Lumbar Spine Fractures Research Articles

P54. Emergency department visits for pediatric spine fractures: trends through COVID-19

BACKGROUND CONTEXTPediatric spine fractures are an important medical and surgical emergency.PURPOSEThe aim of this study was to assess trends in emergency department visits for pediatric spine fractures.STUDY DESIGN/SETTINGDescriptive Epidemiological Study.PATIENT SAMPLEA total of 1,930 (national estimate: 49,186) pediatric patients who presented to the emergency room with a spine fracture from 2001 to 2020.OUTCOME MEASURESCauses of spine fractures, discharge disposition and demographic variables.METHODSThe National Electronic Injury Surveillance System (NEISS) database is a probability sample of hospitals in the United States. This sample was stratified and weighted based on ED size, which was used to generate national estimates (NE). The NEISS database from 2001 to 2020 was queried for less than 18 years old who sustained a cervical, thoracic or lumbar spine fracture. The entire cohort was divided by before and after March 11, 2020, which is when the WHO declared the COVID-19 pandemic.RESULTSThere were 1,930 (NE: 49,186) pediatric patients who presented to the emergency room with a spine fracture from 2001 to 2020. There were 135 (NE:2,807) ED patients in 2020 compared to 110 (NE: 2,161) in 2019 representing a 30% increase compared to the year before. The rate of males with spine fractures decreased (50.88% DC vs. 62.77% BC; p < 0.001). The rate of spine fractures at home increased (30% DC vs. 22% BC; p < 0.001) while rate of spine fractures in a place of recreation decreased (25% DC vs. 34% BC; p < 0.001). Lumbar spine fractures decreased (15% vs. 24%) while cervical and thoracic spine fractures increased (p < 0.001). The amount of ED spine fractures leading to admission decreased (14.69% DC vs 25% BC) while the amount released increased (61% vs. 55%) (p < 0.001). The most decreased three causes of pediatric spine fractures were football (6.84% DC vs. 11.18% BC), stairs (1.72% DC vs. 5.89% BC), and sleds (0.22% DC vs. 4.34% BC) (p < 0.001). The most increased three causes of pediatric spine fractures in the ED were swings (8.57% DC vs. 1.31% BC), horseback riding (10.85% DC vs. 4.35% BC), and ATV vehicles (7.92% DC vs. 1.91% BC) (all p < 0.001).CONCLUSIONSThere was a spike in pediatric spine fractures during the COVID-19 pandemic compared to the year before. Fractures in males, and those related to recreational activities in public places as well as fractures due to football decreased. Fractures at home and in isolated recreational activities such as swings, horseback riding and ATVs increased.FDA DEVICE/DRUG STATUSThis abstract does not discuss or include any applicable devices or drugs.

Expandable pedicle screw may have better fixation than normal pedicle screw: preclinical investigation on instrumented L4-L5 vertebrae based on various physiological movements.

Lumbar spine fracture is typically treated by means of screw fixation, the primary aim of which is to reduce fracture by achieving bony union such that the spinal anatomy is restored. Pedicle screw fixation has certain advantages over conventional vertebral screws, e.g. 3-column fixation and improved surgical alignment. However, expandable pedicle screws have been reported to impart better anchorage as compared to conventional pedicle screws, both in case of healthy and osteoporotic bone. The clinical studies notwithstanding, there is a paucity of preclinical investigations on expandable pedicle screws used on lumbar vertebrae. By employing anatomically viable FE models, the present study intended to estimate stress-strain fields of a functional spinal unit (FSU) of intact L4-L5 vertebra and to further compare the same with FSUs instrumented with normal and expandable pedicle screws under different physiological loading condition. The various physiological loading regimes appeared to have significant influence on the overall load transfer in the L4-L5 vertebrae. The expandable pedicle screw predicted marginally improved anchorage as compared to the normal pedicle screws, with more contact area with the bone resulting in higher stresses (~ 1.6MPa) and high strain at the contact sites. This is indicative of improved stability albeit having marginally greater risk of screw pullout. Greater area (15-80%) with peak stresses at the bone-screw interfaces also indicates lesser degree of stress shielding. Thus, stability aside, one may expect to have lower loosening issues too with the use of expandable pedicle screws.

Treatment strategy for patients with thoracic and lumbar spine fractures with dura mater tear

Background. The dura mater tear are quite common in patients with thoracic and lumbar fractures. Prevention and management of cerebrospinal fluid leakage and sealing of the dura mater suture is an important stage in the treatment of such patients.Objective: to find an optimal surgical tactics for patients with fractures of the thoracic and lumbar spine and dura mater tear.Materials and methods. This study included 167 patients operated on for fractures of the thoracic and lumbar spine with concomitant traumatic spinal canal stenosis. We analyzed their clinical data and results of instrumental examination. All patients underwent laminectomy at the level of their fractures and transpedicular fixation. The main group included 55 patients with dura mater tear, whereas the control group comprised 112 patients without dura mater tear.Results. Dura mater tear was found in 32.9 % of patients with fractures of the thoracic and lumbar spine. Of them, 21.8 % had compression of the spinal cord or nerve roots at the sites of dura mater tear. This fact should be taken into account when performing decompression and the reduction maneuver to prevent additional injuries to the neural structures. Thirty-three (60.0 %) patients underwent direct suturing aimed to restore the dura mater integrity. Their mean size of the dura mater tear was 13.2 ± 7.4 mm2. Thirteen patients (23.6 %) with larger dural tear (27.5 ± 6.3 mm2) underwent their repair using either a fragment of dura mater from a deceased donor (n = 2), Reperen implants (n = 5), or Durepair patches (n = 6). In 9 patients (16.4 %), the integrity of dura mater was restored without suturing (the «sandwich»-sealing method) (mean size of the dura mater defect 5.0 ± 2.6 mm2). Twenty-one patients had additional sealing of dura mater suture using bioglue.Postoperative wound cerebrospinal fluid leakage was registered in 5 out of 55 patients from the main group. Cerebrospinal fluid leakage was most common in patients who had undergone dura mater repair with implants (23.1 %), while those who had undergone direct dura mater suturing were less likely to develop it (6.1 %). No cerebrospinal fluid leakage was observed in patients with small defects (≤3 mm2) or in those whose dural tears were located at the nerve root cuffs. Patients with postoperative cerebrospinal fluid leakage had no additional sealing of dura mater suture using bioglue.Postoperative wound infection was registered in 4 (7.3 %) patients from the main group and 6 (5.4 %) patients from the control group.Conclusion. Sealing of dura mater sutures with glue compositions is an effective method to prevent postoperative cerebrospinal fluid leakage. Sealing of dura mater sutures with a collagen sponge does not prevent wound cerebrospinal fluid leakage.

Quantifying the Effect of Pelvis Fracture on Lumbar Spine Compression during High-rate Vertical Loading.

Fracture to the lumbo-pelvis region is prevalent in warfighters seated in military vehicles exposed to under-body blast (UBB). Previous high-rate vertical loading experimentation using whole body post-mortem human surrogates (PMHS) indicated that pelvis fracture tends to occur earlier in events and under higher magnitude seat input conditions compared to lumbar spine fracture. The current study hypothesizes that fracture of the pelvis under high-rate vertical loading reduces load transfer to the lumbar spine, thus reducing the potential for spine fracture. PMHS lumbo-pelvis components (L4-pelvis) were tested under high-rate vertical loading and force and acceleration metrics were measured both inferior-to and superior-to the specimen. The ratio of inferior-tosuperior responses was significantly reduced by unstable pelvis fracture for all metrics and a trend of reduced ratio was observed with increased pelvis AIS severity. This study has established that pelvis fracture reduces compression forces at the lumbar spine during high-rate vertical loading, thus reducing the potential for fracture to the lumbar spine. Therefore, pelvis injury potential should be considered when implementing lumbar injury criteria specific to UBB.

An inconvenient status in anti-osteoporotic treatment process: corticosteroid use.

There are limited studies investigating the comparison of the efficacy of anti-osteoporotic drugs in different conditions resulting in osteoporosis in older adults. This study aimed to compare the effectiveness of anti-osteoporotic agents in older adults with or without glucocorticoid-induced osteoporosis. This retrospective study included 364 patients with osteoporosis, aged 65 years and older. Bone mineral density measurement was performed, and the percent change from baseline was calculated at month 24. Of the 364 patients, 80 were glucocorticoid users. Similar changes in the bone mineral density of the lumbar spine and femoral neck and fracture risk were found in patients with or without glucocorticoid-induced osteoporosis. There was no significant difference in bone mineral density changes between the groups in terms of anti-osteoporotic agents used. This study demonstrated that the response to anti-osteoporotic agents was similar in older adults with glucocorticoid-induced osteoporosis and those without glucocorticoid-induced osteoporosis. The results of our study may guide osteoporosis treatment in older individuals with glucocorticoid-induced osteoporosis.

Mechanical Analysis of Posterior Pedicle Screw System Placement and Internal Fixation in the Treatment of Lumbar Fractures.

Objective Image segmentation technology is applied to separate a single vertebra from the three-dimensional model of the spine, so as to separate a single vertebra image with smaller error, higher degree of automation, and better results. The objectives are to study the biomechanical characteristics of posterior short-segment pedicle screw fixation by three-dimensional finite element method, analyze the mechanical characteristics of posterior pedicle screw rod fixation system under different factors, and demonstrate the feasibility of its application in the treatment of lumbar fracture. Methods The authors searched the database for articles about the treatment of lumbar spine fracture, screw rod internal fixation system, and its mechanical parameters. The threshold segmentation method based on region segmentation method was used to segment the image, and the three-dimensional finite element model was used to analyze the biomechanical characteristics of different posterior internal fixation for lumbar spine fracture. Results The posterior pedicle internal fixation system for the treatment of multilevel spinal fractures is a mature surgical technique and has fewer postoperative complications. Transpedicle fixation is effective and reliable. It can effectively restore the coronal and sagittal curvature of the vertebral body and restore the stability of the spine better. But the choice of internal fixation method should be individualized based on fracture type, identification of critical and secondary injury sites, and stability assessment. Only after mastering the biomechanical characteristics of the posterior screw rod system for the treatment of lumbar fracture, selecting the appropriate method, and fixing the appropriate movement unit can the best fixation be achieved. Conclusion Threshold method is the most direct and simple image segmentation method. The core technology of thresholding is the selection of threshold, which will affect the final segmentation effect. The most common segmentation method is to calculate the segmentation threshold by histogram. The threshold method has less computation and good segmentation effect for the image with large contrast between background and target. Posterior pedicle screw rod system internal fixation has the advantages of less trauma, good reduction, reliable fixation, and less complications. The design, placement angle and depth of various internal fixation systems, and the number of fixed segments all show different mechanical characteristics. As long as we master the above characteristics, choose the appropriate method and fix the appropriate motor unit, and we can get the best fixation; it can be used as an effective treatment for lumbar fracture.

Seat Belt Syndrome of a Breastfeeding Mother: Bilateral Facet Dislocation Without Fracture in Lumbar Spine and Delayed Ileal Perforation

Introduction: The seat belt syndrome is a term used for multiple injuries associated with seat belt use during a traffic accident. Among these injuries, attention should be paid to spine and abdominal traumas that could be fatal. Case Presentation: This case report describes a 34-year-old woman wearing only a lap belt removing the upper part of her seat belt to breastfeed her baby in the back seat of the car during a traffic accident. Bilateral facet dislocation in lumbar spine without fracture and delayed ileal perforation were found. Spine surgery was performed urgently. Abdominal injury was detected 24 hours after spine surgery. Discussion: This case demonstrates the importance of the seat belt syndrome. It also supports why this type of injured patient needs close follow-up. Various rare injuries may be encountered. The trauma team must be alert in seat belt related traffic accidents, where many different injuries can be seen

Minimally Invasive (Percutaneous) Pedicle Srews as the Treatment of Choice in Thoracolumbar Spine Fractures

Introduction. Minimally invasive techniques of transpedicular fusion have become very common and seem to displace classical open techniques. Pedicle screws fusion is the procedure of choice in unstable traumatic lumbar and thoracic spine fractures of.Aim. The aim of the study was to answer whether open techniques are still used in injuries or whether they have been completely replaced by MISS.Material and Methods. The manuscript presents an analysis of patients treated in 2017–2021 in the Department of Neurosurgery, Neurotraumatology and Pediatric Neurosurgery of Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University.Results. Based on the analysis of medical documentation, it was found that every case of traumatic thoracolumbar spine fracture in 2017–2021 was treated using minimally invasive techniques. According to the documentation, the last case of using open surgical technique in the case of trauma was in 2016. It was noted that percutaneous techniques dominated the surgical treatment of thoracolumbar spine fractures and replaced the classic techniques in our department, which are used only, in some cases, in treatment of non-traumatic spondylolisthesis.Conclusions. Therefore, percutaneous techniques are currently the procedure of choice in spine injuries fusion in our hospital. The use of percutaneous techniques reduces the surgical traumatization of tissues (it is important to avoid additional traumatization and blood loss in traumatic patients). It has been pointed out that these procedures are performed by neurosurgeons who, in teaching process, used percutaneous techniques often and now prefer this method. The use of percutaneous techniques has important aspect in the field of neurosurgical nursing, because care of the operated area consists in observing few (4–16) smaller wounds, not one long wound (as in classic techniques), and these wounds are located directly above the titanium screw tips, which must under neurosurgical nurse care. (JNNN 2022;11(1):3–7)

Failure tolerance of the human lumbar spine in dynamic combined compression and flexion loading

Vehicle safety systems have substantially decreased motor vehicle crash-related injuries and fatalities, but injuries to the lumbar spine still have been reported. Experimental and computational analyses of upright and, particularly, reclined occupants in frontal crashes have shown that the lumbar spine can be subjected to simultaneous and out-of-phase combined axial compression and flexion loading. Lumbar spine failure tolerance in combined compression-flexion has not been widely explored in the literature. Therefore, the goal of this study was to measure the failure tolerance of the lumbar spine in combined compression and flexion. Forty lumbar spine segments with three vertebrae (one unconstrained) and two intervertebral discs (both unconstrained) were pre-loaded with axial compression (2200N, 3300N, or 4500N) and then subjected to rotation-controlled dynamic flexion bending until failure. Clinically relevant middle vertebra fractures were observed in twenty-one of the specimens, including compression and burst fractures. The remaining nineteen specimens experienced failure at the potting-grip interface. Failure tolerance varied within the sample and were categorized by the appropriate data censoring, with clinically relevant middle vertebrae fractures characterized as uncensored or left-censored and potting-grip fractures characterized as right-censored. Average failure force and moment were 3290N (range: 1580N to 5042N) and 51Nm (range: 0Nm to 156 Nm) for uncensored data, 3686N (range: 3145N to 4112N) and 0Nm for left-censored data, and 3470N (range: 2138N to 5062N) and 101Nm (range: 27Nm to 182Nm) for right-censored data. These data can be used to develop and improve injury prediction tools for lumbar spine fractures and further research in future safety systems.

Etiologies, incidence, and demographics of lumbar vertebral fractures in U.S. emergency departments.

Lumbar vertebral fractures are debilitating injuries widely associated with significant patient deformity, disability, pain, and potentially neurological deficit. This cross-sectional database study investigates the most frequent annual etiologies of lumbar vertebral fractures presented to emergency departments throughout the United States (U.S.) from 2010-2018. The National Electronic Injury Surveillance System (NEISS) database was used to identify all patients who visited participating emergency departments between 2010-2018 and were diagnosed with a lumbar spine fracture. Population estimates by age (18+) were obtained from annual U.S. Census estimates and used to calculate annual incidence rates of lumbar fractures per 100,000 people. The annual incidence rate of total lumbar fractures in the U.S. increased from 14.6 to 22.5 per 100,000 people from 2010-2018 (54%). From 2010-2018, there were 382,914 [95% confidence interval (CI): 382,855-382,973] lumbar fractures in the U.S. This increased from 34,328 (95% CI: 34,277-34,379) in 2010 to 57,098 (95% CI: 57,044-57,152) in 2018 (66.3%). Men composed 40.2% and women made up 59.8% of patients. Mean patient age increased by 2.96 years from 65.5 (95% CI: 65.38-65.62) years in 2010 to 68.4 (95% CI: 68.32-68.48) years in 2018 (4.5%). From 2010-2018, floors, stairs/steps, and ladders were the most common etiologies of lumbar fractures. Estimated sum of floor-related fractures was 80,054 (95% CI: 79,986-80,122), stair/step-related fractures was 48,274 (95% CI: 48,209-48,339), and ladder-related fractures was 31,053 (95% CI: 30,987-31,119). The increase in these three etiologies accounted for 48% of the total increase of all-cause lumbar fractures between 2010 and 2018. The volume of lumbar vertebral fracture has increased over the last near decade (66.3%), and approximately half (48%) of these fractures can be attributed to accidents caused by flooring, stairs/steps, and ladder-related injuries. The increasing mean patient age, as well as accidents involving ladders, were found to be statistically correlated with the rise in total lumbar fracture volume.

Sirtuin 1 participates in intervertebral disc degeneration via the nicotinamide phosphoribosyl transferase/nicotinamide adenine dinucleotide/sirtuin 1 pathway responsible for regulating autophagy of nucleus pulposus cells.

Disc degeneration is the main cause of discogenic low back pain, disc herniation, degenerative stenosis of spinal canal, lumbar spondylolisthesis and other diseases. In the process of intervertebral disc degeneration, water and extracellular matrix of nucleus pulposus tissues are lost, so the normal tension in the intervertebral disc cannot be maintained, which worsens the living environment of nucleus pulposus cells. Low back pain (LBP), with a high incidence rate of disability, has become an increasing health concern and a social and economic problem. The present study aimed to analyze the action mechanisms of nicotinamide phosphoribosyl transferase (Nampt) and sirtuin 1 (SIRT1) in intervertebral disc degeneration (IVDD). In total 26 patients with lumbar disc herniation who had surgical resection at The Third Affiliated Hospital of Jinzhou Medical University were recruited as the experimental group and their degenerative nucleus pulposus (DNP) tissues of intervertebral disc were collected. In addition, nucleus pulposus tissues of intervertebral disc were collected from 20 patients with burst fracture of lumbar spine at the same hospital (control). Nucleus pulposus cells from primary culturing were separated for subsequent experimentation. LC3 II/I, beclin-1, SIRT1 and NAMPT mRNA and protein expression levels were determined using reverse transcription-quantitative PCR and western blotting, respectively. Nicotinamide adenine dinucleotide (NAD) contents in nucleus pulposus cells was determined by NAD assay kit. The mRNA and protein expression levels of SIRT1 in DNP tissues were reduced compared with the control tissues and decreased with increasing disease severity. The expression of autophagy-associated LC3 II/I and beclin-1 in DNP tissues was reduced compared with control tissues. SIRT1 regulated the LC3 II/I and beclin-1 expression levels in nucleus pulposus cells. Treatment with resveratrol and inhibitor of SIRT1 showed that Nampt/NAD+/SIRT1 pathway participated in the process of IVDD by regulating autophagy of nucleus pulposus cells. SIRT1 serves a role in the process of IVDD through Nampt/NAD+/SIRT1 pathway that regulates autophagy of nucleus pulposus cells. SIRT1 may become a biological target for the treatment of IVDD.

Assessment of clinical, imaging, surgical risk factors for subsequent fracture following vertebral augmentation in osteoporotic patients.

Currently, the risk factors for subsequent fracture following vertebral augmentation remain incomplete and controversial. To provide clinicians with accurate information for developing a preventive strategy, we carried out a comprehensive evaluation of previously controversial and unexplored risk factors. We retrospectively reviewed patients with osteoporotic vertebral compression fracture in lumbar spine who received vertebral augmentation between January 2019 and December 2020. Based on whether refracture occurred, patients were assigned to refracture and non-refracture group. The clinical characteristics, imaging parameters (severity of vertebral compression, spinal sagittal alignment, degeneration of paraspinal muscles), and surgical indicators (cement distribution and leakage, correction of spinal sagittal alignment) were collected and analyzed. There were 128 patients and 16 patients in non-refracture and refracture group. The incidence of previous fracture, multiple fractures, and cement leakage were notably higher, relative cross-sectional area of psoas (r-CSAPS) was significantly smaller, CSA ratio, fatty infiltration of erector spinae plus multifidus (FIES+MF), FIPS, postoperative lumbar lordosis (post-LL), correction of body angel (BA), and LL were significantly greater in refracture group. Binary logistic regression analysis revealed previous fracture, cement leakage, post-LL, and correction of BA were independent risk factors. According to the ROC curve, correction of BA showed the highest prediction accuracy, and the critical value was 3.45°. The occurrence of subsequent fracture might be the consequence of multiple factors. Previous fracture, cement leakage, post-LL, and correction of BA were identified as independent risk factors. Furthermore, the correction of BA should not exceed 3.45°, especially in patients with risk factors.

Does Cage Position Affect the Risk of Cage Subsidence After Oblique Lumbar Interbody Fusion in the Osteoporotic Lumbar Spine: A Finite Element Analysis

This study aimed to evaluate the biomechanical effects of different cage positions with stand-alone (SA) methods and bilateral pedicle screw fixation (BPSF) in the osteoporotic lumbar spine after oblique lumbar interbody fusion (OLIF). A finite element model of an intact L3-L5 lumbar spine was constructed. After validation, an osteoporosis model (OP) was constructed by assigning osteoporotic material properties. SA models (SA1, SA2, SA3) and BPSF models (BPSF1, BPSF2, BPSF3) in which a cage was placed in the anterior, middle, and posterior third of the L5 superior endplate (SEP) were constructed at the L4-L5 segment of the OP. The L4-L5 range of motion (ROM), the stress of the L5 SEP, the stress of the cage, and the stress of fixation were compared among the different models. According to the degree of ROM of L4-L5, the stress of the L5 SEP and the stress of the cage for most physiological motions, the SA and BPSF models were ranked as follows: SA2 < SA1 < SA3, BPSF2 < BPSF1 < BPSF3. In BPSF2, the stress of fixation was minimal in most motions. At the same cage position, the ROM of L4-L5, the stress of the L5 SEP, and the stress of the cage in the BPSF models were significantly reduced compared with those in SA models; compared with SA2, BPSF2 had a maximum reduction of 83.24%, 70.71%, and 73.52% in these parameters, respectively. Placing the cage in the middle third of the L5 SEP for OLIF could reduce the maximum stresses of the L5 SEP, the cage, and the fixation, which may reduce the risk of postoperative cage subsidence, endplate collapse, and fixation fracture in the osteoporotic lumbar spine. Compared with SA OLIF, BPSF could provide sufficient stability for the surgical segment and may reduce the incidence of the aforementioned complications.

The incidence and risk factors of thromboembolism in patients with traumatic spine fractures in a tertiary care hospital

Objectives: Traumatic spine injuries may lead to devastating outcomes. One of the most common causes of death in these patients is thromboembolism, more with those who have risk factors. This study aimed to find out the incidence and associated risk factors of thromboembolism in traumatic spine fractures. Methods: This retrospective cohort study included all adult patients with traumatic spine fractures from 2007 to 2014 in King Abdulaziz Medical City in Riyadh. Significant differences in the occurrence of deep vein thrombosis (DVT) or pulmonary embolism (PE) in traumatic spinal fractures were looked for. Results: Out of 1128 patients with spine fractures, thromboembolism occurred in 73 (6.5%). In cervical spine fractures, DVT showed statistically significant association with the hospital length of stay, intensive care unit (ICU) length of stay, Glasgow Coma Scale (GCS), and motor vehicle accidents. On the other hand, PE was significantly associated with low GCS and longer ICU and hospital stays. In patients with lumbar fractures, DVT was highly correlated with longer hospital stay and ICU length of stay, low GCS, and severe injury severity score, while PE was highly correlated with high weight and longer hospital and ICU stay. Nevertheless, thoracic spine fractures victims have no significant association with any studied factors. Conclusion: The incidence of thromboembolism was 6.5% in patients with spine fractures. A longer hospital and ICU stay were the main factors that were correlated with increased risk of thromboembolism in cervical and lumbar traumatic spine fractures. However, thoracic spine fractures had no association with any studied factors.

Accuracy of Inserting a Pedicle Screw Percutaneously to Fix Thoracic and Lumbar Spinal Fractures by Minimally Invasive Procedures: A Prospective Observational Study

Aim: To assess the accuracy of inserting a pedicle screw percutaneously to fix thoracic and lumbar spinal fractures by minimally invasive procedures. Study design: Prospective observational study. Place and duration: This study was conducted at , Pakistan Institute of Medical Sciences Islamabad, Pakistan from March 2020 to March 2021. Methodology: A total of 50 patients were evaluated, who had suffered from spinal injuries in the form of thoracic and lumbar spine fractures and were admitted for spinal surgery. Extensive CT scans were ordered for these patients and on the basis of these scans, the clinicians authorized and assessed the positioning for the percutaneous pedicle screw. However, in cases where the scans were not enough to visualize the exact placement of the pedicle cortex, an approach known as the cortical encroachment was applied. In cases where the need for the screw to be inserted laid outside the boundaries of the pedicle cortex the clinicians utilized a method known as the frank penetration. If placement for this screw was located outside the boundaries of the pedicle these boundaries were categorized in three types. Minor: if the displacement was less than 3 millimeters, moderate: where the placement lay between 3 to 6 millimeters and severe: where the placement was greater than 6 millimeters. Results: At total of 380 screws were fitted percutaneously in 50 patients. A total of 281(74%) of these screws were fitted inside the pedicle, 53 screws (14%) were placed in such a way that they encroached the pedicle and 46 (12%) of the cases showed that the screws penetrated the pedicle. Minor screw penetration was in 32 (8.47%) cases, moderate penetration in 10 (2.58 %) and severe penetration in 3 (0.7%) cases. Among one of severe screw penetration post-operative neurological symptoms were noted. Conclusion: Our study concludes that most of the pedicle positioning of screws were ideally placed, while in few cases there were Encroachment and perforation Keywords: Thoracic spine, lumber spine, spinal injury, pedicel screw

Surgical results for osteoporotic vertebral fracture of middle and lower lumbar spine

Surgical results for osteoporotic vertebral fracture of middle and lower lumbar spine

Research Progress of Traditional Chinese Medicine in the Treatment of Diabetes Complicated with Osteoporosis

Diabetes mellitus combined with osteoporosis (OP) is characterized by hyperglycemia and decreased bone density. The slight decrease of bone density causes systemic progressive bone pain, and the severe one causes brittle fracture of hip and lumbar spine. With the acceleration of aging process, the incidence rate also increases year by year, which increases the medical burden of the society. In recent years, the understanding of TCM and TCM treatment of this disease are more and more abundant, and the clinical effect is remarkable. This article reviews the research progress of TCM treatment of diabetes with osteoporosis in order to better guide the clinical practice.

Хирургическое лечение перелома поясничного отдела позвоночника на фоне системного остеопороза. Клинический случай

Fractures in osteoporosis are typically for all bones of skeleton, except for cranial bones. Most often, fractures of bodies of the thoracic and lumbar vertebrae, carpal bones and femoral bone are developed. Osteoporosis is the fourth among the most common diseases leading to disability, after diseases of the cardiovascular system, diabetes mellitus, and oncological neoplasms.Hybrid stabilization is a common surgical strategy for unstable osteoporotic fractures of thoracolumbar vertebrae, leading to good clinical outcomes in most patients.This article describes an experience of successful surgical treatment of fracture of lumbar spine associated with a distant complication after percutaneous vertebroplasty in an elderly patient.Keywords: osteoporotic spine, vertebral subluxation, spinal fracture, instrumented fusion, complication.

Outcome of patients undergoing posterior spine fixation and decompression for posttraumatic thoracolumbar spine fractures and the factors predicting it

Background: Posterior spine fixation and decompression for thoracic and lumbar spine fractures have the advantage of stabilization of the fracture, decompression of neural canal, early mobilization and rehabilitation of the patient. The study aimed to find out the postoperative outcome and complications following posterior spine surgery and the factors affecting the outcome.&#x0D; Methods: A retrospective study was carried out among 44 patients who underwent posterior spine decompression and fusion for thoracic and lumbar spine fracture. The data regarding patient presenting symptoms, comorbidity, associated injuries and imaging finding in CT and MRI were collected. The postoperative outcome of patients after surgery was assessed using ASIA impairment scale, KPS, VAS scale for pain are noted at the preoperative and postoperative period. Other factors like improvement of bowel and bladder symptoms, back stiffness and return to the job after surgery were also found out.&#x0D; Results: There was a significant improvement in ASIA impairment scale (mean =0.74 grade), KPS score (mean = 40) and VAS pain scale (mean = 6.7) at 6 months follow up after surgery. Improvement in ASIA impairment scale was more in the patient with severe canal compromise (mean = 1.62 grade), patients with translational/ distraction injuries (mean= 1.01grade) and patients with paraparesis (mean=1.06). Only one-third of patients with bowel and bladder involvement improved after surgery. Around 56.8% of patients were able to return to jobs at 6 months follow up. Patients who were paraplegic at the initial presentation were mostly not able to return to jobs. The most common reported complication in the study was intraoperative pedicle breakage.&#x0D; Conclusion: Decompression of the spinal cord plus posterior spine fixation is a safe, reliable and effective method in the management of thoracic and lumbar fractures with significant improvement in outcome in terms of motor power, pain and quality of life.

In-Hospital Clinical Outcomes in Patients with Fragility Fractures of the Lumbar Spine, Thoracic Spine, and Pelvic Ring: A Comparison of Data before and after Certification as a DGU® Geriatric Trauma Centre.

Background and Objectives: The implementation of orthogeriatric co-management (OGCM) reflects the demand for interdisciplinary collaborations due to the increasing comorbidities of geriatric trauma patients. This study aimed to assess clinical in-hospital outcomes in lumbar spine, thoracic spine, and pelvic ring fragility fracture patients before and after the implementation of a Geriatric Trauma Centre (GTC) certified by the German Trauma Society (DGU®). Materials and Methods: In this observational, retrospective cohort study, geriatric trauma patients (>70 years of age) were stratified into either a pre-GTC group (hospital admission between 1 January 2012 and 31 December 2013) or a post-GTC group (hospital admission between 1 January 2017 and 31 December 2018). Patients’ pre-injury medical complexity was measured by ASA class (American Society of Anaesthesiologists classification), the use of anticoagulant medication, and the ACCI (Age-adjusted Charlson Comorbidity Index). Outcome parameters were patients’ in-hospital length of stay (LOS) and mortality rates, as well as new in-hospital findings and diagnoses. Further, the necessity of deviation from initial management plans due to complications was assessed using the Adapted Clavien–Dindo Scoring System in Trauma (ACDiT score of ≥1). Results: Patients in the post-GTC group (n = 111) were older (median age 82.0 years) compared to the pre-GTC group (n = 108, median age 80.0 years, p = 0.016). No differences were found in sex, body mass index, ASA class, or ACCI (all p > 0.05). Patients in the post-GTC group used vitamin K antagonists or direct oral anticoagulants more frequently (21.3% versus 10.8%). The incidence of non-surgical treatment and mortality was comparable between groups, while LOS tended to be shorter in the post-GTC group (7.0 days versus 9.0 days, p = 0.076). In the post-GTC group, the detection of urinary tract infections (UTI) increased (35.2% versus 16.2%, p = 0.001), and the delirium diagnoses tended to increase (13.0% versus 6.3%, p = 0.094), while an ACDiT score of ≥1 was comparable between groups (p = 0.169). Conclusions: In this study including lumbar spine, thoracic spine, and pelvic ring geriatric fragility fractures, patients in the post-GTC group were more medically complex. More UTIs and the tendency for increased delirium detection was observed in the post-GTC group, likely due to improved diagnostic testing. Nonetheless, the necessity of deviation from initial management plans (ACDiT score of ≥1) was comparable between groups, potentially a positive result of OGCM.