Longitudinal Ligament Injury Research Articles

Correlation Between Quantitative Cage Pressure Measurements and Surgeons' Qualitative Tactile Assessments During Extraction in Lumbar Lateral Interbody Fusion: A Cadaveric Study.

A cadaveric study. Measuring the pressure exerted on lumbar lateral interbody fusion (LLIF) cages and examining its correlation with qualitative assessment of tactile feedback related to pullout strength during cage extraction to determine the optimal cage height. No data exists on the relationship between the surgeon's tactile feedback related to pullout strength during the LLIF cage extraction and the cage pressures measured during surgery. We used four cadavers to insert the original stress-measuring cages at the L2/3 to L4/5 levels (12 intervertebral spaces) using the oblique lumbar lateral approach. The intervertebral disc height (IDH) was measured before cage insertion. These stainless-steel stress-measuring cages were designed with the same shape as standard cages and included a built-in load cell to measure the stress applied. The cage heights were set at 8, 10, and 12 mm and they were inserted sequentially from 8mm, with stress measurements taken at each step. Four spine surgeons qualitatively evaluated the extraction strength using three rating categories ("loose," "appropriate," and "hard to extract"). After cage removal, endplate damage (ED) and anterior longitudinal ligament injury (ALLI) were checked. The anterior part of the vertebral body was dissected to expose the ALL and it is checked for obvious injuries. Additionally, a surgical probe is used to check for ED and ALLI. The measured cage pressures were 45, 120, and 191 N for the "loose," "appropriate," and "hard to extract" ratings, respectively (P < 0.001). ED was observed in five intervertebral spaces, whereas no ALLI was noted. The average maximum pressure when ED occurred was 127 N. The primary risk factor for ED was identified as the difference between the height of the inserted cage and IDH, with a cut-off value of 4.5mm. The appropriate extraction strength corresponded to a cage pressure of 120 N. A cage pressure ≥127 N posed a risk for ED. ED incidence was high when the difference between the IDH and the height of the inserted cage exceeded 4.5mm. Level Three.

Analysis of risk factors affecting postoperative neurological recovery in patients with cervical spine fracture in ankylosing spondylitis.

Ankylosing spondylitis (AS) is a chronic progressive inflammatory disease that mainly affects the spine and involves the sacroiliac and peripheral joints. Low-energy trauma can often lead to spinal fractures and spinal cord injuries (SCIs), the treatment of AS is challenging. The prognosis of neurological function in patients with AS cervical fracture and SCI is a major problem that must sought clinician attention on urgent basis. A total of 106 patients with AS cervical fractures who underwent surgical treatment at Shanghai Changzheng Hospital between August 2009 and 2021 were included in this study. All the patients were divided into 2 groups (improved group and the control group) based on their neurological function improvement at 1 year mark after the surgery. The baseline characteristics, perioperative factors, and procedural outcomes of all the patients including injury type, AS drug treatment, the injured segment, ossified anterior longitudinal ligament injury, spinal hypersignal, decompression time window, operation duration, blood loss, preoperative and postoperative American Spinal Injury Association (ASIA) score were recorded and analyzed. Among the 106 patients, 79 demonstrated improved neurological function at 1 year mark after the surgery. Binary univariate logistic regression analysis revealed significant differences in injury type (P = .018), ossified anterior longitudinal ligament injury (P = .01), operation duration (P = .002), spinal hypersignal (P = .001), preoperative ASIA score (P < .001), and prior AS drug treatment (P = .012). No significant differences were observed in the other variables (P > .05). Binary multivariate logistic regression analysis identified spinal hypersignal (OR = 37.185, P = .028), preoperative ASIA score (OR = 0.16, P = .012) and previous AS drug treatment (OR = 0.296, P = .049) as factors associated with postoperative neurological function improvement. The preoperative ASIA score and previous drug treatment of AS were identified as protective factors affecting the improvement of neurological functions in patients with AS cervical fracture after surgery. Preoperative T2-weighted spinal hypersignal was identified as an independent risk factor affecting the improvement of neurological function recovery in patients with AS cervical fracture after the surgery.

Nationwide Survey of the Surgical Complications Associated with Lateral Lumbar Interbody Fusion in 2015-2020.

Lateral lumbar interbody fusion (LLIF) has been introduced in Japan in 2013. Despite the effectiveness of this procedure, several considerable complications have been reported. This study reported the results of a nationwide survey performed by the Japanese Society for Spine Surgery and Related Research (JSSR) on the complications associated with LLIF performed in Japan. JSSR members conducted a web-based survey following LLIF between 2015 and 2020. Any complications meeting the following criteria were included: (1) major vessel, (2) urinary tract, (3) renal, (4) visceral organ, (5) lung, (6) vertebral, (7) nerve, and (8) anterior longitudinal ligament injury; (9) weakness of psoas; (10) motor and (11) sensory deficit; (12) surgical site infection; and (13) other complications. The complications were analyzed in all LLIF patients, and the differences in incidence and type of complications between the transpsoas (TP) and prepsoas (PP) approaches were compared. Among the 13,245 LLIF patients (TP 6,198 patients [47%] and PP 7,047 patients [53%]), 389 complications occurred in 366 (2.76%) patients. The most common complication was sensory deficit (0.5%), followed by motor deficit (0.43%) and weakness of psoas muscle (0.22%). Among the patient cohort, 100 patients (0.74%) required revision surgery during the survey period. Almost half of the complications developed in patients with spinal deformity (183 patients [47.0%]). Four patients (0.03%) died from complications. Statistically more frequent complications occurred in the TP approach than in the PP approach (TP vs. PP, 220 patients [3.55%] vs. 169 patients [2.40%]; p<0.001). The overall complication rate was 2.76%, and 0.74% of the patients required revision surgery because of complications. Four patients died from complications. LLIF may be beneficial for degenerative lumbar conditions with acceptable complications; however, the indication for spinal deformity should be carefully determined by the experience of the surgeon and the extent of the deformity.

Soft Tissue Injury in Cervical Spine Is a Risk Factor for Intersegmental Instability: A Finite Element Analysis

Soft tissue cervical spine injury (CSI) has the possibility of causing cervical segmental instability, which can lead to spinal cord injury. There is a lack of certainty in assessing whether soft tissue CSI is unstable or not. This biomechanical study aimed to investigate the risk factors of soft tissue CSI. A 3-dimensional finite element model of the ligamentous cervical spine (C2-C7) was created from medical images. Three soft tissue injury models were simulated at C4-C5: 1) posterior ligament complex (PLC) injury, 2) intervertebral disk (ID) with anterior longitudinal ligament injury (IDI), and 3) anterior longitudinal ligament, PLC, and ID injury (API) model. Pure moment with compressive follower load was applied, and the range of motion, annular stress, nucleus stress, and facet forces were analyzed. For the IDI and API models, the range of motion increased at the injury level in extension (by 101%) and left/right axial rotations (>30%) compared with the intact model. The IDI and API models showed an increase of >50% in annular and nucleus stresses at the injury level in extension and left/right rotations compared with the intact model. The PLC injury showed similar stresses as the intact model except for flexion. The facet contact forces of IDI and API models increased more than 100% compared with other models in all motions. In CSI, all soft tissues have a key role in stabilizing cervical spine, but ID is the most important component of all.

Lower Extremity Radicular Pain Caused by Entrapped Sigmoid Colon Between L5 and S1 Vertebrae

Intestinal entrapment between two vertebral bodies is very rare. In all previous cases, it occurred by major trauma. However, the bowel entrapment between two vertebral bodies without trauma has never been reported, not to mention as the cause of lower extremity radicular pain. We describe the case of an 82-year-old female patient with right lower extremity radicular pain without recent trauma history. The patient was diagnosed sigmoid colon entrapment between the L5 and S1 vertebrae by lumbar spinal computerized tomography and magnetic resonance imaging, and showed improvement in radicular pain after manual reduction of interpositioned colon during surgery. Intestinal entrapment between two vertebrae without trauma is caused by degenerative and vacuum changes of the intervertebral disc combined with the anterior longitudinal ligament injury.

A 92-year-old man with retropharyngeal hematoma caused by an injury of the anterior longitudinal ligament

Abstract Traumatic retropharyngeal hematoma is a rare condition and may be lethal in some cases. In patients with this condition, the absence of a vertebral fracture or a major vascular injury is extremely rare. We present the case of a 92-year-old man who hit his forehead by slipping on the floor in his house. He had no symptoms at the time; however, he experienced throat pain and dyspnea at 6 hours after the injury. On arrival, he complained of severe dyspnea; therefore, an emergency endotracheal intubation was performed. A lateral neck roentgenogram after intubation showed dilatation of the retropharyngeal and retrotracheal space and no evidence of a cervical vertebral fracture. Cervical computed tomography (CT) with contrast medium revealed a massive hematoma extending from the retropharyngeal to the superior mediastinal space but no evidence of contrast medium extravasation or a vertebral fracture. However, sagittal magnetic resonance imaging (MRI) revealed an anterior longitudinal ligament (C 4-5 levels) injury. We determined that the cause of the hematoma was an anterior longitudinal ligament injury and a minor vascular injury around the injured ligament. Therefore, we recommend that patients with retropharyngeal hematoma undergo sagittal cervical MRI when roentgenography and CT reveal no evidence of injury.

Diagnosis and treatment of injury to cervical anterior longitudinal ligaments

Objective To discuss the diagnosis and treatment of the injury to cervical anterior longitudinal ligaments (CALL) . Methods Forty-six patients were enrolled in this study whose CALL injury had been confirmed by radiological examination from March 2001 to July 2003. Their AP X-ray films and MRI of cervical spine were taken within 3 hours to 3 days after injury. Prevertebral soft tissue swelling was found in 35 cases and low cervical spinal instability in 14 cases. Damaged ligaments showed gray or gray-white signals which broke sometimes on MRT1-WI, and sheet sagittal widen uneven high signals which were usually disrupted on MRT2-WI. Early surgery was done for 19 patients complicated with spinal cord injury (SCI) (15 anterior decompression fusion, 2 posterior decompression fusion, 2 anteropesterior decompression fusion). Of 27 patients with simple neck pain, early operation was done for 6, cervical plaster orthosis was applied for 5 and cervical collar for 16. Results The mean follow-up time was from 6 to 41 (average, 16. 7) months in 45 patients. Complete SCI was improved to incomplete one in 2 of the 5 patients with complete SCI. Incomplete SCI was improved in different degrees in 10 of the 14 patients with incomplete SCI. No kyphosis or chronic neck pain was found after early operation for the 6 cases of simple neck pain. Of the 21 patients who were treated by cervical plaster orthosis or cervical collar, 7 had evidence of instability on flexion-exteusion imaging and thus underwent anterior decompression fusion to release their chronic neck pain and discomfort Anterior surgery was done for other 2 patients 2 to 3 years after injury because of disc degeneration and extrusion. Other 3 patients had complaints of discomfort and another one was lost for follow-up. The rest 8 were good. Conclusions MRI is the most valuable measure for diagnosis of CALL injury. Decompression and fusion should be done early for CALL injury complicated with spinal cord compression or with severe vertebral iustability. Early anterior discectomy and fusion should be done for cervical disc and longitudinal ligament injury without spinal cord injury. Key words: Cervical vertebrae; Longitudinal ligaments; Magnetic resonance imaging (MRI)

Diagnosis and treatment for the injury of cervical disc and longitudinal ligament

To study the diagnosis and treatment for the injury of cervical disc and longitudinal ligament. From 2001 to 2005, the clinical data of sixty-three patients with cervical disc and longitudinal ligament injury were studied. Early treatment was done based on spinal cord injuries and spinal stabilities by X rays and MRI. Early operation was done in fifty-four cases and early non-operation in nine cases. The follow-up time was six to forty-one months in all patients. The neurological recovery was found in two of eight complete SCI post-operation, thirty-one in thirty-nine incomplete SCI. Cervical collar or plaster orthotic were used in nine cases with four to six weeks. Evidence of instability was noted in four patients, who were operated with anterior decompression fusion. Neck chronic pain was found in two patients, anterior decompression and fusion was done in one with cervical spinal cord compression. MRI examination is the most value measure for the diagnosis of cervical disc and longitudinal ligament injury. Early anterior decompression and fusion was an important approach for cervical disc and longitudinal ligament injury.

Acute cervical spine injuries: prospective MR imaging assessment at a level 1 trauma center.

To determine the weighted average sensitivity of magnetic resonance (MR) imaging in the prospective detection of acute neck injury and to compare these findings with those of a comprehensive conventional radiographic assessment. Conventional radiography and MR imaging were performed in 199 patients presenting to a level 1 trauma center with suspected cervical spine injury. Weighted sensitivities and specificities were calculated, and a weighted average across eight vertebral levels from C1 to T1 was formed. Fourteen parameters indicative of acute injury were tabulated. Fifty-eight patients had 172 acute cervical injuries. MR imaging depicted 136 (79%) acute abnormalities and conventional radiography depicted 39 (23%). For assessment of acute fractures, MR images (weighted average sensitivity, 43%; CI: 21%, 66%) were comparable to conventional radiographs (weighted average sensitivity, 48%; CI: 30%, 65%). MR imaging was superior to conventional radiography in the evaluation of pre- or paravertebral hemorrhage or edema, anterior or posterior longitudinal ligament injury, traumatic disk herniation, cord edema, and cord compression. Cord injuries were associated with cervical spine spondylosis (P < .05), acute fracture (P < .001), and canal stenosis (P < .001). MR imaging is more accurate than radiography in the detection of a wide spectrum of neck injuries, and further study is warranted of its potential effect on medical decision making, clinical outcome, and cost-effectiveness.

Facet Joint Injuries in Acute Cervical Spine Trauma: Evaluation with CT and MRI

Purpose : To evaluate injury patterns of facet joints and associated soft tissue injuries in patients withacute traumatic cervical facet joint injuries. Materials and Methods : From among patients with cervical spinetrauma, 27 with facet joint injuries, as seen on CT and MRI, were chosen for this study. CT scans were analyzedwith regard to the location of facet joint injury, the presence or absence of facet dislocation or fracture, andother associated fractures. MR images were analyzed with regard to ligament injury, intervertebral disc injury,intervertebral disc herniation, and spinal cord injury. Results : The most common location of facet joint injurywas C6-7 level(n=10), followed by C5-6(n=8). Among these 27 patients with facet joint injuries, 12(44%) hadbilateral injuries and 15(56%) unilateral injuries. Facet fractures were present in 17 cases(63%) and the fractureof inferior facet was more frequent than superi-or. Patterns of fracture were vertical, transverse, or comminuted,but vertical fracture was the most common. Various degrees of dislocation were observed in patients with facetfractures. Fractures other than facet includ-ed pillar(n=11), lamina(n=6), transverse process(n=14), body(n=13),and spinous process(n=3). On MR im-ages, anterior longitudinal ligament injury was found in 8 patients(30%),posterior longitudinal ligament injury in 4(15%), and interspinous ligament injury in 20(74%). Twelvepatients(44%) had spinal cord injuries includ-ing edema(n=8) and hemorrhage(n=4). Among patients with discabnormalities, 11(41%) had intervertebral disc injuries, and traumatic disc herniations were found in nine.Conclusion : Traumatic cervical facet joint injuries were manifested as various patterns and frequentlyassoci-ated with other fractures or soft tissue injuries. Analysis of CT and MR findings of these injury patternshelped formulate a therapeutic plan and determine of prognosis.