Fractured Vertebra Research Articles

Новый способ короткосегментарной мультистержневой задней инструментальной фиксации переломов тел поясничных позвонков: разработка технологии и случай из практики

A new method of short segmental multi-rod posterior instrumental fixation of lumbar vertebral body fractures (groups A3 and A4 according to the AO classification) characterized by the combined use of two short transpedicular screws with maximum lateralization of their heads fixing the injured and adjacent vertebrae and two short laminar implants in the form of distractors and contractors installed according to a standard technique with their positioning symmetrically to the spinous processes was developed. If transpedicular fixation of the fractured vertebra is impossible, both laminar systems are installed in the form of staples with circular coverage of the corresponding half-arc of the adjacent vertebrae due to supra- and infralaminar arrangement of standard hooks. The method involves the use of standard vertebrological instruments as well as widely available licensed implants and the classic technique of their installation. A clinical case of surgical treatment of a 27-year-old victim with a comminuted compression fracture (group A3 according to the AO classification) of the 3rd lumbar vertebra is reported. An excellent clinical and radiological result was obtained.

Cervical Kyphoplasty and OsteoCoolTM Radiofrequency Ablation for Painful Cervical Metastasis: A Case Report and Novel Approach for Pain Relief

Background: Metastatic bone pain is very difficult to treat and challenging to manage for health care professionals. Kyphoplasty or vertebroplasty has been used to reinstate the height of a compressed fractured vertebral body. OsteoCoolTM radiofrequency ablation (RFA) is a relatively new ablation technique and at present, current literature only supports its role for thoracic and lumbar vertebral metastases. Case Report: In the present case report, we utilized OsteoCoolTM RFA using anterolateral cervical kyphoplasty for cervical spinal metastasis with intractable pain and limited range of motion. Discussion: A successful palliative treatment was provided with a combination of kyphoplasty and OsteoCoolTM RFA. The patient has had great relief of pain and an increased range of motion of the cervical spine post procedure. Conclusion: Anterolateral balloon kyphoplasty provides stability to fractured vertebrae and when combined with OsteoCoolTM RFA, it potentially can provide effective pain relief in patients who have failed radiation and for whom surgery is contraindicated. Key words: Cervical kyphoplasty, cervical vertebral metastasis, kyphoplasty, OsteoCoolTM

Does kyphoplasty affect the global sagittal alignment in patients with osteoporotic vertebral fractures? A systematic review and meta-analysis.

Osteoporotic vertebral compression fractures (OVCF) are common in elderly patients and may cause local kyphosis due to the vertebral collapse and wedging. Balloon kyphoplasty (BKP) with polymethyl methacrylate is widely used to relieve back pain and restore the height and kyphosis of the destroyed vertebra Johnell (Osteoporos Int 17(12):1726-33, 2006); Wasnich (Bone 18: 179S-183S, 1996); Finnern (Osteoporos Int 14:429-436, 2003). However, the influence of BKP on global sagittal alignment (GSA) in patients with OVCF remains unclear. To systematically evaluate the relevant literature regarding the influence of BKP on the global spinal sagittal alignment using the following radiological parameters: Pelvic Incidence (PI), Pelvic Tilt (PT), Lumbar Lordosis (LL), Thoracic Kyphosis (TK), Sagittal Vertical Axis (SVA) and Spinosacral Angle (SSA). Visual Analogue Score (VAS) was also recorded. A systematic review of the English language literature dating up until August 2022, was undertaken utilising the PRISMA guidelines. Of a total of 548 articles, 4 studies met the inclusion criteria (4 level III evidence) and were analyzed. Overall, 201 patients of mean age 73.8years (69-77) had acute OVCF of one or more vertebra. The male to female ratio was 51:128. The number of fractured vertebrae was 235 (average of 1.17 fractured vertebrae per patient). Their pre-operative radiological parameters on standing x-rays showed a mean PI of 56°, PT 24.1°, LL 44.4°, TK 42.3°, PI-LL 11.7°, SVA 4.9cm, LL/TK 1 and SSA 114.8°. The average VAS was 7.6 (2.6-10). All the patients underwent BKP and their radiological parameters on standing x-rays post operatively showed a mean PI of 55.3°, PT 23.1°, LL 45.1°, TK 41.4°, PI-LL 10.3°, SVA 4.29cm, LL/TK 1.07 and SSA 116.8°. Their average VAS post BPK was 2.36 (0-4.8).A statistical analysis comparing the pre/post-operative GSA (111 patients, 3 studies with standard deviations) showed no statistical difference in PT (24.1° vs. 23.5°, P = 0.93), TK (42.3° vs. 42.4°, P = 0.57), PI-LL (14.4° vs.12.4°, P = 0.4), SVA (6.1cm vs. 5.5cm, P = 0.19) SSA (114.8° vs. 116.7° P = 0.36). VAS was significantly reduced post BKP (7.1 vs. 2.5 P = 0.004). Performing BKP procedures does not significantly affect the global sagittal alignment in patients with osteoporotic vertebral compression fractures. There was however, a significant improvement in pain scores in patients undergoing BKP at 1 or more levels.

Spinal lesions caused by abusive trauma in young children

Spinal lesions are increasingly recognized as an integral part of the child abuse spectrum; however, the description of lesions, their biomechanics, true incidence, clinical impact, and medicolegal implications are poorly understood. We report from the literature and our personal experience on abusive spinal lesions (ASL) in children under 3years, compared with cases of abusive head injuries (AHI) without spinal lesions on the one hand and with accidental spinal lesions on the other. Between 2002 and 2021, we collected 12 observations of ASL, 4 male and 8 female. These were compared with 338 cases of infants having AHI without ASL and 18 cases of accidental spinal trauma in the same age group. Fractures were found in 10 cases of ASL: wedge fracture in 9, and complete disruption with paraplegia in one, which required emergency reduction and stabilization with a good motor recovery. Two patients had intraspinal hemorrhagic lesions without fracture, associated in one case with tetraplegia which contributed to the fatal outcome. ASL affected girls more often and had a more severe clinical presentation; more than half of ASL involved the lumbar levels, which were unaffected in accidental traumas. ASL are not exceptional, and their presence corroborates cranial lesions indicating child abuse. Two etiologies emerge from this study: wedge fractures and cervical spinal cord lesions caused by shaking and the rare thoraco-lumbar dislocation indicating a particularly violent assault. Systematic MRI study of the spine is warranted in cases of child abuse.

Clinical study on the treatment of thoracolumbar fractures with single plane screw percutaneous internal fixation.

The aim of the study was to investigate the clinical effect of single plane screw percutaneous internal fixation in the treatment of simple thoracolumbar fractures. The subjects of this study were 84 patients with simple thoracolumbar fractures treated in our hospital from January 2018 to December 2020. The patients were grouped by different treatment methods (42 cases in each group). The single plane group was treated by percutaneous single plane screw internal fixation and the universal group was treated with percutaneous universal screw. The surgery completion status and the incidence of complications were recorded. The visual analogue scale (VAS) and the Oswestry Disability Index (ODI) of the two groups were recorded before the surgery, 3 days after the surgery, and 7 days after the surgery. The anterior edge height ratio of the fractured vertebra and the kyphotic Cobb angle were marked before the surgery, immediately after the operation, and at the last follow-up. Difference between groups in surgery time, blood loss and hospital stay was not statistically significant (p>0.05); the single plane group had a substantially lower incidence of complications than the universal group (p<0.05). At the last follow-up, the single plane group had greatly higher anterior edge height ratio of the injured vertebra than the universal group, while kyphotic Cobb angle was greatly higher in the universal group (p<0.05). Both single plane screw and universal screw percutaneous internal fixation were feasible for the treatment of simple thoracolumbar fractures, but single plane screw showed better vertebral height recovery and kyphosis correction effect, which could reduce postoperative correction loss.

Stent-armed kyphoplasty in osteoporotic thoracolumbar fractures-clinical and functional results and a center experience over 10 years.

The optimal treatment of osteoporotic vertebral fractures is still a controversial and under discussion topic. Armed kyphoplasty with expansive intravertebral implants is an emerging procedure, which, in theory, it not only makes it possible to achieve instant analgesia, and to get stabilization gains of benefits of kyphoplasty and vertebroplasty, but also, allows for a more effective maintenance of the restored vertebral height. A retrospective observational study is presented, in which 30 patients participated, including a total of 33 osteoporotic thoracolumbar compression burst vertebral fractures with involvement of one or both vertebral platforms and of more than one fifth of the posterior wall. These individuals underwent armed kyphoplasty with VBS® stents (or stentoplasty) filled with bone cement over 10 years (between 2012 and 2022) at the same center. Clinical (visual analogue scale, Oswestry Disability Index and Patient Global Impression of Change) and imaging results (restoration and maintenance of vertebral body heights) achieved were investigated. The mean follow-up time was 4.5 years (range, 1-10 years). There was a statistically significant improvement in all clinical and functional parameters evaluated, as well as a statistically significant difference in the various vertebral body heights between preoperative and end of follow-up time [increase of 10.7-15.2-5.0 mm (anterior-median-posterior) in the sagittal plane and 6.7-11.6-9.7 mm (right-median-left) in the coronal plane]. There was a statistically significant direct correlation between vertebral heights in the coronal plane, and between the Beck index assessed at the end of the follow-up period and the improvement in functional disability. The percutaneous transpedicular posterior approach, the ability to anatomically restore the fractured vertebra and to maintain it in the medium-long term, as well as the reduced risk of adverse effects, make stent-armed kyphoplasty a very attractive treatment option for osteoporotic compressive thoracolumbar fractures. A clinical-morphological correlation was demonstrated regarding the surgical treatment of these fractures, it was found that a more effective morphological restoration of vertebral heights in both the sagittal and coronal planes is associated with superior satisfactory clinical functional parameters.

Temporary Monosegmental Fixation Using Multiaxial Percutaneous Pedicle Screws for Surgical Management of Bony Flexion-Distraction Injuries of the Thoracolumbar Spine: A Technical Note.

The efficacy of minimally invasive surgeries for thoracolumbar flexion-distraction injuries (FDIs) has been reported, but those surgeries were monosegmental fusion surgeries of two adjacent vertebrae with bone grafts or temporary fixations using percutaneous pedicle screws (PPSs) that were at least bisegmental. Our idea was to fuse the fracture itself, not to fuse the fractured vertebra with an adjacent vertebra or to stabilize the fractured vertebra by bridging rostrally/caudally adjacent intact vertebrae, specifically when the displacement is minimal. This study aimed to present the surgical techniques of reduction and temporary monosegmental fixation of neurologically intact thoracolumbar bony FDIs using multiaxial PPSs, which can minimize the surgical invasiveness and preserve all motion segments, as well as report three cases treated with this procedure. When the fracture extended from the vertebral body to the spinous process at the same level, screws were placed into the fractured vertebra rostrally to the fracture along the rostral endplate, and the caudally adjacent vertebra was instrumented beyond the fracture line. When the fracture extended from the vertebral body to the spinous process of the rostrally adjacent vertebra, screws were placed into the fractured vertebra caudally to the fracture line, and the rostrally adjacent vertebra was instrumented. The kyphotic deformity was reduced through ligamentotaxis by using MPPSs in the rostral vertebra as rigid joysticks to apply direct buttress leverage to the rostral endplate. Intraoperative blood loss was minimal. The correction of kyphotic deformity and its durability were acceptable, and the segmental range of motion of the two affected vertebrae from flexion to extension was maintained after implant removal. This surgery can act as the least-invasive option for the management of thoracolumbar bony FDIs to allow early ambulation without external bracing and to preserve all the motion segments.

An Indo-Pacific humpback dolphin (Sousa chinensis) severely injured by vessel collision: live rescue at sea, clinical care, and postmortem examination using a virtopsy-integrated approach

BackgroundVessel collision induces blunt and sharp force traumas to aquatic animals and is a leading anthropogenic impact affecting cetaceans worldwide. Vessel collision is an important threat affecting vulnerable coastal cetaceans such as the Indo-Pacific humpback dolphins (Sousa chinensis) which reside in coastal waters of Hong Kong amongst heavy marine traffic.Case presentationA severely injured subadult S. chinensis was sighted in the waters off southwestern Hong Kong with four gaping incision wounds on its dorsum. It was in poor body condition and seemed unable to use the fluke effectively. The deepest wound located at the caudal peduncle near the base of the fluke and exposed the underlying fractured caudal vertebrae. The dolphin was monitored in the field over three weeks and eventually captured for medical intervention as veterinary assessment indicated progressive and life-threatening deterioration. During rehabilitation, the dolphin demonstrated initial signs of improvement over the first 36 hours as supported by diagnostic tests but then deteriorated rapidly. It was humanely euthanised after three days of rehabilitation. Postmortem investigation was carried out using virtopsy (postmortem computed tomography and magnetic resonance imaging) and conventional necropsy, with special attention to the traumatic musculoskeletal injuries caused by vessel collision and also revealed acute gastrointestinal compromise and respiratory disease that further hampered the rehabilitation.ConclusionIn cetaceans, the prognosis for recovery from injuries caused by vessel collision depends on the extent, location, and gravity of the injuries (i.e., superficial, deep, penetrating, blunt vs. sharp, fresh vs. septic), as well as the health status of the individual and its ability to respond to the insult. Injuries extending deep into the vertebral column may lead to delayed death and associated welfare issues. The prognosis of this case was likely poor given the severity and location of the injuries, but the attempted rehabilitation and postmortem investigation provided valuable insights for clinical management if similar cases are encountered in the future. Being able to non-invasively assess and document traumatic injuries and other pathologies, diagnostic imaging is particularly useful in the clinical assessment and postmortem investigation (virtopsy) of cases with vessel-induced injuries.

Risk factors for insufficient reduction after short-segment posterior fixation for thoracolumbar burst fractures: Does the interval from injury onset to surgery affect reduction of fractured vertebrae?

BackgroundMany surgeons have encountered patients who could not immediately undergo surgery to treat spinal fractures because they had associated injuries and/or because a complete diagnosis was delayed. For such patients, practitioners might assume that delays could mean that the eventual reduction would be insufficient. However, no report covered risk factors for insufficient reduction of fractured vertebra including duration from injury onset to surgery. The purpose of this study is to investigate the risk factors for insufficient reduction after short-segment fixation of thoracolumbar burst fractures.MethodsOur multicenter study included 253 patients who sustained a single thoracolumbar burst fracture and underwent short-segment fixation. We measured the local vertebral body angle (VBA) on roentgenograms, before and after surgery, and then calculated the reduction angle and reduction rate of the fractured vertebra by using the following formula: left[ {left( {{text{Preoperative}};{text{VBA }}{-}{text{ Postoperative}};{text{VBA}}} right)/{text{Preoperative}};{text{VBA}}} right] , times , 100. A multiple logistical regression analysis was performed to identify risk factors for insufficient reduction. The factors that we evaluated were age, gender, affected spine level, time elapsed from injury to surgery, inclusion of vertebroplasty with surgery, load-sharing score (LSS), AO classification (type A or B), preoperative VBA, and the ratio of canal compromise before surgery.ResultsThere were 140 male and 113 female patients, with an average age of 43 years, and the mean time elapsed between injury and surgery was 3.8 days. The mean reduction angle was 12°, and the mean reduction rate was 76%. The mean LSS was 6.4 points. Multiple linear regression analysis revealed that a higher LSS, a larger preoperative VBA, a younger age, and being female disposed patients to having a larger reduction angle and reduction rate. The time elapsed from injury to surgery had no relation to the quality of fracture reduction in the acute period.ConclusionsOur findings indicate that if there is no neurologic deficit, we might not need to hurry surgical reduction of fractured vertebrae in the acute phase.

Hidden blood loss and its influencing factors after minimally invasive percutaneous transpedicular screw fixation in thoracolumbar fracture

BackgroundMinimally invasive percutaneous transpedicular screw fixation (MIPTSF) is generally accepted as a minimally invasive treatment for thoracolumbar fracture. However, hidden blood loss (HBL) caused by this procedure is usually disregarded. This study aimed to investigate the amount of HBL and its influencing factors after MIPTSF in thoracolumbar fracture.MethodsBetween October 2017 and December 2020, a total of 146 patients (106 males and 40 females, age range 21–59 years) were retrospectively examined, and their clinical and radiological data were recorded and analyzed. The Pearson or Spearman correlation analysis was used to investigate an association between patient’s characteristics and HBL. Multivariate linear regression analysis was performed to elucidate the related clinical or radiological factors of HBL.ResultsA substantial amount of HBL (164.00 ± 112.02 ml, 40.65% of total blood loss (TBL)) occurred after transpedicular screw internal fixation. Multivariate linear regression analysis revealed that HBL was positively associated with TBL (p < .001), percentage of vertebral height loss (VHL) (p < .001), percentage of vertebral height restoration (VHR) (p < .001), numbers of fractured vertebrae (P = .013), and numbers of fixed vertebral segments (P = .002).ConclusionA large amount of HBL was incurred in patients undergoing MIPTSF in thoracolumbar fracture. More importantly, TBL, percentage of VHL, percentage of VHR, the numbers of fractured vertebrae and fixed vertebral segments were independent risk factors for HBL.

Association between osteoporotic fractures and statin use – A review of literature and results of a preliminary case control study done at National Hospital of Sri Lanka

A case control study was conducted among elderly patients presenting to NHSL accident service. A hundred patients aged more than 60 years who presented with newly diagnosed neck of femur, distal radial and vertebral body wedge fractures following minor trauma were recruited from April 2021 to July 2021. Patients who had previous osteoporotic fractures and previous hip, distal radius and spine surgery were excluded from the study. An additional group of 100 patients who were matched for age and sex presenting to the same unit following minor trauma without osteoporotic fractures were selected as the control group with the same exclusion criteria. Use of statins for more than 4 months and other sociodemographic and lifestyle factors were compared among the two groups.&#x0D; As no other independent variable was found to be significantly related to osteoporotic fracturs between the two groups, univariable analysis was done. The odds of current statin use in cases with osteoporotic fracture (45.2%) were lower than the odds of current statin use (54.8%) in subjects without osteoporotic fractures adjusted OR 0.74, 95% CI 0.42, 1.32) (p=0.304).&#x0D; According to our results there might be a protective effect in statin use against osteoporotic fractures although a statistical significance was not demonstrated. However further studies using larger sample size and randomized control studies are suggested to ascertain a statistically significant result.

Low vertebral CT Hounsfield units: a risk factor for new osteoporotic vertebral fractures after the treatment of percutaneous kyphoplasty

PurposesTo identify the characteristics of the vertebral HU in the elderly patient with new osteoporosis vertebral compression fractures (OVCF) after treatment of percutaneous kyphoplasty (PKP), which may help us to preliminarily evaluate the risk of a new OVCF after the treatment of PKP.MethodsWe retrospectively analyzed the patients who received PKP treatments in our hospital to find out the patients suffered new OVCFs after the treatment of PKP and set an age-, sex-, first fracture vertebrae-, surgical segment-, and comorbidity-matched control group without new fractures. We measured the axial and sagittal L1-HU values to compare their differences.ResultsThere were 32 patients who suffered new OVCFs and received another PKP surgery in our department. In the study group, the average L1 sagittal and axial HU values were 46.17 ± 21.31 HU and 47.77 ± 22.38 HU, and they had no statistical difference (P > 0.05). For the control group, the average L1 sagittal and axial HU values were 75.69 ± 29.72 HU and 80.23 ± 30.26 HU, and their difference was not significant (P > 0.05). No matter from the axial or sagittal evaluation, the L1 HU value in the study group was significantly lower than that in the control group (P < 0.001). The AUC of using the L1 axial HU value to differentiate patients with new fractures from controls was 0.85 while the sagittal one was 0.82. In axial (and sagittal) evaluation, the cutoff value (adjusted to the multiple of five) had high specificity of 90% or high sensitivity of 90% to identify patients with new fractures of 45 HU and 75 HU (50 HU and 75 HU), respectively.ConclusionsThe lower the vertebral HU value is, the more likely the patients suffer new OVCFs after PKP treatment.

Differences in spine volumetric bone mineral density between grade 1 vertebral fracture and non-fractured participants in the China action on spine and hip status study

This study evaluated the prevalence of vertebral fractures (VF) in middle-aged and elderly Chinese men and women and explored the differences in lumbar spine volumetric bone mineral density (vBMD) derived from quantitative CT (QCT) between those with a grade 1 vertebral fracture and non-fractured individuals. 3,457 participants were enrolled in the China Action on Spine and Hip Status (CASH) study and had upper abdominal CT examinations. Vertebral fractures were identified by Genant's semi-quantitative method from lateral CT scout views or CT sagittal views. L1-3 vBMD was measured by Mindways QCT Pro v5.0 software. The characteristics of different fracture severity groups were compared using one-way ANOVA, independent-samples t-tests, and Kruskal-Wallis H-tests. 1267 males (aged 62.77 ± 9.20 years) and 2170 females (aged 61.41 ± 9.01 years) were included in the analysis. In men, the prevalence of VF increased from 14.7% at age&lt;50 years to 23.2% at age ≥70 years, and in women from 5.1% at age&lt;50 years to 33.0% at age ≥70 years. Differences in mean age and vBMD were found between the different fracture grade groups. After age stratification, vBMD differences in men aged &lt; 50 years old disappeared (p = 0.162) but remained in the older age bands. There was no significant difference in mean vBMD between those with multiple mild fractures and those with a single mild fracture. In women, the prevalence of VF increased rapidly after age 50, while it grew more slowly in men. In general, with the exception of men &lt;50 years old, participants with a grade 1 VF had lower vBMD than non-fractured individuals. The majority of women younger than 50 with a grade 1 VF had normal bone mass. We recommend that a vertebral height reduction ratio of &lt;25% be diagnosed as a deformity rather than a fracture in people under the age of 50. The presence of multiple mild fractured vertebrae does not imply lower BMD.

Including the Fractured Vertebra in Stabilization of Thoracolumbar Vertebral Fractures: Our Single-Centered Early Stage Clinical and Radiological Results

Including the Fractured Vertebra in Stabilization of Thoracolumbar Vertebral Fractures: Our Single-Centered Early Stage Clinical and Radiological Results

A retrospective study on the efficacy and safety of bone cement in the treatment of endplate fractures.

BackgroundEndplate fractures is an important factor affecting the curative effect of percutaneous kyphoplasty for spinal fracture. The purpose of this study is to investigate the effect of sealing endplate fracture with bone cement on minimally invasive treatment of spinal fracture.MethodsA total of 98 patients with osteoporotic vertebral fractures combined with endplate fractures treated with bone cement surgery in our hospital were retrospectively analyzed. They were grouped according to whether bone cement was involved in the endplate fractures. Group A: bone cement was not only distributed in the fractured vertebral body, but also dispersed into the endplate fractures. Group B: bone cement was confined to the fractured vertebra but did not diffuse into the cracks of the endplate. The basic information, imaging changes of the fractured vertebral body, VAS score, ODI score, bone cement distribution and postoperative complications of the two groups were analyzed and compared.ResultsThe height of the injured vertebra and the kyphotic Cobb angle in the two groups were significantly improved after surgery, but the anterior height of the vertebra in group B was lower than that in group A and the kyphotic Cobb angle was higher than that in group A at the last follow-up (P < 0.05). VAS score and ODI score in 2 groups were significantly improved after operation (P < 0.05), but the VAS score and ODI score in group A were lower than those in group B at the last follow-up (P < 0.05). The incidence of bone cement leakage and adjacent vertebral fracture in group A was higher than that in group B (P < 0.05).ConclusionDiffusion of bone cement into the cracks of the endplate may also restore and maintain the height of the injured vertebra, relieve pain and restore lumbar function. However, diffusion of bone cement into the cracks of the endplate can increase the incidence of cement leakage and adjacent vertebral fractures.

Mechanical testing and biomechanical CT analysis to assess vertebral flexion strength of Chinese cadavers.

Biomechanical CT (BCT), i.e., quantitative computed tomography-based finite element analysis (QCT-FEA), promises an improved technique over bone mineral density (BMD) in predicting bone strength and the risk of osteoporotic vertebral fractures. However, most of the BCT models only consider a uniform compressive loading condition and they have not been validated for Chinese subjects. This study examined the ability of BCT to predict wedge fracture-related vertebral flexion strength in a cohort of Chinese cadaveric vertebrae. Twelve human vertebrae were scanned with dual energy X-ray absorptiometry (DXA) and QCT to measure areal and volumetric BMD, respectively. To produce wedge fractures, the cadaveric vertebrae were experimentally loaded until failure under a 15^° flexion. Vertebral flexion stiffness and strength were measured from the force-displacement curve. Voxel-based heterogeneous FE models of the vertebrae were created and virtually tested in uniform compression and 15^° flexion to compute compressive and flexion strength (and stiffness), respectively. The predictions of vertebral flexion strength with BMD or BCT measures were evaluated with linear regression analyses. Results showed weak correlations between experimentally-measured flexion strength vs. DXA-aBMD (R²=0.26) or QCT-vBMD (R²=0.39). However, there were strong correlations between experimentally-measured flexion strength vs. BCT-computed vertebral strength under either flexion (R²=0.71) or compression (R²=0.70) loading conditions, although flexion reduced the BCT-computed vertebral strength by 9.2%. These results suggest that, regardless of whether a uniform compression or a flexion loading is simulated, BCT can predict in vitro vertebral flexion strength better than BMD.

Incidence of fractures in people with intellectual disabilities over the life course: a retrospective matched cohort study.

SummaryBackgroundCurrent osteoporosis guidelines do not identify individuals with intellectual disabilities (ID) as at risk of fracture, potentially missing opportunities for prevention. We aimed to assess the incidence of fractures in people with ID over the life course.MethodsDescriptive analysis of open cohort study using anonymised electronic health records from the UK Clinical Practice Research Datalink, linked to the Hospital Episode Statistics database (Jan 1, 1998–Dec 31, 2017). All individuals with ID were matched on age and sex to five individuals without ID. We calculated the incidence rate (95% CI) per 10000 person-years (py) and incidence rate ratio (IRR, 95% CI) to compare fractures between individuals with and without ID (age 1–17 and ≥18 years) for any fracture, and in those aged 18–49 and ≥ 50 years for major osteoporotic fracture (vertebra, shoulder, wrist, hip), and for hip fracture.Findings43176 individuals with ID (15470 children aged 1–17 years; 27706 adults aged ≥ 18 years) were identified and included (40.4% females) along with 215733 matched control individuals. The median age at study entry was 24 (10th–90th centiles 3–54) years. Over a median (10th–90th centile) follow-up of 7.1 (0.9–17.6) and 6.5 (0.8–17.6) years, there were 5941 and 24363 incident fractures in the ID and non ID groups respectively. Incidence of any fracture was 143.5 (131.8–156.3) vs 120.7 (115.4–126.4)/10000 py (children), 174.2 (166.4–182.4)/10000 py vs 118.2 (115.3–121.2)/10000 py (adults) in females. In males it was 192.5 (182.4–203.2) vs 228.5 (223.0–234.1)/10000 py (children), 155.6 (149.3–162.1)/10000 py vs 128.4 (125.9–131.0)/10000 py (adults). IRR for major osteoporotic fracture was 1.81 (1.50–2.18) age 18–49 years, 1.69 (1.53–1.87) age ≥ 50 years in women. In men it was 1.56 (1.36–1.79) age 18–49 years, 2.45 (2.13–2.81) age ≥ 50 years. IRR for hip fracture was 7.79 (4.14–14.65) age 18–49 years, 2.28 (1.91–2.71) age ≥ 50 years in women. In men it was 6.04 (4.18–8.73) age 18–49 years, 3.91 (3.17–4.82) age ≥ 50 years. Comparable rates of major osteoporotic fracture and of hip fracture occurred approximately 15 and 20 years earlier respectively in women and 20 and 30 years earlier respectively in men with ID than without ID. Fracture distribution differed profoundly, hip fracture 9.9% vs 5.0% of any fracture in adults with ID vs without ID.InterpretationThe incidence, type, and distribution of fractures in people with intellectual disabilities suggest early onset osteoporosis. Prevention and management strategies are urgently required, particularly to reduce the incidence of hip fracture.FundingNational Institute for Health and Care Research.

The Radiological Outcome of Thoracolumbar Spine Fracture Fixation in Short Vs Long Segment

Objectives: The study determined the radiological outcomes of short-segment vs. long-segment fixation of thoracolumbar spine fractures.&#x0D; Materials and Methods: A total of 322 patients (18 – 60 years) with thoracolumbar spine fractures were included. Preoperative X-rays and CT scans were performed on all patients to determine the integrity and orientation of the pedicle. Cobb's approach was also used to estimate the kyphotic angle on x-rays. The posterior pedicle 65 screw fixation was used in all instances. Group A (N = 161) received long segment fixation at least two levels above and below the fractured vertebra, while Group B (N = 161) received short segment fixation with pedicle screws placed in the broken level as well as one level above and below the fractured level.&#x0D; Results: In Group A, the mean age was 38 years, and the mean length of fracture was 45 hours; in Group B, the mean age was 43 years, and the mean duration of fracture was 46.354 hours. A good radiological outcome was observed in 115 (71.4%) patients in group A as compared to 103 (64%) patients in group B. A radiological outcome (p-value: 0.049) of a duration greater than 8 hours was observed in both groups (A: 75.5%; B: 58.1%).&#x0D; Conclusion: Short segment fixation using a pedicle screw at the level of fracture provides comparable correction to long segment fixation.&#x0D; Keywords: Thoracolumbar Fractures, Short Segment, Long Segment, Radiological Outcome.

Efficacy of Balloon Kyphoplasty in Compression Fractures of the Thoracolumbar Spine

Objective: To study the Efficacy of Balloon Kyphoplasty in compression fractures of the thoracolumbar spine.&#x0D; Material and Methods: This study was conducted on 95 patients with thoracolumbar wedge fractures from 2017 to 2022. Complete neurological examination and CT and MRI scans of the spine of all patients were done. All patients have been treated with a balloon kyphoplasty procedure. Data was collected on VAS score, SF-36 score, kyphotic angle and percentage of vertebral body destruction both preoperatively and post-operatively. Statistical analysis was done by using paired sample t-test.&#x0D; Results: The mean age was 57 years. Males were 58.9% and females 41.0%. Osteoporosis was the cause of fracture in 90.5% and trauma in 9.4% of patients. VAS improved from 7.42 ± 1.24 to post-procedure 3.24 ± 1.51, P &lt; 0.0001. SF-36 improved from 35.31 ± 17.4 to post-procedure 49.23 ± 19.2, P &lt; 0.0001. Kyphosis angle restoration from 18.42 ± 7.41 to post-procedure 10.61 ± 6.32, P value &lt; 0.0001. Percentage loss of vertebral height from 32.91% to postoperatively 17.64% (SD-17.2 and P &lt; 0.0001). 10.5% of patients developed cement leakage and there is no leakage in 89.4%. The adjacent level fracture occurred in 4 patients.&#x0D; Conclusion: Balloon Kyphoplasty is an effective procedure for thoracolumbar wedge fractures. It improves pain, activities of daily living, kyphosis angle improvement, and restoration of vertebral height.

Lateral-Opening Injection Tool Used in Percutaneous Vertebroplasty to Treat Asymptomatic Osteoporotic Vertebral Burst Fractures: A Retrospective Study.

The adequate management of asymptomatic osteoporotic vertebral burst fractures (OVBFs) was still controversial. Percutaneous vertebroplasty (PVP) could achieve quick recovery with minor trauma, but there were certain safety problems by traditional bone cement injection method. Thus, the aim of this study was to assess the efficacy of lateral-opening injection tool used in PVP treating patients with asymptomatic OVBFs. This was a retrospective study of OVBFs treated in our institute from March 2016 to March 2020. A total of 66 patients (mean age 72.10 ± 7.98 years, with 21 men and 45 women) who were diagnosed with acute asymptomatic OVBFs with mild spinal canal compromise were treated with PVP by using a lateral-opening injection tool. Two puncture needles were simultaneously placed transpedicularly in the fractured vertebra, and the inner core was removed, and the lateral-opening injection tool was inserted. The adjustment of lateral hole was to improve the distribution height of bone cement and avoid the entry of bone cement into the posterior wall of vertebral body. Related clinical outcomes and images were assessed, including back pain (visual analog scale [VAS]), vertebral height ratio (fractured vertebral height/average adjacent nonfractured vertebral height), kyphosis Cobb angle, union of the fractured vertebral posterior wall, distribution of bone cement, surgical data, and complications. The average follow-up time of all cases was 21.23 ± 9.35months. The mean amount of bone cement was 3.28 ± 0.35 ml in the vertebrae and the mean operative time was 34.02 ± 5.23 min. There were 60 cases of bone cement that contacted the upper and lower endplates on at least one side. There was no cement leakage into the spinal canal or fracture displacement of the posterior wall of the vertebral body in all cases. The VAS scores were 3.78 ± 0.42 at 1 day postoperatively and 0.53 ± 0.40 at the last follow-up, significantly lower than 8.40 ± 0.48 preoperatively (p < 0.05). The average height ratio of anterior, middle, and posterior vertebral body after operation increased compared with that pre-operation (p < 0.05), and the postoperative kyphosis angle decreased (p < 0.05). At 6 months follow-up, there was no significant height loss of the vertebral body. Computed tomography examination 3 months postoperatively showed that the fracture of posterior vertebral wall healed well in all cases. There were seven cases of bone cement leakage without clinical symptoms and two adjacent vertebral fractures caused by falling. There were no cases of deep vein embolism, lower limb muscle atrophy, pneumonia, decubitus. The lateral opening tool can be safely and effectively used in the PVP treatment on asymptomatic OVBFs with mild spinal canal compromise.