Dorsal Column Research Articles

Predicting Immediate Lordosis Restoration After Anterior Lumbar Interbody Fusion and the Effect of Posterior Column Osteotomies

Anterior lumbar interbody fusion (ALIF) can be combined with posterior column osteotomies (PCOs) to maximize lordotic correction. This study compares radiographic changes in regional and segmental lordosis in patients undergoing ALIF with and without PCOs. Patients >18 years old who underwent ALIF at 1 or 2 segments at a single institution (January 2014-July 2020) were included. Preoperative and postoperative radiographic parameters were determined, and a propensity-matched analysis was performed. Ninety-nine patients (53 [54%] men) underwent ALIF at 129 levels (mean [SD], 1.3 [0.46] levels; median [range] age, 61 [32-83] years). PCOs were performed in 13 (13%) patients at 19 (15%) segments. PCOs included 13 Schwab grade 1 and 6 grade 2 osteotomies. All measures, including lumbar lordosis, segmental lordosis, disc angle, and neural foramen height, increased significantly after surgery (p≤0.003). In the propensity-matched analysis, PCO was associated with greater increases in lumbar lordosis (14.9° vs. 8.2°, p=0.02), segmental lordosis (14.0° vs. 9.6°, p=0.03), and disc angle (15.0° vs. 10.2°, p=0.046). The change in disc angle more closely approximated the inherent lordosis of the cage when PCO was performed (94% vs. 62%, p=0.004). Performing PCOs and ALIFs significantly increased the radiographic correction of overall and segmental lordosis in the selected patient cohort. The disc angle achieved with ALIF without PCOs was approximately 60% of the cage lordosis. The addition of PCO allowed for greater segmental compression, enabling the disc angle to reach nearly 100% of the inherent interbody cage lordosis.

Clinical Outcomes of Prone Transpsoas Lumbar Interbody Fusion: A 1-Year Follow-Up.

Lateral lumbar interbody fusion (LLIF) is commonly used to address various lumbar pathologies. LLIF using the prone transpsoas (PTP) approach has several potential advantages, allowing simultaneous access to the anterior and posterior columns of the spine. The aim of this study was to report the 1-year outcomes of LLIF via PTP. This is a retrospective review of 97 consecutive patients who underwent LLIF via PTP. Radiographic parameters, including lumbar-lordosis, segmental-lordosis, anterior disc height, and posterior disc height, were measured on preoperative, initial-postoperative, and 1-year postoperative imaging. Patient-reported outcomes measures, including Oswestry Disability Index, visual analog scale (VAS), pain EQ5D, and postoperative complications, were reviewed. Ninety-seven consecutive patients underwent 161 levels of LLIF. Fifty-seven percent underwent 1-level LLIF, 30% 2-level LLIF, 6% 3-level LLIF, and 7% 4-level LLIF. The most common level was L4 to L5 (35%), followed by L3 to L4 (33%), L2 to L3 (21%), and L1 to L2 (11%). Significant improvements were noted at initial and 1-year postoperative periods in lumbar-lordosis (2° ± 10°, P = 0.049; 3° ± 9°, P = 0.005), segmental-lordosis (6° ± 5°, P < 0.001; 5° ± 5°, P < 0.001), anterior disc height (8 mm ± 4 mm, P < 0.001; 7 mm ± 4 mm, P < 0.001), and posterior disc height (3 mm ± 2 mm, P < 0.001; 3 mm ± 2 mm, P < 0.001). Significant improvements were seen in Oswestry Disability Index at 6 weeks (P = 0.002), 6 months (P < 0.001), and 1 year (P < 0.001) postoperatively; pain EQ5D at 6 weeks (P < 0.001), 6 months (P < 0.001), and 1 year (P < 0.001) postoperatively; and leg and back visual analog scale at 2 weeks (P < 0.001), 6 months (P < 0.001), and 1 year (P < 0.001) postoperatively. The average length of stay was 2.5 days, and the most common complications were ipsilateral hip flexor pain (46%), weakness (59%), and contralateral hip flexor pain (29%). PTP is a novel way of performing LLIF. These 1-year data support that PTP is an effective, safe, and viable approach with similar patient-reported outcome measures and complications profiles as LLIF performed in the lateral decubitus position.

Fibronectin induces a transition from amoeboid to a fan morphology and modifies migration in Entamoeba histolytica.

Cell migration modes can vary, depending on a number of environmental and intracellular factors. The high motility of the pathogenic amoeba Entamoeba histolytica is a decisive factor in its ability to cross the human colonic barrier. We used quantitative live imaging techniques to study the migration of this parasite on fibronectin, a key tissue component. Entamoeba histolytica amoebae on fibronectin contain abundant podosome-like structures. By using a laminar flow chamber, we determined that the adhesion forces generated on fibronectin were twice those on non-coated glass. When migrating on fibronectin, elongated amoeboid cells converted into fan-shaped cells characterized by the presence of a dorsal column of F-actin and a broad cytoplasmic extension at the front. The fan shape depended on the Arp2/3 complex, and the amoebae moved laterally and more slowly. Intracellular measurements of physical variables related to fluid dynamics revealed that cytoplasmic pressure gradients were weaker within fan-shaped cells; hence, actomyosin motors might be less involved in driving the cell body forward. We also found that the Rho-associated coiled-coil containing protein kinase regulated podosome dynamics. We conclude that E. histolytica spontaneously changes its migration mode as a function of the substrate composition. This adaptive ability might favour E. histolytica's invasion of human colonic tissue. By combining microfluidic experiments, mechanical modelling, and image analysis, our work also introduces a computational pipeline for the study of cell migration.

Anatomical bases of the latissimus dorsi flap to close of cerebrospinal fluid fistulas

Cerebrospinal fluid (CSF) fistulas are a real problem for their resolution. Due to the formation and constant pressure, added to the effect of the liquid on the tissues where the fistula is located, they do not close. Repair of the meninges must be carried out (generally with synthetic materials) and it is also necessary to provide vital tissues for definitive closure. Among the options described is the latissimus dorsi musculocutaneous or myocutaneous flap (LD flap) – musculus latissimus dorsi (TA) for the immediate reconstruction of dorsal defect fistulas, providing a good volume of tissue. The flap bases its circulation on the primary pedicle (subscapular vessels) with mobilization of the muscle towards the dorsal column. The present work presents the anatomical principles in fresh dissections of the LD flap. Detailed dissections of the pedicles that supply the flap are shown, as well as surgical bases to elevate the flap and transpose it towards the dorsal region. A clinical case is presented where LD flap was successfully used to close a cerebrospinal fluid fistula after oncological surgery for a dorsal column tumor

The role of spinal cord neuroanatomy in the variances of epidural spinal recordings

BackgroundSpinal cord stimulation (SCS) has demonstrated multiple benefits in treating chronic pain and other clinical disorders related to sensorimotor dysfunctions. However, the underlying mechanisms are still not fully understood, including how electrode placement in relation to the spinal cord neuroanatomy influences epidural spinal recordings (ESRs). To characterize this relationship, this study utilized stimulation applied at various anatomical sections of the spinal column, including at levels of the intervertebral disc and regions correlating to the dorsal root entry zone.MethodTwo electrode arrays were surgically implanted into the dorsal epidural space of the swine. The stimulation leads were positioned such that the caudal-most electrode contact was at the level of a thoracic intervertebral segment. Intraoperative cone beam computed tomography (CBCT) images were utilized to precisely determine the location of the epidural leads relative to the spinal column. High-resolution microCT imaging and 3D-model reconstructions of the explanted spinal cord illustrated precise positioning and dimensions of the epidural leads in relation to the surrounding neuroanatomy, including the spinal rootlets of the dorsal and ventral columns of the spinal cord. In a separate swine cohort, implanted epidural leads were used for SCS and recording evoked ESRs.ResultsReconstructed 3D-models of the swine spinal cord with epidural lead implants demonstrated considerable distinctions in the dimensions of a single electrode contact on a standard industry epidural stimulation lead compared to dorsal rootlets at the dorsal root entry zone (DREZ). At the intervertebral segment, it was observed that a single electrode contact may cover 20-25% of the DREZ if positioned laterally. Electrode contacts were estimated to be ~0.75 mm from the margins of the DREZ when placed at the midline. Furthermore, ventral rootlets were observed to travel in proximity and parallel to dorsal rootlets at this level prior to separation into their respective sides of the spinal cord. Cathodic stimulation at the level of the intervertebral disc, compared to an ‘off-disc’ stimulation (7 mm rostral), demonstrated considerable variations in the features of recorded ESRs, such as amplitude and shape, and evoked unintended motor activation at lower stimulation thresholds. This substantial change may be due to the influence of nearby ventral roots. To further illustrate the influence of rootlet activation vs. dorsal column activation, the stimulation lead was displaced laterally at ~2.88 mm from the midline, resulting in variances in both evoked compound action potential (ECAP) components and electromyography (EMG) components in ESRs at lower stimulation thresholds.ConclusionThe results of this study suggest that the ECAP and EMG components of recorded ESRs can vary depending on small differences in the location of the stimulating electrodes within the spinal anatomy, such as at the level of the intervertebral segment. Furthermore, the effects of sub-centimeter lateral displacement of the stimulation lead from the midline, leading to significant changes in electrophysiological metrics. The results of this pilot study reveal the importance of the small displacement of the electrodes that can cause significant changes to evoked responses SCS. These results may provide further valuable insights into the underlying mechanisms and assist in optimizing future SCS-related applications.

Predictive Value of Bolster Supine X-Ray for the Correction of Segmental Deformity After Thoracolumbar Fusion Surgery.

Assessment of thoracolumbar spine flexibility is crucial for determining which osteotomy to perform (posterior column osteotomy or 3-column osteotomy) to restore sagittal balance. Although preoperative bolster supine X-rays have been used to evaluate spine flexibility, their correlation with postoperative spinopelvic parameters has not been reported. We aimed to evaluate the predictive value of bolster X-ray for correcting sagittal deformities after thoracolumbar fusion surgery. We retrospectively evaluated patients who underwent bolster supine radiography before posterior thoracolumbar fusion. Demographic data, operative records, and radiographic parameters were also recorded. The segmental Cobb angle, defined as the angle between the upper endplate of the uppermost and lower endplates of the lowest instrumented vertebrae, was compared between bolster and postoperative X-ray to evaluate the correlation between them. The predictive value of bolster X-ray for postoperative deformity correction was measured using intraclass correlation coefficients (ICC). Forty-two patients were included. The preoperative segmental Cobb angle (-1.4 ± 22.4) was significantly lower than the bolster segmental Cobb angle (23.2 ± 18.7, P < .001) and postoperative segmental Cobb angle (27.9 ± 22.3, P < .001); however, no significant difference was observed between the bolster and postoperative segmental Cobb angles (P = .746). Bolster X-ray showed a very strong correlation with postoperative X-ray (r = 0.950, P < .001) for segmental Cobb angle. Bolster supine X-ray had good-to-excellent reliability for postoperative X-ray with an ICC of 0.913 (95% CI, 0.760-0.962, P < .001) for the segmental Cobb angle. Bolster supine X-rays demonstrate good-to-excellent reliability with postoperative X-rays for segmental Cobb angles. These findings offer valuable insights into the selection of appropriate osteotomy techniques for clinical practice.

A Cross-sectional Study on the Prevalence of Cervicogenic Headache amongst University Students

The Cervicogenic Headache Society defines CGH as headache pain that radiates to the head's regions and is mostly caused by nociceptors associated with musculoskeletal disorders. A unilateral headache and neck discomfort resulting from dysfunction of the osseous, disc, and soft tissue constituents of the cervical vertebrae are known as a cervicogenic headache (CGH). It frequently comes with neck pain. Through the trigeminocervical nucleus, pain from the neck can be transmitted to the head. It is anatomically and functionally coherent with the posterior gray columns that constitute these spinal segments, and it extends through the canal of the spinal cord to the C3/4 vertebral column. Convergence refers to the possibility that sensory afferents' input—mainly from the upper 3 cervical nerve roots—may be misinterpreted as discomfort in the head.

A double CYP27A1 gene mutation in spinal cerebrotendinous xanthomatosis in a patient presenting with spastic gait: a case report

BackgroundCerebrotendinous xanthomatosis (CTX, OMIM #213700) is a rare inherited metabolic disease caused by the mutation in the CYP27A1 gene. Spinal CTX is a rare clinical subgroup of CTX which lacks typical symptoms seen in classical CTX. Here we report a spinal CTX case revealed double mutation of CYP27A1 gene.Case presentationA 42-year-old Asian man visited our hospital with spastic gait started at 35. Physical examination showed bilateral masses on his Achilles tendons and were identified as xanthoma on ankle magnetic resonance imaging (MRI). Brain and spinal cord MRI revealed high signal lesions in bilateral cerebellar dentate nuclei and long tract lesions involving lateral corticospinal and gracile tracts. Gene analysis revealed double heterozygous mutation, c.223C > T (p. Gln75Ter) and c.1214G > A (p. Arg405Gln).ConclusionsWe believe that novel mutation detected in our case might have a role in the pathomechanism in CTX. Moreover, spinal CTX should be considered in the patients only presenting with pyramidal symptoms, as CTX shows good prognosis in early treatment with chenodeoxycholic acid.

Iliac Accessory Rod Technique for Rod Fracture Prevention in Long Fusion Constructs: 2-Dimensional Operative Video.

Implant-related complications in surgery for adult spinal deformity (ASD) account for roughly $1 billion US health care expenditures over 5 years, with a majority due to primary rod fracture.1,2 Traditional two-rod constructs have demonstrated rod fracture rates of up to 40%, with a median time to fracture of 3 years.3 Current supplementary rod techniques for decreasing rod fractures inadequately address the issue of increased strain across the lumbosacral junction.4 Here, we describe a novel four-rod technique using "iliac accessory rods," designed to mitigate rod fractures by reinforcing osteotomy levels and dispersing biomechanical stress across the lumbosacral junction. Compared with other supplementary rod techniques for ASD, iliac accessory rods anchor to independent iliac bolts.5 The added fixation points across the lumbosacral junction (4 iliac bolts total) substantially offloads stress on primary rods, most of which fracture near the lumbosacral junction.3 Additionally, connecting these rods to primary rods rostrally via side-to-side connectors, above the osteotomy levels, ensures mobile osteotomy segments are reinforced. Presented is a 78-year-old woman with ASD and worsening lower back pain, radiculopathy, and bilateral leg weakness who failed nonoperative management. She underwent T9 to bi-iliac instrumented fusion with L1-S1 posterior column osteotomies, L4-S1 transforaminal lumbar interbody fusions, and bilateral iliac accessory rod fixation. Postoperatively, she recovered well and had improvement in her symptoms. Imaging revealed correction of spinal alignment. The patient consented to the procedure, and the participants and any identifiable individuals consented to publication of his/her image. Institutional Review Board approval was waived because of institutional exemption policy.

Independent volumetric internal fixation reduces posterior column acetabular fracture site motion as compared to plate/screw construct: A biomechanical analysis

Aims & objectivesTo establish whether a suprapectineal pelvic reconstruction plate and posterior column screw (P&S) construct or a single 6.5-mm cannulated posterior column screw (PCS) construct demonstrates greater mechanical stability for fixation of acetabulum fractures involving the posterior column (PC). We hypothesized that the PCS construct would result in less fracture site motion. Materials & methodsTwelve fourth-generation composite hemipelvi were utilized, 6 for each construct. The P&S construct consisted of a suprapectineal pelvic reconstruction plate with two 3.5-mm posterior column screws crossing the fracture site in lag-by-technique fashion and two screws anchoring the plate to the sciatic buttress. The PCS construct consisted of a single 6.5-mm partially threaded cannulated screw placed in an antegrade fashion. Both fixation models were cyclically loaded at 0.5 cycles/second at 400N and 800N, first in a sit-to-stand position that is expected during recovery, and subsequently in a squat-to-stand position to test overload conditions. ResultsUnder sit-to-stand loading, the PCS construct resulted in less motion at the fracture site than the P&S construct (0.06 ± 0.02 mm vs 0.1 ± 0.02 mm at 400N, p = 0.02; 0.13 ± 0.03 mm vs 0.19 ± 0.04 mm at 800N, p = 0.03). The PCS construct also demonstrated less fracture site motion under squat-to-stand loading (0.22 ± 0.13 mm vs 1.9 ± 0.5 mm at 400N, p = < 0.001; 1.48 ± 0.44 mm vs 4.77 ± 0.3 mm at 800N, p = < 0.001). At 800 N, half of the repairs failed during squat-to-stand loading (2 PCS, 4 P&S). ConclusionFixation of the posterior column of the acetabulum with a 6.5-mm cannulated screw demonstrated comparable fracture motion upon loading compared to the plate and screw construct.

When Euphoria Turns to Neuropathy: Vitamin B12 Deficiency Related to Nitrous Oxide

Background: Nitrous oxide is a widely abused inhalant known for its rapid onset of euphoric sensations. Chronic use, however, can result in functional vitamin B12 deficiency, causing megaloblastic anemia, peripheral neuropathy, and subacute combined degeneration (SCD) of the spinal cord. Case Presentation: This case report examines a 43-year-old male with a history of attention-deficit/hyperactivity disorder (ADHD) and chronic back pain, who presented with neurological symptoms secondary to chronic nitrous oxide use, subsequent B12 deficiency. The patient reported a one week history of lower extremity swelling, paresthesias, and vertigo. He admitted to daily nitrous oxide use for the past month. Neurological examination revealed ataxia, impaired proprioception, and a positive Romberg test. Laboratory studies showed macrocytic anemia and a severely decreased B12 level. MRI of the cervical spine revealed T2 hyperintensity in the dorsal columns, consistent with SCD. He was treated with intramuscular B12 and advised to discontinue nitrous oxide use. At a three-month follow-up, significant neurological improvement was noted, allowing him to return to work. Conclusion: Chronic nitrous oxide use can lead to functional B12 deficiency and subacute combined degeneration, a potentially reversible condition if treated early. Differential diagnoses include pernicious anemia, malabsorption syndromes, and other neurological disorders. Prompt diagnosis through serum B12, methylmalonic acid, homocysteine levels, and spinal imaging is essential to prevent permanent neurological damage. Nitrous oxide abuse is an emerging cause of B12 deficiency. Early recognition and intervention are essential for recovery. Healthcare providers should consider B12 deficiency in patients presenting with neurological symptoms and a history of nitrous oxide use.

Novel method of iliac accessory rods for rod fracture prevention in adult deformity surgery: a case series of 82 patients with outcomes and complications.

Primary rod fracture after surgery for adult spinal deformity (ASD) is a leading cause of revision, with recent prospective multicenter fracture rates reported at 11%-14% by 2 years. Consequently, the addition of supplemental rods has been explored to reduce fractures. Here the authors describe their experience with a novel iliac accessory rod technique in which each accessory rod anchors to an independent iliac bolt caudally via lateral connector, and attaches to the primary rod rostrally via side-to-side connector. This retrospective, single-center case series included patients who underwent thoracolumbar/lumbar fusion for ASD between March 2019 and August 2023. Data on baseline demographics, radiographic parameters, surgical characteristics, complications, rod fracture, and revision rates were collected. Paired, 2-tailed t-tests were used to compare pre- and postoperative radiographic outcomes. Rod fracture rates were compared to prior investigations via chi-square goodness of fit testing. The technique for iliac accessory rod placement is described. The study consisted of 82 patients (mean age 66 years, 51% female, 26% with prior fusion) with a median follow-up of 2 years (IQR 28-104 weeks). A total of 50 patients (61%) had ≥ 2-year follow-up. Each surgery involved an average of 4 posterior column osteotomies and 8 segments. Iliac accessory rods were cobalt chromium and were placed bilaterally in 87% of constructs. Postoperative alignment improved significantly in the following parameters: maximum coronal Cobb angle, fractional curve, sagittal vertical axis, lumbar lordosis, thoracic kyphosis, and pelvic incidence to lumbar lordosis mismatch (p < 0.001 for all comparisons). Of 50 patients with ≥ 2-year follow-up, rod fracture occurred in 1 (2.0%), which was incidentally found and required no intervention. The present rod fracture rate was significantly lower than the authors' historically reported institutional rate of 21% for traditional dual-rod constructs, and the 11%-14% reported in recent prospective multicenter studies that used traditional and supplemental rod constructs (p < 0.05 for all comparisons). Reoperation occurred in 12 patients (14.6%); 7 (8.5%) for proximal junctional kyphosis and 5 (6.1%) for wound complication. Here the authors describe their experience with a novel iliac accessory rod technique to prevent rod fracture in patients undergoing surgery for ASD. The 2-year rod fracture rate (2.0%) in this study is significantly lower than the authors' historical dual-rod fracture rate, and other prospective multicenter investigations. Future studies with longer follow-up are needed to determine the durability of this technique.

Chronic Low Back Pain: History, Symptoms, Pain Mechanisms, and Treatment.

Chronic low back pain (cLBP) is the most frequently reported cause of years lived with disability. Identifying the anatomical structures or dysfunction contributing to patients' symptoms is critical to guiding treatment. The etiology of back pain and differential diagnosis is often broad, ranging from non-degenerative cLBP (trauma, tumor, inflammation, infection, etc.) to degenerative (also described as nonspecific) cLBP. After eliminating suspicion for more insidious causes of cLBP, a thorough investigation can be conducted in an attempt to identify a source of degenerative cLBP. Degenerative cLBP can originate from many sources, and a detailed understanding of the structures potentially involved is invaluable for an accurate diagnosis. This review article aims to provide a broad overview of the utility of clinical history, physical exam findings, imaging findings, and diagnostic procedures in identifying the cause of patients' cLBP. We provide a framework to help guide clinicians by dividing the structures into groups as follows: anterior vertebral column, posterior vertebral column, and extra-vertebral pain. For each condition listed, we touch on the treatment options that can be considered.

Primary stability of multi-hole acetabular cup combined with posterior column plating for the fixation of complex acetabular fractures in elderly patients: a biomechanical analysis.

Acute total hip arthroplasty has gained increasing popularity in the treatment of complex acetabular fractures in elderly patients, but the biomechanical evidence is lacking. Therefore, we measured the primary stability to evaluate whether acute total hip arthroplasty using a multi-hole acetabular cup and posterior column plating through a single K-L approach can safely be used for treating complexed acetabular fractures in the elderly. In 18 composite osteoporotic hemipelves, T-type acetabular fractures were treated in three ways: CSP (Cup with acetabular screws augmentation combined with posterior plate) group, CP (Cup without acetabular screw combined with posterior plate) group and CSPA (Cup with acetabular screws combined with posterior plate and anterior plate) group. Each specimen was dynamically loaded (300 to 1700N, 1Hz). Primary stability of the acetabular cup and fracture gap was evaluated by 3-dimensional (3D) micromotions. No significant differences in the 3D-micromotions were observed among the CSP, CP and CSPA groups except the test point on the anterior column of the acetabulum in the CP scenario (CSP 49.33 ± 21.08μm vs. CP 224.83 ± 52.29μm, p < 0.001; CSPA 45.50 ± 12.16μm vs. CP 224.83 ± 52.29μm, p < 0.001). No significant differences in the fracture gap displacement on the posterior column of acetabulum were observed among the CSP, CP and CSPA groups. Our results show, that acute total hip arthroplasty using a multi-hole cup with acetabular screws and posterior column plating through single a K-L approach offers good primary stability to allow good osseous integration for treating complex acetabular fractures in the elderly. Furthermore, it also provides good fracture gap displacement on the posterior column.

Advances in Spinal Neuromodulation for Chemotherapy-induced Peripheral Neuropathy.

Chemotherapy-induced peripheral neuropathy (CIPN) continues to be a major source of chronic morbidity in patients with cancer. Current treatment options and efficacy are limited; thus, there is a need to investigate more effective therapeutic options. Spinal neuromodulation including dorsal column spinal cord stimulation (SCS) and dorsal root ganglion stimulation (DRG-S) are being explored for these patients. The purpose of this narrative review was to critically summarize and evaluate the advancements that have been made in utilizing SCS and DRG-S for CIPN. A thorough literature search was conducted using PubMed for any research on patients with CIPN who underwent DRG-S or SCS. Studies involving patients with general cancer-related pain were not included. Only articles that were published in English, had original, extractable data, and were available on or before August 1, 2023, were included. This study evaluated twelve studies with a total of 13 patients that reported using SCS for CIPN and four studies with a total of 12 patients that reported using DRG-S for CIPN. Many of the studies demonstrated that DRG-S or SCS can assist in reducing opioid consumption, lowering pain scores, and improving sensory deficits. DRG-S and SCS have the potential to improve symptoms and lower medication usage in patients suffering from CIPN. Spinal neuromodulation could be considered as an alternative therapy for patients with persistent symptoms.

Salvage of Iatrogenic Sciatic Nerve Injury Caused by Operatively Treated Acetabular Fractures: Two Cases and Literature Review.

While sciatic nerve injury has been described as a complication of acetabular fractures, iatrogenic nerve injury remains sparsely reported. This study aims to assess iatrogenic sciatic nerve injuries occurring during acetabular fracture surgery, tracking their neurological recovery and clinical outcomes, and investigating any correlation between recovery and the severity of neurologic injury to facilitate physicians in providing prediction of prognosis. We present two cases of male patients, aged 56 and 22, who developed sciatic palsy due to iatrogenic nerve injury during acetabular fracture surgery. Iatrogenic sciatic nerve injury resulted from operatively treated acetabular fractures. Surgical exploration, involving internal fixation removal and nerve decompression, successfully alleviated symptoms in both cases postoperatively. At the latest follow-up, one patient achieved full recovery with excellent function, while the other exhibited residual deficits at the L5/S1 root level along with minimal pain. Sciatic nerve injury likely stemmed from reduction techniques and internal fixation procedures for the posterior column, particularly when performed with the hip flexed, thereby placing tension on the sciatic nerve. Our case reports underscore the significance of liberal utilization of electrophysiologic examinations and intraoperative monitoring for the prediction of prognosis. Surgical exploration, encompassing internal fixation removal and nerve decompression, represents an effective intervention for resolving sciatic palsy, encompassing both sensory neuropathy and motor symptoms.

Severe (>100 Degrees) Thoracic Adolescent Idiopathic Scoliosis - A Comparison of Surgical Approaches.

Retrospective. Severe curves >100° in adolescent idiopathic scoliosis (AIS) are rare and require careful operative planning. The aim of this study was to assess baseline, perioperative, and 2-year differences between anterior release with posterior instrumentation (AP), posterior instrumentation with posterior column osteotomies (P), and posterior instrumentation with 3-column vertebral osteotomies (VCR). Two scoliosis datasets were queried for primary cases of severe thoracic AIS (≥100°) with 2-year follow-up. Pre- and 2-year postoperative radiographic measures (2D and estimated 3D kyphosis), clinical measurements, and SRS-22 outcomes were compared between three approaches. Sixty-one patients were included: 16 AP (26%), 38 P (62%), 7 VCR (11%). Average age was 14.4 ± 2.0 years; 75.4% were female. Preoperative thoracic curve magnitude (AP: 112°, P: 115°, VCR: 126°, P = 0.09) and T5-T12 kyphosis (AP: 38°, P: 59°, VCR: 70°, P = 0.057) were similar between groups. Estimated 3D kyphosis was less in AP vs P (-12° vs 4°, P = 0.016). Main thoracic curves corrected to 36° in AP vs 49° and 48° for P and VCR, respectively (P = 0.02). Change in estimated 3D kyphosis was greater in AP vs P and VCR (34° vs 13°, P = 0.009; 34° vs 7°, P = 0.046). One incomplete spinal cord injury had residual deficits (P; 1/61, 1.6%). All SRS-22 domains improved postoperatively. All approaches obtained satisfactory coronal and sagittal correction, but AP had smaller residual coronal deformity and greater kyphosis restoration than the other approaches. This information may help inform the decision of whether to include an anterior release for large thoracic AIS curves.

Minimally invasive stabilization using screws and cement for acetabular metastatic tumor: a case report

BackgroundThe aim of this case report is to evaluate minimally invasive stabilization using screws and cement for acetabular metastatic tumor and summarize the indications and contraindications for minimally invasive stabilization of acetabular metastatic tumors with screw and cement techniques.Case presentationUnder imaging guidance, a patient with acetabular metastatic tumor was treated with hollow screw combined with bone cement fixation. Ischial screw, ascending branch screw, and anterior and posterior screws were inserted to firmly fix the anterior and posterior column of the acetabulum. At the same time, the third screw connected the anterior and posterior columns together, combined with bone cement into the fracture site to further increase local stability and resist bone defects caused by local tumor osteolysis. The patient was a 52-year-old Uygur male. Herein, we summarize his clinical symptoms and operation. Differences in visual analog scale and walking function (Musculoskeletal Tumor Society) before operation and at 2 months, 6 months, and 12 months after operation were compared.ResultsPostoperative complications and tumor progression were recorded. The patient was followed up for 16 months, and the operative time was 60 minutes. In total, 20 ml of bone cement was injected into the acetabular posterior column and the top of the acetabulum. VIsual analog scale score was 8 before operation, 3 at 2 months, 3 at 6 months, and 2 at 12 months after operation. Musculoskeletal Tumor Society function was 13 before operation, 23 at 2 months, 25 at 6 months, and 26 at 12 months after operation. During follow-up, no cement leakage, fever, hip nerve injury, pulmonary embolism, or imaging findings of further destruction of the acetabulum and surrounding bone were noted.ConclusionThis case report shows that the treatment of acetabular metastatic cancer with minimally invasive stabilization using screws and cement under the C arm can effectively relieve pain and enhance the strength of the pelvis, and is innovative and feasible.

Developmental Anatomy of Gray Matter of Spinal Cord in Animals with Special Reference to Prenatal Goat: A Review

Spinal cord is the major nerve tract of vertebrates, extending from the brain through the vertebral canal. Primordium, the neural tube was initially with thick lateral walls having three layers: inner germinal/ependymal layer, middle mantle layer forming the gray matter and outer marginal layer forming white matter. It presented a diamond-shaped lumen with a sulcus limitans, alar, basal, roof and floor plates and limiting membranes. Gray matter of the cord occupies the central region of spinal cord and in amniotes has in cross section, the well-known ‘H’ or butterfly-like shape. The white matter forms a thick peripheral zone of the cord and is divided by the gray columns into dorsal, lateral and ventral funiculi. There are three coumns for the gray matter, viz. the dorsal, ventral and lateral horns, with ventral ones being wider at the enlargements of the cord. Lateral horn appears only at thoracic, anterior lumbar and middle sacral levels. The layers of gray matter were laminae I to X. Lamina I or marginal zone capped the dorsal horn. Lamina II represented substantia gelatinosa and covered the dorsal horn, beneath marginal zone. Lamina III was an area with loosely arranged larger cells, entering the substantia gelatinosa. Lamina IV was a poorly defined cell column with nucleus proprius. Lamina V was a broad zone extending across the cervix of the dorsal horn; had spinal reticular nucleus and reticular processes. The region showed small to medium-sized cells which were most numerous in the zone between the ventral part of the dorsal horn and the lateral funiculus of white matter. Lamina VI was broad with unclear boundaries, related medially to central canal. It had compact medial and less compact lateral zones. Lamina VII shows the intermediate gray matter, with intermediolateral and intermediomedial nuclei, cervical nucleus of Stilling and Clark’s column. Lamina VIII had cells of small and medium size and was not sharply distinguished from lamina VII. Lamina IX had alpha and gamma type of neurons, which were larger at enlargements. Ventral horn had lateral and medial nuclear groups of multipolar neurons. Medial nuclear groups were seen in all regions and lateral groups only at enlargements. Medial nuclear group had dorsomedial and ventromedial nuclei; whereas the smaller lateral nuclear group had dorsolateral and ventrolateral nuclei. In addition, the enlargements also had central and retrodorsolateral nuclei. Lamina X was seen around the central canal. Laminae varied in cell size and thickness between regions of the cord. Development of laminae and nuclei of spinal gray in fetuses corresponded to the progressive growth of muscles and skeleton. All the ten laminae were together present in the spinal gray matter by the end of gestation.

Resting-state brain plasticity is associated with the severity in cervical spondylotic myelopathy

ObjectiveTo investigate the brain mechanism of non-correspondence between imaging presentations and clinical symptoms in cervical spondylotic myelopathy (CSM) patients and to test the utility of brain imaging biomarkers for predicting prognosis of CSM.MethodsForty patients with CSM (22 mild-moderate CSM, 18 severe CSM) and 25 healthy controls (HCs) were recruited for rs-fMRI and cervical spinal cord diffusion tensor imaging (DTI) scans. DTI at the spinal cord (level C2/3) with fractional anisotropy (FA) and degree centrality (DC) were recorded. Then one-way analysis of covariance (ANCOVA) was conducted to detect the group differences in the DC and FA values across the three groups. Pearson correlation analysis was then separately performed between JOA with FA and DC.ResultsAmong them, degree centrality value of left middle temporal gyrus exhibited a progressive increase in CSM groups compared with HCs, the DC value in severe CSM group was higher compared with mild-moderate CSM group. (P < 0.05), and the DC values of the right superior temporal gyrus and precuneus showed a decrease after increase. Among them, DC values in the area of precuneus in severe CSM group were significantly lower than those in mild-moderate CSM and HCs. (P < 0.05). The fractional anisotropy (FA) values of the level C2/3 showed a progressive decrease in different clinical stages, that severe CSM group was the lowest, significantly lower than those in mild-moderate CSM and HCs (P < 0.05). There was negative correlation between DC value of left middle temporal gyrus and JOA scores (P < 0.001), and the FA values of dorsal column in the level C2/3 positively correlated with the JOA scores (P < 0.001).ConclusionStructural and functional changes have taken place in the cervical spinal cord and brain of CSM patients. The Brain reorganization plays an important role in maintaining the symptoms and signs of CSM, aberrant DC values in the left middle temporal gyrus may be the possible mechanism of inconsistency between imaging findings and clinical symptoms. Degree centrality is a potentially useful prognostic functional biomarker in cervical spondylotic myelopathy.