Consecutive Vertebral Bodies Research Articles

A Pain in the Neck: An Adolescent with Neck Pain.

A Pain in the Neck: An Adolescent with Neck Pain.

Outcomes and Toxicity of Single- And Multi-Fraction Spine Radiosurgery for Three or More Vertebral Bodies

Spine radiosurgery is an accepted standard treatment for vertebral body metastases and is traditionally restricted to one or two consecutive vertebral bodies due to toxicity concerns with larger volumes. Thus, the outcomes and toxicity of radiosurgery to a larger volume of three or more vertebral bodies are poorly characterized. We sought to describe our single-institution experience of treating patients with radiosurgery to three or more consecutive vertebral bodies. An IRB-approved retrospective review of our prospectively maintained radiosurgery database was performed. Inclusion criteria were men and women receiving single- or multi-fraction spine radiosurgery to three or more consecutive vertebral bodies with at least one month of follow-up. We recorded outcome data such as local control, overall survival, and pain response. Local progression was defined as radiologic progression, recurrent pain in the treatment field, or a vertebral body metastasis in the body adjacent to the treatment volume. Pain scores (scored 0-10) in the treated area were evaluated within one month before treatment and in longer follow-up. Average change in pain score after treatment was reported. Karnofsky performance status (KPS) was also evaluated within one month before treatment and in follow up. KPS was based on debilitation from tumors at the treated site. Toxicity endpoints of interest were radiation myelopathy and vertebral body fracture. 32 patients were identified (18 male, 14 female), and 35 total sites were treated. Median age of patient at time of SRS treatment was 59. Median dose in single fraction was 1300cGy (range: 800-1800cGy), and median dose in multiple fractions was 2400cGy (range: 1800-3000cGy). 21% of patients had cervical spine metastases, 55% with thoracic spine metastases, and 24% with lumbar spine metastases, with primary tumor sites including colon, breast, thymus, pelvis, lung, mammary gland, kidney, thyroid, nasopharynx, rhabdomyosarcoma, bone, schwannoma, and vulva. 14/32 (43%) patients had epidural or paraspinal soft tissue components of their disease. The six-month local control rate was 77%. The one-year survival rate was 49%. Average change in pain score was -.5 (range: -7-+4, st dev ±2.55). Median pre-treatment KPS was 90%, and median post-treatment KPS was 80%, with 7/32 (22%) patients having a decline in 20% or greater, and 2/32 (6.2%) patient having an improvement of 20% or greater. Incidence of vertebral compression fracture was 4/32 (12.5%), and radiation myelopathy was 0/32 (0%). Treatment of patients with radiosurgery to three or more consecutive vertebral body metastases is well tolerated. For the majority of treated patients, single- or multi-fraction radiosurgery provides durable local control, modest pain relief, preserved quality of life, and low rates of severe toxicity.

Quantitative Vertebral Bone Density Seen on Chest CT in Chronic Obstructive Pulmonary Disease Patients: Association with Mortality in the Korean Obstructive Lung Disease Cohort.

ObjectivePatients with chronic obstructive pulmonary disease (COPD) are known to be at risk of osteoporosis. The purpose of this study was to evaluate the association between thoracic vertebral bone density measured on chest CT (DThorax) and clinical variables, including survival, in patients with COPD.Materials and MethodsA total of 322 patients with COPD were selected from the Korean Obstructive Lung Disease (KOLD) cohort. DThorax was measured by averaging the CT values of three consecutive vertebral bodies at the level of the left main coronary artery with a round region of interest as large as possible within the anterior column of each vertebral body using an in-house software. Associations between DThorax and clinical variables, including survival, pulmonary function test (PFT) results, and CT densitometry, were evaluated.ResultsThe median follow-up time was 7.3 years (range: 0.1–12.4 years). Fifty-six patients (17.4%) died. DThroax differed significantly between the different Global Initiative for Chronic Obstructive Lung Disease stages. DThroax correlated positively with body mass index (BMI), some PFT results, and the six-minute walk distance, and correlated negatively with the emphysema index (EI) (all p < 0.05). In the univariate Cox analysis, older age (hazard ratio [HR], 3.617; 95% confidence interval [CI], 2.119–6.173, p < 0.001), lower BMI (HR, 3.589; 95% CI, 2.122–6.071, p < 0.001), lower forced expiratory volume in one second (FEV1) (HR, 2.975; 95% CI, 1.682–5.262, p < 0.001), lower diffusing capacity of the lung for carbon monoxide corrected with hemoglobin (DLCO) (HR, 4.595; 95% CI, 2.665–7.924, p < 0.001), higher EI (HR, 3.722; 95% CI, 2.192–6.319, p < 0.001), presence of vertebral fractures (HR, 2.062; 95% CI, 1.154–3.683, p = 0.015), and lower DThorax (HR, 2.773; 95% CI, 1.620–4.746, p < 0.001) were significantly associated with all-cause mortality and lung-related mortality. In the multivariate Cox analysis, lower DThorax (HR, 1.957; 95% CI, 1.075–3.563, p = 0.028) along with older age, lower BMI, lower FEV1, and lower DLCO were independent predictors of all-cause mortality.ConclusionThe thoracic vertebral bone density measured on chest CT demonstrated significant associations with the patients' mortality and clinical variables of disease severity in the COPD patients included in KOLD cohort.

Involvement of two consecutive vertebral bodies and intervertebral disc space in dorsal spinal hydatid disease

A 59-year-old man who had a history of hepatic hydatid cyst operation presented with progressive back pain and paraparesis. Thoracic spine magnetic resonance imaging revealed heterogeneous low and high signal in the T9, T10 vertebral bodies and intervertebral disc space on both T1and T2weighted magnetic resonance imaging caused by hydatid disease. The intraspinal extradural cystic components of the lesion demonstrated low T1 signal and high T2 signal with low-signal-intensity rims on images (Figs. 1 and 2). Postcontrast images did not reveal significant enhancement (Fig. 3). Plain computed tomography demonstrated destruction of the T9, T10 vertebral end plates and posterior portion of the T10 vertebral body with sclerotic areas (Fig. 4). Surgery was performed, and a pathologic examination confirmed the diagnosis of hydatid disease. Involvement of two consecutive vertebral bodies together with intervertebral disc space involvement in dorsal spinal hydatid disease is extremely rare and should be considered in the differential diagnosis of atypical spondylodiscitis.

Comparison between Prone and Supine Patient Setup for Spine Stereotactic Body Radiosurgery

This paper investigates the dosimetric characteristics of stereotactic body radiotherapy (SBRT) treatment plans of spine patients in the prone position compared to the supine position. A feasibility study for treating spine patients in the prone position using a fiducial-less tracking method is presented. One patient with a multilevel spinal metastasis was simulated for SBRT treatment in both the supine and prone position. CT scans of the patient were acquired, and treatment plans were created using the CyberKnife® planning platform. The potential advantage of the prone setup as a function of lesion location and number of vertebral bodies involved was studied for targets extending over 1, 2 and 3 consecutive vertebral bodies in the thoracic and lumbar spine. The same process was repeated on an anthropomorphic phantom. A dose of 30 Gy in 5 fractions was prescribed to 95% of the tumor volume and the dose to the cord was limited to 25 Gy. To investigate the feasibility of a fiducial-less tracking method in the prone setup, the patient was positioned prone on the treatment table and the spine motion was monitored as a function of time. Patient movement with the respiratory cycle was reduced by means of a belly-board. Plans in the prone and supine position achieved similar tumor coverage and sparing of the critical structures immediately adjacent to the spine (such as cord and esophagus). However, the prone plans systematically resulted in a lower dose to the normal structures located in the anterior part of the body (such as heart for thoracic cases; stomach, lower gastrointestinal tract and liver for lumbar cases). In addition, prone plans resulted in a lower number of monitor units compared to supine plans.

Adult Scheuermann Kyphosis: Evaluation, Management, and New Developments

Scheuermann kyphosis is a structural hyperkyphosis defined radiographically as anterior wedging of ≥5° of at least three consecutive vertebral bodies. Typically, the disease develops during adolescence but may not present until adulthood. The etiology remains unknown. Indications for management include progressive deformity, pain, cosmesis, neurologic deficit, and cardiopulmonary compromise. Surgical intervention is indicated in patients with persistent pain and unacceptable deformity caused by significant kyphosis. Surgery can be performed through posterior-only, anterior-only, or combined anterior-posterior approaches. Correction should include the entire length of the kyphosis and should not exceed 50% of the original deformity. The most common postoperative complications are wound infection and loss of correction.

Predictive factors for subsequent vertebral fracture after percutaneous vertebroplasty

The purpose of this study was to evaluate the predictive factors for subsequent vertebral fracture occurring after percutaneous vertebroplasty (PVP) at the neighboring levels (adjacent vs nonadjacent levels). The medical records of 508 consecutive patients treated with PVP between January 2000 and December 2002 were retrospectively reviewed. A total of 45 patients with 49 painful vertebral fractures occurring after PVP was identified based on clinical and radiological findings. New vertebral fractures, developing at any of the 3 consecutive vertebral bodies (VBs) above or below the previously treated level, were the focus of the study. The patients were divided into 3 groups: an adjacent-level fracture group, nonadjacent-level fracture group, and a control group composed of 50 randomly selected patients in whom there was no evidence of a new fracture. Clinical, imaging, and procedure-related factors for each group were statistically analyzed. In 31 patients 35 VBs were classified as adjacent-level fractures, and in 14 patients 14 VBs were classified as nonadjacent-level fractures. After further vertebroplasty, the overall pain intensity and satisfaction rate in patients with post-PVP fractures were similar to those in the control group. In cases involving adjacent fractures, lower body mass index and intradiscal cement leakage were the significant predictive factors of fracture. In contrast, lower mobility of the index segment was related to nonadjacent-level fracture. According to the authors' results, the mechanisms of subsequent fracture at adjacent and nonadjacent vertebrae are different. A direct pillar effect (that is, the difference in strength caused by cement augmentation) may provoke an adjacent-level fracture, whereas a dynamic hammer effect (the difference in segmental mobility) may lead to a nonadjacent fracture.

Diffuse Idiopathic Skeletal Hyperostosis

Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier’s disease, is common spinal enthesopathy affecting approximately 3% to 30% of men older than the age of 50 years. The diagnosis is made radiographically by the (1) presence of flowing osteophytes on the anterolateral margin of at least 4 consecutive vertebral bodies , (2) the preservation of disc height, and (3) the lack of changes associated with sponydloarthropathy or degenerative arthritis . DISH most commonly affects the thoracic spine but also is found in the cervical and lumbar spine. Patients may present with back pain and axial stiffness, but they often are asymptomatic. Most significantly, patients with DISH, even if they are asymptomatic, are at increased risk for severe spinal cord injury even with minimal spinal trauma.

Axial bone mineral density in patients with acromegaly

The purpose of this study was to assess the influence of long-term elevated levels of growth hormone and insulin-like growth factor I on bone mineral density (BMD) of the spine in patients with acromegaly. The spinal BMD in 40 patients with acromegaly was measured with quantitative computed tomography. The result was expressed as the mean of six measurements of consecutive vertebral bodies and as a z score. Twenty age- and sex-matched healthy persons also underwent spinal BMD measurement and served as controls. In 36 of the 40 patients, the BMD z score ranged within 2 standard deviations (SDs) above or below the mean. Only two patients (one man and one woman) had enhanced BMD loss (below 2 SD). Two other female patients had BMD values of more than 2 SD above the mean. Differences between patient subgroups were not statistically significant, but a statistically significant (P < .05) positive correlation was found between basal serum concentration of growth hormone and spinal BMD for the entire patient group. No correlation between BMD and basal serum concentration of insulin-like growth factor I was found. Hypersecretion of growth hormone in patients with acromegaly, regardless of other factors, has no evident effect on BMD of the lumbar spine.