Vertebral Column Research Articles

Three-dimensional fiber patterning in the annulus fibrosus can be derived from vertebral endplate topography.

The annulus fibrosus (AF) of the Intervertebral disc (IVD) is composed of concentric lamellae of helically wound collagen fibers. Understanding the spatial variation of collagen fiber orientations in these lamellae, and the resulting material anisotropy, is crucial to predicting the mechanical behavior of the complete IVD. This study builds on a prior model predicated on path-independent displacement of fiber endpoints during vertebral body growth to predict a complete, three-dimensional annulus fibrosus fiber network from a small number of subject-independent input parameters and vertebral endplate topographies obtained from clinical imaging. To evaluate the model, it was first fit to mid-plane fiber orientations obtained using polarized light microscopy in a population of bovine caudal discs for which computed tomography images vertebral endplates were also available. Additionally, the model was used to predict the trajectories based on human lumbar disc geometries and results were compared to previously reported data. Finally, the model was employed to investigate potential disc-related variations in fiber angle distributions. The model was able to accurately predict experimentally measured fiber distributions in both bovine and human discs using only endplate topography and three input parameters. Critically, the model recapitulated previously observed asymmetry between the inclinations of right- and left-handed fibers in the posterolateral aspect of the human AF. Level to level variation of disc height and aspect ratio in the human lumbar spine was predicted to affect absolute values of fiber inclination, but not this asymmetry. Taken together these results suggest that patient-specific distributions of AF fiber orientation may be readily incorporated into computational models of the spine using only disc geometry and a small number of subject-independent parameters.

Vertebral augmentation: How we do it

Vertebral augmentation consists of minimally invasive techniques indicated in the treatment of vertebral compression fractures (VCFs). These compression fractures cause vertebral body height loss and consequent significant pain and are most frequently the result of osteoporosis, cancer metastasis, or trauma. The deleterious effects of VCFs often compound, as greater load-bearing stress is transferred to the remaining healthy vertebrae1. Kyphoplasty, vertebroplasty, and intravertebral implants are closely related vertebral augmentation techniques that serve to relieve pain and to counter pathophysiological stress and structural degradation of the vertebral column alignment. All three approaches are performed percutaneously and are therefore attractive options for patients deemed to be poor candidates for open surgery2.Each technique involves transpedicular needle access to the vertebral body matrix, followed by introduction of a cement-like polymer through a catheter to fill the space and provide structural fortification. Vertebroplasty involves injection of the cement material into the matrix space without any adjunctive measures. In kyphoplasty, a balloon is first introduced to expand the collapsed, fractured area with the goal of approximating the pre-fracture anatomy of the vertebral body and thereby spinal curvature, promptly followed by cement introduction. In intravertebral implantation procedures, a permanent jack is inserted into the vertebral body matrix and expanded craniocaudally, with the same purpose of restoring normal structure, before the matrix space is filled with cement polymer3. This article provides an overview of these vertebral augmentation techniques, including pre- and post-procedural considerations, with an emphasis on the technical aspects of the interventions.

Spinal magnetic resonance imaging in cats: differences in clinical significance of intervertebral disk extrusion, intervertebral disk protrusion, and degenerative lumbosacral stenosis.

To determine the occurrence of degenerative changes affecting the vertebral column in cats, assess their clinical significance, and determine the occurrence in cats with intervertebral disk herniation compared to other spinal diseases. 114 client-owned cats. Hospital records were retrospectively reviewed for cats with suspected myelopathy that had undergone spinal MRI. Signalment; history; neurological examination; neurolocalization; primary diagnosis; presence, type, and location of intervertebral disk herniation; and presence and location of other degenerative spinal changes (intervertebral disk degeneration [IVDD], spondylosis deformans [SD], end plate changes, dorsal compressions [DC], and foraminal stenosis [FS]) were recorded. 70% of cats showed at least 1 spinal degenerative change. The most common change was IVDD, followed by SD and intervertebral disk protrusion (IVDP), while intervertebral disk extrusion (IVDE), end plate changes, DC, and FS were uncommon to rare. Primary complaint was attributed to a degenerative condition in 22% of cats, including 100% with IVDE, 9% with IVDP, and 43% with degenerative lumbosacral stenosis (DLSS). The occurrence of degenerative spinal changes and number of intervertebral disks affected by IVDD significantly increased with age and body weight. Age was positively correlated with the occurrence of SD and DLSS. Intervertebral disk degeneration, IVDP, SD, DC, and FS were more prevalent in the lumbosacral junction. Cats with IVDD were significantly more likely to show IVDE and IVDP. This study revealed that in a population of cats presenting for signs of myelopathy, IVDE was always responsible for the clinical presentation, DLSS was commonly considered incidental, and IVDP was infrequently related to neurological signs.

Embryonic Thyroid Hormone Insufficiency Causes Structural Anomalies in the Embryo of Domestic Chick, Gallus domesticus.

Thyroid hormone (TH) is essential for growth and development, yet its specific role during embryogenesis remains incompletely understood. This study investigates the impact of TH deficiency, induced by thiourea, a known inhibitor of thyroid peroxidase (TPO), on the development of domestic chicks. Thiourea was administered before thyroid gland formation, and its presence in treated embryos was confirmed through liquid chromatography-mass spectrometry. In silico docking revealed a strong interaction between thiourea and the CCP-like domain of TPO, which was corroborated by TPO activity assays showing reduced enzyme function. This reduction in enzyme activity led to lower embryonic TH levels and increased thyroid-stimulating hormone (TSH) secretion. Morphological analysis of newly hatched chicks revealed significant structural anomalies, particularly in lateral plate mesoderm-derived structures, including omphalocele, limb deformities, anophthalmia and craniofacial defects. Alcian blue and Alizarin red staining demonstrated reduced ossification in ribs and forelimbs, while histological analysis showed incomplete abdominal wall closure and abnormal vertebral column development. Haematological profiling of TH-deficient newly hatched chicks revealed significantly lower blood cell counts, highlighting TH's critical role in haematopoiesis. These findings emphasise the multifaceted role of TH in embryonic development, with potential implications for understanding congenital hypothyroidism and its developmental impacts, especially in regions with limited healthcare access.

Neck pain but not neurologic disease occurs more frequently in horses with transposition of the ventral lamina from C6 to C7.

To determine reasons for horses to have neck radiographs performed, the incidence of transposition of the ventral lamina of C6 onto C7 (TC67), and the final diagnoses for all horses. Our hypotheses were to find a similar incidence of TC67, as has been previously reported, and an increased incidence of neck pain and dysfunction in horses with TC67. 135 horses. Retrospective observational study. Medical records of 135 horses with cervical vertebral column radiographs between 2020 and 2022 were assessed. Patient signalment, reasons for radiographs, radiographic findings, and diagnoses were analyzed. The Shapiro-Wilk test was used for normality determination. Nonparametric tests were used to analyze data. 20% of horses were diagnosed with TC67. Significantly more horses with TC67 were warmblood horses (63%); TC67 was found in 28% of warmblood horses. There was no significant difference in signalment or whether horses were in work between the groups, although significantly more horses with TC67 performed in English disciplines (71%). No differences in reasons for examination or final diagnoses of neurologic disease, cervical orthopedic disease, or lameness were present between groups. In horses with neck pain, TC67 was significantly more common (31%) than in horses without (18%). Our results indicated that TC67 occurs more in warmblood horses. In the small group of horses with neck pain reported, TC67 was more commonly seen than in those without. Given the complexity of this region and the paucity of studies exploring neck pain and neck biomechanics, we suggest the need for standardized prospective studies.

Parental Stress, Sense of Coherence, Marital Satisfaction, and Hope in Parents of Children with Spina Bifida

Spina bifida is an inborn abnormality that causes the spinal column to be split because the developing brain tube fails to shut during the fourth week of development. Caring for a child with Spina Bifida is a demanding and time-consuming responsibility that often requires parents to reassess their goals and priorities, leading to increased stress. As the implications of having a child with Spina Bifida on parents are varied and vast, the current study attempts to fill a gap in prior research by addressing the significance of the relationship between a sense of coherence, marital satisfaction, and the moderating role of hope. The current study was based on cross-sectional survey research. Data were collected with snowball sampling from parents with the age range between the ages of 25 years to 45 years from different hospitals located in Lahore and also online from social media groups. Findings revealed that parental stress is negatively related to marital satisfaction, and hope is positively associated with a sense of coherence. Hope also moderated the relationship between parental stress, sense of coherence, and marital satisfaction. The findings of this study will help to design social and moral support to facilitate such parents and enable them to face the challenges of parenting a child with SB.

Repatterning of mammalian backbone regionalization in cetaceans

Cetacean reinvasion of the aquatic realm is an iconic ecological transition that led to drastic modifications of the mammalian body plan, especially in the axial skeleton. Relative to the vertebral column of other mammals that is subdivided into numerous anatomical regions, regional boundaries of the cetacean backbone appear obscured. Whether the traditional mammalian regions are present in cetaceans but hard to detect due to anatomical homogenization or if regions have been entirely repatterned remains unresolved. Here we combine a segmented linear regression approach with spectral clustering to quantitatively investigate the number, position, and homology of vertebral regions across 62 species from all major cetacean clades. We propose the Nested Regions hypothesis under which the cetacean backbone is composed of six homologous modules subdivided into six to nine post-cervical regions, with the degree of regionalization dependent on vertebral count and ecology. Compared to terrestrial mammals, the cetacean backbone is less regionalized in the precaudal segment but more regionalized in the caudal segment, indicating repatterning of the vertebral column associated with the transition from limb-powered to axial-driven locomotion.

Causes, effects and treatment of forward head posture. Systematic literature review

The human cervical spine, with its complex structure, is designed to serve unique biomechanical functions. In addition to providing support and protection for the skull, the cervical spine also acts as a shock absorber for brain structures. Mechanically, it transfers weight and facilitates head flexion movements. To effectively carry out its function, proper alignment of the head’s posture with the body’s vertical center of gravity is necessary to minimize pressure and tension on spinal muscles. When continuous activities involving head restraint or forward bending cause an anterior translation of the head over extended periods of time, it can lead to a condition known as forward head posture (FHP). Prolonged FHP can result in injuries to muscles, tendons, and ligaments within both the cervical and lumbar regions of the spine, resulting in various health issues such as neck pain, shoulder pain or discomfort in the upper thoracic scapular segment. The aim of this study was to determine the impact, causes, and management strategies that can be implemented when forward posture occurs in individuals. The data used for this research were obtained from accredited journals such as Mendeley and PubMed. Articles were searched based on keywords related to forward head posture and then filtered according to inclusion and exclusion criteria. Ten out of 140 articles were selected as primary sources for this study. The results indicate that one significant impact of forward head posture is acute neck pain, which primarily affects an individual’s balance negatively. Known causes of forward head posture include engaging in work that involves repetitive bending or maintaining a static position where one leans their neck forwards continuously over prolonged periods. Finally, the recommended management approach when dealing with forward head posture is treatment through exercise therapy, such as Chin tuck exercise, McKenzie Neck Exercise, and Forward Head Posture Exercise.

Load Changes on a Short-Segment Posterior Instrumentation After Transosseous Disruption of L3 Vertebra - A Biomechanical Human Cadaveric Study.

Biomechanical Cadaveric Study. Following the successful use of a novel implantable sensor (Monitor) in evaluating the progression of fracture healing in long bones and posterolateral fusion of the spine based on implant load monitoring, the aim of this study was to investigate its potential to assess healing of transosseous fractures of a lumbar vertebra stabilized with a pedicle-screw-rod construct. Six human cadaveric spines were instrumented with pedicle screws and rods spanning L3 vertebra. The spine was loaded in Flexion-Extension (FE), Lateral-Bending (LB) and Axial-Rotation (AR) with an intact L3 vertebra and after its transosseous disruption, creating an AO B1 type fracture. The implant load was measured on the one rod using the Monitor and on the contralateral rod by strain gauges to validate the Monitor's measurements. In parallel, the range of motion (ROM) was assessed. ROM increased significantly in all directions in the fractured model (P ≤ 0.049). The Monitor measured a significant increase in implant load in FE (P = 0.002) and LB (P = 0.045), however, not in AR. The strain gauge - aligned with the rod axis and glued onto its posterior side - detected an increased implant load not only in FE (P = 0.001) and LB (P = 0.016) but also in AR (P = 0.047). After a complete transosseous disruption of L3 vertebra, the implant load on the rods was considerably higher vs the state with an intact vertebral body. Innovative implantable sensors could monitor those changes, allowing assessment of the healing progression based on quantifiable data.

Echo-planar DWI variants: A comparative study in vertebral marrow pathology.

Single-shot echo-planar imaging (ss-EPI) has limited application in vertebral column imaging due to numerous artifacts. Therefore, we aimed to compare readout-segmented echo-planar imaging (rs-EPI) to ss-EPI and assess its value in the differential diagnosis of vertebral infectious, tumoral infiltrative, and degenerative disorders. Sixty-six adult patients with spondylodiscitis (SD, n = 26), tumoral infiltration (TI, n = 20), or Modic type I degeneration (DE, n = 20) findings on spinal magnetic resonance imaging (MRI) included in this retrospective study. Two radiologists scored images for quality on a 4-point scale (image resolution, degree of geometric distortion, lesion selectivity, and diagnostic reliability) and measured signal intensity (SI), apparent diffusion coefficient (ADC), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). DE and SD groups also united to form the benign group. In all groups, rs-EPI performed better than ss-EPI in image quality, SNR, and CNR (p < .05). The difference between mean pathological ADC (ADCP) in the two sequences was statistically significant (p < .05). There was no significant difference between the groups in terms of ADCP in rs-EPI (p = .229), unlike ss-EPI (p = .025). Pathological SI (SIP) and CNR in rs-EPI were significantly higher in the malignant group than benign group (p = .002, p < .001). In rs-EPI, no significant difference was found between malignant and benign groups' ADCP (p = .13). The rs-EPI is a diffusion-weighted imaging (DWI) method with higher image quality that diminishes motion-induced phase errors and increases resolution through phase corrections. However, the distinction of malignant and benign vertebral bone marrow pathologies is unsatisfactory for rs-EPI compared with ss-EPI.

Movement pattern definitions for resistance training behavior measurement in diabetes.

Type 2 diabetes can result in debilitating vascular complications, and resistance training (RT) is an effective therapy for improving cardiovascular outcomes. However, only 10-30% of adults meet the public health guidance for RT. While current RT guidelines focus on targeting major muscle groups, guidance specific to simplified movement categorization may augment understanding of RT programming and improve uptake and outcomes. Current movement pattern definitions and descriptions lack clarity, accuracy, and consistency. This paper proposes movement definitions and descriptions to be used for RT intervention design and prescription, and includes the following categories: hip, knee, ankle, vertebral column, vertical push, horizontal push, vertical pull, and horizontal pull. These categories are intended to aid clinicians, researchers, and trainers in RT surveillance and RT intervention design for improving vascular complications in type 2 diabetes. Simplified RT program design using these categories may also facilitate greater RT program understanding and adherence for patients.

CSF-venous fistulas associated with traumatic spinal pseudomeningoceles.

CSF-venous fistulas (CVFs) are a common cause of spontaneous intracranial hypotension. These fistulas usually occur without any preceding major trauma, surgery, or other iatrogenic cause. Occasionally, patients have a history of minor trauma, though such cases are usually still considered spontaneous. Little is known about predisposing factors that cause patients to develop spontaneous CVFs. Most patients with CVFs have multiple meningeal diverticula on spine imaging, and fistulas usually arise in association with a diverticulum. In the vast majority of cases, the culprit diverticulum from which the CVF arises is atraumatic in origin, presumably on the spectrum of normal variation in spinal anatomy. Here, we present two cases of CVFs that arose in association with posttraumatic pseudomeningoceles. To our knowledge, this phenomenon has not yet been reported, and it potentially represents a novel etiology for CVFs that furthers understanding of their pathogenesis.

Contrast-enhanced ultrasound imaging detects anatomical and functional changes in rat cervical spine microvasculature with normal aging.

Normal aging is associated with significant deleterious cerebrovascular changes; these have been implicated in disease pathogenesis and increased susceptibility to ischemic injury. While these changes are well documented in the brain, few studies have been conducted in the spinal cord. Here, we utilize specialized contrast-enhanced ultrasound (CEUS) imaging to investigate age-related changes in cervical spinal vascular anatomy and hemodynamics in male Fisher 344 rats, a common strain in aging research. Aged rats (24-26 mo., N=6) exhibited significant tortuosity in the anterior spinal artery and elevated vascular resistance compared to adults (4-6 mo., N=6; tortuosity index 2.20±0.15 vs 4.74±0.45, p<0.05). Baseline blood volume was lower in both larger vessels and the microcirculation in the aged cohort, specifically in white matter (4.44e14±1.37e13 vs 3.66e14±2.64e13 CEUS bolus AUC, p<0.05). To elucidate functional differences, animals were exposed to a hypoxia challenge; whereas adult rats exhibited significant functional hyperemia in both gray and white matter (GM: 1.13±0.10-fold change from normoxia, p<0.05; WM: 1.16±0.13, p<0.05), aged rats showed no response. Immunohistochemistry revealed reduced pericyte coverage and activated microglia behavior in aged rats, which may partially explain the lack of vascular response. This study provides the first in vivo description of age-related hemodynamic differences in the cervical spinal cord.

Design and Performance Analysis of Robotic Vertebral-Disc Unit with Cable-Driven Mechanism.

The humanoid torso is crucial for the overall performance of a humanoid robot. Developing an effective humanoid spine is essential for enhancing this mechanism. This paper introduces a one-vertebral-disc unit inspired by human spine anatomy. A prototype was created using 3D-printed parts and commercially available components. Two general human-like motions are achieved using two servo motors and two pulleys, reducing the number of servo motors needed. The results indicate that a one-vertebral-disc unit can bend up to 15 degrees. The proposed mechanism functions effectively and successfully mimics human movements. It holds potential for integration into humanoid torsos, enabling efficient performance in human-like tasks in the future.

Percutaneous spinal decompression

Symptoms arise when narrowing of the spinal canal, lateral recesses, or intervertebral foramina impinge upon the neural structures that traverse the spinal column. Pathology involving the structures that make up the spine can narrow the relevant spaces. Here a description of percutaneous procedures that address narrowing from disc disease, ligamentum Flavum hypertrophy, and devices that open and stabilize the spine at individual levels are presented.

Role of Proton Beam Therapy in Spinal Chordomas: A Narrative Review of The Literature.

Chordomas are rare malignant neoplasms arising from vestigial remnants of the embryonic notochord. Approximately 55-70% of chordomas develop within the vertebral column. Their affinity to develop within the bones of the axial skeleton and propensity to locally invade and recur makes them challenging candidates for complete surgical excision. Adjuvant therapies are hence necessary to improve outcomes; for which chemotherapy has been observed to be largely ineffective, owing to the tumour being resistant to it. Radiotherapy is the current adjuvant therapy of choice for chordoma management. Over the years, proton beam therapy (PBT) has been the subject of medical attention, given the dosimetric benefits it confers over traditional radiotherapy, allowing more concentrated radiation to be given to the target of interest and reducing damage to surrounding normal tissue. A review of the current literature reveals PBT offers significantly better outcomes when used as an adjuvant to maximal surgical resection rather than as a definitive therapy.

Fetal premature excess vertebral linear calcification: a case series.

During embryogenesis, the vertebrae begin development during the 6th week of gestation via two lateral chondrification centers per segment. It was assumed that when disruptions occur in the process of somitogenesis during membranous vertebral body formation, chondrification and ossification will follow the anomalous membranous vertebral body scaffolding, resulting in an anomalous vertebral formation, such as a hemivertebra. Another hypothesis is that hemivertebra may result from anomalous distribution of intersegmental arteries of the vertebral column. There is no description in the medical literature of "excess linear calcifications" of part of the fetal vertebra, characterized by the presence of linear calcifications in the vertebrae of a developing fetus. In the first two trimesters of pregnancy, the fetal vertebrae usually show three calcified points in an axial section: the vertebral body and two transverse processes. Premature linear vertebral calcification was defined as an anterior or posterior echogenic connection between two of the points (Fig. 1). In this study, we describe seven cases of premature fetal linear vertebral calcification.

Surgical treatment for local recurrence of spinal hemangiomas.

SH is considered to be the most common benign tumor within the human spine. 1-2% of SH get symptomatic with back pain in most cases. Less often, ingrowth of vessels into the spinal canal is seen. In these cases, more invasive surgical treatment is required. Recurrence of SH following surgical treatment is a very rare condition. We present the results of a retrospective chart review, with description of the clinical course of 12 patients with spinal canal invading SH without recurrence and of 5 patients with a recurrent SH. Recurrence was diagnosed 70 months (mean value) after the first procedure. All patients with a recurrent SH had received an incomplete tumor resection as a first treatment. The distribution of gender, age at the diagnosis, levels involved by the tumor, and initial symptoms were comparable in the group of patients with and without recurrence. The patients with recurrent SH were treated with preoperative embolization and en bloc resection or complete piecemeal resection of the affected vertebra. For stabilization, a combined, circumferential fixation was used consisting in a TSM cage filled by bone graft and posterior pedicle screw rod instrumentation in all patients. We followed these patients until 09/ 2023, mean FU 122 months (range 72-184 months). At this time, we found no evidence of tumor recurrence, good clinical conditions in all patients, no signs of implant failure or pseudarthrosis. Thus, radical excision, sufficient stabilization and fusion is considered to be an adequate treatment concept for recurrent SH.

Utility of 3D-Printed Models in the Surgical Planning for Primary Spine Tumors: A Survey of International Spinal Oncology Experts.

Survey study. The purpose of this study was to characterize the utility of 3D printed patient specific anatomic models for the planning of complex primary spine tumor surgeries. A survey of individual members of an international study group of spinal oncology surgeons was performed. Participants were provided a clinical vignette, pathologic diagnosis, and pre-operative imaging for three primary spinal oncology cases. Study participants provided a free text surgical plan for resection and were then presented an associated 3D printed model for each case and asked to re-evaluate their surgical plan. Ten spinal oncology surgeons participated in the study, representing nine institutions across five countries. Four of the surgeons (40%) made significant changes to their surgical plan after reviewing the 3D models, including sacrifice of an additional nerve root to obtain negative margins, sparing an SI joint that was originally planned for inclusion in the en bloc resection, adjusting the location of osteotomy cuts, changes to the number of surgical stages and/or staging order, and preservation of neurology that was originally planned for sacrifice. The overall impression of the 3D models was positive, with 90% of the participants stating they found the 3D model useful in developing a surgical plan. Surgical planning for resection of primary spinal column tumors is challenging and time intensive. 3D printed patient specific surgical models may be an additional tool that can augment surgical planning and execution by improving the chance of accomplishing surgical resection goals and minimizing morbidity.

Sociodemographic Data and Work-Related Musculoskeletal Symptoms in the Metal Polishing Industry: A Case Study in Central Portugal

The prevalence of work-related musculoskeletal disorders is a red flag in industries and is considered an occupational health issue that affects the operator’s well-being, safety, and health. This study contributes to understanding the impact of Industry 5.0 on the workforce and emphasizes the importance of promoting a safe and healthy working environment. Thus, it focuses on the assessment of anthropometric characteristics and work-related musculoskeletal symptoms in a real industrial environment, specifically in the metal polishing sector of a metallurgical industry in Portugal. The research collected data on physical attributes, health status, and musculoskeletal symptoms using the Portuguese version of the Nordic Musculoskeletal Questionnaire, and incorporated sociodemographic data, including age, gender, and professional status, to provide a comprehensive understanding of the active workforce. The results were analyzed by gender and age clusters and revealed a prevalence of musculoskeletal symptoms, particularly in the spinal column and upper limbs, with a significant impact on the ability to perform work tasks. The need for preventive measures and ergonomic interventions to minimize the high predominance of musculoskeletal symptoms in Portuguese industries is also highlighted to improve the working conditions and enhance the well-being and health of operators.