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1.
Medicine (Baltimore) ; 99(12): e19578, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32195971

RESUMO

INTRODUCTION: Spondyloptosis is a form of vertebral dislocation and the most advanced form of spondylolisthesis. Traumatic spondyloptosis is usually caused by high-energy impact and results in unstable spine deformity and spinal canal deformation, which lead to severe spinal cord injury. Traumatic spondyloptosis is mostly reported in the lumbo-sacral junction, while it is rarely documented in mid-lumbar segments. To the best of the authors' knowledge, only 16 cases of mid-lumbar spondyloptosis have been described previously. Herein, we present a L3 to L4 spondyloptosis case that did not involve neurological deficit. PATIENT CONCERNS: A 42-year-old man presented to the emergency department after an accident involving a fall. The patient developed severe back pain and spinal deformity, while his neurologic function remained intact. Radiological examinations indicated complete posterior vertebral dislocation at L3 to L4 and a fracture at the bilateral pelvic ischial tuberosity without major vessel injury or severe dura sac compression. DIAGNOSES: L3 to L4 complete vertebral dislocation, pelvic ischial tuberosity fracture. INTERVENTIONS: For treatment, the patient underwent fracture reduction, L3 to L4 intervertebral fusion, and internal fixation 7 days post-injury. OUTCOMES: Postoperative digital radiography showed the correction of the spinal deformity. The patient was pain-free and fully rehabilitated 3 months after the surgery. At the 1-year follow-up, the patient was completely asymptomatic and had achieved normal alignment. CONCLUSIONS: We reported an L3 to L4 traumatic spondyloptosis case that involved intact neurology, which is the first-ever reported mid-lumbar spondyloptosis case that involved complete posterior column and neural sparing. For the treatment of traumatic spondyloptosis without neurological deficit, restoring stability and preventing secondary cord injury should be taken into consideration.


Assuntos
Dor nas Costas/diagnóstico , Anormalidades Congênitas/diagnóstico , Vértebras Lombares/lesões , Espondilolistese/diagnóstico por imagem , Acidentes por Quedas , Adulto , Assistência ao Convalescente , Criança , Pré-Escolar , Feminino , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/cirurgia , Vértebras Lombares/patologia , Masculino , Pessoa de Meia-Idade , Ossos Pélvicos/lesões , Ossos Pélvicos/patologia , Radiografia/métodos , Fusão Vertebral/métodos , Coluna Vertebral/anormalidades , Espondilolistese/cirurgia , Resultado do Tratamento
2.
Medicine (Baltimore) ; 99(6): e19053, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028424

RESUMO

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


Assuntos
Fraturas por Compressão/cirurgia , Cifoplastia/métodos , Vértebras Lombares/lesões , Fraturas da Coluna Vertebral/cirurgia , Perda Sanguínea Cirúrgica , Feminino , Fraturas por Compressão/diagnóstico por imagem , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Pessoa de Meia-Idade , Duração da Cirurgia , Radiografia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X
3.
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
4.
Sports Biomech ; 19(2): 258-270, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30004294

RESUMO

Female gymnasts have been evidenced to experience sport-specific growth, of which broad shoulders and narrow hips are common characteristics. In addition to being a central component of handstand performance, postural control mechanisms, including whole-body and lumbo-pelvic stability, have been identified as risk factors for overuse spinal pathology. The study aimed to develop a fundamental understanding of musculoskeletal growth and postural control responses of female artistic gymnasts in order to extend longitudinal insights into overuse spinal pathology risk. Whole-body anthropometric measures were collected for 12 competitive female gymnasts (age at recruitment: nine to 15 years) at three time points across a 12 month period. Musculoskeletal growth was partially defined as the rate of bicristal-to-biacromial breadth ratio development, and informed shoulder- and pelvis-dominant growth sub-groups. Kinematic and kinetic indicators of postural control were determined for a total of 700 handstand trials. The shoulder-dominant (gymnastics-specific) growth group was found to have significantly greater biomechanical risk for general stability (p < 0.001) than the pelvis-dominant group. Significantly greater lumbo-pelvic risk was demonstrated for the pelvis-dominant group (p < 0.001). Extended idiosyncratic examination of proportional sport-specific growth measures alongside multi-faceted risk monitoring was advocated for the effective development of future overuse pathology prevention protocols.


Assuntos
Ginástica/fisiologia , Desenvolvimento Musculoesquelético/fisiologia , Equilíbrio Postural/fisiologia , Adolescente , Antropometria , Fenômenos Biomecânicos , Índice de Massa Corporal , Criança , Transtornos Traumáticos Cumulativos/fisiopatologia , Feminino , Ginástica/lesões , Quadril/anatomia & histologia , Quadril/crescimento & desenvolvimento , Humanos , Estudos Longitudinais , Vértebras Lombares/lesões , Pelve/anatomia & histologia , Pelve/crescimento & desenvolvimento , Fatores de Risco , Ombro/anatomia & histologia , Ombro/crescimento & desenvolvimento
5.
Medicine (Baltimore) ; 98(50): e18217, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852080

RESUMO

To evaluate the influence of various distributions of bone cement on the clinical efficacy of percutaneous kyphoplasty (PKP) in treating osteoporotic vertebrae compression fractures.A total of 201 OVCF patients (30 males and 171 females) who received PKP treatment in our hospital were enrolled in this study. According to the characteristic of cement distribution, patients were divided into 2 groups: group A ("H" shaped group), the filling pattern in vertebral body were 2 briquettes and connected with / without cement bridge; and group B ("O" shaped group), the filling pattern in vertebral body was a complete crumb and without any separation. Bone mineral density, volume of injected cement, radiographic parameters, and VAS scores were recorded and analyzed between the 2 groups.All patients finished at least a 1-year follow-up and both groups had significant improvement in radiographic parameters and clinical results. No significant differences in BMD, operation time, bleeding volume, or leakage of cement were observed between the 2 groups. Compared with group B, group A had a larger use of bone cement, lower proportion of unipedicular approach, and better VAS scores at 1 year after surgery.Both "H" and "O" shaped distribution pattern can improve radiographic data and clinical outcomes effectively. However, "H" shaped distribution can achieve better clinical recovery at short-term follow-up.


Assuntos
Cimentos para Ossos , Fraturas por Compressão/cirurgia , Cifoplastia/métodos , Vértebras Lombares/lesões , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/lesões , Idoso , Densidade Óssea , Feminino , Seguimentos , Fraturas por Compressão/diagnóstico , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Fraturas por Osteoporose/diagnóstico , Período Pós-Operatório , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
6.
Z Orthop Unfall ; 157(5): 574-596, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31594004

RESUMO

The basis for assessing thoracolumbar vertebral body fractures are two established classification systems. Important, especially in terms of further treatment, is the distinction between osteoporotic and healthy bones. The AO Spine classification offers a comprehensive tool for healthy bones to reliably specify the morphological criterias (alignment, integrity of the intervertebral disc, fragment separation, stenosis of the spinal canal). In addition to the fracture morphology, the OF classification for osteoporotic fractures includes patient-specific characteristics to initiate adequate therapy. In general an adequate pain therapy is required for early rehabilitation. While in the bone healthy population, physiotherapy reduces the risk of muscle deconditioning, in the osteoporotic population it additionally serves to prevent subsequent fractures. Unlike osteoporotic patients, bone healthy patients with vertebral fractures should not undergo a corset/orthosis treatment.


Assuntos
Tratamento Conservador/métodos , Vértebras Lombares/lesões , Fraturas da Coluna Vertebral/terapia , Vértebras Torácicas/lesões , Educação Médica Continuada , Fraturas por Compressão/terapia , Humanos , Fraturas por Osteoporose/classificação , Fraturas por Osteoporose/terapia , Modalidades de Fisioterapia , Fraturas da Coluna Vertebral/classificação , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico , Traumatismos do Sistema Nervoso/classificação , Traumatismos do Sistema Nervoso/diagnóstico , Traumatismos do Sistema Nervoso/etiologia , Traumatismos do Sistema Nervoso/terapia , Resultado do Tratamento
7.
World Neurosurg ; 132: 253-257, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31520762

RESUMO

BACKGROUND: Foraminal stenosis, a common disorder occurring in elderly patients, is often caused by narrowing of the foramen, resulting in the confinement of neural structures by the tissue and vertebrae. Full-endoscopic lumbar foraminoplasty (FELF) is an effective treatment option for patients with foraminal stenosis. However, to the best of our knowledge, no previous study has reported the treatment of symptomatic cement leakage. We report a case of symptomatic cement leakage treated with FELF with the patient under local anesthesia. CASE DESCRIPTION: An 85-year-old woman was admitted to our spine unit because of lower back pain. The patient had presented with lower back pain and new-onset left thigh pain after vertebroplasty performed 3 months previously. The patient was not able to walk and was bedridden. To overcome this problem, T12 percutaneous vertebroplasty and left transforaminal L3-L4 foraminoplasty was performed with the patient under local anesthesia. After surgery, the patient was able to walk and was discharged 4 days postoperatively. CONCLUSION: The present report has shown that FELF can successfully remove symptomatic cement leakage, resulting in pain relief.


Assuntos
Cimentos para Ossos , Vértebras Lombares/cirurgia , Neuroendoscopia/métodos , Complicações Pós-Operatórias/cirurgia , Radiculopatia/cirurgia , Vertebroplastia , Idoso de 80 Anos ou mais , Constrição Patológica , Feminino , Fraturas por Compressão/cirurgia , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/lesões , Complicações Pós-Operatórias/diagnóstico por imagem , Radiculopatia/diagnóstico por imagem , Procedimentos Cirúrgicos Reconstrutivos/métodos , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia
8.
BMC Musculoskelet Disord ; 20(1): 397, 2019 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-31472691

RESUMO

BACKGROUND: Thoracolumbar fractures are most frequent along the spine, and surgical treatment is indicated for unstable fractures. Percutaneous minimally invasive surgery was introduced to reduce the pain associated with the open posterior approach and reduce the morbidity of the procedure by avoiding damage and dissection of the paravertebral muscles. The goal of this study is to compare the surgical treatment of fractures of the thoracolumbar spine treated by the conventional open approach and the percutaneous minimally invasive approach using similar types of pedicle spine fixation systems. METHODS/DESIGNS: This study is designed as a multi-center, randomized controlled trial of patients aged 18-65 years who are scheduled to undergo surgical posterior fixation. Treatment by the conventional open approach or percutaneous minimally invasive approach will be randomly assigned. The primary outcome measure is postoperative pain, which will be measured using the visual analogue scale (VAS). The secondary outcome parameters are intraoperative bleeding, postoperative drainage, surgery time, length of hospital stay, SF-36, EQ-5D-5 l, HADS, pain medication, deambulation after surgery, intraoperative fluoroscopy time, vertebral segment kyphosis, fracture vertebral body height, compression of the vertebral canal, accuracy of the pedicle screws, and breakage or release of the implants. Patient will be followed up for 1, 2, 3, 6, 12 and 24 months postoperatively and evaluated according to the outcomes using clinical and radiological examinations, plain radiographs and computed tomografy (CT). DISCUSSION: Surgical treatment of thoracolumbar fractures by the open or percutaneous minimally invasive approach will be compared in a multicenter randomized study using similar types of fixation systems, and the results will be evaluated according to clinical and radiological parameters at 1, 2, 3, 6, 12 and 24 months of follow-up. TRIAL REGISTRATION: ClinicalTrial.gov approval number: 1.933.631, code: NCT03316703 in may 2017.


Assuntos
Fixação Interna de Fraturas/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Redução Aberta/efeitos adversos , Dor Pós-Operatória/diagnóstico , Fraturas da Coluna Vertebral/cirurgia , Adolescente , Adulto , Idoso , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Feminino , Seguimentos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Humanos , Tempo de Internação/estatística & dados numéricos , Vértebras Lombares/lesões , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Estudos Multicêntricos como Assunto , Redução Aberta/instrumentação , Redução Aberta/métodos , Duração da Cirurgia , Medição da Dor , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia , Parafusos Pediculares , Ensaios Clínicos Controlados Aleatórios como Assunto , Índice de Gravidade de Doença , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia , Resultado do Tratamento , Adulto Jovem
9.
Clin Orthop Surg ; 11(3): 291-296, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31475049

RESUMO

Background: The purpose of this study was to determine whether restoration of range of motion (ROM) could be achieved by implant removal after natural bone healing and consolidation of fractured vertebrae and examine whether early removal of the implant could maximize restoration of ROM. Methods: This study included 30 cases of thoracolumbar fractures without neurological deficit requiring surgery (nine cases of flexion-distraction injuries and 21 cases of burst fractures). Percutaneous pedicle screw fixation (PPSF) was performed at the fractured vertebrae and one level above and one level below the fracture level. Pedicle screws were removed at an average of 12 months after surgery upon healing of fractured vertebrae. The following radiological and clinical findings were evaluated: restoration of anterior vertebral height ratio (AVHR), Cobb angle (CA), ROM, and complications. Sixteen patients who were checked for ROM were divided into two groups based on the time of implant removal: nine patients within 12 months and seven patients after 12 months. Restoration of vertebral height loss and ROM were compared between the two groups. Results: At the final follow-up, significant pain relief and restoration of AVHR and CA were achieved in patients who underwent PPSF. Patients who had implant removed within 12 months after surgery had better ROM recovery than those who had implant removed after 12 months postoperatively. There were no significant differences in AVHR and CA between the two groups. Conclusions: PPSF followed by implant removal after healing of fractured body appears to be effective in achieving restoration of ROM. In our study, early removal of implant within 12 months after surgery was associated with better achievement of ROM than removal after 12 months. In addition, there were no significant differences in restoration of vertebral height between the two groups.


Assuntos
Vértebras Lombares/cirurgia , Parafusos Pediculares , Fraturas da Coluna Vertebral/cirurgia , Fusão Vertebral/instrumentação , Vértebras Torácicas/cirurgia , Adolescente , Adulto , Idoso , Remoção de Dispositivo , Feminino , Consolidação da Fratura , Humanos , Vértebras Lombares/lesões , Vértebras Lombares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Fraturas da Coluna Vertebral/fisiopatologia , Fusão Vertebral/métodos , Vértebras Torácicas/lesões , Vértebras Torácicas/fisiopatologia , Fatores de Tempo , Adulto Jovem
10.
Ulus Travma Acil Cerrahi Derg ; 25(5): 484-488, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31475333

RESUMO

BACKGROUND: In this study, we aim to evaluate the potential effects of methylprednisolone on the neurological outcome of spinal cord injury (SCI) patients with thoracolumbar junction (T10-L1) spine fractures. METHODS: The data from 182 SCI patients who sustained a thoracolumbar junction spine fracture were operated by us between September 2008 to January 2015 were analysed retrospectively. The patients were divided into two groups: Group 1 underwent methylprednisolone treatment in conjunction with early surgical intervention, while group 2 underwent only early surgical intervention without methylprednisolone treatment. American Spinal Injury Association (ASIA) motor index scores of the patients were evaluated and compared with statistical methods at admission and at the first-year follow-up. RESULTS: The main follow-up period was 14.4±1.4 months in group 1 and 13.6±1.7 months in group 2. Initial and last follow-up ASIA scores of the patients were similar between groups (p>0.05), but the complication rate was significantly high in group 1 (p<0.05). CONCLUSION: The findings showed that steroids have no significant beneficial effects on the neurological outcome but have significant side effects and leads to increased complication rate in SCI patients.


Assuntos
Vértebras Lombares/lesões , Metilprednisolona/uso terapêutico , Doenças do Sistema Nervoso , Fraturas da Coluna Vertebral , Vértebras Torácicas/lesões , Anti-Inflamatórios/uso terapêutico , Humanos , Doenças do Sistema Nervoso/tratamento farmacológico , Doenças do Sistema Nervoso/etiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/tratamento farmacológico , Fraturas da Coluna Vertebral/cirurgia
11.
BMJ Case Rep ; 12(8)2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31471360

RESUMO

Running is one of the most popular sports worldwide. Studies suggest that 11%-85% of recreational runners have at least one running-related injury (RRI) each year, resulting in a reduction or interruption in training. A high risk for running-related injuries (RRIs) represents an important inconvenience counterbalancing the beneficial effects of running. RRIs primarily affect the joints of the lower limb and lumbar spine. Noteworthy, in some cases, the clinical presentation of signs and symptoms is confusing and may hide serious conditions; thus, clinicians have to pay special attention when potential factors arise, such as the presence of red flags. As reported in this case report, patients can present with low back pain (LBP) as a primary problem, mimicking a red flag such as a fracture of the spine. The aim of this case report was to describe a case of a recreational runner presenting with LBP as the sole symptom of an underlying thoracolumbar fracture.


Assuntos
Dor Lombar/diagnóstico , Vértebras Lombares/lesões , Corrida/lesões , Fraturas da Coluna Vertebral/diagnóstico , Vértebras Torácicas/lesões , Adulto , Diagnóstico Diferencial , Humanos , Dor Lombar/etiologia , Masculino , Programas de Rastreamento/métodos , Modalidades de Fisioterapia , Fraturas da Coluna Vertebral/etiologia
12.
J Orthop Surg Res ; 14(1): 299, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488174

RESUMO

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


Assuntos
Imagem de Difusão por Ressonância Magnética/métodos , Fraturas por Compressão/diagnóstico por imagem , Espectroscopia de Ressonância Magnética/métodos , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Idoso , Diagnóstico Diferencial , Imagem de Difusão por Ressonância Magnética/normas , Feminino , Fraturas por Compressão/metabolismo , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/lesões , Vértebras Lombares/metabolismo , Espectroscopia de Ressonância Magnética/normas , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/metabolismo , Fraturas da Coluna Vertebral/metabolismo , Neoplasias da Coluna Vertebral/metabolismo , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/lesões , Vértebras Torácicas/metabolismo
13.
Orthop Surg ; 11(4): 613-619, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31387160

RESUMO

OBJECTIVE: To develop a novel screw positioning method to improve the treatment of unstable thoracolumbar fractures. METHODS: A total of 72 patients with unstable thoracolumbar fractures who were treated with anterior screw-rod interfixation from January 2011 to October 2015 were included in this clinical study. Those patients included 48 male and 24 female patients with an average age of 45.10 years (range, 26-63 years). Patients were randomly divided into two groups: an observation group (n = 36) and a control group (n = 36). The quadrant positioning method was used for screw insertion in the observation group during the operation, while the traditional screw positioning method was used in the control group. The quadrant positioning method targeted four quadrants, including the superior anterior (SA), superior posterior (SP), inferior anterior (IA) and inferior posterior (IP) quadrants, while for the traditional screw positioning, four screws were inserted into the vertebral bodies above and below the excision. Patients were followed up for approximately 40 months to record recovery. Clinical and radiological records, local angle and fractured vertebra body height, clinical outcomes, complications, neurological improvement, and fusion rate were recorded and compared between the two groups. RESULTS: The quadrant positioning method was successfully used for anterior screw insertion. The quadrant center in the lateral view of the vertebral body was well marked, and screws were easily located on the scheduled quadrant. Blood loss (BL), hospital stay (HS), and operation time (OP) in the observation group were 749.40 ± 379.90 mL, 17.10 ± 4.10 days, and 167.40 ± 44.70 min, respectively. While those parameters in the control group were 1198.40 ± 339.27 mL, 23.22 ± 3.77 days, and 221.47 ± 32.15 min, respectively. The average operation time and hospital stay time were significantly shorter, and blood loss was significantly less in the observation group than in the control group (P < 0.05). Local angle and vertebral body height were markedly improved and 1-2 grade improvement was achieved in patients with neurological deficits in both groups. Both groups of patients achieved bony fusion during follow-up. No incision infection or internal fixation failure was observed in the two groups, and complications including cerebrospinal fluid and chylous leakage and hemothorax were resolved. CONCLUSIONS: The quadrant positioning method can shorten operation time, reduce blood loss, and accelerate postoperative recovery. The technique provides an effective method for screw insertion for double screw-rod instrumentation fixation in the treatment of thoracolumbar fracture via the anterior approach.


Assuntos
Parafusos Ósseos , Fixação Interna de Fraturas/métodos , Vértebras Lombares/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/cirurgia , Adulto , Perda Sanguínea Cirúrgica , Feminino , Humanos , Vértebras Lombares/lesões , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Vértebras Torácicas/lesões
14.
Neurology ; 93(12): e1205-e1211, 2019 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-31409736

RESUMO

OBJECTIVE: To determine the hemodynamic conditions associated with optimal neurologic improvement in individuals with acute traumatic spinal cord injury (SCI) who had lumbar intrathecal catheters placed to measure CSF pressure (CSFP). METHODS: Ninety-two individuals with acute SCI were enrolled in this multicenter prospective observational clinical trial. We monitored mean arterial pressure (MAP) and CSFP during the first week after injury and assessed neurologic function at baseline and 6 months after injury. We used relative risk iterations to determine transition points at which the likelihood of either improving neurologically or remaining unchanged neurologically was equivalent. These transition points guided our analyses in which we examined the linear relationships between time spent within target hemodynamic ranges (i.e., clinical adherence) and neurologic recovery. RESULTS: Relative risk transition points for CSFP, MAP, and spinal cord perfusion pressure (SCPP) were linearly associated with neurologic improvement and directed the identification of key hemodynamic target ranges. Clinical adherence to the target ranges was positively and linearly related to improved neurologic outcomes. Adherence to SCPP targets, not MAP targets, was the best indicator of improved neurologic recovery, which occurred with SCPP targets of 60 to 65 mm Hg. Failing to maintain the SCPP within the target ranges was an important detrimental factor in neurologic recovery, particularly if the target range is set lower. CONCLUSION: We provide an empirical, data-driven approach to aid institutions in setting hemodynamic management targets that accept the real-life challenges of adherence to specific targets. Our results provide a framework to guide the development of widespread institutional management guidelines for acute traumatic SCI.


Assuntos
Pressão Sanguínea/fisiologia , Pressão do Líquido Cefalorraquidiano/fisiologia , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/terapia , Medula Espinal/irrigação sanguínea , Medula Espinal/fisiologia , Cateterismo/métodos , Vértebras Cervicais/lesões , Gerenciamento Clínico , Feminino , Hemodinâmica/fisiologia , Humanos , Vértebras Lombares/lesões , Estudos Prospectivos , Traumatismos da Medula Espinal/diagnóstico , Vértebras Torácicas/lesões
15.
Iowa Orthop J ; 39(1): 77-80, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31413678

RESUMO

Background: Vertebral fracture after posterior arthrodesis and instrumentation for idiopathic scoliosis is a rare occurrence with limited reported cases in the literature. Case Presentation: A 16-year-old female patient surgically treated for adolescent idiopathic scoliosis with T2-L1 posterior spinal fusion was in a low-energy fall resulting in fracture of L1 and new kyphosis and scoliosis of the thoracolumbar spine at the distal aspect of the fusion. The fracture was initially managed conservatively, however pain persisted and thus she was indicated for extension of the fusion and correction of the post-traumatic kyphosis. Conclusions: Fractures after posterior spinal fusion for idiopathic scoliosis are rare and evidence for the appropriate management remains limited in the literature.Level of Evidence: V.


Assuntos
Acidentes por Quedas , Cifose/cirurgia , Escoliose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , Adolescente , Feminino , Seguimentos , Humanos , Cifose/etiologia , Vértebras Lombares/lesões , Vértebras Lombares/cirurgia , Radiografia Torácica/métodos , Reoperação/métodos , Medição de Risco , Escoliose/diagnóstico , Escoliose/etiologia , Fraturas da Coluna Vertebral/etiologia , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia , Resultado do Tratamento
16.
Eur J Radiol ; 118: 239-244, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31439248

RESUMO

PURPOSE: to review the role of the radiologist in reporting pre-signing medical imaging prior to athlete transfer between clubs. METHOD: When a professional athlete transfers from one club to another they may undergo a transfer or "pre-signing" medical examination, of which imaging forms a major component. The purpose of imaging is to enable the overseeing sports physician to make a risk assessment on the athlete that may influence decisions such as the duration of contract offered. Imaging studies have to be performed and reported often within limited time constraints, usually by MSK radiologists specialised in sports imaging. This article describes the role of the sports radiologist in reporting pre-signing medical imaging studies, and discusses some of the common pathology identified, as well as some of the ethical and medicolegal issues encountered. RESULTS: Not applicable. This is a review article. CONCLUSION: the sports radiologists report of the pre-signing medical is an important component of the decision making process to sign an athlete, and is closely linked to the physical examination.


Assuntos
Atletas , Exame Físico/métodos , Papel do Médico , Radiologistas , Futebol/lesões , Medicina Esportiva/métodos , Traumatismos do Tornozelo/diagnóstico , Traumatismos em Atletas/diagnóstico , Tomada de Decisão Clínica/métodos , Humanos , Traumatismos do Joelho/diagnóstico , Vértebras Lombares/lesões , Imagem por Ressonância Magnética , Pelve/lesões , Lesões do Ombro/diagnóstico
17.
Int J Sports Med ; 40(11): 704-710, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31404936

RESUMO

Competitive cricket demands a high level of performance from fast bowlers. Ground reaction forces during the landing phase pose a risk for lower limb and lumbar spine injury. Good dynamic knee strength allows the knee to flex to absorb these forces and extend prior to ball release for maximum efficiency. Plyometric training has been shown to improve dynamic strength. There is a lack of literature on this subject for cricket. This study evaluated the effect of a combined plyometric and strength training program on isokinetic knee strength of fast bowlers. Forty-two professional fast bowlers were randomly assigned to a training group (n=21) and a control group (n=21). Both groups underwent isokinetic knee strength and vertical and standing broad-jump testing. Quadriceps and hamstring concentric and eccentric peak torques, bilateral strength asymmetries (BSAs), and dynamic control ratios (DCRs) were evaluated by isokinetic testing. The study group underwent 12 weeks of plyometric training, whereas the control group continued with their own training methods. The study group showed a significant improvement (p<0.05) in jump performance and eccentric strength. There was a reduction in the proportion of bowlers with poor BSA and DCR. Improving dynamic knee strength through plyometric training reduces injury risk and improves performance in cricket fast bowlers.


Assuntos
Articulação do Joelho/fisiologia , Força Muscular/fisiologia , Exercício Pliométrico/métodos , Treinamento de Resistência/métodos , Esportes/fisiologia , Adolescente , Adulto , Traumatismos em Atletas/prevenção & controle , Desempenho Atlético/fisiologia , Fenômenos Biomecânicos , Teste de Esforço , Humanos , Extremidade Inferior/lesões , Vértebras Lombares/lesões , Masculino , Fatores de Risco , Adulto Jovem
18.
Ulus Travma Acil Cerrahi Derg ; 25(4): 417-423, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31297784

RESUMO

Steel rod impalements, mostly experienced by construction workers due to falls from heights, are known entities, but only some individuals unfortunately suffer spinal cord injury. The management of the spine involved injuries is challenging due to the lack of guidelines, various clinical presentations resulting from different trajectories, and high risk of infection. We report a case of steel rod impalement involving the spinal canal and review the literature to enhance the management strategies and to identify the risk factors for possible complications, particularly infection. A 37-year-old male construction worker presented to our emergency department due to falling onto a concrete reinforcing steel rod that penetrated through his perineum to the L4 vertebra. Examination revealed paralysis and sensory loss of the left foot. The rod was removed in the operating room (closed removal) under general anesthesia, followed by laparotomy. Rectal laceration was primarily repaired, and colostomy was performed. In a separate session, laminectomy was performed. At 3 months post-discharge, the patient was ambulatory with armrest based on the same motor examination performed on presentation This case is a good example of careful preoperative planning, multidisciplinary involvement, and appropriately sequenced interventions resulting in an acceptable outcome for an injury with high morbidity and mortality and demonstrates the feasibility and potential benefits of closed removal of the rod in an operating room just before laparotomy. The presence of an intestinal perforation increases the infection risk, but infections can still be prevented in this setting. Shorter time intervals between the incidence and surgery may reduce the infection rate.


Assuntos
Acidentes por Quedas , Vértebras Lombares/lesões , Traumatismos da Medula Espinal/etiologia , Traumatismos da Coluna Vertebral/etiologia , Ferimentos Penetrantes/etiologia , Adulto , Colonografia Tomográfica Computadorizada , Colostomia , Humanos , Lacerações , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Períneo/lesões , Fatores de Risco , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/diagnóstico por imagem , Traumatismos da Coluna Vertebral/complicações , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Aço , Ferimentos Penetrantes/complicações , Ferimentos Penetrantes/diagnóstico por imagem , Ferimentos Penetrantes/cirurgia
19.
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
20.
Medicina (Kaunas) ; 55(7)2019 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-31284666

RESUMO

Background and objectives: Lumbar spine surgery may be considered if pharmacologic, rehabilitation and interventional approaches cannot provide sufficient recovery from low back-related pain. Postoperative physiotherapy treatment in England is often accompanied by patient information leaflets, which contain important rehabilitation advice. However, in order to be an effective instrument for patients, the information provided in these leaflets must be up to date and based on the best available evidence and clinical practice. This study aims to critically analyse the current postoperative aspects of rehabilitation (exercise prescription and return to normal activity) that are provided in patient information leaflets in England as part of an evaluation of current practice following lumbar spine surgery. Materials and Methods: Patient information leaflets from English National Health Service (NHS) hospitals performing lumbar spine surgery were sourced online. A content analysis was conducted to collect data on postoperative exercise prescription and return to normal activities. Results: Thirty-two patient information leaflets on lumbar surgery were sourced (fusion, n = 11; decompression, n = 15; all lumbar procedures, n = 6). Many of the exercises prescribed within the leaflets were not based on evidence of clinical best practice and lacked a relationship to functional activity. Return to normal activity advice was also wide ranging, with considerable variation in the recommendations and definitions provided. Conclusions: This study highlights a clear variation in the recommendations of exercise prescription, dosage and returning to normal activities following lumbar spine surgery. Future work should focus on providing a consistent and patient-centred approach to recovery.


Assuntos
Terapia por Exercício/estatística & dados numéricos , Vértebras Lombares/cirurgia , Procedimentos Ortopédicos/normas , Educação de Pacientes como Assunto/normas , Volta ao Esporte/estatística & dados numéricos , Inglaterra , Exercício/fisiologia , Terapia por Exercício/métodos , Humanos , Dor Lombar/complicações , Dor Lombar/cirurgia , Vértebras Lombares/lesões , Procedimentos Ortopédicos/métodos , Procedimentos Ortopédicos/estatística & dados numéricos , Folhetos , Educação de Pacientes como Assunto/métodos , Período Pós-Operatório , Pesquisa Qualitativa , Medicina Estatal/organização & administração , Medicina Estatal/estatística & dados numéricos
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