Midsagittal Diameter Research Articles

Computed-tomography assessment of the lumbar spine body/canal index and review of the literature

Lumbar spinal stenosis (LSS) involves narrowing of the lumbar spinal space due to various factors. Torg-Pavlov Index measures predict LSS. The objective was to define the mean characteristics of the lumbar spine body/canal index in a Hispanic population stratified by age and sex. A retrospective, observational, transverse, and descriptive study was performed. Imaging studies included consecutive bone window full abdominal CT scans, in adult patients (≥18 years), without evidence of bone disease, musculoskeletal pathology, or traumatic event and a fully visible lumbar spine (L1-L5). The anteroposterior diameter (APD) and midsagittal diameter (MSD) of each vertebral level were measured using the Carestream image reformatting program at each lumbar vertebral level from L1 to L5 of the CT scan. A total of 400 CTs of subjects with a mean age of 47.7±14.8 (range 18-80 years) were evaluated, of which 59.3% (n 237/400) were women. The presence of a ≤0.5 body/canal index was 31.6% (n 126). The MSD/APD lumbar index did not differ significantly between age groups in any of the vertebrae. However, there was a tendency to decrease with age. An mean index higher than 0.5 was the mean found in the patients evaluated where there was no previous data of spinal cord involvement. This study provides an accurate description of the normal morphometric parameters of the lumbar body/canal ratio in a Mexican population to assess clinical scenarios of lumbar spinal stenosis. Few studies evaluate the use of cut-off points to define an LSS.

Morphometric study of the lumbar vertebrae in dried anatomical collections

Background The objective of this anatomical study was to perform the morphometry of dried lumbar vertebrae in human cadavers. Methods This study utilized 200 adult human cadaveric dried lumbar vertebrae. The digital Vernier calipers was used to perform the measurements. The height, antero-posterior length, transverse length of the body of the vertebrae, interpedicular distance at the lateral ends, lamina length, height and thickness, superior and inferior articular facet height and width, mid sagittal and transverse diameter of vertebral foramen, height, width and thickness of the pars inter-articularis were measured. Results The vertebral body’s anteroposterior length was more at the lower border than at the superior border (p < 0.01). The length of lamina was higher over the right in comparison to the left (p < 0.001). The height of lamina, width of inferior articular facet, diameter of lateral recess and thickness of pars inter-articularis were greater for the left sided specimens (p < 0.01). The statistical significance was not observed for the comparison of the remaining parameters (p > 0.05). Conclusion This anatomical study offered several dimensions of lumbar vertebrae, which are essential in the surgical practice. The implants at the lumbar vertebrae need to be manufactured based on the anatomical dimensions of that particular sample population.

Normative MRI for Lumbar Spinal Canal and Vertebral Body Dimensions in a Jordanian Population Sample

Aim: To provide normal values for the lumbar spinal canal, lumbar vertebral body and dural sac dimensions and canal body ratio by MRI for a Jordanian population sample.
 Material and methods: Three well trained observers reviewed 218 lumbar MRI scans performed between 2019–2021 (1090 lumbar levels) and obtained from the central computerized medical archive of three main governmental hospitals in north, central and south Jordan. All MRIs with alignment abnormalities (scoliosis and kyphosis), canal compression, vertebral disease (including fractures) or technical artifacts were excluded. The following were measured from L1 to L5 levels: the midsagittal diameters of the spinal canal and vertebral body, axial anteroposterior (AP), and transverse diameter of the vertebral body, dural canal and dural canal area. Data on sex and age were also documented.
 Results: The studied MRI scans included 113 males (51.8%) and 105 females (48.2%). Age ranged between 23–86 years old (mean 52.23 ± 13.125). The mid sagittal mid vertebral AP diameter of the lumbar spine range was 2.8–3.1 cm. The mid sagittal spinal canal diameter range was 1.3–1.5 cm. Canal body ratio was 3.3–3.6. The AP, transverse dural sac diameter ranges were 1.2–1.4 cm and 1.5–1.9 cm, respectively. Finally, the dural sac area ranged from 331–362 mm2.
 Conclusion: The dimensions of the lumbar spinal canal, vertebral bodies, and vertebral canal ratio at all levels were documented for a Jordanian population sample. Dimensions varied according to sex and when compared with other ethnic groups (Asian and African). The findings suggest that canal stenosis criteria should take these differences into consideration.

Morphometric study of the lumbar vertebrae in dried anatomical collections

Background: The objective of this anatomical study was to perform the morphometry of dried lumbar vertebrae in human cadavers. Methods: This study utilized 200 adult human cadaveric dried lumbar vertebrae. The digital Vernier calipers was used to perform the measurements. The height, antero-posterior length, transverse length of the body of the vertebrae, interpedicular distance at the lateral ends, lamina length, height and thickness, superior and inferior articular facet height and width, mid sagittal and transverse diameter of vertebral foramen, height, width and thickness of the pars inter-articularis were measured. Results: The vertebral body’s anteroposterior length was more at the lower border than at the superior border (p < 0.01). The length of lamina was higher over the right in comparison to the left (p < 0.001). The height of lamina, width of inferior articular facet, diameter of lateral recess and thickness of pars inter-articularis were greater for the left sided specimens (p < 0.01). The statistical significance was not observed for the comparison of the remaining parameters (p > 0.05). Conclusion: This anatomical study offered several dimensions of lumbar vertebrae, which are essential in the surgical practice. The implants at the lumbar vertebrae need to be manufactured based on the anatomical dimensions of that particular sample population.

Morphometric study of the lumbar vertebrae in dried anatomical collections.

The objective of this anatomical study was to perform the morphometry of dried lumbar vertebrae in human cadavers. This study utilized 200 adult human cadaveric dried lumbar vertebrae. The digital Vernier calipers was used to perform the measurements. The height, antero-posterior length, transverse length of the body of the vertebrae, interpedicular distance at the lateral ends, lamina length, height and thickness, superior and inferior articular facet height and width, mid sagittal and transverse diameter of vertebral foramen, height, width and thickness of the pars inter-articularis were measured. The vertebral body's anteroposterior length was more at the lower border than at the superior border ( p < 0.01). The length of lamina was higher over the right in comparison to the left (p < 0.001). The height of lamina, width of inferior articular facet, diameter of lateral recess and thickness of pars inter-articularis were greater for the left sided specimens ( p < 0.01). The statistical significance was not observed for the comparison of the remaining parameters ( p > 0.05). This anatomical study offered several dimensions of lumbar vertebrae, which are essential in the surgical practice. The implants at the lumbar vertebrae need to be manufactured based on the anatomical dimensions of that particular sample population.

Morphometric Study of Lumbar Spinal Canal Dimensions in Bosnia and Herzegovina Population.

The lumbar spinal canal consists of 5 interconnected lumbar vertebrae through which the final part of the spinal cord passes and the lumbar and sacral spinal nerves that form the cauda equina. The lumbar canal stenosis can directly affect neurological symptoms and pain in the lumbar region and lower extremities. Due to the frequency of such symptoms, lumbar stenosis has been the subject of research around the world. The objective of this study was to measure, analyze and compare the mediosagital and interpeduncular diameters of the lumbar spinal canal in the population of Bosnia and Herzegovina to other populations around the world. We conducted a retrospective descriptive study on patients (n=200) who underwent Multi-slice computer tomography (MSCT) performed on a 40-slice CT scanner (Siemens Somatom Definition AS) for lumbar pain between January 1, 2013 and December 31, 2014. Age, gender, midsagittal (MSG) and interpeduncular (IP) diameters of the lumbar spine were recorded for each patient. Results of our study show that the largest MSG diameter is at L1 level for both sexes, with an average length of 19,06mm, and the smallest at L3 level, with an average length of 16,66mm. Our study shows that the MSG diameter is significantly larger in females than males on all levels from L1 to L5. In both sexes, MSG diameter shows the form of an hourglass with narrowing at L3 level. IPD is largest at L5 level for both sexes, with an average length of 31,94mm, and the smallest average length at L1 level, at 24,78mm. IPD diameter is significantly larger in males than females on all levels from L1 to L5. IPD shows a tendency of growth from L1 to L5 in both sexes. There were significant differences in the dimensions of the lumbar spine canal between female and male patients. We found significant difference in MSG and IP diameters measurements between Bosnian and Herzegovinian population compared to other populations. The dimensions of the lumbar canal provide a baseline of normative data for the evaluation of patients presenting with lower back pain and lumbar canal stenosis in study population.

In-Fracture Pedicular Screw Placement During Ligamentotaxis Following Traumatic Spine Injuries, a Randomized Clinical Trial on Outcomes.

To investigate the efficacy and safety of two different techniques for spinal ligamentotaxis. Spine ligamentotaxis reduces the number of retropulsed bone fragments in the fractured vertebrae. Two different ligamentotaxis techniques require clinical evaluation. This was a randomized clinical trial. The case group was defined as one pedicular screw insertion into a fractured vertebra, and the control group as a no-pedicular screw in the index vertebra. Spine biomechanical values were defined as primary outcomes and complications as secondary outcomes. A total of 105 patients were enrolled; 23 were excluded for multiple reasons, and the remaining were randomly allocated into the case (n=40) and control (n=42) groups. The patients were followed up and analyzed (n=56). The postoperative mid-sagittal diameter of the vertebral canal (MSD), kyphotic deformity correction, and restoration of the anterior height of the fractured vertebrae showed equal results in both groups. Postoperative retropulsion percentage and pain were significantly lower in the case group than in the control group (p=0.003 and p=0.004, respectively). There were no group preferences for early or long-term postoperative complications. Regarding clinical and imaging properties, inserting one extra pedicular screw in a fractured vertebra during ligamentotaxis results in better retropulsion reduction and lower postoperative pain.

Morphometric study of the lumbar vertebrae in dried anatomical collections

Background: The objective of this anatomical study was to perform the morphometry of dried lumbar vertebrae in human cadavers. Methods: This study utilized 200 adult human cadaveric dried lumbar vertebrae. The digital Vernier calipers was used to perform the measurements. The height, antero-posterior length, transverse length of the body of the vertebrae, interpedicular distance at the lateral ends, lamina length, height and thickness, superior and inferior articular facet height and width, mid sagittal and transverse diameter of vertebral foramen, height, width and thickness of the pars inter-articularis were measured. Results: The vertebral body’s anteroposterior length was more at the lower border than at the superior border (p &lt; 0.01). The length of lamina was higher over the right in comparison to the left (p &lt; 0.001). The height of lamina, width of inferior articular facet, diameter of lateral recess and thickness of pars inter-articularis were greater for the left sided specimens (p &lt; 0.01). The statistical significance was not observed for the comparison of the remaining parameters (p &gt; 0.05). Conclusion: This anatomical study offered several dimensions of lumbar vertebrae, which are essential in the surgical practice. The implants at the lumbar vertebrae need to be manufactured based on the anatomical dimensions of that particular sample population.

Correlation between clinical scoring systems and quantitative MRI parameters in degenerative lumbar spinal stenosis

BackgroundMany quantitative MRI parameters and clinical scores have been used patients with lumbar spinal stenosis (LSS). However, the correlation between clinical scores and MRI parameters is not very clear. The objective of the study was to find out the correlation between commonly used clinical scoring systems and quantitative MRI parameters. MethodsEighty two patients (more than 40 years) with clinical and radiological characteristics of degenerative LSS completed 10 clinical questionnaires which included Oswestry disability index (ODI), Swiss spinal stenosis (SSS) questionnaire, Quebec pain disability scale (QPD), Visual analogue scale (VAS), modified Japanese orthopaedic association scale (mJOA), Pain disability index (PDI), Short form health survey (SF-36), Self-paced walking test (SPWT), Euro quality of life-5D (EQ-5D) and Neurogenic claudication outcome score (NCOS). Lumbosacral MRIs were performed and 8 quantitative parameters namely transverse & AP diameter of dural sac (TDD, APDD), anteroposterior diameter of spinal canal (APDS), ligamentous interfacet distance (LID), mid-sagittal diameter of thecal sac (MSDT), cross-sectional area dural sac (CSAD), lateral recess depth and angle (LRD, LRA) were measured at the maximum stenotic level at the level of the disc. The clinical and radiological parameters were then statistically analysed. ResultsThere were 51 females and 31 males in the study with a mean age of 53.0253.02 ± 9.18 years. NCOS score had a moderate correlation with CSAD, LID and TDS (p<0.05,0.7>r ≥ 0.3). MSDT showed a moderate negative correlation with SSS, VAS, ODI and QPD (p<0.05,0.7>r ≥ 0.3). LRD had a moderate negative correlation with ODI and VAS score (p<0.05,0.7>r ≥ 0.3). LRA had a moderate correlation with the EQ-5D and ODI (p<0.05,0.7>r ≥ 0.3). The CSAD had a moderate negative correlation with PDI (r = −0.383, p = 0.000). For all other comparisons, there was poor or no correlation. MRI parameters showed poor or no correlation with most of components of SF-36 score. ConclusionsA poor correlation or no correlation was noted for most of the MRI parameters when compared to commonly used clinical scores. Hence, poor MRI's don't necessarily mean poor clinical scores in LSS. The role of MRI parameters should be supplementary and overreliance on them in LSS management should be avoided.

Variation of Torg-Pavlov ratio with age, gender, vertebral level, dural sac area, and ethnicity in lumbar magnetic resonance imaging

The objectives of the study were to provide normal values of the Torg-Pavlov ratio (TPR) of the lumbar spine in magnetic resonance imaging (MRI) for the Jordanian population and examine differences observed according to factors including age, gender, lumbar level, dural sac area, or ethnic group. Two hundred and eighteen lumbar MRIs from the Picture Archiving and Communication System were reviewed. These were collected from three main governmental hospitals, in North, Central, and South of Jordan. The mid-sagittal diameters of the vertebral body, spinal canal, and dural canal area were measured at all levels. Patients' gender and age were documented as well. Exclusion criteria were kyphoscoliosis alignments disorders, lumbar spinal canal compression regardless of the cause, vertebral bony disease (including fractures), and the presence of technical artifacts. Statistical analyses used descriptive and correlational methods. Comparisons were made between genders, age groups, lumbar level, dural sac area in the study population using independent t-test and one-way ANOVA tests, and between ethnicities by reviewing previous reports on subjects of different ethnicities. The mean TPR ratio for the study participants was 0.4502 ± 0.097. The value of TPR was widest in the 20-29-year-old group at all vertebral levels and in both males and females. Females had a significantly wider TPR than males (P = 0.003) in all age groups. TPR differed significantly between the five vertebral levels (P = 0.026). The difference in TPR between age groups was not statistically significant. TPR showed a positive significant correlation with dural sac (r = 0.203, P = 0.003). Comparison with the previous literature demonstrated variation in the TPR where Jordanian population had a lower TPR in comparison with Negros and Caucasoids whereas similar to Koreans, especially in females. There are significant differences in TPR according to gender, dural sac area, lumbar spinal level (except between L1 and L2), and ethnic group, but no significant difference with the age was found. The present study has identified normal values of Torg's ratio in the Jordanian population. Although the study may not be able to provide clear guidelines for use in clinical practice, it has still highlighted possible between countries variations and has identified differences in these values to different factors. Implications on clinical practice could be reflected on the diagnosis of lumbar spinal stenosis or on predicting the prognosis of lumbar spine injury.

Study of pedicles and spinal canal diameters at the level of lumbar vertebral in normal adult Saudi population using computed tomography

The values of normal transverse (interpedicular) and sagittal (midsagittal) diameters are different at various levels of lumbar spinal canal in individuals of the same race and differ at identical levels in individuals of various races. The aim of the study was to determine normal reference range of the lumbar spinal canal dimensions and to evaluate lumbar pedicle dimensions with respect to spinal level, age, gender in Saudi population by using Computed Tomography. This study was conducted in Najran province (K.S.A), archival abdominal CT scan images from PACS in hospitals were used. The data of this study was collected from 210 (102 male and 108 female) normal Saudi adults individuals with different ages, gender over a period of 20 months (2019 - 2021). The mean spinal canal transverse distance (SCTR) showed steady decrease from L1 to L4, as there was an increasing in (SCTR) at L5 relative to L4, The mean spinal canal anteroposterior diameter (SCAP) showed a decrease from L1 to L3, and then a gradual increase from L4 to L5 (Fig.4-10). This pattern was observed in males only as there was an increase of female (SCAP) at L2 and L5, and no significant gender difference was noted at any lumbar level for (SCAP) The mean pedicle width (PW) showed steady increase from L1 to L5. While the mean pedicle height (PH) showed a gradual decrease from L1 to L5. The study conclude that Computed tomography is a reliable method for determining the morphological measurements of the spinal canal and pedicles diameter.

Extent and characteristic of relationships in canal dimension and canal body ratio between cervical and lumbar spine

A known prevalence of concurrent cervical and lumbar spinal stenosis was shown to be 5–25%, but there is a lack of evidence regarding direct relationships in canal dimension and canal-body ratio between cervical and lumbar spine. Total 247 patients (mean age: 61 years, male: 135) with cervical and lumbar computed tomography scans were retrospectively reviewed. Midsagittal vertebral body and canal diameters in reconstructed images were measured at all cervical and lumbar vertebrae, and canal-body ratios were calculated. The canal diameter and ratio were also compared according to the gender and age, and correlation analysis was performed for each value. There were significant correlations between cervical (C3–C7) and lumbar (L1–L5) canal dimension (p < 0.001). C5 canal diameter was most significantly correlated with L4 canal diameter (r = 0.435, p < 0.001). Cervical canal-body ratios (C3–C7) were also correlated with those of lumbar spine (L1–L5) (p < 0.001). The canal-body ratio of C3 was most highly correlated with L3 (r = 0.477, p < 0.001). Meanwhile, mean canal-body ratios of C3 and L3 were significantly smaller in male patients than female (p = 0.038 and p < 0.001) and patient’s age was inversely correlated with C5 canal diameter (r = − 0.223, p < 0.001) and C3 canal-body ratio (r = − 0.224, p < 0.001). Spinal canal dimension and canal-body ratio have moderate degrees of correlations between cervical and lumbar spine and the elderly male patients show the tendency of small canal diameter and canal-body ratio. This relationship of cervical and lumbar spine can be an important evidence to explain to the patients.

RETRACTED ARTICLE: Percutaneous pedicle screw fixation combined with selective transforaminal endoscopic decompression for the treatment of thoracolumbar burst fracture

BackgroundThe objective of this study was to evaluate the feasibility, safety, efficacy, and indications of percutaneous pedicle screw fixation (PPSF) combined with selective transforaminal endoscopic decompression (TED) in the treatment of thoracolumbar burst fracture (TBLF).MethodsFrom August 2015 to October 2018, a total of 41 patients with single-segment TLBF (28 men and 13 women) were enrolled in this study. X-ray and computed tomography were obtained before surgery, 1 week after surgery, and 1 year after surgery to evaluate spinal recovery. In addition, we used the visual analog scale (VAS), the Oswestry Disability Index (ODI), the Japanese Orthopedic Association score (JOA), and the Frankel classification of neurological deficits to evaluate the effectiveness of the treatments.ResultsThe average follow-up time was 22.02 ± 8.28 months. The postoperative Cobb angle, vertebral body compression ratio, vertebral wedge angle, mid-sagittal canal diameter compression ratio, and Frankel grade were significantly improved. There were also significant improvements in the VAS (7.61 ± 1.41 vs. 1.17 ± 0.80, P < 0.001), ODI (89.82 ± 7.44 vs. 15.71 ± 13.50, P < 0.001), and JOA (6.90 ± 2.91 vs. 24.90 ± 3.03, P < 0.001).ConclusionsOur results showed that PPSF combined with selective TED in the treatment of TLBF had excellent efficacy, high safety, less secondary injury than other treatments, and a wide range of indications and that it could accurately distinguish patients who did not need spinal canal decompression after posterior fixation. PPSF combined with selective TED is therefore a good choice for the treatment of TLBF.

Measurement of cervical spinal canal diameter by radiographs to study the degree of cervical spinal canal stenosis in an Indian population; Predictive value of Torgs ratio to assess cervical spinal canal stenosis

Cervical myelopathy a debilitating degenerative condition occurs due to cervical spinal canal stenosis, the incidence of which increases significantly with age and is more common above the age of 50 years. Imaging of the spinal canal is an indispensable procedure for evaluation of cervical myelopathy and standard lateral radiographs remain the recommended initial imaging study of choice. The present study was undertaken to measure the cervical spinal canal diameter by lateral radiographs of the cervical spine and to study the degree of cervical spinal canal stenosis in symptomatic patients and asymptomatic cases. The canal body ratio and its reliability to assess cervical spinal canal stenosis and risk of cervical myelopathy was evaluated.In this study 200 cases who presented to the radiology department for radiographs of cervical spine, were divided into symptomatic and asymptomatic cases and were grouped age wise. Measurements of the cervical vertebral body and cervical spinal canal were taken. Torg ratio was assessed. The measurements were analyzed statistically and results tabulated.Cervical spinal canal diameter was lower in symptomatic cases as compared to asymptomatic cases across all age groups and the lowest value was measured at C3 level. All the symptomatic cases had Torg ratio of less than 0.82, and that of C3 was lowest. The data analysis showed the sensitivity of the Torg ratio as 100%. 40% of patients above 50 years were symptomatic and had cervical spinal canal stenosis on lateral radiographs.Our results suggest that plain films can estimate the cervical spinal canal midsagittal diameter and be used as a first step examination for the evaluation of cervical spinal stenosis. The importance of canal body ratio in lateral cervical radiographs for determining the stenosis of cervical spinal canal is confirmed.

Radiographic and clinical outcome of lateral lumbar interbody fusion for extreme lumbar spinal stenosis of Schizas grade D: a retrospective study

BackgroundExtreme lumbar spinal stenosis was thought to be a relative contraindication for lateral lumbar interbody fusion (LLIF) and was excluded in most studies. This is a retrospective study to analyze the radiographic and clinical outcome of LLIF for extreme lumbar spinal stenosis of Schizas grade D.MethodsFor radiographic analysis, we included 181 segments from 110 patients who underwent LLIF between June 2017 and December 2018. Lumbar spinal stenosis was graded according to Schizas’ classification. Anterior and posterior disc heights, disc angle, foramen height, spinal canal diameter and central canal area were measured on CT and MRI. For clinical analysis, 18 patients with at least one segment of grade D were included. Visual analogue scale (VAS) and Oswestry disability index (ODI) scores were used to evaluate clinical outcome. Continuous variables were compared using Student’s t-test, with P-values < 0.05 considered to indicate statistically significant differences.ResultsAmong the 181 segments included for radiological evaluation, there were 23 grade A segments, 37 grade B segments, 103 grade C segments and 18 grade D segments. Postoperatively, the average change of midsagittal canal diameter of grade D was significantly greater than that of grade A, and not significantly different compared to grades B and C. As to the average change of disc height, bilateral foraminal height, disc angle and central canal area (CCA), grade D was not significantly different from the others. The average postoperative CCA of grade D was significantly smaller than the average preoperative CCA of grade C. Eighteen patients with grade D stenosis were followed up for an average of 19.61 ± 6.32 months. Clinical evaluation revealed an average improvement in the ODI and VAS scores for back and leg pain by 20.77%, 3.67 and 4.15 points, respectively. Sixteen of 18 segments with grade D underwent posterior decompression.ConclusionThe radiographic decompression effect of LLIF for Schizas grade D segments was comparable with that of other grades. Posterior decompression was necessary for LLIF to achieve a satisfactory clinical outcome for extreme lumbar spinal stenosis of Schizas grade D.

Degenerative Cervical Myelopathy: How to Identify the Best Responders to Surgery?

Surgery is the only definitive treatment for degenerative cervical myelopathy (DCM), however, the degree of neurological recovery is often unpredictable. Here, we assess the utility of a multidimensional diagnostic approach, consisting of clinical, neurophysiological, and radiological parameters, to identify patients likely to benefit most from surgery. Thirty-six consecutive patients were prospectively analyzed using the modified Japanese Orthopedic Association (mJOA) score, MEPs/SSEPs and advance and conventional MRI parameters, at baseline, and 3- and 12-month postoperatively. Patients were subdivided into “normal” and “best” responders (<50%, ≥50% improvement in mJOA), and correlation between Diffusion Tensor Imaging (DTI) parameters, mJOA, and MEP/SSEP latencies were examined. Twenty patients were “best” responders and 16 were “normal responders”, but there were no statistical differences in age, T2 hyperintensity, and midsagittal diameter between them. There was a significant inverse correlation between the MEPs central conduction time and mJOA in the preoperative period (p = 0.0004), and a positive correlation between fractional anisotropy (FA) and mJOA during all the phases of the study, and statistically significant at 1-year (r = 0.66, p = 0.0005). FA was significantly higher amongst “best responders” compared to “normal responders” preoperatively and at 1-year (p = 0.02 and p = 0.009). A preoperative FA > 0.55 was predictor of a better postoperative outcome. Overall, these results support the concept of a multidisciplinary approach in the assessment and management of DCM.

A mysterious risk factor for bone cement leakage into the spinal canal through the Batson vein during percutaneous kyphoplasty: a case control study

BackgroundPercutaneous kyphoplasty (PKP) can effectively treat osteoporotic vertebral compression fractures (OVCFs). Although satisfactory clinical outcomes can be achieved, bone cement leakage remains a primary complication of PKP. Previous studies have found many high risk factors for bone cement leakage into the spinal canal; however, less attention to the posterior wall morphologies of different vertebral bodies may be one reason for the leakage. Here, we investigated the effect of posterior vertebral wall morphology in OVCF patients on bone cement leakage into the spinal canal during PKP.MethodsNinety-eight OVCF patients with plain computed tomography (CT) scans and three-dimensional (3D) reconstruction images from T6 to L5 were enrolled. 3D-CT and multiplanar reconstructions (MPR) were used to measure the concave posterior vertebral wall depth (PVWCD) and the corresponding midsagittal diameter of the nonfractured vertebral body (VBSD), and the PVWCD/VBSD ratio was calculated. All subjects were divided into the thoracic or lumbar groups based on the location of the measured vertebrae to observe the value and differences in the PVWCD between both groups. The differences in PVWCD and PVWCD/VBSD between the thoracic and lumbar groups were compared. Three hundred fifty-seven patients (548 vertebrae) who underwent PKP within the same period were also divided into the thoracic and lumbar groups. The maximal sagittal diameter (BCSD), the area of the bone cement intrusion into the spinal canal (BCA), and the spinal canal encroachment rate (BCA/SCA × 100%) were measured to investigate the effect of the thoracic and lumbar posterior vertebral wall morphologies on bone cement leakage into the spinal canal through the Batson vein during PKP.ResultsThe PVWCDs gradually deepened from T6 to T12 (mean, 4.6 mm); however, the values gradually became shallower from L1 to L5 (mean, 0.6 mm). The PVWCD/VBSD ratio was approximately 16% from T6 to T12 and significantly less at 3% from L1 to L5 (P < 0.05). The rate of bone cement leakage into the spinal canal through the Batson vein was 10.1% in the thoracic group and 3.7% in the lumbar group during PKP. In the thoracic group, the BCSD was 3.1 ± 0.5 mm, the BCA was 30.2 ± 3.8 mm2, and the BCA/SCA ratio was 17.2 ± 2.0%. In the lumbar group, the BCSD was 1.4 ± 0.3 mm, the BCA was 14.8 ± 2.2 mm2, and the BCA/SCA ratio was 7.4 ± 1.0%. The BCSD, BCA and BCA/SCA ratio were significantly higher in the thoracic group than in the lumbar group (P < 0.05).ConclusionsThe PVWCD in the middle and lower thoracic vertebrae can help reduce bone cement leakage into the spinal canal by enabling avoiding bone cement distribution over the posterior 1/6 of the vertebral body during PKP. The effect of the difference between the thoracic and lumbar posterior vertebral wall morphology on bone cement leakage into the spinal canal through the Batson vein in OVCF patients during PKP is one reason that the rate of bone cement leakage into the thoracic spinal canal is significantly higher than that into the lumbar spinal canal.

Multiple parameters for evaluating posterior longitudinal ligaments in thoracolumbar burst fractures.

The posterior longitudinal ligament plays a key role in spinal stability. The purpose of this study was to determine the injuries of the posterior longitudinal ligament (PLL) in thoracolumbar burst fractures. Patients suffering a thoracolumbar burst fracture from January 2011 to December 2015 were divided into an intact group and a disrupted group according to the status of the PLL. Mid-sagittal canal diameter, width and height of bone fragments, inversion angle and horizontal rotation angle of bone fragments and local kyphosis angle were measured. Anterior, middle and posterior vertebrae compression ratio, mid-sagittal diameter compression ratio, ratio of height of bone fragments occupying the posterior wall of the injured vertebral body and ratio of the width of bone fragment occupying the transverse canal diameter were calculated. Atotal of 95patients were included in the study including 52patients in the intact group and 43patients in the disrupted group. There were significant differences on anterior and posterior vertebrae compression ratio, mid-sagittal diameter compression ratio, inversion angle and horizontal rotation angle of bone fragment (P 0.05) between the two groups. Injury of the PLL showed a positive correlation with the mid-sagittal diameter compression ratio and inversion angle of bone fragment (P 0.05). The mid-sagittal diameter compression ratio and inversion angle of bone fragment can be used to assess the status of the PLL in thoracolumbar burst fractures. When the mid-sagittal diameter compression ratio was 52% and the inversion angle of the bone fragment was 33° the PLL was likely to be disrupted.

Features of total body sizes and anthropometric torso sizes in female volleyball players of mesomorphic somatotype

Determination of constitutional parameters that are inherent in highly skilled athletes of a particular sport can serve as reliable predictive markers during sport selection. But the last time an indisputable fact is the somatotypological conditionality of individual sizes that characterize the external structure of the body, and the visceral structures of the organism. The purpose of the work is to establish differences in the anthropometric dimensions between young women volleyball players of high level of athletic skill and non-sports young women belonging to the mesomorphic somatotype. On the base of the research center of the National Pirogov Memorial Medical University, we conducted an anthropo-somatotypological study of 127 female volleyball players of youth age (from 16 to 20 years) with a high level of athletic skill. Sports experience in all cases was greater than 3 years. From the database of research center of the National Pirogov Memorial Medical University was selected 140 practically healthy young women of the same age who were not engaged in sports. Anthropometric measurements were carried out using the method of V.V. Bunak (1941), somatotypological research – according to the estimated modification of the Heath-Carter method (1990). After the conducted somatotyping, it was found that 29 volleyball players and 33 non-sports young women belonged to the mesomorphic type of constitution. The analysis of the obtained results is carried out in the licensed package of Statistica 5.5 using nonparametric methods of evaluation of indicators. In the volleyball players of the mesomorphic somatotype, compared to young women who are not engaged in sports of the same constitutional type, we have found a significantly larger length of the body, the mass and area of the body surface, the height of the suprasternal, pubic, shoulder anthropometric points, chest cords, transverse mid and lower chest and sagittal middle-thigh diameters, intervertebral distance of the pelvis and its external conjugates. Relatively smaller in female volleyball players of mesomorphic type of physique was the thickness of the skin-fat folds under the shoulder blade. One can conclude that within the same somatotype there are significant changes in the anthropometric parameters, in particular total body and longitudinal, transverse, front and rear body dimensions, which is affected by the body of modern young women volleyball players with mesomorphic somatotype, under the influence of intensive loads.

Kinematic evaluation of thoracic spinal cord sagittal diameter and the space available for cord using weight-bearing kinematic magnetic resonance imaging.

Retrospective kinematic MRI (kMRI) study. To evaluate the dynamic changes of thoracic anterior and posterior space available for cord (SAC), and thoracic spinal cord in the dural sac in three positions. Expert MRI, Bellflower California; andUniversity of Southern California, in Los Angeles, USA. A total of 118 patients (66 males and 52 females, mean age ( ± SD) of 45.6 ± 10.6 years) who underwent thoracic spine kMRI were evaluated from T4-5 to T11-12 in flexion, neutral, and extension positions. The anterior SAC, posterior SAC, and mid-sagittal thoracic cord diameter were measured at each level from T4-5 to T11-12. Inter- and intraobserver agreements were analyzed. The anterior SAC was significantly narrower in flexion position compared with other positions at T8-9 to T11-12 levels (p < 0.01). The T8-9 level had significantly wider posterior SAC in flexion and extension positions compared with the neutral position (p < 0.005). However, the posterior SAC at T9-10 was narrower in extension than the neutral position (p = 0.002). Thoracic spinal cord diameter significantly increased in flexion position when compared with the neutral position at T8-9, T9-10, and T11-12 levels (p < 0.005). Thoracic spinal cord had dynamic changes with positions. In flexion position, the thoracic cord at T8-9 and below tended to move anteriorly, getting closer to the vertebral body and intervertebral disc. The mid-sagittal diameter of the thoracic cord increased in flexion position at the levels below T8-9. In the presence of lesions in anterior epidural space, the risk of spinal cord compression is higher in flexion position, especially at levels below T8-9.