Spinous Process Research Articles

Surgical Transplantation of Tumor Cells into the Spinal Cord of Mice.

Spinal cord gliomas are commonly malignant tumors of the spinal cord, leading to a high rate of disability. However, uniform treatment guidelines and comprehensive data on spinal cord gliomas remain limited due to the lack of suitable preclinical animal models. Developing a simple and reproducible animal model has become essential for advancing basic and translational research. A murine model is ideal, as the murine spinal cord shares structural similarities with the human spinal cord. This protocol describes the generation of a reproducible murine model of spinal cord glioma by directly injecting tumor cells into the intervertebral space using the spinous process of the seventh cervical vertebra as a guide. Compared to other methods, this approach is more effective and convenient, involving a smaller incision, reduced invasiveness and blood loss, faster recovery, and more stable tumor formation. This model is expected to advance the understanding of disease mechanisms, optimize surgical strategies, and support the development of therapeutic drugs for spinal cord gliomas.

Reliability of a Measurement Method for Upper Limb Raised Standing Spinal Alignment Using a Smartphone Inclinometer Application.

To evaluate the reliability and validity of spinal alignment measurements in the raised arm standing posture using a smartphone app. An inclinometer is a reliable tool for measuring spinal alignment. Measurement of static standing posturespinal curvature angles using smartphone inclinometer applications has been investigated in the lumbar spine but has not been reported for the thoracic spine. However, the sacral vertebrae were used as the reference point for the measurement of the lumbar spine, and the method of palpation of the sacral vertebrae was unclear. No measurement methods, including inclinometers, have been found for upper limb elevation. Thoracic kyphosis and lumbar lordosis angles were measured in 18 healthy young adults (mean age: 21.0 ± 3.5). Measurements were taken in the raised standing posture. The points of measurement included angle α at the thoracic spine (T)1/2, angle β at the T12/lumbar spine (L)1, and angle γ at the L4/L5 spinous processes. The thoracic kyphosis angle was calculated as the sum of α and β, while the lumbar lordosis angle was the sum of β and γ. Two raters measured these angles twice using the same smartphones. Inter-rater reliability was assessed using intraclass correlation coefficients (ICC 2.1), and measurement precision was determined by calculating MDC95 from the ICC values.Validity was also carried out on 12 healthy young adults (age: 20.8 ± 4.0 years). The measurement points were the same as described above, and two types of measurements were taken with a smartphone and an inclinometer; the results of the two types of measurements were used to determine the relationship using Pearson's correlation coefficient. During upper limb raising, the smartphone's ICC (95% confidence interval) was 0.92 (0.81-0.97) for thoracic kyphosis and 0.90 (0.74-0.96) for lumbar lordosis. The MDC95 values indicated acceptable precision, with 7.00° for thoracic kyphosis and 9.95° for lumbar lordosis.All correlation coefficients between inclinometers and smartphones were above 0.9 for both the thoracic and lumbar spines. Measuring spinal alignment angles using a smartphone inclinometer app in the raised standing posture demonstrates good reliability for inter-rater comparisons.It was also good with regard to validity.

Analgesic Efficacy Comparison Between Ultrasound-Guided Erector Spinae Plane Block and Retrolaminar Block in Patients Undergoing Modified Radical Mastectomy: A Randomized Controlled Trial.

Breast cancer is the most common cancer in females. Surgery is the gold standard therapy, with modified radical mastectomy (MRM) being the most commonly performed procedure for breast cancer. Management of postoperative pain after MRM poses a clinical challenge and hence receives utmost priority. Ultrasound-guided regional nerve blocks are commonly administered to combat post-surgical pain after MRM. In this context, retrolaminar block (RLB) and erector spinae plane block (ESPB) are relatively newer techniques. Though these blocks are quicker, safer, and easier to administer, very few studies have been done to compare their postoperative analgesic efficacy. Henceforth, we conducted this trial to compare the postoperative analgesic efficacy of ESPB and RLB in patients scheduled for MRM. The procedures followed in this trial were according to the norms of the Declaration of Helsinki (2013). The study was started after obtaining approval from the Institutional Ethics Committee (IEC), written informed consent from the patients, and trial registration in the Clinical Trials Registry of India. Sixty female patients of the American Society of Anesthesiologists with physical statuses 1, 2, and 3, aged 18 years and above, planned for unilateral MRM under general anesthesia, were included, whereas patients not giving consent, allergic to study drugs, having contraindications to regional anesthesia, with a body mass index (BMI) of ≥ 35 kg/m2, deformity of the spine, psychiatric illness, lactating, or pregnant women were excluded. Computer-generated randomization was used to allocate the patients to groups E and R to receive ESPB or RLB, respectively, using 30 mL of ropivacaine (0.5%) with 2 mL of dexamethasone at the T4 spinous process level under ultrasound guidance. The primary outcome was to determinethe time to rescue analgesia based on a visual analog scale score ≥ 4. Secondary objectives were the intraoperative fentanyl consumption and side effects (if any). Sixty participants completed the study. Both groups were comparable in terms of demographic parameters, duration of surgery, time to the first dose of rescue analgesia, intraoperative fentanyl consumption, and side effects. The mean (SD) of duration of surgery (minutes) was 202.33 (14.55) and 197.00 (18.60) with P = 0.134, time to rescue analgesia (minutes) was 425.67 (134.33) and 468.50 (142.74) with P = 0.236, and intraoperative fentanyl consumption (mcg) was 4.00 (11.02) and 4.67 (8.60) with P = 0.410 in Group E and R, respectively. Both groups were similar in terms of the time to rescue analgesia, fentanyl consumption intraoperatively, and side effects. Thus, the ESPB is comparable to and not better than RLB for providing postoperative analgesia in patients with carcinoma breast undergoing MRM.

A case report of rare variant: well-developed paracondylar process.

The paracondylar process (PCP) is defined as the bony prominence extending from the outer side of the condyles on the outer surface of the occipital bone downwards towards the transverse process of the atlas (TPA). In this case report, the morphometry of the rarely seen PCP and its morphometric data with neighboring structures are evaluated. Unilateral (right-sided) PCP was observed in the cranium of a Caucasian female. The base of the PCP, located on the outer side of the occipital condyle (OC) and just behind the jugular foramen (JF), was broader than its apex and had a molar shape. The base width was measured as 13.6, and the top width was measured as 8.7mm. PCP length was measured at 15.2mm. The base distance of the PCP, which was located very closely with the OC and JF, to these structures was measured as 0.42 and 0.59mm, respectively. The distance to the spinous process (SP) and mastoid process (MP) of the temporal bone was relatively greater and was measured as 1.07 and 15.5mm, respectively. The rare PCP reported, in this case, was well-developed and molar type. It is likely large enough to articulate with the TPA regarding length. However, this could not be shown because the matched atlas could not be found. We believe that supporting the close adjacencies of PCP with OC and JF with metric data may benefit clinicians working in regional surgery.

Sex estimation via the measurement of the seventh cervical vertebrae on Computerized Tomography images.

Background: Sex estimation from skeletal remains is crucial for estimating an individuals biological profile. Although the pelvis and skull are most commonly used for sex estimation, other skeletal elements, e.g., the vertebrae, have reportedly demonstrated acceptable accuracy rates. The aim of this study was to evaluate the efficacy of using seventh cervical vertebra measurements on computed tomography images for sex estimation. Material and methods: Cervical computed tomography images of 300 female and 300 male patients (= 20 aged 60 = years) were evaluated. Sex estimation modeling was performed with eight measurements of the seventh cervical vertebrae, and indices and corpus volume obtained from the measurements. Corpus length and width, foramen vertebra length and width, corpus height, spinous process angle, and spinous process height and length of each seventh cervical vertebra were measured. Foramen vertebral index, spinous process index, and corpus volume were used as indices. The Independent Sample T test was used to compare the means of two independent groups showing normal distribution, and the Mann-Whitney U test was used for data that were not normally distributed. Binary logistic regression analysis was performed using the Forward Wald approach in modeling the categorical dependent variable with independent variables. Results: According to multivariate logistic regression analysis, sex estimation from measurements was 87.7% accurate, whereas index and volume were up to 85.3% accurate. Conclusions: In conclusion, the seventh cervical vertebra is dimorphic with a high accuracy rate for the Turkish population and can be used for sex estimation.

What exactly is a nuchal ligament and who exactly has one?

Nuchal ligaments are relatively well understood and have venerable histories of recognition in extant euungulates, canids, elephants, and humans, but whether any anatomical structures in other taxa, both extant and extinct, qualify as nuchal ligaments is unclear because the term ‘nuchal ligament’ lacks a clear, narrow, consistently applied definition. Possible definitions of the term could be etymological, taxonomic, compositional, or morphological/topological, or a combination thereof. Currently, a de facto morphological/topological definition of ‘nuchal ligament’ sensu stricto seems most common: a nuchal ligament is an epaxial, cervical ligament with a funiculus that is elevated above the cervical spinous processes and connected to them only via laminae. However, many references to ‘nuchal ligaments’ in both extant and extinct taxa instead seem to employ a broader, etymological definition that encompasses numerous different compositions, morphologies and topologies. Several, largely untested assumptions have been made about functional and osteological correlates of a nuchal ligament, such as possessing a ‘large’ or ‘heavy’ head and/or a ‘long’ neck, possessing specific features on the occipital region of the skull, and possessing specific morphologies or dimensions of the cervical and cranial thoracic spinous processes. These assumptions have led to corollary assumptions that many extinct tetrapods—particularly those phylogenetically far removed from taxa known to possess them—had nuchal ligaments, but until these presumed correlates are tested and demonstrated in extant taxa, such assumptions remain purely speculative, and alternative cranio-cervical support mechanisms also must be considered. Depending on the definition applied, attributions of nuchal ligaments to extinct taxa, and even to some extant taxa (including humans), may be references to other sorts of morphologically and topologically distinct epaxial structures such as supraspinous ligaments and fibrous septa/raphes that occupy similar anatomical positions as nuchal ligaments sensu stricto. ‘Nuchal ligament’ requires a narrow definition to understand what, if any, features correlate with the presence of the ligament, as well as what taxa have convergently evolved the structure.

A Solitary Osteochondroma Originating from the Spinous Process of the Third Cervical Vertebra: A Case Report and Comprehensive Literature Review

Background Osteochondroma is one of the most common solitary bone lesions. Multiple lesions are possible only in some genetic abnormalities, such as hereditary multiple exostoses (HME). Half of spinal osteochondroma is documented at the cervical level, although there are some levels and locations where it is rare to find an osteochondroma. Methods An advanced search of the PubMed database was performed for case reports and case series of spinal cervical osteochondroma. After data extraction, information was organized in one table and many figures to facilitate data comprehension. Result Osteochondroma was common in younger patients, with 26% of all cases in the literature being in those aged 18 to 35 years, and 24% of patients were aged 36 to 50. Over half (55%) of cases were in males. The most common presentation among all patients was neck pain and swelling or lump sensation. Moreover, 38% of cases were osteochondroma at the C1 level, and 33% were noted to affect the posterior arch. The majority of the cases had a favorable prognosis as most of them underwent total surgical resection of the tumor and decompression of the neural compartment. Conclusion Solitary cervical osteochondroma is a bony, benign lesion that can have devastating sequelae such as severe painful radiculopathy and quadriplegia if it is not approached correctly. History, examination, and radiological investigation are all crucial to making the best clinical judgment for the patients.

Multicenter External Validation of the Accuracy of Computed Tomography Criteria for Detecting Thoracolumbar Posterior Ligamentous Complex Injury.

Recent studies have proposed computed tomography (CT) criteria for posterior ligamentous complex (PLC) injury: disrupted if ≥2 CT findings, indeterminate if single finding, and intact if 0 CT findings. The study aims to validate the CT criteria for PLC injury externally. Three level 1 trauma centers enrolled 614 consecutive patients with acute thoracolumbar fractures (T1-L5) who received CT and MRI. Three reviewers from each center assessed CT for facet joint malalignment, horizontal laminar fracture, spinous process fracture, and interspinous widening and MRI for disrupted PLC, defined as black stripe discontinuity. The primary outcome is the diagnostic accuracy of CT criteria (0, 1, ≥2 findings) in detecting disrupted PLC on MRI using all CT readings. A subgroup analysis was performed for each participating center and reviewer. The inter-reader agreement on PLC status on MRI and CT criteria was assessed using Fleiss Kappa (k). The positive predictive value for PLC injury was 0 findings 3%, single positive CT 43%, and ≥2 CT findings in 94%. The accuracy measures were consistent across various centers and reviewers. The area under the curve for ≥1 CT finding in detecting PLC injury ranged from 90% to 97%, indicating excellent discrimination for all centers. The inter-reader k on PLC status by MRI and overall CT findings was substantial (k > 0.60). This study externally validates the previously proposed CT criteria for PLC injury. A total of ≥2 positive CT findings or 0 CT findings can be used as criteria for a disrupted PLC (B-type injury) or intact PLC (A-type injuries), respectively, without added MRI. A single CT finding implies indeterminate PLC status and the need for further MRI assessment. The CT criteria will potentially guide MRI indications and treatment decisions for neurologically intact thoracolumbar burst fractures.

An Open-Source Tool for Investigation of Differential RNA Expression Between Spinal Cord Cells of Male and Female Mice.

Chronic pain is a highly debilitating condition that differs by type, prevalence, and severity between men and women. To uncover the molecular underpinnings of these differences, it is critical to analyze the transcriptomes of spinal cord pain-processing networks for both sexes. Despite several recently published single-nucleus RNA-sequencing (snRNA-seq) studies on the function and composition of the mouse spinal cord, a gene expression analysis investigating the differences between males and females has yet to be performed. Here, we combined data from three different large-scale snRNA-seq studies, which used sex-identified adult mice. Using SeqSeek, we classified more than 37,000 unique viable cells within predicted cell types with the use of machine learning. We then utilized DESeq2 to identify significant differentially expressed genes (DEGs) between males and females in a variety of cell populations, including superficial dorsal horn (SDH) neurons. We found a large number of DEGs between males and females in all cells, in neurons, and in SDH neurons of the mouse spinal cord, with a greater level of differential expression in inhibitory SDH neurons compared to excitatory SDH neurons. The results of these analyses are available on an open-source web-app: https://justinbellavance.shinyapps.io/snRNA_Visualization/. Lastly, we used gene set enrichment analysis to identify sex-enriched pathways from our previously identified DEGs. Through this, we have identified specific genetic players within the rodent spinal cord that diverge between males and females, which may underlie reported sex differences in spinal nociceptive mechanisms and pain processing.

Finite element analysis shows minimal stability difference between individualized mini-hemilaminectomy-corpectomy and partial lateral corpectomy in a dog model.

Use finite element analysis to evaluate the biomechanical effects of spinal decompression procedures in healthy Beagle dogs, comparing individualized mini-hemilaminectomy-corpectomy (iMHC), mini-hemilaminectomy, partial lateral corpectomy (PLC), and hemilaminectomy. A finite element model of the L1-L2 functional spinal unit was generated using CT data. For each decompression model, loads were applied in 0.2-Nm steps (maximum, 2.0 Nm) in 6 directions: flexion, extension, right and left lateral bending, and right and left axial rotation. The L1 spinous process tip displacement angle was quantified numerically. Among the 4 techniques, mini-hemilaminectomy exhibited the smallest displacement angles across all directions. Hemilaminectomy exhibited the largest displacement angles in extension, flexion, right rotation, and left rotation across all techniques. Left and right lateral bending displacement angles were marginally larger for iMHC than for hemilaminectomy at 0.4 Nm; however, at 2.0 Nm, displacement angles were similar. Mini-hemilaminectomy minimizes functional spinal unit instability to the greatest extent. Hemilaminectomy is more unstable than iMHC and PLC in flexion, extension, and rotation. Mini-hemilaminectomy-corpectomy and PLC are more unstable than hemilaminectomy in lateral bending, with iMHC being slightly more unstable than PLC or nearly equal. Mini-hemilaminectomy minimizes instability to the greatest extent in cases of ventrolateral spinal compression. In cases of ventral spinal compression, iMHC may be preferable to PLC for providing equivalent stability without impeding spinal cord visualization, but both techniques can cause instability depending on loading direction, so careful attention to postoperative instability is necessary when excessive vertebral body resection is involved.

Effect of different interventions on lumbar spinal stenosis: a systematic evaluation and network meta-analysis

BackgroundSurgery is the preferred option for lumbar spinal stenosis (LSS) when conservative methods cannot meet the needs. Recent advancements in surgical techniques have brought various new methods for treating LSS. MethodFour databases, PubMed, Embase, the Cochrane Library, and Web of Science, were searched, covering the period from the establishment of the databases until May 2024. Randomized controlled trials (RCTs) were carried out to treat LSS using different surgical approaches. The outcome measures included the visual analogue scale (VAS) score, Oswestry disability index (ODI) score, surgical duration, intraoperative blood loss, and length of hospital stay of patients. Bayesian random-effects network meta-analysis (NMA) was performed using R software (V4.4) and STATA17.0 software to analyze each surgical approach. ResultsA total of 29 studies involving 4,200 patients were included. Nine intervention methods, including laminotomy, decompression, decompression plus fusion (DPF), endoscopic decompression, interspinous process spacer device (IPSD), laminectomy, minimally invasive decompression (MID), spinous process osteotomy (SPO), and lumbar interbody fusion (LIF), were analyzed. NMA results indicated that endoscopic decompression (SUCRA=88.70%) was the most effective in reducing short-term back VAS scores. IPSD (SUCRA=98.00%) was the most effective in reducing long-term back VAS scores, surgical duration (SUCRA=95.20%), and intraoperative blood loss (SUCRA=100.00%). Endoscopic decompression (SUCRA=83.60%) also showed the most significant effect in reducing hospital stays. ConclusionEndoscopic decompression can effectively improve short-term back VAS scores and reduce hospital stays, while IPSD is effective in reducing long-term back VAS scores with minimal surgical duration and blood loss.

Anatomic Surface Measurement of the Lumbar Laminae for Safely Resection During Percutaneous Endoscopic Surgery: A Computed Tomography-Based 3-Dimensional Morphometric Study

The aim of this study was to use computed tomography-based 3-dimensional morphometric imaging to precisely quantify the anatomic parameters of the lumbar laminae and increase the precision of laminar fenestration during percutaneous endoscopic spinal surgery. Lumbar computed tomography data for the L1-L5 vertebrae of 62 patients (310 total vertebrae) were collected. Laminar width, height, thickness, and bilateral angle were measured in detail, and each parameter was compared and analysed. Measurements at the upper, middle, and lower planes of the laminae yielded mean surface laminar widths of 19.90 mm, 15.64 mm, and 18.07 mm, respectively. The safe lamina resection distances were 11.21 mm, 9.35 mm, and 9.63 mm at the upper, middle, and lower planes of the laminae, respectively. The mean surface laminar height was 21.83 mm at the articular process and 22.52 mm at the base of the spinous process. The mean values for laminar thickness were 6.33 mm, 5.96 mm, and 5.98 mm at the outer, central, and inner aspects, respectively. Overall, the angle between the laminae was larger in the upper lumbar vertebrae than in the lower lumbar vertebrae, with mean bilateral laminar angles of 124.08°, 125.45°, 125.00°, 116.19°, and 108.31° for L1 to L5, respectively. This study has revealed significant anatomical diversity within the laminae of lumbar vertebral segments. These findings provide important anatomical information for surgeons performing precise laminar fenestration during endoscopic spinal surgery.

Rate-Dependent Depression of the Hoffmann Reflex: Practical Applications in Painful Diabetic Neuropathy.

Measurement of the rate-dependent depression (RDD) of the Hoffmann (H) reflex, a technique developed over half a century ago, is founded on repeated stimulation of the H-reflex with tracking of sequentially evoked H-wave amplitudes in the resulting electromyogram. RDD offers insight into the integrity of spinal reflex pathways and spinal inhibitory regulation. Initially, RDD was predominantly utilized in the mechanistic exploration and evaluation of movement disorders characterized by spasticity symptoms, as may occur following spinal cord injury. However, there is increasing recognition that sensory input from the periphery is modified at the spinal level before ascending to the higher central nervous system and that some pain states can arise from, or be exaggerated by, disruption of spinal processing via a mechanism termed spinal disinhibition. This, along with the urgent clinical need to identify biological markers of pain generator and/or amplifier sites to facilitate targeted pain therapies, has prompted interest in RDD as a biomarker for the contribution of spinal disinhibition to neuropathic pain states. Current research in animals and humans with diabetes has revealed specific disorders of spinal GABAergic function associated with impaired RDD. Future investigations on RDD aim to further elucidate its underlying pathways and enhance its clinical applications.

Anatomy and Pathologies of the Spinous Process.

The spinous processes act as a lever for attachments of muscles and ligaments. Spinal imaging is commonly performed as a diagnostic test for pain and radiculopathy. A myriad of incidental or unexpected findings, both potentially asymptomatic and symptomatic, may be encountered during the interpretation of these images, which commonly comprise radiographs, Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). Isolated lesions of the spinous process, although less common, are some of the lesions that may be encountered and can present a diagnostic dilemma. These can range from congenital abnormalities, traumatic lesions, neoplasms and lesions of inflammatory, infective and metabolic aetiology. The literature specifically reviewing these lesions is sparse. The article reviews a range of pathologies affecting the spinous process, along with their pertinent imaging features, based on isolated pathologies of spinous process lesions identified on imaging by the authors at a tertiary orthopaedic centre over a 10-year period. A search on the hospital Picture Archive and Communication System (PACS) and Radiology Information System (RIS) was performed using the keyword "spinous process" and a list of the isolated pathologies of the spinous process based on the imaging reports was compiled for the purpose of this narrative review. It is important that radiologists consider these lesions when they are identified on routine imaging of the spine.

Pedicled myocutaneous trapezius flap for chronic osteomyelitis of the spinous processes - a case report.

Complex injuries to the posterior trunk can still pose a significant challenge to the reconstructive surgeon. Due to the lack of skin laxity, dependent anatomical location and the importance of the deeper structures, a systematic approach tailored to the individual defect should be considered for these types of reconstructions. In our case report, we present a reconstructive solution of a chronic defect of the back caused by resection of an ulceration. What was previously considered to be a relapse of a malignant melanoma turned out to be a chronic osteomyelitis of the spinous processes of the thoracic vertebrae. The defect after the resection of the ulceration and infected spinous processes of the thoracic vertebrae with exposed dorsal lamina was covered with pedicled myocutaneous flap. Reconstruction yielded well-vascularized tissue that provided sufficient volume and tissue quality. Even in the light of modern perforator flaps, local or locoregional muscle and myocutaneous flaps remain the first choice for the treatment of deep back defects. Considering all the factors in the given case, plastic surgeons are able to tailor the reconstructive technique to every individual case to match the desired reconstruction goal.

The Lumbar Artery Perforator Free Flap as an Alternative Option for Breast Reconstruction in Low BMI Patients: Analysis of CT Angiography of Donor Sites Across BMI.

In patients with a low body mass index (BMI), the options for autologous breast reconstruction are limited. With the hypothesis that adipose tissue deposition favors the lumbar region over the abdominal wall, this study sought to investigate the lumbar artery perforator (LAP) flap as an alternative reconstructive option in patients with deficient autologous donor sites consequent to a low BMI. A retrospective cohort analysis was performed, from a prospectively maintained database, of all consecutive deep inferior epigastric artery perforator flap breast reconstructions performed in our unit. A randomized selection of 100 patients with low BMI < 22, normal BMI 22 to 24, and high BMI > 30 was performed. Patient computerized tomography scans were analyzed to measure abdominal wall and lumbar tissue thickness and to define anatomical landmark relations of the LAP. A statistically significant difference was identified between the ratio of lumbar-to-abdominal wall thickness between BMI groups, highlighting preservation of the lumbar thickness in patients with low BMI. The mean distance at which the fourth lumbar perforator entered the subcutaneous tissues was 7.7 cm lateral to the spinous process (range 6.4-9.5 cm), with no significant difference between BMI groups, highlighting this consistent anatomical position. This study confirms a greater lumbar-to-abdominal wall thickness, therefore volume, in low BMI patients, with consistent lumbar perforator anatomy of 6.4 to 9.5 cm lateral to the spinous process. The LAP flap should therefore be strongly considered for autologous breast reconstruction in this patient cohort.

Clay-Shoveler Fracture in a Golfer: A Rare Sports Injury Case Report

Clay-shoveler's fracture is a relatively rare stress-type avulsion fracture of the lower cervical or upper thoracic spinous processes, most commonly occurring at C7 and T1. The term of this injury comes from its historical association with manual laborers who lifted and threw big objects, as well as with scooping huge loads of clay in the early 20th centuryThe case report describes A 29 year old male experienced severe back pain after playing golf. at the time of the golf swing, the golf swing did not hit the ball but hit the ground. the patient experienced radiculopathy pain to both hands. A "pop" sound was audible in the spine at the moment of the hitting fault, and there was no paralysis in the lower limbs.The primary method for managing a clay-shoveler fracture is conservative. In most cases, traction of the rhomboid and trapezius muscles on the spinous process leads to nonunion. In rare cases if the pain persists, surgically removing the bone fragment may be a possibility.

A new sensing paradigm for the vibroacoustic detection of pedicle screw loosening.

The current clinical gold standard to assess the condition and detect loosening of pedicle screw implants is radiation-emitting medical imaging. However, solely based on medical imaging, clinicians are not able to reliably identify loose implants in a substantial amount of cases. To complement medical imaging for pedicle screw loosening detection, we propose a new methodology and paradigm for the radiation-free, non-destructive, and easy-to-integrate loosening detection based on vibroacoustic sensing. For the detection of a loose implant, we excite the vertebra of interest with a sine sweep vibration at the spinous process and use a custom highly sensitive piezo vibration sensor attached directly at the screw head to capture the propagated vibration characteristics which are analyzed using a detection pipeline based on spectrogram features and a SE-ResNet-18. To validate the proposed approach, we propose a novel, biomechanically validated simulation technique for pedicle screw loosening, conduct experiments using four human cadaveric lumbar spine specimens, and evaluate our algorithm in a cross-validation experiment. The proposed method reaches a sensitivity of and a specificity of for pedicle screw loosening detection.

Intra-rater and inter-rater reliability of a handheld myotonometer measuring myofascial stiffness of lower lumbar myofascial tissue in healthy adults.

Biomechanical muscle properties, such as stiffness, can be valuable indicators of tissue health and show promise as a diagnostic and treatment measure for chronic low back pain (CLBP). The development of accessible assessment technologies, such as the MyotonPRO portable device, allows for the convenient quantification of muscle tone and stiffness changes. The aim of this study is to assess the reliability of lumbar erector spinae muscle stiffness with the MyotonPRO in healthy adults and to compare stiffness changes between prone and sitting position. Thirty asymptomatic participants (N = 15 women and N = 15 men) aged between 18 and 65 years were recruited to participate in this study. Two examiners tested muscle stiffness at the palpable muscle belly, one finger away from the spinous process at the level of the L4 vertebra, first from the left and then from the right side, both in prone position and after in sitting position. For inter-rater reliability, all participants were tested by two examiners on the same day, and intra-rater reliability was calculated using the same examiner's assessment results with an exact 24-h interval. Intraclass correlation coefficients (ICC), standard error measures (SEM) and minimum detectable change (MDC) with a 95% confidence interval were calculated to assess intra-rater and inter-rater reliability. Statistical analysis revealed good intra-rater reliability with an ICC of 0.88 (95% CI [0.76-0.94]) for the stiffness of the left erector spinae and excellent intra-rater reliability with an ICC of 0.91 (95% CI [0.82-0.95]) for the right erector spinae, both in the prone position. Intra-rater reliability in the sitting position was excellent to very good with an ICC of 0.91 (95% CI [0.82-0.96]) for the left side and an ICC of 0.89 (95% CI [0.78-0.95]) for the right side. The results for the left-sided prone position showed good inter-rater reliability with an ICC of 0.87 (95% CI [0.73-0.94]). The prone position on the right side also showed good inter-rater reliability with an ICC of 0.84 (95% CI [0.68-0.92]). The inter-rater reliability for the left and right side in the sitting position was excellent with an ICC of 0.96 (95% CI [0.92-0.98]) for the left side and an ICC of 0.95 (95% CI [0.90-0.97]) for the right side. This study demonstrated high reliability in measuring lumbar erector spinae muscle stiffness with the MyotonPRO in healthy adults and the ability of the device to detect even small changes in erector spinae muscle stiffness, testing both the right and left sides and measuring in both prone and sitting positions. The use of the sitting position to assess lumbar tissue tension in individuals may serve as a valuable substitute for the prone position, particularly for patients who experience discomfort in the prone position, and could have additional practical significance in clinical settings.

"Surviving the dip" after subacromial balloon spacer implantation for massive rotator cuff tear treatment: a retrospective case series.

Subacromial balloon spacer implantation (SBSI) attempts to decrease glenohumeral joint (GHJ) pain and improve function in patients with an irreparable rotator cuff tear (RCT) and minimal osteoarthritis. Between 12 and 26 weeks post-SBSI, gradual implant resorption may create a "balloon dip" that decreases GHJ function and increases pain. This retrospective cohort study attempted to delineate shoulder function, active mobility, strength, pain, and functional task impairment during the "balloon dip" period. Sixty-five consecutive patients (55.9 ± 7years of age, 42 men) with an irreparable RCT treated by the same fellowship-trained shoulder surgeon participated in this study. Outcome measurements pre-SBSI, during Phase I (early pain control ≤ 3weeks post-SBSI), Phase II (early rehabilitation > 3-11weeks post-SBSI), Phase III (advanced rehabilitation-early balloon resorption > 11-16weeks post-SBSI), Phase IV (early strength training > 16-24weeks post-SBSI), and Phase V (advanced strength training > 24weeks post-SBSI) included the American Shoulder and Elbow Society (ASES) score for perceived bilateral shoulder function, visual analog scale (VAS) surgical shoulder pain score, active mobility, and shoulder manual muscle strength testing (p ≤ 0.05). The mean final follow-up time was 40weeks (range = 24.1-89.7weeks). The surgical shoulder had higher ASES scores at Phase V than pre-SBSI. Surgical shoulder pain was less during Phase V than pre-SBSI. The surgical shoulder had greater flexion during Phase V than at Phase II or pre-SBSI, and greater external rotation (adducted) during Phases V-III than pre-SBSI. Peak shoulder internal rotation to level 12 (thoracic spinous process #10) occurred during Phase V. Peak shoulder flexor, external rotator, and internal rotator strength occurred during Phase V. During Phase I, most subjects were unable to sleep on their surgical shoulder, wash their back/do up their bra, reach a high shelf, or lift 10-lbs overhead. Tasks that were impaired during the "balloon dip" (between Phase III and V) were lifting 10-lbs overhead, reaching a high shelf, and doing normal work. By the end of Phase V, however, most subjects could perform each task with minimal or no difficulty. Surgical shoulder function improved and pain decreased, however, specific perceived functional task impairments remained. During the "balloon dip" phase, the perceived ability to lift 10 lbs above shoulder level, to reach a high shelf, and to do usual work activities were the most impaired tasks.