J Radiol ; 20(1): 126-133, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30627028

RESUMO

Objective: To compare the lumbar vertebral bone marrow fat-signal fractions obtained from six-echo modified Dixon sequence (6-echo m-Dixon) with those from single-voxel magnetic resonance spectroscopy (MRS) in patients with low back pain. Materials and Methods: Vertebral bone marrow fat-signal fractions were quantified by 6-echo m-Dixon (repetition time [TR] = 7.2 ms, echo time (TE) = 1.21 ms, echo spacing = 1.1 ms, total imaging time = 50 seconds) and single-voxel MRS measurements in 25 targets (23 normal bone marrows, two focal lesions) from 24 patients. The point-resolved spectroscopy sequence was used for localized single-voxel MRS (TR = 3000 ms, TE = 35 ms, total scan time = 1 minute 42 seconds). A 2 × 2 × 1.5 cm3 voxel was placed within the normal L2 or L3 vertebral body, or other lesions including a compression fracture or metastasis. The bone marrow fat spectrum was characterized on the basis of the magnitude of measurable fat peaks and a priori knowledge of the chemical structure of triglycerides. The imaging-based fat-signal fraction results were then compared to the MRS-based results. Results: There was a strong correlation between m-Dixon and MRS-based fat-signal fractions (slope = 0.86, R2 = 0.88, p < 0.001). In Bland-Altman analysis, 92.0% (23/25) of the data points were within the limits of agreement. Bland-Altman plots revealed a slight but systematic error in the m-Dixon based fat-signal fraction, which showed a prevailing overestimation of small fat-signal fractions (< 20%) and underestimation of high fat-signal fractions (> 20%). Conclusion: Given its excellent agreement with single-voxel-MRS, 6-echo m-Dixon can be used for visual and quantitative evaluation of vertebral bone marrow fat in daily practice.


Assuntos
Tecido Adiposo/diagnóstico por imagem , Medula Óssea/fisiologia , Vértebras Lombares/fisiologia , Imagem por Ressonância Magnética/métodos , Espectroscopia de Ressonância Magnética/métodos , Triglicerídeos/análise , Tecido Adiposo/patologia , Adulto , Idoso , Feminino , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/patologia , Humanos , Dor Lombar/diagnóstico , Dor Lombar/patologia , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/patologia
18.
J Bone Miner Res ; 34(1): 3-21, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30677181

RESUMO

Vertebral augmentation is among the current standards of care to reduce pain in patients with vertebral fractures (VF), yet a lack of consensus regarding efficacy and safety of percutaneous vertebroplasty and kyphoplasty raises questions on what basis clinicians should choose one therapy over another. Given the lack of consensus in the field, the American Society for Bone and Mineral Research (ASBMR) leadership charged this Task Force to address key questions on the efficacy and safety of vertebral augmentation and other nonpharmacological approaches for the treatment of pain after VF. This report details the findings and recommendations of this Task Force. For patients with acutely painful VF, percutaneous vertebroplasty provides no demonstrable clinically significant benefit over placebo. Results did not differ according to duration of pain. There is also insufficient evidence to support kyphoplasty over nonsurgical management, percutaneous vertebroplasty, vertebral body stenting, or KIVA®. There is limited evidence to determine the risk of incident VF or serious adverse effects (AE) related to either percutaneous vertebroplasty or kyphoplasty. No recommendation can be made about harms, but they cannot be excluded. For patients with painful VF, it is unclear whether spinal bracing improves physical function, disability, or quality of life. Exercise may improve mobility and may reduce pain and fear of falling but does not reduce falls or fractures in individuals with VF. General and intervention-specific research recommendations stress the need to reduce study bias and address methodological flaws in study design and data collection. This includes the need for larger sample sizes, inclusion of a placebo control, more data on serious AE, and more research on nonpharmacologic interventions. Routine use of vertebral augmentation is not supported by current evidence. When it is offered, patients should be fully informed about the evidence. Anti-osteoporotic medications reduce the risk of subsequent vertebral fractures by 40-70%. © 2018 American Society for Bone and Mineral Research.


Assuntos
Dor nas Costas/cirurgia , Fraturas por Compressão/cirurgia , Cifoplastia , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia , Comitês Consultivos , Dor nas Costas/patologia , Dor nas Costas/fisiopatologia , Feminino , Fraturas por Compressão/patologia , Fraturas por Compressão/fisiopatologia , Humanos , Masculino , Fraturas por Osteoporose/patologia , Fraturas por Osteoporose/fisiopatologia , Qualidade de Vida , Fraturas da Coluna Vertebral/patologia , Fraturas da Coluna Vertebral/fisiopatologia , Coluna Vertebral/patologia , Coluna Vertebral/fisiopatologia , Coluna Vertebral/cirurgia
19.
Ann Biomed Eng ; 47(4): 980-989, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30673956

RESUMO

Metastasis of cancer to the spine impacts bone quality. This study aims to characterize vertebral microdamage secondary to metastatic disease considering the pattern of damage and its relationship to stress and strain under load. Osteolytic and mixed osteolytic/osteoblastic vertebral metastases were produced in athymic rats via HeLa cervical or canine Ace-1 prostate cancer cell inoculation, respectively. After 21 days, excised motion segments (T12-L2) were µCT scanned, stained with BaSO4 and re-imaged. T13-L2 motion segments were loaded in axial compression to induce microdamage, re-stained and re-imaged. L1 (loaded) and T12 (unloaded) vertebrae were fixed, sample blocks cut, polished and BSE imaged. µFE models were generated of all L1 vertebrae with displacement boundary conditions applied based on the loaded µCT images. µCT stereological analysis, BSE analysis and µFE derived von Mises stress and principal strains were quantitatively compared (ANOVA), spatial correlations determined and patterns of microdamage assessed qualitatively. BaSO4 identified microdamage was found to be spatially correlated with regions of high stress in µFEA. Load-induced microdamage was shown to be elevated in the presence of osteolytic and mixed metastatic disease, with diffuse, crossed hatched areas of microdamage present in addition to linear microdamage and microfractures in metastatic tissue, suggesting diminished bone quality.


Assuntos
Fraturas de Estresse , Vértebras Lombares , Fraturas da Coluna Vertebral , Neoplasias da Coluna Vertebral , Animais , Feminino , Análise de Elementos Finitos , Fraturas de Estresse/metabolismo , Fraturas de Estresse/patologia , Vértebras Lombares/metabolismo , Vértebras Lombares/patologia , Camundongos , Camundongos Nus , Metástase Neoplásica , Ratos , Fraturas da Coluna Vertebral/metabolismo , Fraturas da Coluna Vertebral/patologia , Neoplasias da Coluna Vertebral/metabolismo , Neoplasias da Coluna Vertebral/patologia , Suporte de Carga
20.
Bone ; 121: 134-138, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30244157

RESUMO

FRAX is a commonly used tool to evaluate patient fracture risk based on individual patient models that integrate the risks associated with clinical risk factors with or without bone mineral density (BMD) at the femoral neck. Retrospectively, factors identified by the FRAX scoring algorithm were used to predict the risk for vertebral compression fractures at baseline in newly diagnosed multiple myeloma patients. The data were derived from myeloma patients enrolled in Total Therapy Protocols (TT4 & TT5) between 8/2008 and 9/2017. FRAX scores were calculated and baseline PET and MRI imaging obtained. Univariate and multivariate logistic regression analyses determined the association between FRAX components and the existence of vertebral compression fractures, both pathologic and osteoporotic. The patient population had a median age of 61 years (43-76), 37% female, and 87% white. The median major osteoporotic score (MOS) and Hip fracture scores (HFS) for TT4 patients (low-risk myeloma) were 5.6 and 0.5, respectively, while median MOS and HFS for TT5 (high risk myeloma) patients were 6.2 and 0.7, respectively. The odds ratio for fracture at diagnosis in patients with elevated MOS (>2), and HFS (>4.5) was significant OR (1.48, 95% confidence interval (1.35,1.62)) and OR (1.61, 95% confidence interval (1.42, 1.81)), respectively. In sum, an elevated baseline FRAX score was highly predictive of baseline vertebral fractures in MM patients at presentation. In addition, patients with higher FRAX scores had significantly shorter survival in the low-risk (TT4) group but this survival effect was not seen in the high-risk (TT5) group. These findings suggest that FRAX assessment of baseline fracture risk is beneficial in MM patients to identify an individual patients' risk of vertebral fracture.


Assuntos
Mieloma Múltiplo/diagnóstico por imagem , Mieloma Múltiplo/patologia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/patologia , Adulto , Idoso , Algoritmos , Feminino , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/patologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Estudos Retrospectivos
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