Injured Vertebrae Research Articles

P152. Is short segment fracture fixation appropriate for AO spine type B and C injuries?

<h3>BACKGROUND CONTEXT</h3> The AO Spine Classifications are associated with a hierarchical injury severity score. "Type A" fractures represent the most stable injuries and "Type C" represent the most severe and unstable injuries. "Three column" subaxial cervical spine and thoracolumbar injuries are designated as Type B (tension band) and Type C (fracture dislocation). Although the load sharing classification describes burst type fractures, Type B and C injuries are often minimally comminuted but grossly unstable due to "three-column" disruption. Therefore, the load sharing classification may not be appropriate to guide short- or long-segment fixation. <h3>PURPOSE</h3> To identify if construct length affects the rate of surgical complications or instrumentation revision following Type B and C subaxial or thoracolumbar injuries. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort study. <h3>PATIENT SAMPLE</h3> All patients with cervical or thoracolumbar Type B and Type C injuries between 2006-2021 were identified from a prospectively collected database. Only patients who underwent operative intervention were included. <h3>OUTCOME MEASURES</h3> Surgical complications (persistent cerebrospinal fluid leak, wound dehiscence, epidural hematoma, surgical site infection) and reoperations (instrumentation revision and/or exchange). <h3>METHODS</h3> Patients were divided based on the number of levels instrumented above and below the injured level (>2 levels (long-segment) versus < 2 levels (short-segment)). Patient demographics, surgical characteristics and clinical outcomes were collected and compared. Independent t-tests or Mann-Whitney U tests compared continuous variables, while Pearson's chi-square tests compared categorical variables. Bivariate logistic regression measured the effect of fixation construct length (long-segment fixation) on the likelihood of having a surgical complication and reoperation for instrumentation revision and/or exchange. Alpha was set at P<0.05. <h3>RESULTS</h3> A total of 180 patients representative of 187 fractures were included. Of the 187 injuries, 69 (36.9%) underwent long-segment fixation. Patients who underwent long-segment fixation were older (61.1 vs 51.5 years, p=0.005), were more likely to have comorbid ankylosing spondylitis (AS) or diffuse idiopathic skeletal hyperosteosis (DISH) (47.8% vs 21.2%, p<0.001), and were more likely to have an injury that involved a thoracic vertebra (53.6% vs 30.5%, p=0.008). Further, patients who underwent long-segment fixation were more likely to undergo posterior-only fixation (85.5% vs 60.2%, p<0.001) in comparison to anterior-only and combined anterior-posterior fixation. There was no significant difference in the proportion of long-segment versus short-segment constructs that included bilateral, unilateral or no pedicle screws within the injured vertebrae (p=0.371). Bivariate logistic regression demonstrated that a long-segment fixation construct had a non-significant increase in complication rates (OR=2.08, p=0.176) and reoperations for instrumentation revision or exchange (OR=2.99, p=0.142). We subanalyzed the 58 fractures with AS/DISH compared to the 129 fractures without AS/DISH. Injuries with AS/DISH had a mean 2.57+ 1.01 and 2.34 + 0.81 levels instrumented above and below the injury compared to injuries without AS/DISH, mean 1.97 + 1.04 and 1.90 + 0.96 levels instrumented above and below the injury (p<0.001), respectively. However, there was no difference in the rate of surgical complications (8.62% vs 7.75%, p=0.780) or instrumentation revision (6.90% vs 3.10%, p=0.256) between the two groups based on construct length. <h3>CONCLUSIONS</h3> Long-segment fixation of Type B or C subaxial cervical spine or thoracolumbar spine injuries resulted in a non-significant increase in complications and spine reoperations for instrumentation revision. Instrumentation technology has improved since the load sharing classification. This exploratory study suggests short segment fixation may be appropriate even for unstable spine fractures. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Effect of cement distribution type on clinical outcome after percutaneous vertebroplasty for osteoporotic vertebral compression fractures in the aging population.

ObjectiveThe study aimed to investigate the effect of the type of bone cement distribution on clinical outcomes following percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCF) in the elderly.MethodsRetrospective analysis of 160 patients diagnosed with OVCF who underwent PVP treatment from March 2018 to December 2020. Based on the kind of postoperative bone cement distribution, bone cement was classified as types I, II, III, IV, and V. Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Cobb angle, anterior vertebral height ratio, refracture rate of injured vertebrae, and incidence of adjacent vertebral fractures were compared for the five types before and after three days, and one year of operation.ResultsVAS and ODI at three days and one year postoperative were significantly lower than those preoperative (P < 0.05) for all five distribution types. VAS and ODI for types I, II, and III were lower at one year postoperatively than for types IV and V (P < 0.05). There was no significant difference in Cobb angle and anterior vertebral body height ratio between preoperative and three days postoperative groups (P < 0.05); however, there were significant differences between three days and one-year postoperative and preoperative groups (P < 0.05). Following one year of surgery, the Cobb angle and the anterior vertebral height ratio of types IV and V were significantly different from those of types I, II, and III (P < 0.05), and there was a statistically significant difference between types IV and V (P < 0.05). In terms of the incidence of injured vertebral refractures and adjacent vertebral fractures, the evenly distributed types I, II, and III were significantly lower than the unevenly distributed types IV and V, and the incidence of type V was higher (P < 0.05).ConclusionsThe clinical efficacy of cement distribution following PVP of types I, II, and III is better than that of types IV and V, which can better relieve pain with long-lasting efficacy and minimize the occurrence of refractures of injured vertebrae and adjacent vertebral body fractures.

Finite element analysis of dynamic changes in spinal mechanics of osteoporotic lumbar fracture

AimThis study aims to explore the effects of finite element biomechanical properties of different methods in the treatment of osteoporotic thoracolumbar fractures.MethodsBased on the ultra-thin computed tomography scan data of a volunteer’s thoracolumbar spine, the finite element method was used to simulate the treatment of osteoporotic thoracolumbar fracture. Spiral computed tomography scanning was used to obtain images of the thoracolumbar region, which was then imported into Mimics software to obtain the three-dimensional geometric model. The finite element model of normal T11 – L2 segment was established by finite element software Abaqus and the validity of the model loading was verified. The finite element model of T11 vertebral compression fracture was established based on normal raw data. The clinical overextension reduction manipulation was simulated by different treatment methods and the changes in stress and displacement in different parts of injured vertebrae were analyzed.ResultsAn effective finite element model of T11–L2 segment was established. The maximum stress, axial compression strength, axial compression stiffness, and transverse shear stiffness were significantly better in the percutaneous kyphoplasty and percutaneous vertebroplasty treatment group than in the conservative treatment group and open treatment group (P < 0.05). Additionally, there was no significant difference between the open treatment group and conservative treatment group, or between the PKP and PVP treatment group.ConclusionPercutaneous vertebroplasty and percutaneous kyphoplasty not only met the requirements of normal functional kinematics of thoracolumbar spine, but also restored the stability of thoracolumbar spine. They had good biomechanical properties and remarkable application effects. The application of finite element analysis can help select a scientific, reasonable, and effective treatment scheme for the clinical diagnosis and treatment of osteoporotic thoracolumbar fractures.

Clinical Effect of Minimally Invasive Percutaneous Pedicle Screw Internal Fixation Combined with Injured Vertebrae Bone Grafting in the Treatment of Thoracolumbar Fractures in Orthopedic Surgery.

Objective To observe the clinical effect of minimally invasive percutaneous pedicle screw internal fixation combined with injured vertebrae bone grafting in the treatment of thoracolumbar fractures in orthopedic surgery. Methods A total of 132 patients with thoracolumbar fractures admitted to the hospital were enrolled between January 2020 and April 2021. Both groups underwent minimally invasive percutaneous pedicle screw internal fixation. According to the presence or absence of intraoperative injured vertebrae bone grafting, they were divided into the grafting group (73 cases) and the injured vertebrae ungrafted group (59 cases). The perioperative indexes, pain at 2 weeks after surgery, surgical stress, recovery of an injured vertebra, self-care ability, quality of life, and postoperative complications were compared between the two groups. Result There was no significant difference in intraoperative blood loss, operation time, or hospitalization time between the grafting group and the nongrafting group (P > 0.05).2 weeks after surgery, scores of the Visual Analogue Scale (VAS) in the grafting group were lower than those in the nongrafting group (P < 0.05).At 3d after surgery, levels of serum cortisol (COR), epinephrine (E), and norepinephrine (NE) in both groups were higher than those before surgery, which were lower in the grafting group than in the nongrafting group (P < 0.05).At 3 months after surgery, the anterior edge height of the injured vertebra in both groups was increased, which was higher in the grafting group than in the nongrafting group (P < 0.05). At 3 months after surgery, the Cobb angle of sagittal kyphosis in both groups was decreased, which was lower in the grafting group than that in the nongrafting group (P < 0.05). At 3 months after surgery, the scores of activity of daily living (ADL) and the MOS item-short form health survey (SF-36) in both groups were higher than those before surgery, which were higher in the grafting group than in the nongrafting group (P < 0.05). The difference in the incidence rate of injured vertebrae collapse, internal fixation breakage, or kyphosis between the grafting group and the nongrafting group was not statistically significant (1.37% vs 6.78%) (P > 0.05). Conclusion Minimally invasive percutaneous pedicle screw internal fixation combined with injured vertebrae bone grafting in orthopedic surgery can improve postoperative pain and surgical stress in patients with thoracolumbar fractures, which is conducive to the recovery of injured vertebrae and improvement in the quality of life.

Treatment of Elderly Patients with Acute Symptomatic OVCF: A Study of Comparison of Conservative Treatment and Percutaneous Kyphoplasty.

ObjectiveThe present study was designed for the contrastive analysis of conservative and percutaneous kyphoplasty (PKP) on pain severity and recovery of injured vertebrae in elderly patients with acute symptomatic osteoporotic vertebral compression fracture (OVCF).MethodsA total of 60 elderly patients with acute symptomatic OVCF were divided into two groups according to different treatment protocols, with 30 patients in each group. Patients in the Con group received conservative treatment, while patients in the PKP group received percutaneous kyphoplasty treatment. Clinical evaluation included the visual analogue scale (VAS), the Dallas pain questionnaire, the vertebral body leading edge height, the Cobb angle of injured vertebrae, the MOS item short-form health survey (SF-36), the Barthel index, and the mini-mental state examination (MMSE).ResultsAt 3 days, 3 months, and 6 months post-treatment, the score of VAS and the Cobb angle of injured vertebrae in patients of the PKP group were all significantly lower than those in the Con group (P < 0.05), while the height of vertebral body leading edge in patients of the PKP group was significantly longer than that in the Con group (P < 0.05). At 6 months post-treatment, the scores of the four dimensions of the Dallas pain questionnaire scale in the PKP group were all significantly lower than those in the Con group (P < 0.05), while the score of SF-36 (PCS), SF-36 (MCS), and Barthel index in patients of the PKP group were all significantly lower than those in the Con group (P < 0.05), and there was no significant difference in the scores of MMSE between these two groups (P > 0.05).ConclusionCompared with conservative treatment, PKP treatment of elderly patients with acute symptomatic OVCF provides rapid pain relief, restoration of damaged vertebral body height, correction of Cobb's angle, and improved quality of life.

Efficacy of percutaneous short segment fixation in the treatment of Magerl A3 thoracolumbar fractures with low bone mineral density:a retrospective study

To explore the clinical efficacy of percutaneous pedicle screw short segment internal fixation with or without the intermediate screw in the treatment of Magerl A3 thoracolumbar fractures with low bone mineral density. Patients with Magerl A3 thoracolumbar fracture underwent percutaneous pedicle screw short segment internal fixation from January 2017 to July 2020 were retrospectively analyzed, 93 cases met the diagnosis and inclusion criteria, 9 cases were excluded according to the exclusion criteria, and the remaining 84 cases obtained complete imaging follow-up data. There were 38 males and 46 females, the age ranged from 56 to 73 years old with an average of (64.78±7.12) years old, bone mineral density (BMD) ranged from 0.61 to 0.89 g/cm3 with an average of (0.73±0.14) g/cm3, the follow-up time was 11 to 25 months with an average of (17.58±6.12) months. There were 45 cases in group A with intermediate screw and 39 cases in group B without intermediate screw. The operation time and intraoperative blood loss were recorded, Oswestry Disability Index (ODI) and visual analogue scale (VAS) were used for clinical evaluation. The Cobb angle, vertebral wedge angle (VWA) and anterior vertebral body height (AVBH) were measured by X-ray after the operation. The corrected loss of the above parameters was calculated. There were 5 cases of screw loosening in 84 patients (2 cases in group A and 3 cases in group B, P>0.05). There were significant differences in operation time and intraoperative blood loss between two groups(P<0.01). Clinical effects of two groups were good, postoperative VAS and ODI after operation obviously improved, there was no significant difference between two groups during all follow-up periods (3 days, 1 month after operation and the final follow-up) (P>0.05). Three days after the operation, the image evaluations (Cobb angle, VWA and AVBH) were significantly improved (P<0.05), but significant reduction loss was observed in both groups at 1 month after the operation and at the final follow-up (P<0.05). At the final follow-up, the loss of Cobb angle, VWA and AVBH in group A were (5.26±4.18) °, (4.63±3.80) ° and (9.54±8.71)%, respectively;group B was (6.01±4.34) °, (6.55±6.21) ° and (11.67± 9.95)%, respectively;however, there was no significant difference in reduction loss between the two groups(P>0.05). Although the curative effect of the patients is satisfactory, the stability of the patients can not be improved by increasing the middle injured vertebra screw placement, the two groups of percutaneous short segment internal fixation can not resist the reduction loss of Magerl-A3 thoracolumbar fracture with low bone mineral density. Because the injured vertebra screw increases the operation time and intraoperative blood loss, it is not significant to use the intermediate screw for the elderly Magerl A3 thoracolumbar fractures with low bone mineral density.

The effect of the sequence of intermediate instrumentation and distraction-reduction of the fractured vertebrae on the surgical treatment of mild to moderate thoracolumbar burst fractures

To investigate the effect of the sequence of intermediate instrumentation with long screws and distraction-reduction on mild to moderate thoracolumbar fractures treated by posterior open and short-segmental fixation. The clinical data of 68 patients with mild to moderate thoracolumbar burst fractures who met the selection criteria between January 2016 and June 2019 were retrospectively analyzed. The patients were divided into group ISDRF (intermediate screws then distraction-reduction fixation, 32 cases) and group DRISF (distraction-reduction then intermediate screws fixation, 36 cases) according to the different operation methods. There was no significant difference between the two groups in age, gender, body mass index, fracture segment, cause of injury, and preoperative load-sharing classification score, thoracolumbar injury classification and severity score, vertebral canal occupational rate, back pain visual analogue scale (VAS) score, anterior height of fractured vertebra, and Cobb angle ( P>0.05). The operation time, intraoperative blood loss, complications, and fracture healing time were recorded and compared between the two groups. The vertebral canal occupational rate, anterior height of fractured vertebra, kyphosis Cobb angle, and back pain VAS score before and after operation were used to evaluate the effectiveness. There was no significant difference in intraoperative blood loss and operation time between the two groups ( P>0.05). No vascular or spinal nerve injury and deep infections or skin infections occurred in both groups. At 1 week after operation, the vertebral canal occupational rate in the two groups was significantly improved when compared with that before operation ( P<0.05), no significant difference was found in the difference of vertebral canal occupational rate before and after operation and improvement between the two groups ( P>0.05). The patients in both groups were followed up 18-24 months, with an average of 22.3 months. All vertebral fractures reached bone union at 6 months postoperatively. At last follow-up, there was no internal fixation failures such as broken screws, broken rods or loose screws, but there were 2 cases of mild back pain in the ISDRF group. The intra-group comparison showed that the back pain VAS score, the anterior height of fractured vertebra, and the Cobb angle of the two groups were significantly improved at each time point postoperatively ( P<0.05); the VAS scores at 12 months postoperatively and last follow-up were also improved when compared with that at 1 week postoperatively ( P<0.05). At last follow-up, the anterior height of fractured vertebra in the ISDRF group was significantly lost when compared with that at 1 week and 12 months postoperatively ( P<0.05), the Cobb angle had a significant loss when compared with that at 1 week postoperatively ( P<0.05); the anterior height of fractured vertebra and Cobb angle in DRISF group were not significantly lost when compared with that at 1 week and 12 months postoperatively ( P>0.05). The comparison between groups showed that there was no significant difference in the remission rate of VAS score between the two groups at 1 week postoperatively ( P>0.05), the recovery value of the anterior height of fractured vertebra in ISDRF group was significantly higher than that in DRISF group ( P<0.05), the loss rate at last follow-up was also significantly higher ( P<0.05); the correction rate of Cobb angle in ISDRF group was significantly higher than that in DRISF group at 1 week postoperatively ( P<0.05), but there was no significant difference in the loss rate of Cobb angle between the two groups at last follow-up ( P>0.05). In the treatment of mild to moderate thoracolumbar burst fractures with posterior short-segment fixation, the instrumentation of long screws in the injured vertebrae does not affect the reduction of the fracture fragments in the spinal canal. DRISF can better maintain the restored anterior height of the fractured vertebra and reduce the loss of kyphosis Cobb angle during the follow-up, indicating a better long-term effectiveness.

Risk Factors for Postoperative Loss of Correction in Thoracolumbar Injuries Caused by High-Energy Trauma Treated via Percutaneous Posterior Stabilization without Bone Fusion.

Background and Objectives: Percutaneous pedicle screws were first introduced in 2001, soon becoming the cornerstone of minimally invasive spinal stabilization. Use of the procedure allowed adequate reduction and stabilization of spinal injuries, even in severely injured patients. This decreased bleeding and shortened surgical time, thereby optimizing outcomes; however, postoperative correction loss and kyphosis still occurred in some cases. Thus, we investigated cases of percutaneous posterior fixation for thoracolumbar injury and examined the factors affecting the loss of correction. Materials and Methods: Sixty-seven patients who had undergone percutaneous posterior fixation for thoracolumbar injury (AO classifications A3, A4, B, and C) between 2009 and 2016 were included. Patients with a local kyphosis angle difference ≥10° on computed tomography at the postoperative follow-up (over 12 months after surgery) or those requiring additional surgery for interbody fusion were included in the correction loss group (n = 23); the no-loss group (n = 44) served as the control. The degree of injury (injury level, AO classification, load-sharing score, local kyphosis angle, cuneiform deformity angle, and cranial and caudal disc injury) and surgical content (number of fixed intervertebral vertebrae, type of screw used, presence/absence of screw insertion into the injured vertebrae, and presence/absence of vertebral formation) were evaluated as factors of correctional loss and compared between the two groups. Results: Comparison between each group revealed that differences in the wedge-shaped deformation angle, load-sharing score, degree of cranial disc damage, AO classification at the time of injury, and use of polyaxial screws were statistically significant. Logistic regression analysis showed that the differences in wedge-shaped deformation angle, AO classification, and cranial disc injury were statistically significant; no other factors with statistically significant differences were found. Conclusion: Correction loss was seen in cases with damage to the cranial intervertebral disc as well as the vertebral body.

Intervertebral disc injury is the mainspring for the postoperative increase in Cobb Angle after thoracolumbar burst fracture.

A single-institution retrospective study of a cohort of patients who underwent internal fixation spine surgery for thoracolumbar burst fracture (TLBF). To observe the imaging manifestations of intervertebral disc changes in TLBF, to analyze the relationship between the degree of disc injury and the Cobb angle increase. We retrospectively analyzed the data of patients who underwent short-segment pedicle screw instrumentation in the spinal surgery department of a single hospital between January 2014 and December 2017 (n = 90). According to the magnetic resonance imaging characteristics of the superior intervertebral disc tissue of the injured vertebrae before the operation, the intervertebral disc injury was divided into three types, which was used for group allocation: group A, uninjured intervertebral disc group; group B, mild intervertebral disc injury group; and group C, severe intervertebral disc injury group. The main imaging results of the three groups Cobb, IVA, IHI, AHIV, and VAS were compared among groups. Ninety patients were included in the study (n = 38, 32, and 20, in groups A, B, and C, respectively). There was no statistically significant difference in demographics among the three groups (p > .05). 1-year post-surgery, the Cobb angle in group C differed significantly from that in groups A and B (p < .01). There was a significant difference in Cobb angle between groups A and B after internal fixation was removed for 6 months. At 1-year post-surgery, the IHI group C differed significantly from groups A and B (p < .01), while groups A and B were similar (p = .102); however, at 6 months after the internal fixation was removed, the IHI differed significantly between these two groups, also the AHIV between groups A and B was statistically significant (p < .01). The VAS pain score was similar among the three groups. Pearson's test showed that the increase in the Cobb angle was moderately correlated with IVA and IHI, and weakly correlated with AHIV. For TLBF with an intervertebral disc injury, the presurgical degree of intervertebral disc injury is the main reason for the post-surgery increase in the Cobb angle. Thus, diagnosis and treatment of this kind of patient require attention to the risk of spinal deformity.

Treatment of osteoporotic vertebral compression fractures by unilateral puncture through the posterior outer upper part of the vertebral body

Objective: To comprehensively analyze the effect of unilateral and bilateral puncture in the treatment of osteoporotic vertebral compression fractures (OVCFs).Methods: The main subjects of this study were: OVCFs patients (a total of 100 cases, starting from October 2020 and ending from October 2021). According to the different treatment methods, two groups (50 cases in each group) were named, one group was the control group (applying bilateral puncture treatment through the vertebral body), the other group was the experimental group (unilateral puncture treatment through the vertebral body).Results: Compared with the control group, the operation time of the experimental group was shorter, P < 0.05; Compared with the control group, the amount of intraoperative blood loss in the experimental group was less, P < 0.05; Compared with the control group, the amount of bone cement filling and X-ray exposure in the experimental group were significantly less, P < 0.05; Compared with the control group, there was no difference in bone cement leakage rate in the experimental group (P > 0.05). Before treatment, compared with the control group, there were no differences in Cobb Angle, pain degree score, spinal dysfunction score and quality of life score between the experimental group and the control group, P > 0.05; After treatment, compared with the control group, the quality of life score of the experimental group was higher, P < 0.05; Compared with the control group, the Cobb Angle, pain degree score and spinal dysfunction score of the injured vertebrae in the experimental group were lower, P < 0.05.Conclusion: Unilateral puncture through posterior and upper vertebral body is more effective than bilateral puncture in OVCFs patients.

Application of Curved Diffusion Needle in unilateral percutaneous vertebroplasty

To evaluate the effectiveness of Curved Diffusion Needle in unilateral percutaneous vertebroplasty (PVP) by compared with bilateral PVP. A clinical data of 93 patients with osteoporotic vertebral compression fracture (OVCF) treated with PVP between January 2020 and January 2021 was retrospectively analyzed, including 47 patients underwent unilateral PVP assisted with Curved Diffusion Needle (unilateral group) and 46 patients underwent bilateral PVP (bilateral group). There was no significant difference in gender, age, cause of injury, time from injury to operation, T value of bone mineral density, AO classification, distribution of injured vertebrae, and preoperative visual analogue scale (VAS) score, Oswestry disability index (ODI), relative height of injured vertebrae, and Cobb angle between the two groups ( P>0.05). The operation time, the amount of bone cement injection, the incidence of bone cement leakage, the bone cement diffusion distribution, VAS score, ODI, the relative height of injured vertebrae, and Cobb angle were recorded and compared between the two groups. All operations successfully completed. The operation time was significantly shorter in unilateral group than in bilateral group ( t=-13.936, P=0.000), and the amount of bone cement injection was significantly less in unilateral group than in bilateral group ( t=-13.237, P=0.000). The incidence of bone cement leakage in unilateral group was 19.14%, which was significantly lower than that in bilateral group (39.13%) ( χ 2=4.505, P=0.034). The score of bone cement distribution in unilateral group was 7.0±1.3, of which 41 cases were excellent and 6 cases were well. The score of bilateral group was 7.4±0.8, of which 43 cases were excellent and 3 cases were well. There was no significant difference in score and grading of bone cement distribution between the two groups ( t=-1.630, P=0.107; Z=-1.013, P=0.311). All patients were followed up and the follow-up time was 3-10 months (mean, 6.5 months) in unilateral group and 3-10 months (mean, 6.1 months) in bilateral group. The VAS score, ODI, the relative height of injured vertebrae, and Cobb angle at 24 hours after operation and last follow-up were significantly better than those before operation in the two groups ( P<0.05). There were significant differences in all indicators between 24 hours after operation and last follow-up ( P<0.05). There was no significant difference in all indexes between the two groups ( P>0.05) at the same time point after operation. During follow-up, there was no complication such as contralateral vertebral collapse, refracture, adjacent vertebral fracture, or local kyphosis in the two groups. Unilateral PVP assisted with Curved Diffusion Needle for OVCF is beneficial to the distribution of bone cement, which can not only achieve similar effectiveness to bilateral PVP, but also achieve shorter operation time, less bone cement injection, and lower risk of bone cement leakage.

Неосложненные переломы шейных позвонков у детей и подростков

Introduction Various aspects of uncomplicated fractures of the cervical vertebrae in children and adolescents remain topical. Purpose To study incidence, character and type of uncomplicated fractures of the vertebrae of the cervical spine in children and adolescents. Materials and methods Out of 1000 children who had uncomplicated vertebral fractures, 27 (2.7 %) people were diagnosed with fractures at the cervical level. There were more boys among the injured – 77.77 % of the injured. 29.63 % of the patients were under the age of 12, and 70.37 % of – aged 12–17. Traditional methods for emergency traumatology were used for clinical diagnostics. Results In 17 (62.96 %) of the patients only the cervical vertebrae were compressed, in 10 (37.04 %) patients – both the thoracic vertebrae and the cervical vertebrae. Among the cervical vertebrae, compression of C7 vertebral body was most often observed – in 30.64 % of cases, less often – the body of C3 – in 4.08 % of cases. The main mechanism of injury was falling on head from a height of 2 m and more – 25.98 % of cases. Analysis of the character of C2 fractures showed that four patients had fractures of the odontoid process (three patients – type I, one – type III), one patient – fractures of the arches of this vertebra corresponding to type I. Fractures of subaxial location mainly corresponded to group "A" (subgroup I (36 compressed vertebrae), subgroup II (6 injured vertebrae)). In 2 cases, vertebral fractures were referred to group "B" (subgroup I). In 25 (92.59 %) clinical cases conservative treatment was used, in 2 (7.41 %) – there were indications for surgical treatment. The average duration of in-patient treatment for fractures of the cervical vertebrae was 9.4 days. Evaluation of long-term treatment results showed "good" results in 83.33 % of cases, satisfactory – in 16.67 % of clinical observations. Discussion The results that we have received are mainly comparable with the literature data on the main aspects of cervical trauma in children. At the same time, it is necessary to mention some differences. For example, many authors report that younger children most often get fractures of the C2 vertebra. According to our data, the average age of patients with these fractures was 14.8 years.

Clinical Outcomes of Fracture Haemorrhage Aspiration for Percutaneous Vertebroplasty in Treating Osteoporotic Vertebral Compression Fractures.

BackgroundA retrospective study aimed to introduce a new method for improving the diffusion degree of bone cement and to observe its clinical efficacy in percutaneous vertebroplasty treating osteoporotic vertebral compression fractures (OVCFs).MethodsFrom January 2019 to March 2020, a total of 83 patients were enrolled and reviewed. The patients were divided into two groups according to the operation method. The clinical and radiographic parameters were recorded and compared between these two groups. Those who received percutaneous vertebroplasty with haemorrhage aspiration were recorded as group A (n=42). In group A, the haemorrhage in the vertebral fracture was aspirated compared with conventional percutaneous vertebroplasty. Patients who underwent conventional percutaneous vertebroplasty were classified as group B (n=41).ResultsVisual analogue scale (VAS) values and Oswestry Disability Index (ODI) scores showed no significant difference between the two groups preoperatively, postoperatively or at the final follow-up (FU) (P>0.05). The intraoperative VAS score (bone cement injection) in group A was significantly lower than that in group B (3.83±0.79 vs 5.44±1.32, P < 0.01). The local kyphotic angle (LKA) (final follow-up), LKA loss, fractured vertebral anterior height loss (FVAHL) and anterior vertebral height loss ratio (AVHLR) were significantly lower in group A than in group B. The anterior vertebral height ratio (AVHR) at the final FU in group A was higher than that in group B (P=0.013). The distribution of bone cement was significantly different (P=0.034). By analysing the distribution pattern of bone cement, it was found that the values of LKA loss, FVAHL and AVHLR were superior in the type A bone cement distribution to those in types B and C.ConclusionCompared with traditional surgical methods, bone haemorrhage aspiration could improve the diffusion degree of bone cement and reduce the height loss and deformity of injured vertebrae. This method provides a feasible new scheme for improving the dispersion of bone cement.

A combination of digital design and three-dimensional printing to assist treatment of thoracolumbar compression fractures using percutaneous kyphoplasty

ObjectiveTo evaluate the clinical efficacy of the preoperative digital design combined with three-dimensional (3D) printing models to assist percutaneous kyphoplasty (PKP) treatment for thoracolumbar compression fractures. MethodsFrom January 2018 to August 2020, we obtained data of 99 patients diagnosed thoracolumbar compression fractures. These patients were divided into control group (n = 50) underwent traditional PKP surgery, and observation group (n = 49) underwent preoperative digital design combined with 3D printing model assisted PKP treatment. The clinical efficacy was evaluated with five parameters, including operation time, number of intraoperative radiographs, visual analogue scale (VAS) score, Cobb Angle change, and high compression rate of injured vertebrae. ResultsThere were statistically significant differences of operation time and number of intraoperative radiographs between the two groups (P < 0.05). For VAS score, Cobb Angle change and vertebral height compression rate, all of these three parameters were significantly improved when the patients accepted surgery treatment in two groups (P < 0.05). However, there were no significant differences between control group and observation group for these three parameters either before or after surgery (P > 0.05). ConclusionsThrough the design of preoperative surgical guide plate and the application of 3D printing model to guide the operation, the precise design of preoperative surgical puncture site and puncture Angle of the injured vertebra was realized, the number of intraoperative radiographs was reduced, the operation time was shortened and the operation efficiency was improved.

Use of Computed Tomography Compression Ratio in Diagnosis of Disc Injuries and Posterior Ligamentous Complex Injuries in Osteoporotic Thoracolumbar Compression Fractures

Background: Osteoporotic compression fractures are common among the elderly. It is important to predict the posterior ligamentous complex (PLC) and disc injuries in computed tomography (CT) scans of patients with magnetic resonance imaging (MRI) contraindications. Objectives: To determine the role of the CT compression ratio (CTCR) in diagnosing PLC and disc injuries and to compare it with the loss of vertebral body height (LOVBH) in osteoporotic thoracolumbar compression fractures. Patients and Methods: A total of 91 consecutive patients with vertebral fractures were included as the study population. The PLC and disc injuries were assessed using MRI, and the following radiological parameters were determined based on CT scans for further MRI examinations: CTCR, LOVBH, local kyphosis (LK), interspinous widening (ISW), vertebral translation (VBT), and posterior structures fractures (PSF). Statistical analysis was performed to identify the diagnostic value of CT features in PLC and disc injuries. Results: The PLC injuries were detected in 9/91 cases, and the number of disc injuries was 47/91. Neither CTCR nor LOVBH was associated with PLC injuries (P &gt; 0.05). However, the CTCR was associated with disc injuries (P &lt; 0.05), with an optimal threshold of 1.755 (sensitivity, 68.1%; specificity, 79.5%), while the LOVBH was not significantly associated with disc injuries. Based on the results, VBT was significantly related to PLC and disc injuries (P &lt; 0.05). Conclusion: The injured vertebral CTCR was associated with disc injuries rather than PLC injuries, suggesting that compression fractures are relatively stable with less PLC injury. Overall, CTCR is a useful indicator reflecting the compression degree of the injured vertebrae; it is also a valid predictor of disc injuries.

Short-term effectiveness of percutaneous pedicle screw fixation combined with intravertebral allograft by different methods for thoracolumbar fractures

To investigate the short-term effectiveness of percutaneous pedicle fixation combined with intravertebral allograft by different methods for thoracolumbar fractures. The clinical data of 94 patients with single segment thoracolumbar fracture who underwent percutaneous pedicle fixation combined with intravertebral allograft by different methods between October 2018 and October 2019 were retrospectively analyzed. According to the different methods of intravertebral allograft, they were divided into group A (bone grafting by Jack dilator, 40 cases) and group B (bone grafting by funnel, 54 cases). There was no significant difference between the two groups ( P>0.05) in the gender, age, body mass index, cause of injury, injured segment, Wolter index, time from injury to operation, and preoperative visual analogue scale (VAS) score, injured vertebral height ratio, and Cobb angle. The operation time, fluoroscopy frequency, allograft volume, and complications were recorded and compared between the two groups. VAS score of low back pain was used to evaluate the remission of clinical symptoms before operation, at 3 days, 3 months, 12 months after operation, and at last follow-up. The injured vertebral height ratio and Cobb angle were measured before operation, at 3 days, 3 months, and 12 months after operation. The operation time, fluoroscopy frequency, and allograft volume in group A were significantly higher than those in group B ( P<0.05). No complication occurred after operation, such as loosening or fracture of internal fixation. And bone grafting in the injured vertebrae healed at last follow-up. The VAS score, injured vertebral height ratio, and Cobb angle at each postoperative time point significantly improved when compared with preoperative ones ( P<0.05); compared with 3 days postoperatively, the VAS score improved further after 3 months, but the injured vertebral height ratio decreased and the Cobb angle increased, and the differences were significant ( P<0.05). There was no significant difference in the VAS scores of low back pain between the two groups at each time point after operation ( P>0.05); the injured vertebrae height ratio in group A was significantly higher than that in group B, and the Cobb angle was significantly lower than that in group B, all showing significant differences ( P<0.05). The intravertebral allograft via Jack dilator can restore the height and decrease the Cobb angle of the injured vertebrae, but accompanied with higher fluoroscopy frequency and longer operation time when compared with funnel bone grafting. For patients with single level thoracolumbar fractures, intravertebral allograft via Jack dilator is recommended.

The Clinical Effect of Manual Reduction Combined with Internal Fixation Through Wiltse Paraspinal Approach in the Treatment of Thoracolumbar Fracture.

ObjectiveTo evaluate the clinical outcome of manual reduction combined with pedicle fixation through Wiltse paraspinal approach (WPA) in the treatment of thoracolumbar fractures.MethodsFrom May 2017 to May 2019, 48 thoracolumbar fractures patients without neurological symptoms were enrolled in this study. Forty‐eight patients were randomly divided into two groups based on the different surgical treatment. Group 1 was manual reduction combined with pedicle screw fixation through Wiltse paraspinal approach treatment group. Group 2 was pedicle screw fixation through traditional posterior approach treatment group. The operation time (OT), intraoperative blood loss (BL), postoperative drainage (PD), time of brace (TB) and the cobb angle recovery of the injured kyphosis in the prone position were obtained and compared between the two groups, respectively. Comparison of cobb angle changes, serum creatine kinase (CK) level, pain visual analogue score (VAS), Oswestry disability index (ODI), and multifidus cross‐sectional (MCS) area changes were achieved between the two groups, respectively.ResultsForty‐eight patients were enrolled in this study and each group had 24 patients. There was no significant difference between the two groups in patient's age, height, weight, and body mass index (BMI). There were 20 males and four females in group 1. The mean age, height, weight, and BMI of patients were 61.99 ± 11.00 years (range, 42–75 years), 175.21 ± 4.49 cm, 76.71 ± 4.87 kg, and 24.98 ± 1.03 kg/m2 in group 1, respectively. Group 2 had 18 males and six females, and the mean age, height, weight, and BMI of patients were 57.95 ± 9.22 years (range, 44–77 years), 176.37 ± 4.56 cm, 77.42 ± 4.61 kg, and 24.87 ± 1.10 kg/m2 in group 2, respectively. The mean bleeding volume of group 1 was significantly less than group 2 (64.13 ± 9.77 ml and 152.13 ± 10.73 ml, respectively) (P < 0.05). The mean operation time, postoperative drainage, and time of brace were 62.95 ± 9.80 min, 66.25 ± 12.75 ml, and 3.62 ± 0.97 days in group 1, respectively, and they were significantly better than those of group 2 (69.29 ± 6.82min, 162.96 ± 14.55ml and 7.88 ± 1.94 days, respectively) (P < 0.05). The mean multifidus cross‐sectional area was significantly smaller than per‐operation after surgery in two groups (P < 0.05). The mean creatine kinase of group 1 was 403.13 ± 39.78 U/L and 292.12 ± 45.81 U/L at 1 and 3 days after surgery, respectively, which was significantly smaller than those in group 2 (654.25 ± 53.13 U/L and 467.67 ± 44.25 U/L, respectively) (P < 0.05). The Oswestry disability index of group 1 were significantly better than those in group 2 especially at 1 month and final follow‐up after surgery (P < 0.05). Moreover, group 1 also had better outcomes in postoperative Cobb angle change than those in group 2, with significant difference on intra‐operation, 1 day and 1 month post‐operation (P < 0.05).ConclusionIn short, this operation is suitable for thoracolumbar fractures without neurologic symptoms. Preoperative manual reduction had advantages of restoring the height of injured vertebrae. Wiltse intermuscular approach can reduce intraoperative blood loss, shorten operation time, and reduce paraspinal muscle damage. Using the traditional posterior approach, it is easy for surgeons to grasp this technique and it should be recommended as conforming with the minimally invasive approach of recent years.

Bilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach for osteoporotic vertebral compression fracture of lumbar

To evaluate the feasibility and short-term effectiveness of bilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach for osteoporotic vertebral compression fracture (OVCF) of lumbar. A retrospective analysis was made on the clinical data of 93 patients with OVCF of lumbar who met the selection criteria between January 2018 and June 2019. According to the different surgical methods, they were divided into group A (44 cases, treated with bilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach) and group B [49 cases, treated with percutaneous kyphoplasty (PKP) via bilateral transpedicle approach]. There was no significant difference in gender, age, body mass index, T value of bone mineral density, injury cause, fractured level, time from injury to operation, comorbidities, and preoperative Cobb angle of injured vertebra, visual analogue scale (VAS) score, and Oswestry disability index (ODI) between the two groups ( P>0.05). The operation time, intraoperative fluoroscopy times, bone cement injection amount, and incidence of bone cement leakage were recorded and compared between the two groups; Cobb angle of the injured vertebrae, VAS score, and ODI were measured before operation, at 2 days and 1 year after operation. The contralateral distribution ratio of bone cement was calculated according to the anteroposterior X-ray film at 2 days after operation. The operation time and the intraoperative fluoroscopy times in group A were significantly less than those in group B ( P<0.05). There was no bone cement adverse reactions, cardiac and cerebrovascular adverse events, and no complications such as puncture needles erroneously inserted into the spinal canal and nerve injuries occurred in the two groups. Bone cement leakage occurred in 6 cases and 8 cases in groups A and B, respectively, all of which were asymptomatic paravertebral or intervertebral leakage, and no intraspinal leakage occurred; the bone cement injection amount and incidence of bone cement leakage between the two groups showed no significant differences ( P>0.05). The contralateral distribution ratio of bone cement in group A was significantly lower than that in group B ( t=2.685, P=0.009). Patients in both groups were followed up 12-20 months, with an average of 15.3 months. The Cobb angle of the injured vertebrae, VAS score, and ODI in the two groups were significantly improved at 2 days after operation, however, the Cobb angle of the injured vertebra at 1 year after operation was significantly lost when compared with the 2 days after operation, the VAS score and ODI at 1 year after operation were significantly further improved when compared with the 2 days after operation, the differences were all significant ( P<0.05). There was no significant difference in the Cobb angle of the injured vertebrae, VAS score, and ODI between the two groups at each time point after operation ( P>0.05). Bilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach is comparable to bilateral PKP in short-term effectiveness with regard to fracture reduction, reduction maintenance, pain relief, and functional improvement. It has great advantages in reducing operation time and radiation exposure, although it is inferior in bone cement distribution.

Value of quantitative CT in vertebroplasty for osteoporotic fracture combined with scoliosis

To investigate the value of lumbar quantitative CT (QCT) in vertebroplasty for osteoporotic fracture combined with scoliosis. The clinical data of 60 patients with osteoporotic fractures combined with different degrees of scoliosis treated by vertebroplasty from December 2017 to December 2019 were retrospectively analyzed. There were 18 males and 42 females, aged from 65 to 81 (72.63±3.34)years old. All patients were received QCT examination before surgery. According to the QCT value, the patients were divided into osteopenia group(QCT>80 g/L, 10 cases, 12 vertebrae), osteoporosis group(QCT 40-80 g/L, 35 cases, 48 vertebrae) and severe osteoporosis group(QCT<40 g/L, 15 cases, 22 vertebrae). The dispersion and leakage of bone cement in the injured vertebrae of patients with different degrees of QCT value were observed, and the QCT value in the selection of puncture point, correction of Cobb angle and recovery of vertebral height were analyzed in the patients. Among 60 cases of 82 vertebrae, 41 cases of 55 vertebrae were punctured by concave unilateral puncture, according for 67.07%. Among them, there were 2 cases with 2 vertebrae in osteopenia group, 26 cases with 35 vertebrae in osteoporosis group, and 13 cases with 18 vertebrae in severe osteoporosis group. There was significant difference in the number of cases with unilateral or bilateral puncture among the three groups (χ2=13.699, P=0.001); there was no significant difference in the number of cases with bone cement leakage among the three groups (χ2=1.403, P=0.496). The Cobb angle of scoliosis was significantly differentbetween preoperative and postoperative follow-up(P<0.05);the height of injured vertebral body was significantly different between preoperative and postoperative follow-up (P<0.05). For patients with osteoporotic fracture combined with scoliosis undergoing vertebroplasty, the severity of osteoporosis should be determined according to lumbar QCT detection, and the concave side of scoliosis should be selected for puncture, which is conducive to improving scoliosis, restoring spinal stability and improving surgical safety.

Imageology study of correlation loss and its related factors after short-segment pedicle screw reduction and fixation for lumbar fractures

To analyze the correction loss after posterior segmental fixation for lumbar spine fractures and explore the related image factors. Posterior short-segment fixation was received in 48 patients with L2-L4 fractures. There were 32 males and 16 females, with ages of 23 to 60 (45.98±8.20) yeaes. The anterior vertebrae height (AVH), vertebral wedge angle (VWA) of the injured vertebra and local kyphosis angle (LKA) were measured before operation, 1 week after operation and the final follow-up. The loss of segmental discal angle (LoSDA), LKA(LoLKA), AVH(LoAVH) were calculated between 1 week postoperative and the last follow up. Preoperative load-sharing scores(LSS), TLICS scores, and adjacent intervertebral disc injuries (IDIs) were assessed. Then the correlation between the age, follow up time, LSS, TLICS, IDIs and the correction loss was analyzed. The average follow-up was 12 to 18 (16.13±5.39) months. LKA, AVH and VWA at 1 week postoperative and those at the final follow up, were significantly improved compared with those preoperative (P<0.05). In the final follow up, the average LKA(5.70±3.17)° and AVH(4.31±5.95)% correction loss were observed compared with those 1 week postoperative(P<0.05). Otherwise the lose of VWA was not obvious(P>0.05). Univariate analysis showed that the SDA (r=0.706, 0.579, 0.449) and LKA(r=0.715, 0.566, 0.502) correction loss were aggravated with the increase of LSS, TLICS and IDIs, and AVH (r=-0.325, -0.219) correction loss was aggravated with the increase of LSS and TLICS(P<0.05). Multivariate analysis showed that increased LSS scores were all risk factors for segmental disc angle (SDA) loss, LKA correction loss, and AVH correction loss (P<0.05). The angle of adjacent intervertebral discs and anterior height of injured vertebrae were lost statistically after posterior short-segment pedicle screw treatment for lumbar fractures, and multivariate analysis showed that all of them were correlated with load-sharing score.