Body Height Loss Research Articles

Should dry spinal tuberculosis be managed differently than wet spinal tuberculosis?

On radiopathological examination of spinal tuberculosis (TB), two predominant forms are known: dry and wet types. Wet TB, as the name suggests, has abscess formation as its predominant presenting feature and is the exudative form; dry TB includes caseation and sequestration with minimal exudate. Dry TB often exhibits poorer recovery patterns than the wet counterparts, which can be possibly ascribed to vasculitis, ischemia, or tubercular myelitis, rather than isolated mechanical compression. These pathologic processes may lead to neurological deficit which is less responsive to treatment. To quantify the recovery and prognosis, and test for the significance of difference between neurological recovery pattern and prognosis of the two forms of spinal TB. A retrospective analytical observational study design in the form of a cohort study was performed. Single-center patient data over 6 years was analyzed. Of 217 patients with spinal TB, 18 had dry TB (Group 1). Two patients were excluded because they presented very late after the onset of neurological deficit, which could have played a role in the non-recovering nature of motor weakness. The remaining patients had wet TB, of which 22 patients were selected for propensity score matching to form a comparison group. Radiological measures included vertebral body height loss, deformity, canal encroachment, cord diameter, altered cord signal intensity and loss of CSF space. Functional measures were ambulatory status of the patient at final follow-up and neurologic status measured by ASIA (American Spinal Injury Association) and LEMS (Lower Extremity Motor Score) scoring. The criteria for dry TB were imaging suggestive of granulation tissue (heterogenous hypo- or hyper-intensity on T2WI sequence), with at least one of the two factors (1) absence of anterior or posterior epidural abscess formation within the spinal canal (2) a canal encroachment of <30%. The groups were compared with respect to their differences in demographic distribution, symptom complex, mycobacterial drug sensitivity and presence of history of tuberculosis elsewhere in the body. Analysis was done by various tests of significance depending on the type of variable. Bar charts and Pie charts were used for visual representation of the analyzed data. Level of significance was set at 0.05. Dry TB showed partial or no return to ambulation (75%,versus 31.5% in wet, p=0.01) at 12-months and took more time to reach final ambulatory level (9.16 months versus 2.9 months in wet), despite having a lower average Cobb angle (16.5 degrees versus 20.95 in wet (p=0.132), lower mean canal-encroachment (24.9% versus 50.09% in wet, p<0.01) and preserved posterior-CSF flow as compared to wet TB (p=0.02). At final follow-up, 4/16 (25%) of dry and 0% of wet TB were ASIA A, and 9/16 (56.25%) dry and 18/22 (72.7%) of wet TB were ASIA E (p=0.04). Dry TB of the spine has poorer functional outcome in terms of time to ambulation and final ambulatory status despite having minimal destruction and abscess formation causing mechanical cord compression.

Vertebral augmentation: How we do it

Vertebral augmentation consists of minimally invasive techniques indicated in the treatment of vertebral compression fractures (VCFs). These compression fractures cause vertebral body height loss and consequent significant pain and are most frequently the result of osteoporosis, cancer metastasis, or trauma. The deleterious effects of VCFs often compound, as greater load-bearing stress is transferred to the remaining healthy vertebrae1. Kyphoplasty, vertebroplasty, and intravertebral implants are closely related vertebral augmentation techniques that serve to relieve pain and to counter pathophysiological stress and structural degradation of the vertebral column alignment. All three approaches are performed percutaneously and are therefore attractive options for patients deemed to be poor candidates for open surgery2.Each technique involves transpedicular needle access to the vertebral body matrix, followed by introduction of a cement-like polymer through a catheter to fill the space and provide structural fortification. Vertebroplasty involves injection of the cement material into the matrix space without any adjunctive measures. In kyphoplasty, a balloon is first introduced to expand the collapsed, fractured area with the goal of approximating the pre-fracture anatomy of the vertebral body and thereby spinal curvature, promptly followed by cement introduction. In intravertebral implantation procedures, a permanent jack is inserted into the vertebral body matrix and expanded craniocaudally, with the same purpose of restoring normal structure, before the matrix space is filled with cement polymer3. This article provides an overview of these vertebral augmentation techniques, including pre- and post-procedural considerations, with an emphasis on the technical aspects of the interventions.

A cost-free approach to evaluating vertebral body bone density and height loss in lung transplant recipients using routine chest CT

BackgroundTo assess changes in bone density and vertebral body height of patients undergoing lung transplant surgery using computed tomography (CT). MethodsThis institutional review board (IRB) approved retrospective observational study enrolled patients with a history of lung transplant who had at least two chest CT scans. Vertebral body bone density (superior, middle, and inferior sections) and height (anterior, middle, and posterior sections) were measured at T1-T12 at baseline and follow up CT scans. Changes in the mean bone density, mean vertebral height, vertebral compression ratio (VBCR), percentage of anterior height compression (PAHC), and percentage of middle height compression (PMHC) were calculated and analyzed. ResultsA total of 93 participants with mean age of 58 ± 12.3 years were enrolled. The most common underlying disease that led to lung transplants was interstitial lung diseases (57 %). The inter-scan interval was 34.06 ± 24.8 months. There were significant changes (p-value < 0.05) in bone density at all levels from T3 to T12, with the greatest decline at the T10 level from 163.06 HU to 141.84 HU (p-value < 0.05). The average VBCR decreased from 96.91 to 96.15 (p-value < 0.05). ConclusionRoutine chest CT scans demonstrate a gradual decrease in vertebral body bone density over time in lung transplant recipients, along with evident anatomic changes such as vertebral body bone compression. This study shows that utilizing routine chest CT for lung transplant recipients can be regarded as a cost-free tool for assessing the vertebral body bone changes in these patients and potentially aiding in the prevention of complications related to osteoporosis.

Spine Involvement and Vertebral Deformity in Patients Diagnosed with Chronic Recurrent Multifocal Osteomyelitis.

Chronic recurrent multifocal osteomyelitis (CRMO) is an inflammatory disorder of bone, typically arising adjacent to the physes of long bones but also seen throughout the skeleton. For patients with spinal involvement, CRMO lesions can cause compression deformities with a range of severity from minimal anterior wedging to circumferential height loss, known as vertebra plana. This study examines a large cohort of CRMO patients to determine the prevalence of spine involvement and vertebral deformity. This is a retrospective review of all patients with a diagnosis of CRMO seen at our institution between January 2003 and December 2020. These patients were identified through a prospectively maintained database of all CRMO patients seen at the institution. A retrospective review was undertaken to identify all patients with spinal involvement and determine the prevalence of CRMO in the spine and its effects on vertebral height and deformity. Of 170 patients included in this study, 48 (28.2%) were found to have spinal involvement. Among patients with spinal involvement, vertebral body lesions were identified in 27 (56.3%) patients. The remaining lesions were in the sacrum or posterior elements. Radiographic evidence of the vertebral body height loss was noted in 23 of these 27 patients. This cohort of CRMO patients demonstrates that 28% of patients have spinal involvement, and 48% of those patients have vertebral body height loss. While the ideal treatment for spinal CRMO has yet to be determined, imaging studies, including whole-body MRI and spine-specific MRI, are useful in identifying vertebral lesions and deformities. Identification and surveillance of these lesions are important as the disorder has a relapsing and remitting course, and patients can develop significant vertebral body height loss. Once deformity has developed, we have seen no evidence of reconstitution of the height of the collapsed vertebra. Bisphosphonates have been successful in preventing the progression of vertebral body height loss. Level II: Retrospective study investigating spinal involvement and prevalence of vertebral body deformity in patients diagnosed with CRMO.

Accuracy of an artificial intelligence algorithm for detecting moderate-to-severe vertebral compression fractures on abdominal and thoracic computed tomography scans.

To describe the accuracy of HealthVCF, a software product that uses artificial intelligence, in the detection of incidental moderate-to-severe vertebral compression fractures (VCFs) on chest and abdominal computed tomography scans. We included a consecutive sample of 899 chest and abdominal computed tomography scans of patients 51-99 years of age. Scans were retrospectively evaluated by the software and by two specialists in musculoskeletal imaging for the presence of VCFs with vertebral body height loss > 25%. We compared the software analysis with that of a general radiologist, using the evaluation of the two specialists as the reference. The software showed a diagnostic accuracy of 89.6% (95% CI: 87.4-91.5%) for moderate-to-severe VCFs, with a sensitivity of 73.8%, a specificity of 92.7%, and a negative predictive value of 94.8%. Among the 145 positive scans detected by the software, the general radiologist failed to report the fractures in 62 (42.8%), and the algorithm detected additional fractures in 38 of those scans. The software has good accuracy for the detection of moderate-to-severe VCFs, with high specificity, and can increase the opportunistic detection rate of VCFs by radiologists who do not specialize in musculoskeletal imaging.

Clinical efficacy and safety of kyphoplasty for the treatment of osteoporotic vertebral compression fractures at different surgical timings based on the theory of “dynamic-static integration”

ObjectiveTo investigate the clinical efficacy and safety of percutaneous kyphoplasty at different surgical timings in the treatment of osteoporotic vertebral compression fracture (OVCF) based on the theory of “dynamic-static integration”. MethodsPatients with OVCF who underwent percutaneous kyphoplasty in our hospital were selected and divided into Groups A, B, and C for those undergoing surgery within 7, 7–21, and >21 days of fracture occurrence. The variations in the amount of bone cement injected, pre- and post-operative pain levels, functional activity, deformity correction of the injured vertebrae, bone cement leakage, and vertebral body height loss were compared among the three groups. ResultsRegarding pain relief and functional activity, the postoperative Visual Analog Scale and Oswestry Disability Index scores of the three groups significantly improved. Furthermore, the deformities of the injured vertebrae in the three groups were significantly corrected, with Groups A and B exhibiting superior correction compared to Group C. Moreover, the bone cement leakage rates in groups A and C were higher than that in Group B. At the 3-month follow-up, the loss of vertebral height in Group C was significantly higher than those in groups A and B. ConclusionKyphoplasty is effective for OVCF treatment. Early surgery can effectively restore the vertebral height of the injured vertebra, reduce kyphosis, and reduce height loss of the injured vertebra after surgery; nevertheless, treatment within 1–3 weeks of the fracture can reduce the occurrence of bone cement leakage, making the surgery safer. Therefore, surgical treatment within 1–3 weeks of fracture is safer and can achieve satisfactory therapeutic effects. From the perspective of traditional Chinese medicine, PKP surgery can transform the fracture end from a micromotion state to a fixed state, which fully embodies the theory of “dynamic-static integration”.

Do upright radiograph findings affect treatment plans for patients with thoracic and lumbar spine injuries?

Background After spinal trauma, upright radiographs are commonly used to evaluate spinal stability. However, the benefits and risks of upright films have not yet been thoroughly studied. This study aimed to elucidate the effect that upright imaging has on patients with thoracic and/or lumbar spinal injuries by evaluating the impact on treatment decisions. Methods A retrospective review of all adult patients who suffered traumatic spine injuries and received thoracic and/or lumbar spine imaging between April 2019 and March 2021 in a Level 1 University Trauma Center. Patients’ charts were reviewed, and those patients who received upright films as a final dynamic evaluation of their spine before clearance for standing were identified. Fractures due to infection or malignancy were excluded as were 17 patients who only received post-operative upright films. We examined whether upright films modified the treatment strategy. Results Of the 353 upright radiographs conducted on patients without prior surgical intervention, 27 (7.6%) of these studies provided information not known from prior imaging; the remaining 92.4% of upright films were considered “unchanged” or “stable.” Of the 27 patients who had changes in uprights, in only 7 cases (2.0%) did the new findings affect the treatment plans. In 6/7 cases, upright films showed increased vertebral body height loss and/or worsening fractures—suggestive of instability—in previously known T12-L1 fractures. Conclusions We studied 353 patients who received T and/or L uprights after suffering a traumatic spine injury and before receiving any surgical interventions. Of these patients, 98.0% did not gain substantial benefit from the additional imaging as the upright radiographs did not affect the treatment strategy. In 2% of cases a significant change in management was indicated following the upright films; virtually all of these were in T11-L2 fractures. The utility of upright films should be re-evaluated and more studies directed to potentially clarify which subgroups of patients will benefit from these radiographs.

Functional and Radiological Outcome of Short Same Segment Instrumentation in Thoracolumbar Burst fracture.

Thoracolumbar region is important biomechanics transition zone in which rigid thoracic and flexible lumbar spine meet. This area is highly vulnerable to traumatic spinal fracture.Among all spine fracture, compression type is most common and managed conservatively. Thoracolumbar spine fracture can be associated with neurological deficit, spinal instability. The optimal treatment for these injuries is still controversy and subject for research. This retrospective study included 30 patients with single level thoracolumbar fracture.All the patients clinical and radiological parameters were evaluated preoperative, post-operative and 1 year follow up. Clinical parameters were included Visual analogue score, Oswestry disability index. Radiologic measurement were regional kyphotic angle by cobb's method and anterior vertebral body height loss (Mumford' santerior body compression equation method) in X-ray. All the data were analysed in SPSS version 20. A total of 30 patients were included in this study,19 were male.The mean age of the patients were 40.8±13.The main cause of injury was fall from height,26 patients. The most common level of fracture vertebra was L1,11 patients.The mean difference of preop and postop kyphosis was 11.70±50 with P<0.05.The mean difference of preop Oswestry disability index and postop Oswestry disability index score was 30.7±7.6 with T score 22(P<0.05).The preop and postop Visual analogue score score also improved ,mean difference was 2.8±1(P<0.05). Short segment instrumentation with placement of pedicle screw at fracture vertebra is one option in the treatment of thoracolumbar burst fracture.

Pre-operative spirometry evaluation in adolescent girls with severe idiopathic scoliosis

Introduction. Pulmonary impairment may be observed in patients with severe idiopathic scoliosis (IS). The aim of the study was to analyze spirometry parameters and identify the pulmonary status of patients prior to scoliosis surgery. Materials and methods. Ninety-two adolescent girls with IS, aged 10-18 underwent a spirometry examination and radiographic evaluation. The body height loss was calculated from Stokes’ formula. The values of the pulmonary parameters were interpreted against the measured versus the corrected body height. Results. The mean thoracic Cobb angle was 68.3°, range 50°-89°. A restrictive pattern was observed in over 40% of patients. The use of reference values calculated for corrected body height decreased the number of patients presenting pulmonary parameters within the normal range (48.9% versus 56.5%) and increased the number of patients with a possible restrictive pattern (42.4% versus 32.6%). Airway obstruction was observed in 10.9% of patients when measured body height was used versus 8.7% of patients while corrected body height was used. Conclusions. More than half of patients with severe thoracic idiopathic scoliosis present pulmonary impairment, mainly of a restrictive pattern. The calculations of reference values from the corrected body height as a substitute for the measured one may influence the interpretation of the spirometry examination results.

147. Proximal junctional failure in primary thoracolumbar fusion/fixation to the sacrum/pelvis for adult symptomatic lumbar scoliosis: long-term follow-up of a prospective multicenter cohort of 160 patients

<h3>BACKGROUND CONTEXT</h3> Proximal junctional kyphosis (PJK) is a common adverse event in adult spinal deformity (ASD) surgery. Proximal junctional failure (PJF) is a severe form of PJK that often warrants revision surgery. Previous reports on PJK/PJF have been limited by heterogeneous patient populations and relatively short follow-up. <h3>PURPOSE</h3> The objectives of this study were to better understand risk factors for PJF and assess its long-term incidence and revision rates in a prospectively-collected, homogenous patient population (primary adult symptomatic lumbar scoliosis [ASLS]) with long-term follow-up. <h3>STUDY DESIGN/SETTING</h3> Retrospective review of prospectively-collected multicenter patient cohort. <h3>PATIENT SAMPLE</h3> This study included 160 ASLS patients. <h3>OUTCOME MEASURES</h3> Occurrence of PJF; Patient-reported outcome measures (ODI, SRS-22r, SF-36). <h3>METHODS</h3> We reviewed data from ASLS-1, an NIH-sponsored multicenter prospective study. Inclusion criteria were: age=40 years with ASLS (Cobb >30° and ODI >20 or SRS-22 7 levels. PJF was defined as postop proximal junctional angle (PJA) change=20°, fracture of the upper-most instrumented vertebra (UIV) or UIV+1 with 20% vertebral body height loss, anterolisthesis of UIV/UIV +1 =3 mm, and/or UIV screw dislodgment. Demographic, clinical, radiographic and surgical data were collected. Comparative and multivariate analysis were performed comparing patients with and without PJF. <h3>RESULTS</h3> A total of 160 patients were included (mean age 61 yrs; 141 women) with mean follow-up of 4.3 yrs (range: 0.1-6.1 yrs). Forty-six patients (28.7%) developed PJF at a median of 0.92 yrs (interquartile range: 0.14-1.23 yrs) postop. PJF incidences at 1, 2, 3, and 4 yrs were 14.4%, 21.9%, 25.9%, and 27.4%, respectively. On univariate analysis, factors associated with PJF included greater age (p=0.03), greater body mass index (BMI; p=0.03), worse baseline PROMs (ODI; SRS-22r: subscore, pain, function, mental health; SF-36 PCS; all p <0.04), greater use of posterior column osteotomies (p=0.004), and worse TK (p=0.0031) and PJA (P <0.001 on first postop standing imaging. Use of hooks at the UIV was protective against PJF (p=0.03). On regression analysis (excluding postop imaging measures), factors associated with PJF were greater BMI (OR=1.077, 95%CI=1.007-1.153, p=0.03), lower preop PJA (OR=0.607, 95%CI=0.407-0.906, p=0.01), and greater preop TK (OR=1.362, 95%CI=1.082-1.715, p=0.009). Patients with PJF had significantly worse PROMs at last follow-up (ODI; SRS-22r subscore and self-image; SF-36 PCS; all p <0.04). Sixteen (34.8%) of the patients with PJF underwent revision surgery; recurrent PJF occurred in 3 of the 16. <h3>CONCLUSIONS</h3> In this homogenous population of primary ASLS patients, the PJF rate was 28.7% at mean 4.3-yr follow-up with a revision rate of 34.8%. Higher risk of PJF was associated with greater age and BMI, use of posterior column osteotomies, lower preop PJA, and greater preop TK. Use of UIV hooks was protective against PJF. These findings demonstrate that PJF remains a challenge and that new strategies to mitigate its occurrence are needed. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Percutaneous pedicle screw fixation without arthrodesis of 368 thoracolumbar fractures: long-term clinical and radiological outcomes in a single institution.

Traumatic thoracolumbar (TL) fractures are the most common vertebral fractures. Although a consensus on the preferred treatment is missing, percutaneous pedicle screw fixation (PPSF) has been progressively accepted as treatment option, since it is related to lower soft tissues surgical-injury and perioperative complications rate. This study aims to evaluate the long-term clinical-radiological outcomes after PPSF for TL fractures at a single tertiary academic hospital. This is a retrospective cohort study. Back pain was obtained at preoperative, postoperative and final follow-up using Visual Analog Scale. Patient-reported outcomes, the Oswestry Disability Index and the 36-Item Short Form, were obtained to asses disability during follow-up. Radiological measures included Cobb angle, mid-sagittal index, sagittal index (SI) and vertebral body height loss. A multivariate regression analysis on preoperative radiological features was performed to investigate independent risk factors for implant failure. A total of 296 patients with 368 TL fractures met inclusion criteria. Mean follow-up was 124.3months. The clinical and radiological parameters significantly improved from preoperative to last follow-up measurements. The multivariate analysis showed that Cobb angle (OR = 1.3, p < 0.001), SI (OR = 1.5, p < 0.001) and number of fractures (OR = 1.1, p = 0.05), were independent risk factors for implant failure. The overall complication rate was 5.1%, while the reoperation rate for implant failure was 3.4%. In our case series, PPSF for TL injuries demonstrated good long-term clinical-radiological outcomes, along with low complication and reoperation rates. Accordingly, PPSF could be considered as a valuable treatment option for neurologically intact patients with TL fractures. Additionally, in this cohort, number of fractures ≥ 2, Cobb angle ≥ 15° and sagittal index ≥ 21° were independent risk factors for implant failure.

Low cervical vertebral CT value increased early subsidence of titanium mesh cage after anterior cervical corpectomy and fusion

Study designThis study was a retrospective review.ObjectiveTo study the predictive effect of Hounsfield units (HU) value in the cervical vertebral body derived from computed tomography (CT) on the early titanium mesh cage (TMC) subsidence after anterior cervical corpectomy and fusion (ACCF).MethodsThis retrospective study was conducted on patients who underwent ACCF at one institution between January 2014 and December 2018. We collected date included age, gender, body mass index (BMI), disease type, surgical segment, whether merge ACDF, HU value of the vertebral body and endplate, vertebral body height loss, cervical lordosis angle, and cervical sagittal alignment. VAS, JOA, and NDI were used to assess clinical efficacy. Univariate analysis was performed to screen the influencing factors of TMC subsidence, and then logistic regression was used to find out the independent risk factors. The ROC curve and area under curve (AUC) were used to analyze the HU value to predict the TMC subsidence.ResultsA total of 85 patients who accepted ACCF were included in this study, and early titanium mesh cage subsidence was demonstrated in 29 patients. The subsidence rate was 34.1%. The JOA, VAS, and NDI scores significantly improved in both groups after the operation. Between the subsidence and non-subsidence groups, there were significant differences in age, intervertebral distraction height, and HU value in both upper and lower vertebral body and endplate. The logistic regression analysis proved that the HU value of the lower vertebral body was an independent risk of TMC subsidence, the AUC was 0.866, and the most appropriate threshold of the HU value was 275 (sensitivity: 87.5%, specificity: 79.3%).ConclusionPreoperative cervical CT value is an independent correlative factor for early TMC subsidence after ACCF, and patients with a low CT value of the inferior vertebral body of the operative segment have a higher risk of TMC subsidence in the early postoperative period.Trial registration: This study is undergoing retrospective registration.

Vertebral augmentation: an overview.

Vertebral compression fractures (VCFs) are a common pathologic process seen in 30-50% of individuals over the age of 50years. Historically, VCFs were first treated with nonsurgical management while vertebral augmentation was reserved for severe cases resulting in deformity or significant disability. Current treatment algorithms based on established appropriateness criteria have changed recommendations towards supporting early vertebral augmentation for the VCFs causing the most clinically difficulty and taking into account the degree of vertebral body height loss, kyphotic deformity, and the degree of clinical progression. Percutaneous vertebroplasty (PVP) involves injecting primarily polymethacrylate (PMMA) bone cement directly into the cancellous bone of the vertebral body. There is recent literature showing the effectiveness of PVP including data comparing vertebroplasty to sham treatment. Vertebroplasty evolved into balloon kyphoplasty (BKP) where a balloon is first inserted into the vertebral body to create a cavity and reduce the fracture followed by an injection of bone cement. Both PVP and BKP have been shown to be significantly more effective at treatment of VCFs compared to nonsurgical management. The benefits shown in the literature have been demonstrated randomized control trials, cohort matched trials, post-market trials, registries, and many other data sources with approximately 250 manuscripts produced per year dedicated to the topic of vertebral augmentation.

Cortical step sign in spinal clearance on trauma computed tomography – Indicator of acute thoracolumbar compression fracture

Introduction Differentiating an acute from chronic compression fracture of the thoracolumbar (TL) spine can pose a dilemma for radiologists interpreting spinal imaging following trauma. Mild wedging of the vertebrae can be due to spondylosis or osteoporosis, whilst acute simple compression fractures may not always be associated with loss of body height. In this observational study, we hypothesize that the presence of a vertebral body cortical step is a reliable sign of an acute compression fracture on Computed Tomography (CT) scans. Methods In a retrospective review of thoracolumbar CT scans following trauma, two observers analysed for the presence of a cortical step at the anterior or posterior vertebral body cortex, fracture morphology and associated injuries. A ‘cortical step’ is defined as a break of hyperdense cortex on CT scans, intervening non-sclerosed trabecular bone, and sharp overlap of the underlying cortex. MRI of the spine was used as gold standard. Results 187 consecutive CT scans over 2 years were assessed. Sensitivity, specificity and accuracy of cortical step sign were 100%, 90.2% and 97% in diagnosing an acute thoracolumbar compression fracture, respectively. The interobserver reliability was high (kappa = 0.97). False positive cortical step was seen in Kummel’s disease and large Schmorl’s nodule. Conclusion Our results demonstrate high sensitivity and specificity of ‘cortical step sign’ in diagnosing acute vertebral body compression fractures of TL spine on CT scans in patients with trauma. This sign can be useful to radiologists for safe clearance of the thoracolumbar spine following trauma, helping distinguish acute trauma from chronic causes of vertebral body height loss.

Numerical Comparison of Restored Vertebral Body Height after Incomplete Burst Fracture of the Lumbar Spine.

Background and objectives: Vertebral compression fracture is a major health care problem worldwide due to its direct and indirect negative influence on health-related quality of life and increased health care costs. Although a percutaneous surgical intervention with balloon kyphoplasty or metal expansion, the SpineJack, along with bone cement augmentation has been shown to efficiently restore and fix the lost vertebral height, 21–30% vertebral body height loss has been reported in the literature. Furthermore, the effect of the augmentation approaches and the loss of body height on the biomechanical responses in physiological activities remains unclear. Hence, this study aimed to compare the mechanical behavior of the fractured lumbar spine with different restored body heights, augmentation approaches, and posterior fixation after kyphoplasty using the finite element method. Furthermore, different augmentation approaches with bone cement and bone cement along with the SpineJack were also considered in the simulation. Materials and Methods: A numerical lumbar model with an incomplete burst fracture at L3 was used in this study. Two different degrees of restored body height, namely complete and incomplete restorations, after kyphoplasty were investigated. Furthermore, two different augmentation approaches of the fractured vertebral body with bone cement and SpineJack along with bone cement were considered. A posterior instrument (PI) was also used in this study. Physiological loadings with 400 N + 10 Nm in four directions, namely flexion, extension, lateral bending, and axial rotation, were applied to the lumbar spine with different augmentation approaches for comparison. Results: The results indicated that both the bone cement and bone cement along with the SpineJack could support the fractured vertebral body to react similarly with an intact lumbar spine under identical loadings. When the fractured body height was incompletely restored, the peak stress in the L2–L3 disk above the fractured vertebral body increased by 154% (from 0.93 to 2.37 MPa) and 116% (from 0.18 to 0.39 MPa), respectively, in the annular ground substance and nucleus when compared with the intact one. The use of the PI could reduce the range of motion and facet joint force at the implanted levels but increase the facet joint force at the upper level of the PI. Conclusions: In the present study, complete restoration of the body height, as possible in kyphoplasty, is suggested for the management of lumbar vertebral fractures.

Effectiveness of Percutaneous Pedicle Screw Fixation for Traumatic Thoracolumbar Spine Fracture

Introduction: Surgical treatment of thoracolumbar fracture without neurological damage has resulted in better clinical and radiological outcome than conservative treatment. Traditional open approach is associated with extensive paravertebral muscle damage and postoperative morbidity so percutaneous pedicle screw fixation is highly valuable alternatives.&#x0D; Aims: to evaluate the efficacy and outcome of percutaneous pedicle screw fixation in the treatment of traumatic thoracolumbar fracture without neurological deficit.&#x0D; Methods: This study was conducted in Nepalgunj Medical College, Nepalgunj in a time span of one year; total of 40 patients were included and treated with percutaneous pedicle screw fixation and followed up for 6months. They were evaluated clinically and radiologically.&#x0D; Results: 40 patients with thoracolumbar fractures were managed with percutaneous pedicle screw fixation with a mean operative time of 77.30 min and intraoperative blood loss was 88.38ml. There was significant improvement in cobb’s angle (mean difference 13.92 degree), vertebral body height loss (mean difference 37.7%) and visual analogue scale (mean difference 3.55) postoperatively. These improvements remained statically significant at 6months follow up.&#x0D; Conclusion: Percutaneous pedicle screw fixation is safe, valid and effective treatment of thoracolumbar fracture without neurological deficit.

Effect of vertebral compression fractures on aortic neck angulation after endovascular aneurysm repair

ObjectiveAortic neck angulation (ANA) prior to endovascular aneurysm repair (EVAR) and its changes after EVAR are considered important predictors of postoperative complications. We sought to assess the effects of vertebral body height loss on ANA in patients post-EVAR. MethodsAll patients who had undergone EVAR for infrarenal aortic aneurysms in our institution between August 2010 and December 2018 were assessed. Anterior and posterior vertebral body heights were measured in all patients on preoperative, early postoperative, and follow-up computed tomography scans (T12-L5 vertebral bodies). Patients who had significant height loss in their follow-up period were designated as the Study group. These were matched to a Control group of the same size using propensity-score matching based on age, gender, and duration between follow-up scans. Aortic neck morphology indices including ANA and its changes were measured, and information related to postoperative endoleaks and aneurysm sac size were extracted in the Study and Control groups. ResultsDuring the follow-up period, 10 of 185 patients had a radiologically significant vertebral body compression fracture. There was no significant difference between the Study (n = 10) and Control groups in age (77.6 ± 6.9 vs 77.2 ± 7.5 years; P = .64), gender (seven males and three females in each group; P = 1.0), duration between postoperative scans (1830 ± 665 vs 1800 ± 670 days; P = .25), preoperative ANA (36.0° ± 15.6° vs 42.4° ± 18.6°; P = .41), and early postoperative ANA (21.9° ± 11.7° vs 20.9° ± 16.3°; P = .72). Changes in ANA in the postoperative period (7.2° ± 11.1° vs −4.7° ± 6.7°; P = .009; power = .838) were significantly higher in the Study group. ConclusionsPost-EVAR vertebral body compression fractures exacerbate ANA. Awareness of this can guide both preoperative assessment and postoperative management and follow-up.

Spirometry Examination of Adolescents with Thoracic Idiopathic Scoliosis: Is Correction for Height Loss Useful?

Loss of body height is observed in patients with idiopathic scoliosis (IS) due to spine curvatures. The study compared pulmonary parameters obtained from spirometry examination considering the measured versus the corrected body height. One hundred and twenty adolescents with Lenke type 1 or 3 IS who underwent preoperative spirometry examination and radiographic evaluation were enrolled. The mean thoracic Cobb angle was 68° ± 12.6, range 48–102°. The difference between the measured and the corrected body height increased with the greater Cobb angle. Using the corrected body height instead of the measured body height significantly changed the predicted values of pulmonary parameters and influenced the interpretation of the pulmonary testing results.

Bone Metastases: State of the Art in Minimally Invasive Interventional Oncology.

Bone is the third most common site involved by cancer metastases, and skeleton-related events such as intractable pain due to direct osseous tumor involvement, pathologic fracture, and neurologic deficits as a consequence of nerve or spinal cord compression often affect patients' functional independence and quality of life unfavorably. The annual medical-economic burden related to bone metastases is a substantial component of the total direct medical cost estimated by the National Institutes of Health. There have been substantial recent advances in percutaneous image-guided minimally invasive musculoskeletal oncologic interventions for the management of patients with osseous metastatic disease. These advances include thermal ablation, cementation with or without osseous reinforcement with implants, osteosynthesis, thermal and chemical neurolyses, and palliative injections, which are progressively incorporated into the management paradigm for such patients. These interventions are performed in conjunction with or are supplemented by adjuvant radiation therapy, systemic therapy, surgery, or analgesic agents to achieve durable pain palliation, local tumor control, or cure, and they provide a robust armamentarium for interventional radiologists to achieve safe and effective treatment in a multidisciplinary setting. In addition, these procedures are shifting the patient management paradigm in modern-era practice. The authors detail the state of the art in minimally invasive percutaneous image-guided musculoskeletal oncologic interventions and the role of radiologists in managing patients with skeletal metastases. ©RSNA, 2021.

Are we neglecting long-term effects of vertebral shortening on pulmonary function in spinal tuberculosis?

In developing part of the world, it is common to see complete destruction of vertebral bodies in tuberculosis. Our study aims to assess the effect of spinal tuberculosis with vertebral shortening on pulmonary function. Fifty cases of spinal TB (14 males, 36 females) managed both operatively and non-operatively, who presented to tertiary care institute between years 2011 and 2016 were assessed. Vertebral height loss was assessed by spinal deformity index (SDI). All patients underwent pulmonary function testing using same equipment sitting in upright position. Mean age was 27.9years (27.9 ± 11.9). 11 patients with mean SDI of 2.7 ± 1.1 showed normal lung function. 36 patients showed restrictive pattern of which 12 were mild, 14 were moderate and 10 showed severe pattern with a mean SDI of 3.8 ± 1.2, 5.6 ± 1.3 and 6.1 ± 1.4, respectively. 3 cases showed obstructive pattern. As the apex of curve shifted proximally, FVC% reduced. Increase in SDI value was associated with a fall in the vital capacity and FEV1. Increase in the kyphotic angle was associated with a deleterious effect on PFT results. Risk stratification of pulmonary dysfunction resulting from vertebral body height loss due to kyphosis will emphasize the need for early detection of spinal tuberculosis before deformity occurs.