Mid-thoracic Spine Research Articles

Effectiveness of mid thoracic spine mobilization on postural balance and gait ability in subacute stroke patients: A randomized clinical trial.

Although mulligan sustained natural apophyseal glides (SNAG) and maitland mobilization (MM) are common interventions for musculoskeletal disease, no study has directly compared the effectiveness of mid-thoracic spine mobilization in subacute stroke patients. To investigate the effects of mid-thoracic spine mobilization (SNAG vs. MM) on postural balance and gait ability in subacute stroke patients. Fifty subacute stroke patients were randomly allocated to the SNAG (n= 17), MM (n= 16), and control (n= 17) groups, each receiving a neuro-developmental therapy program for four successive weeks. The SNAG and MM groups additionally received mid-thoracic spine mobilization (T4∼8). The primary outcome measure was postural sway, and secondary outcome measures included the five times sit-to-stand test (FTSST), functional reach test (FRT), 10-m walk test (10MWT), 6-minute walk test (6MWT) and global rating of change (GRC). Participants reported no adverse events, and there was no loss to follow-up. The SNAG and MM group patients demonstrated significant improvements (p< 0.05) in postural sway, FTSST, FRT, 10MWT, and 6MWT compared with those in the control group, with no between-group differences. Mid-thoracic spine mobilization allows significant improvements in postural balance and gait ability in subacute stroke patients, with no differences between the SNAG and MM techniques.

P106. Selecting the upper instrumented vertebrae in ASD surgery: what happens when you stop in the mid-thoracic spine?

P106. Selecting the upper instrumented vertebrae in ASD surgery: what happens when you stop in the mid-thoracic spine?

Morphologic Changes of the Intervertebral Disk During Growth.

Cross-sectional. The aim of this study was to describe morphologic changes of the annulus fibrosus (AF) and nucleus pulposus (NP) in children during growth using magnetic resonance imaging. Little is known of intervertebral disk (IVD) maturation as opposed to degeneration, such as changes in relative AF/NP proportions and orientation during growth. Studies suggest that IVD plays a role in the etiology of pediatric spinal deformities. Therefore, understanding the morphologic development of the AF and NP during growth is key. An existing database of children aged 0 to 18 that had magnetic resonance imaging for indications unrelated to the spine were analyzed. The AF/NP were segmented semiautomatically from T1 to L5. The parameters: mean IVD height, cross-sectional area, slenderness (height/width ratio), volume (ratio), and relative position of the centroid of the NP within the IVD in three directions ( x , y , z ) were extracted, and compared between age, sex, and spinal level. IVD height increased modestly and predominantly in the low-thoracic and lumbar spine during the first 5 to 10 years of life. Cross-sectional area and thus volume increased steadily at all levels throughout growth. IVD slenderness decreased sharply in the first years of life and remains relatively stable throughout the remainder of growth. IVDs were smaller and more slender in females, especially in the mid-thoracic spine at early adolescence. In the upper-thoracic and mid-thoracic spine the NP comprises 10% to 12% of total IVD volume during growth, this percentage increases in the low-thoracic and lumbar spine towards 20% to 25%. In the anterior-posterior direction, the position of the nucleus increasingly shifts with age, possibly in line with the developing sagittal profile of the spine. This study describes the development of thoracic and lumbar IVDs during growth and may be used as a reference for future studies on the role of IVD in the etiology of disk-related disorders.

Retrospective Review of 181 Patients with Pathologic Vertebral Compression Fractures

Background: Compression fractures are often associated with lower energy trauma and may occur in the setting of abnormal bone health associated with genetic disorders and endocrine disorders, neoplastic disease, infection, and inflammatory disorders. There is no significant series in the literature describing the prevalence or etiology of pathologic pediatric compression fractures.Methods: IRB-approved retrospective study was performed at a tertiary children's hospital from 2012-2022. Patients <18 years old diagnosed with atraumatic vertebral compression fractures were included and reviewed for demographics, underlying diagnosis/comorbidity, presentation, mobility, deformities, imaging data, treatments, and outcomes.Results: 181 patients (54% Male) were included with mean age 14.17 years and follow-up of 20 months. A compression fracture was the presenting symptom of an underlying diagnosis in 32% of patients, and 21% of patients received an MRI to distinguish between metastatic disease and benign fractures. Primary osteoporosis was the cause in 15% and secondary osteoporosis was in 65% of patients; most commonly due to immunosuppressants (46%) and acute lymphoblastic leukemia (ALL) (10%). Primary lesions were the etiology in 20% of patients. There was a median of 3 fractures per patient, mostly of the midthoracic (82%) and thoracolumbar spine (51%). Radiographs revealed wedge fractures in 82%, biconcave fractures in 22%, and vertebra plana in 12%. Patients were managed with observation (46%), bracing (31%), bisphosphonates (31%), and fusions (4%). By last follow-up, there was a higher proportion of patients who developed scoliosis or became wheelchair-bound. Overall, there was a 16% mortality rate which was mostly associated with cancer.Conclusion: Overall, 32% of patients presented with a compression fracture as the presenting symptom of an underlying disease. Pathologic vertebral compression fractures in children frequently occurred due to immunosuppressants, ALL, and metastatic disease. The fractures were most often wedge morphology in the thoracolumbar and mid-thoracic regions of the spine. MRIs may be useful for distinguishing between benign fractures and malignancy.Levels of Evidence: Level IV Key Concepts•Pathologic Vertebral Compression Fractures occur commonly in children with primary or secondary osteoporosis or due to primary site lesions, such as metastases.•Patients often have multiple fractures about the thoracolumbar and mid-thoracic regions of the spine.•Wedge and biconcave fractures were the most common fracture type at presentation and indicated an underlying disease not previously known in one-third of patients.•MRI is useful for distinguishing between benign fractures and malignancy as the etiology of the fracture.

Comparison of median and paramedian technique of thoracic epidural anaesthesia in patients undergoing laparotomy under combined general and epidural anaesthesia - A prospective observational study.

Most studies have found that lumbar epidural catheterisation is technically easier with a paramedian than median approach. There is scant literature comparing the two approaches to the epidural space in the mid-thoracic spine. This study aims to compare the median versus paramedian approaches in the location of epidural space in the T7-9 region in patients undergoing laparotomy under combined general and epidural anaesthesia. A prospective observational study was conducted after ethical approval and written informed consent on 70 patients undergoing major abdominal surgery. The patients received epidural analgesia either through a median or paramedian approach (Group M, n = 35 and Group P, n = 35). The primary objective was the incidence of successful epidural catheter placement in the first attempt. The secondary objectives were the overall success rate, the requirement of change of intervertebral space, approach or operator and complications associated with the procedure. Sixty-seven patients were analysed. Epidural catheter was placed successfully in the first attempt in 40% of patients in Group M and 78.1% in Group P (P = 0.003). The overall success rate was 74.3% in Group M and 87.5% in Group P (P = 0.223). The number of attempts in Group M was more (one attempt 14, two 6, three 5 and four 1) as compared to Group P (one 25, two 2, three 1 and four 0) (P = 0.014). The incidence of complications was comparable between the groups. Epidural catheter insertion was technically easier in paramedian as compared to the median approach in T7-9 thoracic region with no difference in complications.

Imaging Evaluation for Thoracic Spine Fractures in Pediatric Trauma Patients: A Single-Center Experience at an Academic Children's Hospital.

Imaging workup for evaluating thoracic spine fracture (TSF) in pediatric blunt trauma is variable. The aim of the study was to determine the number of TSFs missed by radiography and identified on computed tomography (CT) or magnetic resonance imaging (MRI) that required intervention or resulted in a change in management. A retrospective review of children with TSFs was performed. Diagnostic images and reports for these patients were reviewed. Data regarding demographics, clinical presentation, management, and outcomes were extracted from institutional electronic medical records. Use of radiographs, CT, and MRI for evaluation of TSF was quantified. Incidence of TSFs was calculated and stratified by mechanism. The number of TSFs and complicating factors missed on radiography but identified on subsequent CT or MRI were quantified. Three thousand two hundred sixty-five trauma patients 18 years or younger were reviewed. Of these, 3.3% (90/3265) had TSFs (36 females, 54 males; mean age, 10.80 ± 4.4 years). The most common mechanism of injury was fall (43% [39/90]) followed by motor vehicle collisions (30% [27/90]). The most common fracture was simple compression fracture 64%, which occurred most frequently in the mid thoracic spine, followed by transverse process fractures 19% and spinous process fractures 7%. Almost half of all TSFs diagnosed on CT and/or MRI were missed on initial radiographs. While all fractures that required operative management were identified on radiographs, 13 of the 19 fractures that required nonoperative intervention were missed. Approximately 50% of TSFs diagnosed on CT or MRI were not identified on preceding radiographs. This is similar to studies in adult populations that show poor sensitivity of radiographs.

Reference values and functional descriptions of transverse plane spinal dynamics during gait based on surface topography

Spinal dynamics during gait have been of interest in research for many decades. Based on respective previous investigations, the pelvis is generally expected to be maximally forward rotated on the side of the reference leg at the beginning of each gait cycle and to reach its maximum counterrotation approximately at the end of the reference leg’s stance phase. The pelvic–upper-thoracic-spine coordination converges towards an anti-phase movement pattern in high velocities during ambulation. The vertebral bodies around the seventh thoracic vertebra are considered to be an area of transition during human ambulation where no or at least little rotary motion can be observed. The respective cranial and caudal vertebrae meanwhile are expected to rotate conversely around this spinal point of intersection. However, these previous assumptions are based on scarce existing research, whereby only isolated vertebrae have been analyzed contemporaneously. Due to huge methodological differences in data capturing approaches, the results are additionally hardly comparable to each other and involved measurement procedures are often not implementable in clinical routines. Furthermore, none of the above-mentioned methods provided reference data for spinal motion during gait based on an appropriate number of healthy participants. Hence, the aim of this study was to present such reference data for spinal rotary motion of every vertebral body from C7 down to L4 and the pelvis derived from surface topographic back shape analyses in a cohort of 201 healthy participants walking on a treadmill at a given walking speed of 5 km/h. Additionally, the spine‘s functional movement behavior during gait should be described in the transverse plane based on data derived from this noninvasive, clinically suitable measurement approach and, in conclusion, the results shall be compared against those of previous research findings derived from other measurement techniques. Contrary to the previous functional understanding, the area of the mid-thoracic spine was found to demonstrate the largest amplitude of rotary motion of all investigated vertebrae and revealed an approximately counterrotated movement behavior compared to the rotary motion of the pelvis. In both directions, spinal rotation during gait seemed to be initiated by the pelvis. The overlying vertebrae followed in succession in the sense of an ongoing movement. Therefore, the point of intersection was not statically located in a specific anatomical section of the spine. Instead, it was found to be dynamic, ascending from one vertebra to the next from caudal to cranial in dependence of the pelvis’s rotation initiation.

Hormone Positive HER2 Negative Breast Cancer Metastatic to the Rectum: A Case Report

Background: The rectum is an uncommon site for metastases from Invasive Ductal Carcinoma (IDC) of the breast, and it poses risks such as perforation and obstruction.&#x0D; Case Report: A 50-year-old non-diabetic, non-alcoholic, and nonsmoker premenopausal female patient diagnosed with rectal metastasis primarily originating from breast cancer.&#x0D; In 2009, the patient was diagnosed with stage IV hormone positive, Her-2 (+2) negative, FISH positive right breast cancer with cervical (C6) vertebrae metastasis seen on PET scan. As she had oligo metastasis with a single bony focus, she was treated with intent to cure. For this purpose, she received radiation therapy to the cervical vertebrae, resulting in a complete response. This was followed by pseudo-neoadjuvant chemotherapy with six cycles of Docetaxel and trastuzumab. The patient then underwent a right-modified radical mastectomy. The pathology showed no complete response with residual 2.5 cm invasive carcinoma (PT2), and 4 out of 25 Axillary lymph nodes were positive for metastases (PN2). She was given (pseudo) adjuvant radiotherapy to the chest wall and lymphatics and was started on (pseudo) adjuvant tamoxifen. Trastuzumab was completed for one year as a (pseudo) adjuvant setting.&#x0D; Her disease seemed to be cleared up as no new cancer signs were reported by follow-up full body scans (CT/PET). After seven years, in May 2016, her PET-CT scan showed multiple new hypermetabolic osseous lesions, in keeping with metastasis involving the right shoulder, mid-thoracic spine, left aspect of L5, right sacrum, and the greater trochanteric region of the left femur and left ischium. She also presented a new hypermetabolic retroperitoneal paracaval lymph node, in keeping with metastasis. The new ill-defined hypodensity in the left hepatic lobe was associated with increased FDG uptake, which is suspicious for early metastasis. She also presented a tiny right lung peri-fissural nodularity that was too small to be characterized by PET.&#x0D; She was treated with Zoladex 3.6 mg injection monthly, Femara 2.5 mg daily, Palbociclib 125 mg PO daily for 21 days over a 28-day cycle, and Denosumab 120 mg monthly. The treatment was initiated in Singapore. As previously stated, Her-2 testing was reported as negative. The patient went into complete remission for more than six years, as documented by the PET scan conducted on January 19, 2022. Later, in June 2022, the patient developed signs and symptoms of intestinal obstruction (abdominal pain, nausea, and vomiting) and was diagnosed with rectal cancer metastases of breast origin.&#x0D; Conclusion: As the patient first developed breast cancer with oligo-bony metastasis, which was successfully treated with chemotherapy and radiotherapy, but later relapsed in the lung, liver, lymph nodes, and multiple bony sites. She was treated successfully via hormonal and targeted therapy. Finally, she relapsed in the form of rectal metastasis.

Cement augmentation for treatment of high to mid-thoracic osteoporotic compression fractures, high-viscosity cement percutaneous vertebroplasty versus balloon kyphoplasty

Whilst the majority of the literature suggests that balloon kyphoplasty (BKP) can relieve pain associated with vertebral compression fractures (VCFs), evidence of high-viscosity cement (HVC) vertebroplasty (VP) or low viscosity cement (LVC) BKP for the treatment of VCFs at the levels of high and mid-thoracic vertebrae remains limited. The purpose of this study was to identify the different outcomes between HVC VP and LVC BKP used to repair high (T4–6) and mid (T7–9)-thoracic VCFs. A total of 114 patients with painful collapsed single-level vertebrae at high to mid-thoracic level who had undergone HVC VP or LVC BKP at a single tertiary medical center was reviewed retrospectively. All patients were divided into the HVC VP group (n = 72) and the LVC BKP group (n = 42). Clinical outcomes including demographic data and visual analogue scale (VAS) were compared. Radiographic data were collected preoperatively, postoperatively, and at final follow-up. More volume (ml) of cement injection was seen in the LVC BKP group (4.40 vs. 3.66, p < 0.001). The operation time (minutes) of the HVC VP group was significantly less than that of the LVC BKP group (33.34 vs. 39.05, p = 0.011). Leakage rate of cement was also fewer in the HVC VP group (26/72 vs. 27/42, p = 0.004). Compared with preoperative data, the VAS was improved after surgery in both groups. The LVC BKP group corrected more middle vertebral body height and local kyphosis angle than the HVC VP group. The outcomes of LVC BKP were not superior to that of HVC VP. HVC VP might be a good alternative to LVC BKP in the treatment of osteoporotic VCFs in high to mid-thoracic spine.

Pancoast Tumor Presenting as Neck Pain in the Chiropractic Office: A Case Report and Literature Review

Patient: Male, 59-year-old Final Diagnosis: Adenocarcinoma of the lung • pancoast tumor Symptoms: Cough • neck and shoulder pain and numbness Medication: — Clinical Procedure: Magnetic resonance imaging (MRI) of the cervical and thoracic spine Specialty: Infectious Diseases • Pulmonology • Radiology • Rehabilitation Objective: Rare disease Background:Pancoast tumors, also called superior sulcus tumors, are a rare type of cancer affecting the lung apex. These tumors can spread to the brachial plexus and spine and present with symptoms that appear to be of musculoskeletal origin.Case Report:A 59-year-old Asian man presented to a chiropractor in Hong Kong with a 1-month history of neck and shoulder pain and numbness that had been treated unsuccessfully with exercise, medications, and acupuncture. He had an active history of tuberculosis, which was currently treated with antibiotics, and a 50-pack-year history of smoking. Cervical magnetic resonance imaging (MRI) was performed urgently, revealing a small cervical disc herniation thought to correspond with radicular symptoms. However, as the patient did not respond to a brief trial of care, a thoracic MRI was urgently ordered, revealing a large superior sulcus tumor invading the upper to mid-thoracic spine. The patient was referred for medical care and received radiotherapy and chemotherapy with a positive outcome. A literature review identified 6 previously published cases in which a patient presented to a chiropractor with an undiagnosed Pancoast tumor. All patients had shoulder, spine, and/or upper extremity pain.Conclusions:Patients with a previously undiagnosed Pancoast tumor can present to chiropractors given that these tumors may invade the brachial plexus and spine, causing shoulder, spine, and/or upper extremity pain. Chiropractors should be aware of the clinical features and risk factors of Pancoast tumors to readily identify them and refer such patients for medical care.

Comparison of the clinical and radiologic outcomes between T9 vs T10 vertebra in the midthoracic spine as upper instrumented vertebra in the long fusions down to sacrum for adult spinal deformity

Comparison of the clinical and radiologic outcomes between T9 vs T10 vertebra in the midthoracic spine as upper instrumented vertebra in the long fusions down to sacrum for adult spinal deformity

A RARE CASE OF MYOCARDIAL INFARCTION DUE TO INTIMAL SARCOMA OF THE AORTIC ARCH

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Intimial sarcoma (IS) of the large systemic arteries are an extremely rare class of tumors with only 81 reported cases in literature, most commonly arising in the abdominal aorta (1). Due to its nonspecific clinical presentation, IS is frequently diagnosed late in the disease process when metastasis has already developed, specifically to the lungs, abdominal organs, vertebral bone, and skin (2). Accurate diagnosis is made with immunohistochemical (IHC) staining positive for CD31, Fli-1, and ERG1. We present a case of an IS of the aortic arch resulting in a fatal tumor embolism to the left coronary artery (LCA), as diagnosed on autopsy. CASE PRESENTATION: A healthy 51-year-old male presented with severe sharp pain in the thoracic spine. Physical exam was positive for tenderness to palpation in the mid-thoracic spine with bilateral lower extremity (LE) neurological deficits. Magnetic resonance imaging (MRI) of the spine revealed bone lytic lesions in the thoracic spine from T5 to T7 with a T6 compression fracture. A computed tomography (CT) scan of the chest, abdomen, and pelvis showed no evidence of the primary tumor site. Biopsy revealed metastatic bone sarcoma of unknown origin. The patient underwent palliative radiation therapy for two weeks. One month after completion of treatment, the patient was re-admitted with worsening back pain. Repeat CT scan showed worsening compression fractures and extraosseous tumor extension into the prevertebral space. Subsequently, the patient underwent spinal cord decompression surgery. On post-operative day 4, he developed severe chest pain with refractory ventricular fibrillation leading to his death. Autopsy revealed an IS extending from the aortic arch to the aortic valve with metastasis to the thoracic vertebrae and thyroid gland. Ultimately, the cause of death was due to a tumor embolus that occluded his LCA. DISCUSSION: Aortic IS is an extremely rare neoplasm that typically presents late in the disease process. The initial manifestation of aortic IS in our case was metastatic vertebral bone lesions with no other evidence of the primary site on radiologic modalities, despite retrospective imaging analysis. It is important that aortic IS be included on the differential diagnosis for sarcoma of unknown origin in order to better understand the disease course. To our knowledge, this is the first reported case of aortic IS that presented as a sarcoma of unknown origin with bone metastases and resulted in a myocardial infarction with findings of metastasis to the thyroid gland. CONCLUSIONS: Aortic IS can be classified as: Angiosarcoma, expressing endothelial-specific antigens, and Myofibroblast, expressing mesenchymal-specific antigens. Diagnosis is tricky as IS are easily missed on CT and MRI. Definitive diagnosis requires IHC analysis. Prognosis for aortic IS is quite poor, with a mean survival period of one year. REFERENCE #1: Sebenik, M., et al. (2005). Undifferentiated Intimal Sarcoma of Large Systemic Blood Vessels. American Journal of Surgical Pathology, 29(9), 1184-1193. REFERENCE #2: Staats, P., et al. (2014). Intimal sarcomas of the aorta and iliofemoral arteries: A clinicopathological study of 26 cases. Pathology,46(7), 596-603 DISCLOSURES: No relevant relationships by Daniel Rushing, source=Web Response No relevant relationships by Amjed Zidan, source=Web Response

Experimental Analysis of Fabricated Synthetic Midthoracic Paediatric Spine as Compared to the Porcine Spine Based on Range of Motion (ROM).

The present study is aimed at investigating the mechanical behaviour of fabricated synthetic midthoracic paediatric spine based on range of motion (ROM) as compared to porcine spine as the biological specimen. The main interest was to ensure that the fabricated synthetic model could mimic the biological specimen behaviour. The synthetic paediatric spine was designed as a 200% scaled-up model to fit into the Bionix Servohydraulic spine simulator. Biomechanical tests were conducted to measure the ROM and nonlinearity of sigmoidal curves at six degrees of freedom (DOF) with moments at ±4 Nm before the specimens failed. Results were compared with the porcine spine (biological specimen). The differences found between the lateral bending and axial rotation of synthetic paediatric spine as compared to the porcine spine were 18% and 3%, respectively, but was still within the range. Flexion extension of the synthetic spine is a bit stiff in comparison of porcine spine with 45% different. The ROM curves of the synthetic paediatric spine exhibited nonlinearities for all motions as the measurements of neutral zone (NZ) and elastic zone (EZ) stiffness were below “1.” Therefore, it showed that the proposed synthetic paediatric spine behaved similarly to the biological specimen, particularly on ROM.

Image-Guided Right T10 Costotransverse Joint Resection for Costotransversitis: Operative Technique and Nuances: 2-Dimensional Operative Video

We describe the operative approach and management for costotransverse joint inflammation in a 49-yr-old man with worsening midthoracic pain radiating to the right paraspinal area. He underwent physical therapy with no relief of his symptoms. Thoracic spine magnetic resonance imaging (MRI) revealed severe arthritic changes involving the right T10 costotransverse joint. Scoliosis X-rays showed a dextroconvex curvature in the midthoracic spine, without any significant imbalance. Single-photon emission computed tomography (SPECT) scan revealed focal increased uptake of the right T10 costotransverse joint. T10 costotransverse joint lidocaine injection did not provide any relief. We performed a computed tomography (CT)-guided biopsy, which was negative for malignancy and also cultures were negative. MRI revealed a significant enhancement in this area and the patient's C-reactive Protein was elevated. Decision was made to perform open biopsy and costotransverse joint resection. We present a case of minimally invasive, image-guided costotransverse joint resection, which has not been described in the literature. The right T10 costotransverse joint was dissected out with the image-guided dilator, and tubular retractors were inserted. Under the microscope, using the image-guided drill, the right T10 costotransverse joint was drilled out. The lateral aspect of the right T10 process was drilled out as well as the medial-dorsal aspect of the right T10 rib. The patient recovered from surgery well with abatement of his preoperative thoracic pain, which remained abated at 6-mo follow-up. This case highlights the complex technical nuances of this procedure, and the importance of a thorough preoperative evaluation with a bone SPECT scan to help localize the pain generator. Patient consented for the procedures and for the publication of the video.

Trends and patterns of thoracic intervertebral disc degeneration in symptomatic subjects: a magnetic resonance imaging analysis.

This study aimed to analyse the trends and patterns of IVD degeneration in different age groups at each level of the thoracic spine. This cross-sectional MRI study included 1000 symptomatic patients who had undergone upright thoracic spine MRI. A total of 13,000 thoracic IVDs from C7/T1 to T12/L1 were classified into five grades using Pfirrmann classification. Patients were divided according to their ages into five groups (n = 200/group). The severity and pattern of IVD degeneration were analysed in each age group. A predictive model of the severity and pattern of IVD degeneration in each age group was proposed. The total grade of IVD degeneration and the number of degenerated levels increased with increasing age (P < 0.001). The most common degenerated level was T6/7 (13.3%), while the least common degenerated level was T12/L1 (1.8%). The most common grades were grade I in group 1 (60.5%), grade II in groups 2 (39%) and 3 (37.3%), and grade III in groups 4 (42.5%) and 5 (44.6%). Adjacent-level degenerations were more common than skip-level degenerations. Severe disc degeneration (Pfirrmann grades IV or V) could be predicted to occur more in group 5 (patients with 60years and above) (margin = 0.79, 95% CI = 0.73-0.84, P < 0.001). The severity of thoracic IVD degeneration and the number of degenerated levels increased with age. Disc degeneration was more accelerated in the mid-thoracic spine. Adjacent-level degeneration was more common than skip-level degenerations.

The effect of multiplanar loading on the intradiscal pressure of the whole human spine: systematic review and meta-analysis.

For spinal load and muscle force estimation as well as for numerical model and experimental setup validation, data on human intradiscal pressure are essential. Therefore, the aim of the present meta-analysis was to summarise all in vitro measurements of human intradiscal pressure performed under defined boundary conditions, i.e. without external loading (intrinsic pressure), under axial loading (compression, traction, shear) and under single-planar bending loading (flexion, extension, lateral bending, axial rotation). Data were evaluated based on segmental level and normalised to force and moment. Regression analysis was performed to investigate coefficients of determination and statistical significance of relationships between intradiscal pressure and segmental level for the single loading conditions. 35 studies fulfilled the inclusion criteria, from which a total of 451 data points were collected for the meta-analysis. High coefficients of determination were found in axial compression (r2 = 0.875) and flexion (r2 = 0.781), while being low for intrinsic pressure (r2 = 0.266) and lateral bending (r2 = 0.385), all showing significant regression fitting (p < 0.01). Intradiscal pressure decreases from the upper cervical spine to the sacrum in all loading conditions, considering the same amount of loading for all segmental levels, while the intrinsic pressure exhibits a minimum of the regression curve in the mid-thoracic spine. Apart from its potential for numerical and experimental model validation, this dataset may help to understand the load distribution along the human spine.

Long-segment versus short-segment fixation through a posterior approach for tuberculous spondylodiscitis of the mid-thoracic spine in adults: a study of mid- to long-term efficacy.

This retrospective study aimed to perform a comparative evaluation of the mid- to long-term efficacy of long-segment and short-segment fixations via the posterior approach as a treatment for tuberculous spondylodiscitis in the mid-thoracic spine. A total of 95 patients with tuberculous spondylodiscitis in the mid-thoracic spine underwent surgery via the posterior approach including single-stage posterior debridement, interbody fusion, and pedicle screw fixation. Long-segment fixations were performed for 46 patients (group A), while short-segment fixations were performed for the other 49 patients (group B). Clinical and radiological outcomes were assessed during mid- to long-term follow-up. The average follow-up periods for groups A and B were 75.5±11.8 and 76.8±11.6 months, respectively. The operative time and intraoperative blood loss were lower in group B than in group A (P<0.05). Both management approaches significantly corrected the kyphotic deformity detected either in the early postoperative period or at the final visit after long-term follow-up (P>0.05). Bony fusion was generated after average periods of 10.8±2.1 months and 11.0±2.0 months in groups A and B, respectively. Favorable outcomes were observed on assessment of neurological function and patients' well-being at the final follow-up. No therapeutic differences were observed between long-segment and short-segment fixation as surgical treatment for mid-thoracic Pott's disease during mid- to long-term follow-up. Kyphotic deformity and neurological impairment were significantly relieved via both posterior fixation approaches, with patients' well-being reaching a favorable level. Moreover, short-segment fixation led to less blood loss and required a shorter operative time.

Midterm outcome after posterior stabilization of unstable Midthoracic spine fractures in the elderly

BackgroundThe evidence for the treatment of midthoracic fractures in elderly patients is weak. The aim of this study was to evaluate midterm results after posterior stabilization of unstable midthoracic fractures in the elderly.MethodsRetrospectively, all patients aged ≥65 suffering from an acute unstable midthoracic fracture treated with posterior stabilization were included. Trauma mechanism, ASA score, concomitant injuries, ODI score and radiographic loss of reduction were evaluated. Posterior stabilization strategy was divided into short-segmental stabilization and long-segmental stabilization.ResultsFifty-nine patients (76.9 ± 6.3 years; 51% female) were included. The fracture was caused by a low-energy trauma mechanism in 22 patients (35.6%). Twenty-one patients died during the follow-up period (35.6%). Remaining patients (n = 38) were followed up after a mean of 60 months. Patients who died were significantly older (p = 0.01) and had significantly higher ASA scores (p = 0.02). Adjacent thoracic cage fractures had no effect on mortality or outcome scores. A total of 12 sequential vertebral fractures occurred (35.3%). The mean ODI at the latest follow up was 31.3 ± 24.7, the mean regional sagittal loss of reduction was 5.1° (± 4.0). Patients treated with long segmental stabilization had a significantly lower rate of sequential vertebral fractures during follow-up (p = 0.03).ConclusionUnstable fractures of the midthoracic spine are associated with high rates of thoracic cage injuries. The mortality rate was rather high. The majority of the survivors had minimal to moderate disabilities. Thereby, patients treated with long segmental stabilization had a significantly lower rate of sequential vertebral body fractures during follow-up.

Interpretation of osteoporotic vertebral deformity on frontal view radiographs of the chest and abdomen: a pictorial review.

Osteoporotic vertebral fracture (OVF) has high prevalence in the elderly population. It affects at least one-fourth of all postmenopausal women and is commonly seen among women approximately one decade after menopause. A vertebral fracture, after minor trauma, is a hallmark of osteoporosis. Many fractures and associated complications, including secondary fractures and mortality, can be prevented by routine osteoporosis screening in older people and timely treatment initiation in at-risk individuals. Depending on the technical condition of the radiographs, a substantial portion of moderate to severe grades OVFs in mid-thoracic and lower thoracic spine as well as lumbar spine can be detected on a frontal view digital radiograph of the chest or abdomen. Radiologists should pay attention to the potential existence of an OVF while reading chest and abdominal radiographs of elderly female subjects. In this pictorial review, we describe our experience in evaluating the normal shaped and deformed vertebrae on chest and abdominal radiographs.

Ct guided reference markers for spinal dorsal lesions: A safe and valuable tool impacting intraoperative localization time

BackgroundIntraoperative localization of the correct spine level can be challenging when dealing with the thoracic spine; especially in morbidly obese patients and in mid-thoracic spine lesions. Different radiological reference markers techniques for dorsal surgery have been reported without a clear DAP (effective dose), localization and surgical time analysis. PurposeThe aim of the study is to analyze the radiological reference markers technique in terms of localization time and radiation dose during surgery for dorsal lesions. MethodsWe used a radiopaque marker (fiducial) directly positioned before surgery over the lamina or the spinous process using CT scan for precise localization and vertebra count. We prospectively collected data about patients who underwent preoperative thoracic localization between April 2015 and September 2018 at Neurosurgery Department of Ferrara University Hospital. Clinical data as pathology, related surgical technique, radiological exams, localization time and radiation exposure were analyzed. Results19 patients who underwent preoperative radiopaque marker (fiducial) positioning and 11 patients who underwent fluoroscopy technique were enrolled.No complications related to fiducial placement and no wrong-level occurred. The localization time with the fiducial was reduced dramatically (3 min vs 15 min of the standard technique). The average DAP (effective dose) for the fiducial group was 20 Gy-cm2 compared with 16 Gy-cm2 of the traditional group. ConclusionThe use of preoperative fiducial for intraoperative localization of the target level in the thoracic spine dramatically reduce the location time without a significantly higher DAP (effective dose).