Paravertebral Tissue Research Articles

The paravertebral lymphatic system is involved in the resorption of the herniated nucleus pulposus and the regression of inflammation associated with disc herniation

ObjectiveTo investigate the role of the paravertebral lymphatic system in the nucleus pulposus herniation (NPH) resorption and the inflammation regression. DesignClinical specimens (n = 10) from patients with lumbar disc herniation (LDH) were collected, C57BL/6 (n = 84) and conditional Vegfr3 knockout mice (n = 14) were used. Immunofluorescence staining detected lymphatic vessels (LVs) and NP cells. Near-infrared imaging assessed lymphatic drainage function, and Alcian Blue/Orange determined inflammation. ResultsLymphangiogenesis was observed in the herniated NP of patients with LDH, and the proportion of capillary LVs was higher than that of collecting LVs (mean 68.2% [95% confidence interval: 59.4, 77.1]). In NPH mice, NP cells were detected in paravertebral tissue (38.6 [32.0, 45.2]) and draining lymph nodes (dLN) at 4 h (76.9 [54.9, 98.8]). A significant increase of NP cells in dLNs was observed at 24 h (157.1 [113.7, 200.6]). Most of the herniated NP cells were cleared in paravertebral tissue after 1 week (7.5 [4.4, 10.6]), but disc inflammation peaked at 1 week (19.9 % [14.7, 25.1]), along with persistent lymphangiogenesis (9.5 [7.2, 11.8]). However, conditional Vegfr3 knockout mice exhibited impaired lymphangiogenesis (5.7 [4.4, 7.0]) and herniated NP cells clearance (6.1 [1.8, 10.5]) during NPH, leading to exacerbated disc inflammation (23.7% [19.3, 28.2]). ConclusionThe paravertebral lymphatic system is involved in the NPH resorption and inflammation regression. Promoting lymphangiogenesis may be a novel strategy for facilitating NPH resorption and inflammation regression in patients with LDH.

Atlantoaxial intra-articular cage fusion by posterior intermuscular approach for treating reducible atlantoaxial dislocation: a technique note with case series.

To evaluate the clinical feasibility of atlantoaxial intra-articular cage (AIC) fusion via intermuscular approach for treating reducible atlantoaxial dislocation (AAD). An analysis was conducted on the data of 10 patients who underwent C1-C2 segmental fixation and AIC fusion for AAD by unilateral intermuscular approach and contralateral open approach. Outcome assessments included Japanese Orthopaedic Association score (JOA) and Visual Analog Scale Score for Neck Pain (VASSNP). The duration of surgical exposure, screw insertion and cage insertion, and postoperative drainage volume were also compared between two approaches. Bone fusion was evaluated through computed tomography (CT) reconstruction. Postoperative paravertebral tissue edema was evaluated by paravertebral tissue cross-sectional area (CSA) and signal intensity on T2 weighted sequence of magnetic resonance imaging (MRI) at 3 days postoperatively. The intermuscular approach exhibited a longer exposure time but lower drainage postoperatively compared to the open approach (P < 0.05). After operation, JOA scores significant improved (P < 0.05), while VASSNP scores significantly decreased (P < 0.05). There was no significant difference in preoperative CSA between two approaches (P > 0.05). However, compared to the open approach, the intermuscular approach exhibited less CSA (P < 0.05) and lower T2 signal intensity on MRI postoperatively, indicating less invasive to the paravertebral tissues. AIC fusion by intermuscular approach is an effective and safe technique in the treatment of reducible AAD. Intermuscular approach could reduce the postoperative drainage volume and the extent of paravertebral tissue edema compared to open approach.

Diabetes increases risk of lumbar spinal fusion complications: association with altered structure of newly formed bone at the fusion site.

Diabetes predisposes to spine degenerative diseases often requiring surgical intervention. However, the statistics on the prevalence of spinal fusion success and clinical indications leading to the revision surgery in diabetes are conflicting. The purpose of the presented retrospective observational study was to determine the link between diabetes and lumbar spinal fusion complications using a database of patients (n = 552, 45% male, age 54 ± 13.7years) residing in the same community and receiving care at the same health care facility. Outcome measures included clinical indications and calculated risk ratio (RR) for revision surgery in diabetes. Paravertebral tissue recovered from a non-union site of diabetic and nondiabetic patients was analyzed for microstructure of newly formed bone. Diabetes increased the RR for revision surgery due to non-union complications (2.80; 95% CI, 1.12-7.02) and degenerative processes in adjacent spine segments (2.26; 95% CI, 1.45-3.53). In diabetes, a risk of revision surgery exceeded the RR for primary spinal fusion surgery by 44% (2.36 [95% CI, 1.58-3.52] vs 1.64 [95% CI, 1.16-2.31]), which was already 2-fold higher than diabetes prevalence in the studied community. Micro-CT of bony fragments found in the paravertebral tissue harvested during revision surgery revealed structural differences suggesting that newly formed bone in diabetic patients may be of compromised quality, as compared with that in nondiabetic patients. In conclusion, diabetes significantly increases the risk of unsuccessful lumbar spine fusion outcome requiring revision surgery. Diabetes predisposes to the degeneration of adjacent spine segments and pseudoarthrosis at the fusion sites, and affects the structure of newly formed bone needed to stabilize fusion.

A Study of the Effect of Specific Antibacterial Therapy on the Course of Tuberculous Spondylitis in an Experiment

A Study of the Effect of Specific Antibacterial Therapy on the Course of Tuberculous Spondylitis in an Experiment

Biomechanical effects of endplate sagittal coverage change on cervical disc replacement: a finite element analysis.

In recent years, the number of artificial cervical disc replacements has increased, and paravertebral ectopic ossification is a common complication. Although the exact mechanism is not clear, some studies suggest that it is related to the concentration of tissue stress caused by incomplete coverage of the trailing edge of the endplate. Therefore, this study performed a quantitative analysis to compare the biomechanical effects of different sagittal distances at the posterior edge of the endplate of the upper and lower prosthesis on the cervical spine and to explore the mechanical response of incomplete coverage of the posterior edge of the endplate on the paravertebral tissues. A C2-C7 nonlinear finite element model of the cervical spine was established and validated. Based on the cervical spine model, cervical disc replacement surgery models were constructed with different distances of sagittal distance at the posterior edge of the upper prosthetic endplate (0, 1, 2, 3mm, respectively) and sagittal distance at the posterior edge of the lower prosthetic endplate (1, 2, 3mm, respectively). Each model was subjected to the same 1Nm torque and 73.6N driven compressive load. Range of motion (ROM), intervertebral disc pressure (IDP), facet joint force (FJF), and endplate stress were measured at the cervical surgical and other segments. Compared to the intact cervical spine model, the sagittal distance of the posterior edge of the prosthesis endplate at different distances increased the stress on the intervertebral disc and the capsular joint in the adjacent vertebral body segments to different degrees, especially in extension. In different directions of motion, the posterior margin sagittal distance of the posterior edge of the endplate of the lower prosthesis has a greater mechanical influence on the cervical spine compared to the posterior margin sagittal distance of the posterior edge of the endplate of the upper prosthesis. Compared with the intact model, the biomechanical parameters (ROM, FJF, endplate stress) of the C5-C6 segment increased the most when the sagittal distance of the posterior edge of the endplate of the upper prosthesis was 3mm. Compared with the intact model, the maximum intervertebral disc stress of C4-C5 and C6-C7 was 0.57MPa and 0.53MPa, respectively, when the sagittal distance of the posterior edge of the upper prosthetic endplate was 3mm. After the sagittal distance of the posterior edge of the prosthetic endplate was completely covered, the mechanical influence of the entire cervical spine was low. The sagittal distance at the posterior edge of the endplate of different sizes changed the motion pattern and load distribution of the implanted segment to some extent. When the sagittal distance between the prosthesis and the upper endplate was greater than or equal to 3mm, the mechanical indices of the implanted segment increased significantly, increasing the risk of local tissue injury, especially during extension motion. Compared to the sagittal distance at the posterior edge of the endplate of the lower prosthesis, increasing the sagittal distance at the posterior edge of the endplate of the upper prosthesis has a greater effect on the mechanics of the cervical spine.

Huge extradural multilevel lumbar abscess

Extensive spinal epidural abscesses (ESEAs), occupying three or more spinal regions, are rare forms of vertebral infection. Multilevel laminectomy in these cases is controversial because of the risk of vertebral instability. We report the case of a 47-year-old patient known with ureterohydronephrosis 2nd degree, admitted for severe vertebral pain (VAS 8/10) from 2 months, paraparesis (ASIA 1/5 left, 4/5 right, retention of urine and faeces) from three days. The analysis discovered Diabetes Mellitus type 2, and high levels of inflammatory tests. CT and MRI of the vertebral area with contrast revealed dorsal compression of the spinal cord and cauda equina by an epidural abscess extending from L1-L5, bilateral in the soft adjacent paravertebral tissues especially psoas muscles but sparing the intervertebral discs. Surgical treatment: alternate fenestrations L1-L5, more important on the left side. By this technique, we removed the fluid pus and also granulomatous pus from posterior epidural space L1-L5, bilateral medial foramina, interspinous and supraspinous space, and psoas muscles. The identified germ was Staphylococcus aureus ++++. Postoperatively, we used a continuous drainage washing system with Vancomicyne and diluted Betadine—a course of six-week Vancomycin 2 grams/day iv. The drainage system was blocked after 24 hours and we had to remove it and all the wires of the suture. We had to dress up every day for the surgical field and wash deep inside the field with diluted betadine for 3 weeks till the surgical field was completely cured. After 3 months postoperatively the patient was cured radiologically and clinically. Follow up 18 months. Conclusion: alternate fenestration has the advantages of removing liquid and granulomatous pus in the epidural posterior area and preserving the spine stability.

Biomechanical evaluation of the hybrid pedicle screw—cortical bone trajectory technique in transforaminal lumbar interbody fusion to adjacent segment degeneration—finite element analysis

BackgroundTransforaminal lumbar interbody fusion is an effective surgical treatment of intervertebral disk herniation. However, its clinical efficacy for adjacent segment disk degeneration (ASDD) after hybrid bilateral pedicle screw - bilateral cortical screw (pedicle screw at L4 and cortical bone trajectory screw at L5) and hybrid bilateral cortical screw - bilateral pedicle screw (bilateral cortical screw at L4 and bilateral pedicle screw at L5) remains undiscovered. Therefore, the aim of this study is to evaluate the effect of the hybrid bilateral pedicle screw - bilateral cortical screw and hybrid bilateral cortical screw - bilateral pedicle screw on the adjacent segment via a 3-dimensional (3D) finite element (FE) analysis.MethodsFour human cadaveric lumbar spine specimens were provided by the anatomy teaching and research department of Xinjiang Medical University. Four finite element models of L1-S1 lumbar spine segment were generated. For each of these, four lumbar transforaminal lumbar interbody fusion models at L4-L5 segment with the following instruments were created: hybrid bilateral pedicle screw - bilateral cortical screw, bilateral cortical screw - bilateral cortical screw (bilateral cortical screw at both L4 and L5 segments), bilateral pedicle screw - bilateral pedicle screw (bilateral pedicle screw at both L4 and L5 segments), and hybrid bilateral cortical screw - bilateral pedicle screw. A 400-N compressive load with 7.5 Nm moments was applied for the simulation of flexion, extension, lateral bending, and rotation. The range of motion of L3-L4 and L5-S1 segments and von Mises stress of the intervertebral disc at the adjacent segment were compared.ResultsHybrid bilateral pedicle screw - bilateral cortical screw has the lowest range of motion at L3-L4 segment in flexion, extension, and lateral bending, and the highest disc stress in all motions, while the range of motion at L5-S1 segment and disc stress was lower than bilateral pedicle screw - bilateral pedicle screw in flexion, extension, and lateral bending, and higher than bilateral cortical screw - bilateral cortical screw in all motions. The range of motion of hybrid bilateral cortical screw - bilateral pedicle screw at L3-L4 segment was lower than bilateral pedicle screw - bilateral pedicle screw and higher than bilateral cortical screw - bilateral cortical screw in flexion, extension, and lateral bending, and the range of motion at L5-S1 segment was higher than bilateral pedicle screw - bilateral pedicle screw in flexion, lateral bending, and axial rotation. The disc stress at L3-L4 segment was lowest and more dispersed in all motions, and the disc stress at L5-S1 segment was higher than bilateral pedicle screw - bilateral pedicle screw in lateral bending and axial rotation, but more dispersed.ConclusionHybrid bilateral cortical screw - bilateral pedicle screw decreases the impact on adjacent segments after spinal fusion, reduces the iatrogenic injury to the paravertebral tissues, and provides throughout decompression of the lateral recess.

Spontaneous extensive spinal epidural methicillin-resistant Staphylococcus aureus (MRSA) abscess at the level of the cervical and thoracic area in a 21-year-old female: A case report

Spinal epidural abscess is a rare but potentially devastating condition. It usually spans 3 to 4 spinal levels and is associated with patients in an immunocompromised state. We report a case of a 21-year-old Filipino female who presented with high-grade fever, severe nuchal, and upper back pain later associated with progressive ascending numbness and weakness of the lower extremities and bladder and bowel disturbance, related to a furuncle in the right elbow. Contrast-enhanced magnetic resonance imaging showed peripherally enhancing fluid collections in the cervicothoracic paraspinal regions consistent with an extensive epidural abscess. Blood and paravertebral tissue culture were positive for methicillin-resistant Staphylococcus aureus. She underwent a T1-T3 and T5 laminectomy with the evacuation of the abscess followed by an 8-week antibiotic regimen which provide improvement in symptoms. Currently, she is undergoing physical and occupational therapy. To our awareness and with consideration for its rarity, this is the first Filipino case of extensive spinal epidural methicillin-resistant S aureus abscess in an HIV seronegative individual.

Bone cement embolism into the right heart.

Percutaneous vertebroplasty with the use of bone cement is a widely performed minimally invasive orthopedic procedure for treating osteolytic vertebral metastases and osteoporotic vertebral fractures. One of the main complications associated with percutaneous bone cement injection is cement leakage, either into the paravertebral tissue or, less frequently, into the perivertebral venous plexus, which may result in embolization into the right heart or pulmonary vasculature. In this report, we present a case of intracardiac bone cement embolism after percutaneous vertebroplasty.

Solitary fibrous tumor/hemangiopericytoma of the cervical spine: A systematic review of the literature with an illustrative case.

In the WHO 2016 classification of central nervous system tumors, solitary fibrous tumors (SFT) and hemangiopericytomas (HPC) were considered part of the same category given a shared mutation. Nevertheless, since the new 2021 WHO classification, the term "hemangiopericytoma" has been retired, and SFT is considered an independent pathological entity. We reviewed the literature following preferred reporting items for systematic reviews and meta-analyses guidelines focusing on the treatment options and prognosis of patients with cervical SFT. We also present a 68-year-old female with spinal intradural extramedullary SFT complicated by diffuse extension into paravertebral tissues and muscles. We found 38 cervical SFT in the literature. Patients averaged 47.3 years of age and 47.4% were female. Typically, these lesions spanned two spinal levels resulting in cord compression and most frequently exhibited benign features (i.e., diagnosed as Grade I SFTs). Interestingly, two patients exhibited distant metastases and had initial pathology consistent with grade II SFT. SFT of the cervical spine is rare and its management varies according to the histological grade and the clinical behavior, generally warranting surgical excision and adjuvant radiation therapy and/or systemic chemotherapy.

Minimally Invasive Transforaminal Lumbar Interbody Fusion (TLIF) Compared with Open TLIF for Acute Cauda Equina Syndrome: A Retrospective Single-Center Study with Long-Term Follow-Up

In a retrospective study, we sought to compare the clinical efficacy and postoperative magnetic resonance imaging (MRI) scans of minimally invasive (MI) and open (O) transforaminal lumbar interbody fusion (TLIF) in the treatment of cauda equina syndrome (CES) caused by lumbar disc herniation. In total, 116 patients with CES associated with disc herniation underwent decompression and stabilization surgery from January 2005 to January 2020 in a single-center study, and data were collected and retrospectively analyzed. The patients were divided into the O-TLIF and the MI-TLIF group. The perioperative clinical data and MRI assessment were used to assess the efficacy of the respective surgical methods preoperatively and with a minimum follow-up of 30 months. As expected, the O-TLIF group had statistically significantly longer surgery times and hospital stay, more bleeding, and perioperative surgical complications than the MI-TLIF group. At a minimum follow-up period of 30 months, the MI-TLIF group had significantly better Oswestry Disability Index, visual analog scale, and Short-Form-36, and neurologic CES symptoms than the O-TLIF group. The postoperative MRIs revealed a statistically significant difference in the multifidus muscle area in MI group compared with the O group. In patients with acute CES caused by disc herniation, MI-TLIF, with decreased disruption of paravertebral tissues and postoperative pain syndrome, results in earlier mobilization and rehabilitation with better long-term clinical outcomes compared with O-TLIF.

Mesenchymal Stem Cells Isolated from Paediatric Paravertebral Adipose Tissue Show Strong Osteogenic Potential.

Mesenchymal stem cells (MSCs) represent the basis of novel clinical concepts in cellular therapy and tissue regeneration. Therefore, the isolation of MSCs from various tissues has become an important endeavour for stem cell biobanking and the development of regenerative therapies. Paravertebral adipose tissue is readily exposed during spinal procedures in children and could be a viable source of stem cells for therapeutic applications. Here, we describe the first case of MSCs isolated from paravertebral adipose tissue (PV-ADMSCs), obtained during a routine spinal surgery on a child. Using quantitative real-time PCR and flow cytometry, we show that PV-ADMSCs have different levels of stem marker expression compared to the MSCs from other sources while having the highest proliferation rate. Furthermore, we evaluate the multipotency of PV-ADMSCs by the three-lineage (adipogenic, osteogenic and chondrogenic) differentiation and compare it to the multipotency of MSCs from other sources. It was found that the PV-ADMSCs have a strong osteogenic potential in particular. Taken together, our data indicate that PV-ADMSCs meet the criteria for successful cell therapy, defined by the International Society for Cellular Therapy (ISCT), and thus, could provide a source of MSCs that is relatively easy to isolate and expand in culture. Due to their strong osteogenic potential, these cells provide a promising basis, especially for orthopaedic applications.

Експериментальне моделювання туберкульозного спондиліту

Актуальність. Туберкульозний спондиліт (ТС) в структурі кістково­суглобового туберкульозу у дорослих займає провідне місце і досягає 40–61,5 %. Метою даної публікації є висвітлення процесу моделювання туберкульозного спондиліту і його особливостей у морських свинок для подальшого використання результатів експерименту у лікувальній та науковій практиці. Матеріали та методи. Експеримент ставився на 40 статевозрілих морських свинках. Моделювання туберкульозного спондиліту проводилось на основі розробленого нами способу (патент № 112423 (UА) Україна). Усі тварини були розподілені на чотири рівні групи: 1­ша — 3­тя групи (основні) — виконувалась ін’єкція 0,5 мл суспензії М.tuberculosis (0,1 мг сухої маси в 1 мл) в тіло хребця згідно з методикою; 4­та група — контрольна. Тваринам робилась ін’єкція стерильного фізіологічного розчину (0,9% — 0,5 мл) в тіло хребця. Група 1 (10 свинок) — лікування специфічними антибактеріальними препаратами (АБП) першого ряду (ізоніазид, стрептоміцин, рифампіцин). Група 2 (10 свинок) — лікування специфічними антибактеріальними препаратами другого ряду (амікацин, рифабутин, офлоксацин). Група 3 (10 свинок) — не проводилося лікування. За всіма тваринами проводилося динамічне спостереження з клінічними, рентгенологічними, патоморфологічними і лабораторними дослідженнями. Виведення ­експериментальних тварин з досліду проходило за раніше розробленим графіком — при виявленні ознак досліджуваних стадій туберкульозного процесу. Всім виведеним з експерименту тваринам проводилося патоморфологічне дослідження. При цьому основна увага приділялася вивченню патоморфології уражених специфічним процесом хребців. Результати. У результаті морфологічного дослідження встановлено наявність активного туберкульозного процесу в тілах хребців і паравертебральних тканинах у тварин із модельованим туберкульозом і лікуванням специфічним АБП першого ряду, а також у тварин, які не приймали специфічного лікування. Важливо зазначити, що ступінь вираженості деструктивних змін у вражених хребцях у тварин нелікованих і тих, які приймали АБП першого ряду, практично однаковий. У тварин, яким моделювали туберкульоз і лікували специфічним АБП другого ряду, виявлено пригнічення патологічного процесу з утворенням молодої кісткової та сполучної тканини різного ступеня зрілості та наявністю зони, що відмежовує вогнище запалення від здорової тканини в ранні терміни захворювання (один місяць). В результаті виконаної роботи вдалося простежити стадійність розвитку туберкульозного спондиліту у морської свинки та сучасні особливості клінічного, рентгенологічного та патоморфологічного перебігу. Виявлена ідентичність моделі основних клінічних форм туберкульозного спондиліту у морської свинки та людини. Висновки. Дане дослідження показало, що проведення сучасної інтенсивної специфічної антибактеріальної терапії в умовах експерименту дозволяє досягти відмежування деструктивного процесу в порівняно ранні терміни розвитку захворювання (4–5 тижнів). Отримані нові знання про патоморфологічні особливості перебігу туберкульозного спондиліту дозволяють проводити радикальні оперативні втручання на хребті без ризику генералізації туберкульозного процесу в більш ранні терміни.

Spinal motor segment labeling with a mixture of n-butyl-2-cyanoacrylate and iohexol in determining the level of thoracic spine surgery

To develop a safe minimally invasive low-traumatic and cost-effective method for preoperative marking the level of thoracic spine surgery. A mixture of biodegradable adhesive based on cyanoacrylate and water-soluble iodine-containing X-ray contrast agent was used for preoperative marking in 8 patients scheduled for thoracic spine and spinal cord surgery. This mixture was injected into paravertebral tissues at the level of further intervention. Preoperative marking ensured a fixed and clearly visible landmark during intraoperative fluoroscopy in 7 patients. In 1 patient, mixture spread in paravertebral soft tissues that did not allow us to obtain appropriate landmark during intraoperative radiography. The described method makes it possible to create an immobile X-ray-positive «mark» in paravertebral soft tissues, which can be used to control the level of intervention at all surgical stages.

Methylation of estrogen receptor 2 (ESR2) in deep paravertebral muscles and its association with idiopathic scoliosis

Idiopathic scoliosis (IS) is one of the most common spinal disorders in adolescents. Despite many studies, the etiopathogenesis of IS is still poorly understood. In recent years, the role of epigenetic factors in the etiopathogenesis of IS has been increasingly investigated. It has also been postulated that the development and progression of the disease is related to gender and puberty, and could be associated with estrogen action. Estrogen hormones act via estrogen receptor 1 (ESR1) and estrogen receptor 2 (ESR2). It has been suggested that ESR2 expression is dependent on methylation within its gene promoter. So far, no studies have evaluated local, tissue-specific DNA methylation in patients with IS. Thus, our study aimed to analyze the methylation and expression level of ESR2 in the paraspinal muscles of the convex and concave side of the IS curvature. The methylation level within ESR2 promoter 0N, but not exon 0N, was significantly higher on the concave side of the curvature compared to the convex side. There was no significant correlation between ESR2 expression and methylation level in the promoter 0N on the convexity of thoracic scoliosis, whereas, on the concave side of the curvature, we observed a moderate negative correlation. There was no difference in the methylation levels of the ESR2 promoter and exon 0N between groups of patients with Cobb angle ≤ 70° and > 70° on the concave and convex side of the curvature. We also found no statistically significant correlation between the Cobb angle value and the mean methylation level in either the ESR2 promoter or exon 0N on the convex or concave side of the curvature. Our findings demonstrate that DNA methylation at the ESR2 promoter in deep paravertebral muscle tissue is associated with the occurrence but not with the severity of idiopathic scoliosis.

Red Flag for Cauda Equina Syndrome in Symptomatic Lumbar Disc Herniation

In a retrospective study, we sought to compare the clinical efficacy and postoperative magnetic resonance imaging (MRI) scans of minimally invasive (MI) and open (O) transforaminal lumbar interbody fusion (TLIF) in the treatment of cauda equina syndrome (CES) caused by lumbar disc herniation.In total, 116 patients with CES associated with disc herniation underwent decompression and stabilization surgery from January 2005 to January 2020 in a single-center study, and data were collected and retrospectively analyzed. The patients were divided into the O-TLIF and the MI-TLIF group. The perioperative clinical data and MRI assessment were used to assess the efficacy of the respective surgical methods preoperatively and with a minimum follow-up of 30 months.As expected, the O-TLIF group had statistically significantly longer surgery times and hospital stay, more bleeding, and perioperative surgical complications than the MI-TLIF group. At a minimum follow-up period of 30 months, the MI-TLIF group had significantly better Oswestry Disability Index, visual analog scale, and Short-Form-36, and neurologic CES symptoms than the O-TLIF group. The postoperative MRIs revealed a statistically significant difference in the multifidus muscle area in MI group compared with the O group.In patients with acute CES caused by disc herniation, MI-TLIF, with decreased disruption of paravertebral tissues and postoperative pain syndrome, results in earlier mobilization and rehabilitation with better long-term clinical outcomes compared with O-TLIF.

Predictive factors for positive disco-vertebral biopsy culture in pyogenic vertebral osteomyelitis, and impact of fluoroscopic versus scanographic guidance

BackgroundThe aims of this study were to identify the predictive factors for microbiological diagnosis through disco-vertebral biopsy (DVB) in patients with pyogenic vertebral osteomyelitis (PVO) and negative blood cultures, and compare the performance of DVB under fluoroscopic versus scanographic guidance.MethodsWe performed a cohort study comparing positive and negative DVB among patients with PVO. All cases of PVO undergoing a DVB for microbiological diagnosis in our center were retrospectively reviewed. Infections due to Mycobacterium tuberculosis, infections on foreign device, and non-septic diseases were excluded. Anamnestic, clinical, biological, microbiological, as well as radiological data were collected from medical charts thanks to a standardized data set.ResultsA total of 111 patients were screened; 88 patients were included. Microbiological cultures were positive in 53/88 (60.2%) patients. A thickening of the paravertebral tissue ≥10 mm on magnetic resonance imaging (MRI) in axial MR scans was a predictive factor of DVB microbiological positivity (52.4% vs. 13.3%; p = 0.006; OR = 5.4). Overall, 51 DVB were performed under fluoroscopic guidance and 37 under scanographic guidance. Considering lumbar DVB, 25/36 (69.4%) of cases yielded positive results under fluoroscopic guidance versus 5/15 (33.3%) under scanographic guidance (p = 0.02; OR = 4.4). No adverse event linked to DVB was notified.ConclusionEvery patient with PVO and negative blood cultures should undergo a DVB. A thickening of the paravertebral tissue ≥10 mm on MRI is associated with a higher rate of positive DVB culture. A lumbar DVB under fluoroscopic guidance is more sensitive than under scanographic guidance to identify the micro-organism involved.

Paraspinal structures of thermoregulation

A detailed analysis of the literature on the structure and functions of the paraspinal structures of human thermoregulation involved in maintaining temperature homeostasis is presented. It is shown that in the process of evolution, a peculiar paraspinal morphofunctional complex is formed around the spinal center of thermoregulation, including thermal- generating structures (adipose and muscle tissue); venous thermal distribution rings formed by paraspinal venous plexuses and thermoregulatory nervous apparatus (meningeal and posterior branches of the spinal nerves and their nerve endings). It was found that the heat-generating structures are represented by adipose tissue of the epidural space, adipose tissue of the bone marrow, paravertebral and interscapular adipose tissue, back muscles and intercostal muscles). Bone marrow fatty tissue plays an important role not only in thermoregulation, but also in bone remodeling. Fatty tissue mainly includes components of white and a small amount of brown adipose tissue. Heat from muscles through the venous system of the spinal column affects the functioning of the spinal center of thermoregulation by contractile thermogenesis. It has been shown that around the center of thermoregulation of the spinal cord, venous vessels form four thermal distribution rings. The first of them is the venous bed of the soft membrane of the spinal cord and cerebrospinal fluid of the subarachnoid space; the second is the internal vertebral venous plexus; the third - intraosseous (intraorgan) venous plexuses of the vertebrae; the fourth is the anterior and posterior external vertebral venous plexuses. All four thermal distribution venous rings anastomose among themselves, forming a single thermal distribution system around the spinal center of thermoregulation. The innervation of thermal generating structures and thermal distribution of venous rings is carried out by somatic and autonomic nerve fibers.

Algometry. Measuring pain threshold, method and characteristics in healthy subjects

A pressure algometer was tested using a specially designed protocol in 28 healthy adult males and females. Two observers examined the pressure threshold (PT) of local tenderness at the joints of the wrists, elbows, knees, ankles, and at the paravertebral tissues. Several characteristics of the instrument were found. There were no significant differences in PT's between the same points on either side of the body (r = 0.738-0.934). A large source of variance was the measurement of one area within short time intervals. No significant differences in means were found between the two observers for the paravertebral points, while significant differences were found at the peripheral joints. Male subjects had significantly higher PT's than females. The PT's of the paravertebral tissues decreased in a cranial direction, while PT's of the peripheral joints showed similar levels. There was no significant influence on observing PT's on different dates or in a different order.

Role of Magnetic Resonance Imaging in Evaluation of post traumatic Vertebral Column

Abstract Background Trauma of the vertebral column is potentially devastating as they may lead to significant neurological damage as the clinical and prognostic spectrum of the effects of spinal injuries is vast. Timely imaging studies can help mitigate these possibly life threatening complications. There is a dearth of studies that purely evaluate the role of MR imaging after spinal trauma. Aim of the work Hence, this study was undertaken to assess the ability of MRI in identifying traumatic injuries to the tissue structures of the spine. Methods The study performed over 20 cases after spinal vertebral traumatic injuries then underwent MR imaging in the period 2016 till March 2018. The osseous and non-osseous structures namely; Para vertebral tissues, Vertebrae, Anterior Longitudinal Ligament (ALL), Posterior Longitudinal Ligament (PLL), Intervertebral Disc, Ligamentum Flavum, Interspinous Ligament and the Spinal Cord were evaluated. The data were classified to; patient's age, sex, mode of trauma, region of imaging, main findings, associated findings and others. The statistically significant and non-significant relations between primary data and different post-traumatic findings of MRI were thus calculated. Results Of the 20 patients, 85% of patients were male, common ages affected were 20-30 and &amp;gt;40 years with 30% for each. The site of injury was the cervical spine (30%) and thoracolumbar spine was the next highest in occurrence with 25%. L1 was the commonest level exposed to fracture (30%). Cord compression was the commonest MRI main finding in post trauma (60 %), but syrinx was (5%). In associated findings; the spinal muscles spasm was the commonest (40%) and ligamentum flavum injury comprised (15%). Bone marrow edema was the highest (35%) as other findings. There were statically significant relations between age and T12 vertebral fracture and between mode of trauma and facet joint affection. Conclusion MRI was found to be the best modality in detecting injuries to the spinal cord and the ligaments and as well as for detection of vertebral fractures and also bone marrow edema. Though more studies required for further highlight the advancing ability of the MRI.