Thoracic Spine Area Research Articles

Effects of Bone Cross-Link Bridging on Fracture Mechanism and Surgical Outcomes in Elderly Patients with Spine Fractures.

This study adopted a cross-sectional study design. This study was designed to investigate the effects of bone cross-link bridging on fracture mechanism and surgical outcomes in vertebral fractures using the maximum number of vertebral bodies with bony bridges between adjacent vertebrae without interruption (maxVB). The complex interplay of bone density and bone bridging in the elderly can complicate vertebral fractures, necessitating a better understanding of fracture mechanics. We examined 242 patients (age >60 years) who underwent surgery for thoracic to lumbar spine fractures from 2010 to 2020. Subsequently, the maxVB was classified into three groups: maxVB (0), maxVB (2-8), and maxVB (9-18), and parameters, including fracture morphology (new Association of Osteosynthesis classification), fracture level, and neurological deficits were compared. In a sub-analysis, 146 patients with thoracolumbar spine fractures were classified into the three aforementioned groups based on the maxVB and compared to determine the optimal operative technique and evaluate surgical outcomes. Regarding the fracture morphology, the maxVB (0) group had more A3 and A4 fractures, whereas the maxVB (2-8) group had less A4 and more B1 and B2 fractures. The maxVB (9-18) group exhibited an increased frequency of B3 and C fractures. Regarding the fracture level, the maxVB (0) group tended to have more fractures in the thoracolumbar transition region. Furthermore, the maxVB (2-8) group had a higher fracture frequency in the lumbar spine area, whereas the maxVB (9-18) group had a higher fracture frequency in the thoracic spine area than the maxVB (0) group. The maxVB (9-18) group had fewer preoperative neurological deficits but a higher reoperation rate and postoperative mortality than the other groups. The maxVB was identified as a factor influencing fracture level, fracture type, and preoperative neurological deficits. Thus, understanding the maxVB could help elucidate fracture mechanics and assist in perioperative patient management.

Lower thoracic spine extension mobility is associated with higher intensity of thoracic spine pain

ABSTRACT Objectives To evaluate the association of thoracic spine (TS) posture and mobility with TS pain. Methods Participants with TS pain reported maximum, average, and night pain in TS area, and pain summary score was calculated. Upright and sitting TS postures were evaluated by inspection. TS posture and mobility (flexion and extension) were recorded using an inclinometer and a tape measure, respectively. Correlations between posture and mobility assessments were calculated using Spearman rank correlation, the association of TS posture and mobility with TS pain by logistic regression analysis. Results The participants’ (n = 73, 52 females, age range 22–56) TS pain duration was 12 weeks on average. The correlations for measurements of TS posture and flexion mobility were higher than correlations of other TS measurements being between 0.53 and 0.82. Decreased extension mobility of the upper (from 1st to 6th TS segments; Th1–Th6) TS was associated with higher worst pain (OR 1.04, 95% CI 1.00–1.07) and whole TS with pain sum score (OR 1.05, 95% CI 1.01–1.08). Less kyphotic whole TS was associated with lower pain sum score (OR 0.96, 95% CI 0.92–1.00). Greater flexion mobility of upper and lower (Th6–Th12) TS were associated with lower pain sum score (OR 0.96, 95% CI 0.91–1.00, and OR 0.96, 95% CI 0.91–1.00, respectively). Conclusions Reduced thoracic extension mobility was associated with higher pain scores and the greater flexion mobility with lower pain scores. Future research is warranted to evaluate if treatments geared toward TS extension mobility improvements would result in lower TS pain.

Standard values of the upper body posture in male adults.

Interactions within the musculoskeletal system have been investigated and confirmed in numerous studies. Since there are no standard values for the posture of healthy persons, this study attempts to define reference values for the upper body posture in healthy men. A 3-dimensional back scan was performed to quantify the upper back posture while habitually standing. Tolerance regions for habitual posture were calculated, including the upper and lower limit for 95% of all values. Furthermore, the left and right limit of the confidence interval (CI) was carried out. Group differences were tested by using the t-test or the Wilcoxon-Mann-Whitney U test. Height, weight and body mass index (BMI) of the participants were comparable to those of the average young German males. The spinal column was marginally twisted to the right. The spinal curves, defined by the thoracic or lumbar flexion angle, and the kyphosis and lordosis angle, indicated that the angle in the thoracic spine area was larger than that in the lumbar region. Consequently, a more kyphotic posture was observed in the sagittal plane. The habitual posture was slightly scoliotic, with a rotational component (scapular depression left, right scapula marginally located more dorsally, high state of pelvic left, iliac left further rotated posteriorly and simultaneously tilted further ventrally). No significant difference between right and left-handed persons could be proven. Video raster stereography is a suitable method to measure the 3-dimensional back surface. Using this method for healthy young men, we observed that they had an almost ideally balanced posture with minimal ventral body inclination and a marginal scoliotic deviation. The normal values allow a better comparison of data between different studies of body posture.

Multifocal Extensive Spinal Tuberculosis Accompanying Isolated Involvement of Posterior Elements: A Case Report

Study Design: A case report. Objectives: To report a rare case of atypical spinal tuberculosis. Summary of Literature Review: In spinal tuberculosis, non-contiguous multifocal involvement and isolated involvement of posterior elements of the spine have been considered atypical features. There have been a few reports of each of these atypical features but no reports have described spinal tuberculosis with both of these atypical features. Materials and Methods: A 39-year-old man presented with back pain and progressive weakness of both lower extremities. He was diagnosed with spinal tuberculosis from the cervical to sacral spine, showing multifocal non-contiguous involvement with multiple abscesses on magnetic resonance imaging. Notably, in the thoracic spine area, isolated involvement of posterior elements was found with an epidural abscess compressing the spinal cord. He underwent a total laminectomy of the thoracic spine and multiple abscesses were drained with pigtail catheter insertions into the cervical, thoracic, and lumbar spine. Results: At the 8-month follow-up, the patient’s neurologic status had improved to Frankel Grade D, and the patient was able to walk with the support of a walker. At the 3-year follow-up, the patient had recovered completely without any neurologic deficit. Conclusions: Since atypical spinal tuberculosis may show various patterns, examination of the entire spine is important for early diagnosis. Treatment should be provided properly from minimally invasive procedures to open surgery depending on the extent of structural instability and neurologic deficit.

Occupational accident and disease claims, work-related stress and job satisfaction of physiotherapists.

IntroductionPhysiotherapists are exposed to diverse occupational demands. Until now, little has been known about the interaction between occupational stress and the job satisfaction of physiotherapists. This paper aims to examine their work-related stress and job satisfaction. It will analyse accidents at work and occupational diseases of physiotherapists along with work-related physical and psychosocial stress and job satisfaction.MethodWe analysed routine data of the German Institute for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW) on accidents at work and occurring en route to/from work as well as occupational diseases of physiotherapists. Work-related stress and job satisfaction were examined in a cross-sectional survey using a standard questionnaire to be completed by subjects themselves.ResultsBetween 2007 and 2011, 1,229 cases of occupational disease were reported to the BGW. The majority of reports involved skin diseases (73%). Stumbles and falls were the most frequent causes of accidents at work (42.9%). Eighty-five physiotherapists all over Germany took part in the survey. They experience high quantitative demands at work. The main physical demands consist of a torso posture between 45° and 90° and high hand activity. Of the 85 subjects, 51% suffer from complaints of the musculoskeletal system in the neck and thoracic spine area and 24% have skin diseases. Most physiotherapists (88%) are satisfied with their work overall. This is aided by a high degree of influence on their work and breaks, by practical application of skills and expert knowledge, high regard for their profession, varied work and a good atmosphere at work. Reservations tend to be about statutory regulations and the social benefits provided by the German healthcare system.ConclusionOverall, despite high demands and stress relating to the adequacy of resources, the majority of physiotherapists surveyed seem to be satisfied with their job. The main focus of action to promote the health of physiotherapists should be on preventing skin disease, problems of the musculoskeletal system and accidents caused by stumbles and falls.

The Efficacy of Ultrasound-facilitated Electrical Stimulation as an Adjunct to Exercise in Treating Chronic Neck and Shoulder Pain

AbstractObjective: To evaluate the effectiveness of ultrasound [US]-facilitated electrical stimulation [US/ES] of thoracic spine area trigger points [TrPs] as an adjunct to exercise/electrical stimulation therapy alone in patients with chronic neck and shoulders pain.Methods: Subjects were randomly allocated into two treatment groups; one group to receive classic treatment [exercise plus ES] and the second group in which the classic treatment was supplemented with US/ES treatment of TrPs in the upper trunk area on the painful side. Participants were tested for pain intensity using a visual analog scale [VAS] for pain, Box plots [Box], Margolis' scoring system [size of pain area], and pain self-efficacy questionnaire [PSEQ].Results: Forty two male and female patients, aged 27 and 76 years, entered the study and 39 patients [34 women and five men; aged 51.8 ± 10 years] completed the study. The group that received the additional US/ES treatment exhibited greater improvements in pain intensity [Box, p = 0.05;...

Use of Peripheral Nerve Field Stimulation for Treatment of Pain Originating from Tardive Dyskinesia

BackgroundDystonia is a condition in which there is involuntary, sustained muscle contraction resulting in abnormal postures, repetitive movements and, often, severe pain. Tardive dyskinesia [TD] describes a form of cervical dystonia, also known as spasmodic torticollis, induced by long-term use of neuroleptic, antiemetic, or some antivertiginous agents. Treatment of TD can vary from pharmacological to surgical options. Each treatment modality, however, has its own limitations. Medical management commonly involves anticholinergic medications, benzodiazepines, or injections of botulinum toxin. Surgical options include selective peripheral denervation and deep-brain stimulation.FindingsA 28-year-old female presented with a two-year history of TD with cervical dystonia. Her most severe pain was located in the thoracic spine area at the level of T4–T9 spinal levels. She failed multiple conservative treatments for upper thoracic back pain. The option of a peripheral nerve stimulator trial was then presented to...

A randomised, placebo-controlled, clinical trial for the short-term effectiveness of manipulative therapy and acupuncture on pain caused by mechanical thoracic spine dysfunction

Abstract Introduction: A randomised, assessor-blinded, placebo-controlled trial was used to compare the short-term effectiveness of manipulative therapy and acupuncture on the pain caused by mechanical thoracic spine dysfunction and on the pressure pain threshold. Subjects and Methods: The research sample consisted of 114 female patients aged 20–60 years. The primary complaint of these subjects had been pain in the thoracic spine area. After completing a questionnaire and undergoing a clinical examination, 114 subjects were diagnosed with mechanical thoracic spine dysfunction and these were randomised into the final study groups. Five persons dropped out the trial and thus the remaining 109 subjects were randomly divided into the manipulation group (n = 37), the acupuncture group (n = 35), and the placebo group (interference-electrotherapy with suction cups without electricity; n = 37). The subjects were treated four times with a 1-week follow-up assessment. The measurements of VAS and pressure pain thres...

Application of radiofrequency energy in surgical and interventional procedures: are there interactions with ICDs?

During surgical and interventional procedures, interference may occur between ICDs and electrical cautery or with the application of RF energy. This may lead to the false induction of ICD therapies or could even result in device malfunction, which represents a potential perioperative hazard for the patient. This study analyzed the intraoperative interactions in 45 consecutive ICD patients in reference to different surgical and interventional procedures. A total of 33 surgical operations (general surgery [n = 14], urologic [n = 5], abdominal [n = 10], gynecological [n = 2], thoracic [n = 1], neurosurgical [n = 1]) and 12 interventional therapies (RF catheter ablation [n = 10], endoscopic papillotomy [n = 2]) were performed. The ICD devices were all located in left pectoral position and consisted of 25 single and 20 dual chamber defibrillators. During the procedure, tachyarrhythmia detection (VF 296 +/- 20 ms, VT 376 +/- 49 ms) of the devices was maintained active (monitoring mode), only ICD therapies were inactivated. The indifferent electrode of the electrical cauter/RF generator was placed in standard positions (right/left mid-femoral position [n = 27/8], thoracic spine area [n = 10]). After the procedure, the ICD memory was checked for detections and for changes in the programming. There was no oversensing, reprogramming, or damage of any defibrillator caused by RF energy. Despite the lack of undesired interactions, ICDs should be inactivated preoperatively to assure maximum patient safety. However, should inactivation not be possible, or the achievement uncertain, electromagnetic interference is highly unlikely.

Surgical and interventional use of radiofrequency current: is there interference with implantable cardioverter/defibrillators?

During surgical and interventional procedures, interactions between implantable cardioverter defibrillators (ICD) and electrical cautery, respectively, application of radiofrequency (RF) energy may occur. Induction of inadequate shock therapies or device malfunction may result and represent a potential perioperative hazard for the patient. Hence, we analyzed the intraoperative interactions in 23 consecutive ICD patients with regard to different surgical and interventional procedures. Sixteen surgical operations (general surgery n = 7, urologic n = 5, abdominal n = 2, gynecological n = 1, thoracic n = 1) and 7 interventional therapies (RF catheter ablation n = 5, endoscopic papillotomy n = 2) were performed. The ICD devices were all located in the left pectoral position and consisted of 15 single and 8 dual chamber defibrillators. During the procedure tachyarrhythmia detection (VF 295 +/- 21 ms, VT 370 +/- 55 ms) of the devices was maintained active (monitoring mode); only ICD therapies were inactivated. The indifferent electrode of the electrical cauter/RF generator was placed in standard positions (right mid femoral position n = 18, thoracic spine area n = 5). After the procedure, the ICD memory was checked for detections, respectively, for changes of the programming. There was no misdetection or reprogramming of the ICD caused by electrical cautery or RF energy. Despite the lack of undesired interactions ICDs should be inactivated preoperatively to assure maximum patient safety. However, should inactivation be ineffective or not manageable, electromagnetic interference is highly unlikely.

Costovertebral Joint Erosion in Ankylosing Spondylitis

We describe a patient with ankylosing spondylitis who had severe pain in the thoracic spine area owing to a destructive arthropathy of a costovertebral joint. A computed tomographic scan revealed severe osteolysis of the head of the right eleventh rib, with hypertrophic sclerotic arthropathy of the joint as the source of the patient's pain. Costovertebral arthropathy should be considered in ankylosing spondylitis patients with severe thoracic pain.