Loss Of Posterior Height Research Articles

Subcondylar osteotomy – case report

Background: The fractures of the mandibular condyles are very controversial, regarding the diagnosis and mainly regarding the treatment. The classification used for condyle fractures is usually anatomical and divides them by the comprehension of the fracture tract (head, neck and subcondylar). Those fractures usually originate from indirect trauma and affect from 18% to 57% of mandibular fractures. Its etiology is represented by: automotive accidents, physical aggressions, falls, sports accidents, accidents at work, among others. Conservative treatment is used as first choice in condylar fractures because it is minimally invasive. However, when poorly indicated it may lead to secondary complications such as: poor bone healing, loss of posterior height, limiting mouth opening, anterior open bite, facial asymmetry, local pain, edema and temporomandibular ankylosis. Surgical treatment compared to conservative treatment has been shown to be more efficient. This treatment has been increasingly used by surgeons due to its prognosis and better postoperative recovery because it is recommended extra-oral accesses and rigid internal fixation. The use of subcondylar osteotomy was shown to be effective for correction of condylar fractures sequel, especially when associated with rigid internal fixation and its complications are the same as any surgical procedure for mandibular condyle fractures.

Clinical importance of posterior vertebral height loss on plain radiography when conservatively treating osteoporotic vertebral fractures

PurposeTo predict spinal canal compromise, the assessment of plain radiography with magnetic resonance imaging (MRI) can aid the detection of vertebral body collapse and prevent the development of neurological deficits. MethodsPatients who suffered osteoporotic vertebral fractures (OVFs) between January 2012 and December 2014 underwent consecutive radiological assessments, including measurements of anterior height loss (AHL), posterior height loss (PHL), and the kyphotic angle (KA). The fracture morphology was classified by AOSpine thoracolumbar spine injury classification system. MRI was performed at the initial assessment and the extent of canal encroachment (CE) was calculated in all patients. Follow-up computed tomography (CT) or MRI was performed in patients exhibiting significant height loss in follow-up radiography. The fracture patterns in T1- and T2-weighted MRI were also assessed. ResultsA total of 485 patients visited our institute for treatment of OVFs and 97 were enrolled; 15 were male and 82 were female. The mean age at initial visit was 70.3±14.6years. The initial spinal CE was correlated with the initial PHL and the initial AHL. The follow-up CE was correlated with age, the initial PHL, and the difference between the initial and last PHL (ΔPHL(initial-last)). OVFs with both endplate fractures have a greater tendency of posterior wall collapse than those with single endplate fracture. On initial T1-weighted sagittal MRI, a diffuse low signal change pattern of the fractured vertebra was correlated with PHL. Delayed neurological deficits developed in four patients. These patients underwent surgical intervention. ConclusionsIn patients with simple compression fractures, attention should be paid to the posterior vertebral body and both endplates as well as the T1-weighted MRI findings to allow early detection of spinal canal compromise, which can have devastating consequences.

Vertebral Body Compression Fractures and Bone Density: Automated Detection and Classification on CT Images.

Purpose To create and validate a computer system with which to detect, localize, and classify compression fractures and measure bone density of thoracic and lumbar vertebral bodies on computed tomographic (CT) images. Materials and Methods Institutional review board approval was obtained, and informed consent was waived in this HIPAA-compliant retrospective study. A CT study set of 150 patients (mean age, 73 years; age range, 55-96 years; 92 women, 58 men) with (n = 75) and without (n = 75) compression fractures was assembled. All case patients were age and sex matched with control subjects. A total of 210 thoracic and lumbar vertebrae showed compression fractures and were electronically marked and classified by a radiologist. Prototype fully automated spinal segmentation and fracture detection software were then used to analyze the study set. System performance was evaluated with free-response receiver operating characteristic analysis. Results Sensitivity for detection or localization of compression fractures was 95.7% (201 of 210; 95% confidence interval [CI]: 87.0%, 98.9%), with a false-positive rate of 0.29 per patient. Additionally, sensitivity was 98.7% and specificity was 77.3% at case-based receiver operating characteristic curve analysis. Accuracy for classification by Genant type (anterior, middle, or posterior height loss) was 0.95 (107 of 113; 95% CI: 0.89, 0.98), with weighted κ of 0.90 (95% CI: 0.81, 0.99). Accuracy for categorization by Genant height loss grade was 0.68 (77 of 113; 95% CI: 0.59, 0.76), with a weighted κ of 0.59 (95% CI: 0.47, 0.71). The average bone attenuation for T12-L4 vertebrae was 146 HU ± 29 (standard deviation) in case patients and 173 HU ± 42 in control patients; this difference was statistically significant (P < .001). Conclusion An automated machine learning computer system was created to detect, anatomically localize, and categorize vertebral compression fractures at high sensitivity and with a low false-positive rate, as well as to calculate vertebral bone density, on CT images. © RSNA, 2017 Online supplemental material is available for this article.

Midterm Follow-Up of Vertebral Geometry and Remodeling of the Vertebral Bidisk Unit (VDU) After Percutaneous Vertebroplasty of Osteoporotic Vertebral Fractures

The purpose of this study was to investigate geometrical stability and preservation of height gain of vertebral bodies after percutaneous vertebroplasty during 2 years' follow-up and to elucidate the geometric remodeling process of the vertebral bidisk unit (VDU) of the affected segment. Patients with osteoporotic vertebral compression fractures with pain resistant to analgetic drugs were treated with polymethylmethacrylate vertebroplasty. Mean +/- standard error cement volume was 5.1 +/- 2.0 ml. Vertebral geometry was documented by sagittal and coronal reformations from multidetector computed tomography data sets: anterior, posterior, and lateral vertebral heights, end plate angles, and compression index (CI = anterior/posterior height). Additionally, the VDU (vertebral bodies plus both adjacent disk spaces) was calculated from the multidetector computed tomography data sets: anterior, posterior, and both lateral aspects. Patients were assigned to two groups: moderate compression with CI of >0.75 (group 1) and severe compression with CI of <0.75 (group 2). A total of 83 vertebral bodies of 30 patients (7 men, 23 women, age 70.7 +/- 9.7 years, range 40-82 years) were treated with vertebroplasty and prospectively followed for 24 months. In the moderate compression group (group 1), the vertebral heights were stabilized over time at the preinterventional levels. Compared with group 1, group 2 showed a greater anterior height gain (+2.8 +/- 2.2 mm vs. +0.8 +/- 2.0 mm, P < 0.001), better reduction of end plate angle (-4.9 +/- 4.8 degrees vs. -1.0 +/- 2.7 degrees , P < 0.01), and improved CI (+0.12 +/- 0.13 vs. +0.02 +/- 0.07, P < 0.01) and demonstrated preserved anterior height gain at 2 years (+1.2 +/- 3.2 mm, P < 0.01) as well as improved end plate angles (-5.2 +/- 5.0 degrees , P < 0.01) and compression indices (+0.11 +/- 0.15, P < 0.01). Thus, posterior height loss of vertebrae and adjacent intervertebral disk spaces contributed to a remodeling of the VDU, resulting in some compensation of the kyphotic malposition of the affected vertebral segment. Vertebroplasty improved vertebral geometry during midterm follow-up. In severe vertebral compression, significant height gain and improvement of end plate angles were achieved. The remodeling of the VDUs contributes to reduction of kyphosis and an overall improvement of the statics of the spine.