Edge Of Vertebral Body Research Articles

Arthroscopic-assisted uni-portal ligament flavum sparing bone anchoring annular suture technique for lumbar disc herniation: A case report and literature review.

Lumbar disc herniation (LDH) manifests in diverse forms. If the nucleus pulposus or endplate tissues protrudes, the location of annular tears also varies, which poses various challenges for the annular suture technique. Tears at the annular attachment area at the edge of the vertebral body (cephalad or caudad) are considered a prohibitively challenging area for annular suturing. A 37-year-old woman presented with a gradual onset of symptoms, experiencing leg pain and numbness over the left leg for 1 year before presentation. The pain radiated to the left S1 dermatome. Despite undergoing continuous medical therapy for more than 6 months, her symptoms showed no improvement. The strength of the left plantar flexion in the ankle and great toe was rated at 4 out of 5. The straight leg-raising and strengthening tests were positive for the left sides. Lumbar computed tomography and magnetic resonance imaging revealed left-sided disc herniation at the L5-S1 level, and nerve root compression, confirming the diagnosis of LDH. The preoperative impression was LDH, intraoperative confirmation of a tear in the annular attachment area at the vertebral body edge. This patient was treated with an arthroscopic-assisted uniportal spinal surgery (AUSS) technique focusing on ligament flavum (LF) preservation, protruding nucleus pulposus removal, nerve root decompression, and vertebral edge tear was then sutured using a bone anchoring annular suture with the Smile suture device. This technique was performed successfully in a patient with LDH. Significant improvements were observed in postoperative pain and numbness, Visual Analog Scale, and Japanese Orthopaedic Association scores. No postoperative instability or complications were observed, with computed tomography and magnetic resonance imaging confirming complete decompression. To the best of our knowledge, this is the first used AUSS with LF preservation and bone anchoring annular suture technique for LDH. This case study demonstrates the AUSS combined with LF preservation and the bone anchoring annular suture technique provides favorable clinical and imaging outcomes and is a safe and effective technique for the treatment of LDH.

An MRI study of lateral vascular safety zones in oblique lumbar interbody fusion surgery

To study the anatomical characteristics of blood vessels in the lateral segment of the vertebral body through the surgical approach of oblique lumbar interbody fusion (OLIF) using MRI imaging, and evaluate its potential vascular safety zone. The lumbar MRI data of 107 patients with low back and leg pain who met the selection criteria between October 2019 and November 2022 were retrospectively analyzed. The vascular emanation angles, vascular travel angles, and the length of vessels in the lateral segments of the left vertebral body of L 1-L 5, as well as the distance between the segmental vessels in different Moro junctions of the vertebral body and their distances from the edges of the vertebrae in the same sequence (bottom marked as I, top as S) were measured. The gap between the large abdominal vessels and the lateral vessels of the vertebral body was set as the lateral vascular safe zones of the lumbar spine, and the extent of the safe zones (namely the area between the vessels) was measured. The anterior 1/3 of the lumbar intervertebral disc was taken as the simulated puncture center, and the area with a diameter of 22 mm around it as the simulated channel area. The proportion of vessels in the channel was further counted. In addition, the proportions of segmental vessels at L 5 without a clear travel and with an emanation angel less than 90° were calculated. Except for the differences in the vascular emanation angles between L 4 and L 5, the vascular travel angles between L 1, L 2 and L 4, L 5, and the length of vessels in the lateral segments of the vertebral body among L 1-L 4 were not significant ( P>0.05), the differences in the vascular emanation angles, vascular travel angles, and the length of vessels between the rest segments were all significant ( P<0.05). There was no significant difference in the distance between vessels of L 1, L 2 and L 2, L 3 at Moro Ⅰ-Ⅳ junctions ( P>0.05), in L 3, L 4 and L 4, L 5 at Ⅱ and Ⅲ junction ( P>0.05). There was no significant difference in the vascular distance of L 2, L 3 between Ⅱ, Ⅲ junction and Ⅲ, Ⅳ junction, and the vascular distance of L 3, L 4 between Ⅰ, Ⅱ junction and Ⅲ, Ⅳ junction ( P>0.05). The vascular distance of the other adjacent vertebral bodies was significant different between different Moro junctions ( P<0.05). Except that there was no significant difference in the distance between L 2I and L 3S at Ⅰ, Ⅱ junction, L 3I and L 4S at Ⅱ, Ⅲ junction, and L 2I and L 3S at Ⅲ, Ⅳ junction ( P>0.05), there was significant difference of the vascular distance between the bottom of one segment and the top of the next in the other segments ( P<0.05). Comparison between junctions: Except for the L 3S between Ⅰ, Ⅱ junction and Ⅱ, Ⅲ junction, and L 5S between Ⅰ, Ⅱ junction and Ⅱ, Ⅲ and Ⅲ, Ⅳ junctions had no significant difference ( P>0.05), there were significant differences in the distance between the other segmental vessels and the vertebral edge of the same sequence in different Moro junctions ( P<0.05). The overall proportion of vessels in the simulated channels was 40.19% (43/107), and the proportion of vessels in L 1 (41.12%, 44/107) and L 5 (18.69%, 20/107) was higher than that in the other segments. The proportion of vessels in the channel of Moro zone Ⅰ (46.73%, 50/107) and zone Ⅱ (32.71%, 35/107) was higher than that in the zone Ⅲ, while no segmental vessels in L 1 and L 2 were found in the channel of zone Ⅲ ( χ 2=74.950, P<0.001). Moreover, 26.17% (28/107) of the segmental vessels of lateral L 5 showed no movement, and 27.10% (29/107) vascular emanation angles of lateral L 5 were less than 90°. L 1 and L 5 segmental vessels are most likely to be injured in Moro zones Ⅰ and Ⅱ, and the placement of OLIF channels in L 4, 5 at Ⅲ, Ⅳ junction should be avoided. It is usually safe to place fixation pins at the vertebral body edge on the cephalic side of the intervertebral space, but it is safer to place them on the caudal side in L 1, 2 (Ⅰ, Ⅱ junction), L 3, 4 (Ⅲ, Ⅳ junction), and L 4, 5 (Ⅱ, Ⅲ, Ⅳ junctions).

Percutaneous kyphoplasty assisted by three dimensional printing percutaneous guide plate for the treatment of osteoporotic vertebral compression fractures

To verify the safety of three dimensional printing percutaneous guide plate assisted percutaneous kyphoplasty(PKP) in the treatment of osteoporotic vertebral compression fractures(OVCFs). The clinical data of 60 patients with OVCFs treated by PKP from November 2020 to August 2021 were retrospectively analyzed. There were 24 males and 36 females, aged from 72 to 86 years old with an average of (76.5±7.9) years. Routine percutaneous kyphoplasty was performed in 30 cases (conventional group) and three dimensional printing percutaneous guide plate assisted PKP was performed in 30 cases (guide plate group). Intraoperative pedicle puncture time (puncture needle to posterior vertebral body edge) and number of fluoroscopy, total operation time, total number of fluoroscopy, amount of bone cement injection, and complication (spinal canal leakage of bone cement) were observed. The visual analogue scale (VAS) and the anterior edge compression rate of the injured vertebra were compared before operation and 3 days after operation between two groups. All 60 patients were successfully operated without complication of spinal canal leakage of bone cement. In the guide plate group, the pedicle puncture time was(10.23±3.15) min and the number of fluoroscopy was(4.77±1.07) times, the total operation time was (33.83±4.21) min, the total number of fluoroscopy was(12.27±2.61) times;and in the conventional group, the pedicle puncture time was (22.83±3.09) min and the number of fluoroscopy was (10.93±1.62) times, the total operation time was(44.33±3.57) min, the total number of fluoroscopy was(19.20±2.67) times. There were statistically significant differences in the pedicle puncture time, intraoperative number of fluoroscopy, the total operation time, and the total number of fluoroscopy between the two groups(P<0.05). There was no significant difference in amount of bone cement injection between the two groups(P>0.05). There were no significant differences in VAS and the anterior edge compression rate of the injured vertebra at 3 days after operation between two groups(P>0.05). Three dimensional printing percutaneous guide plate assisted percutaneous kyphoplasty is safe and reliable, which can reduce the number of fluoroscopy, shorten the operation time, and decrease the radiation exposure of patients and medical staff, and conforms to the concept of precise orthopaedic management.

Application of different puncture techniques to inject bone cement in osteoporotic vertebral compression fractures

To study the application of different puncture techniques to inject bone cement in osteoporotic vertebral compression fractures (OVCFs). The clinical data of 282 patients with OVCFs treated from January 2017 to December 2019 were collected for a retrospective study. According to the surgical plan the patients were divided into group A and B, with 141 cases in each group. In group A, extreme lateral puncture was used to inject bone cement through unilateral puncture and bilateral puncture. In group B, bone cement was injected through unilateral pedicle puncture through pedicle approach. The operation status(operation time, radiation exposure time, bone cement injection volume, hospital stay) and complications were observed between two groups. Before operation and 6, 12 months after operation, the pain mediators such as serotonin 5-hydroxytryptamine (5-HT), prostaglandin E2(PGE2), substance P(SP) were compared, bone mineral density, anatomical parameters of the injured vertebrae (height of the anterior edge of the vertebral body, height of the posterior edge of the vertebral body, Cobb angle), visual analogue scale (VAS) and Oswestry disability index (ODI) were evaluated between two groups. There were no significant difference in operation time, radiation exposure time, hospital stay between two groups (P>0.05). The amount of bone cement injected in group A was greater than that in group B (P<0.05). The serum 5-HT, SP and PGE2 levels of group A were lower than those of group B at 12 months after operation (P<0.05). The height of anterior edge and height of the posterior edge of vertebral body in group A were greater than those of group B at 12 months after operation, Cobb angle of group A was smaller than that of group B, VAS and ODI were lower than those of group B(P<0.05). There was no significant difference in bone mineral density between two groups at 6 and 12 months postoperatively(P<0.05). There was no significant difference between two groups in postoperative complications (P>0.05). Compared with unilateral puncture of the pedicle approach, unilateral puncture and bilateral cement injection technique is more conducive to the recovery of the injured vertebral anatomy and function, and do not prolong operation time, radiation exposure time, hospital stay, nor do increase the risk of nerve damage and bone cement leakage, and postoperative bone metabolism and bone mineral density are improved well, which is a safe and reliable surgical method for the treatment of OVCFs.

Kyphoplasty with high viscosity bone cement for the treatment of stage III Kümmell disease without neurological symptoms: restoration of vertebral body height, reduction of kyphoplasty and restoration of column sagittal sequence.

BACKGROUND: Percutaneous kyphoplasty is widely used in the treatment of stage I and II Kummell disease, which can rapidly relieve pain, stabilize vertebral body and correct kyphosis;however, the treatment of stage III Kummell disease is still controversial. OBJECTIVE: To evaluate the clinical outcome of kyphoplasty with high-viscosity bone cement for treatment of stage III Kummell disease without neurologic symptoms. METHODS: Twenty-eight patients (11 males and 17 females, aged 57-82 years) with stage III Kummell disease without neurologic symptoms were admitted to Jiangyin People’s Hospital from May 2016 to May 2019, in which T11 vertebral body in 6 cases and T12 vertebral body in 14 cases, L1 vertebral body in 5 cases and L2 vertebral body in 3 cases were treated by kyphoplasty with high viscosity bone cement. At 1 day after operation and 1 year after follow up, postoperative pain and improvement of life ability were evaluated by the Visual Analogue Scale and Oswestry Disability Index. The recovery of vertebral height and correction of kyphosis were measured with X-ray films. The study was approved by the Ethics Committee of Jiangyin People’s Hospital, approval No. [2017](021). RESULTS AND CONCLUSION: (1) Totally 28 patients were followed up for 12-22 months. No serious complications such as wound infection or pulmonary embolism were found during treatment. Asymptomatic cement leakage occurred in three patients. Adjacent vertebral fracture was encountered in 1 patient at 3 months after operation, and healed after kyphoplasty. (2) Visual Analogue Scale, Oswestry Disability Index, and kyphotic angle were lower at 1 day and 1 year after operation than those before operation in 28 patients (P < 0.05). The height of anterior, middle and posterior edges of vertebral body at 1 day and 1 year after operation was higher than that before operation (P < 0.05). (3) The results showed that kyphoplasty with high-viscosity bone cement can relieve back pain, improve viability, retain the vertebral body height, reduce kyphosis, and restore spinal alignment, and is an effective method for treatment of stage III Kummell disease. (English) [ABSTRACT FROM AUTHOR] 背景：经皮球囊扩张椎体后凸成形能够快速缓解疼痛、稳定椎体、矫正脊柱后凸畸形，被广泛用于Ⅰ期、Ⅱ期Kummell病的治疗，但对于 Ⅲ期Kummell病的治疗方法目前尚存在争议。 目的：探讨高黏度骨水泥椎体后凸成形治疗无神经症状Ⅲ期Kummell病的疗效。 方法：选择2016年5月至2019年5月江阴市人民医院收治的无神经症状Ⅲ期Kummell病患者28例，其中男11例，女17例，年龄57-82岁；病 变椎体集中于胸腰段，其中T11椎体6例，T12椎体 14例，L1椎体5例，L2椎体3例，均接受高黏度骨水泥椎体后凸成形治疗。术后1 d及1年随 访时，采用目测类比评分和Oswestry功能障碍指数评价患者术后疼痛和生活能力改善情况，拍摄正、侧位X射线片测量椎体高度恢复和后 凸畸形矫正情况。研究获得江阴市人民医院伦理委员会批准，批件号：[2017]伦审研第(021)号。 结果与结论：①28例患者均顺利完成手术并完成随访，随访12-22个月，治疗过程中未出现伤口感染、肺栓塞等严重并发症，3例发生骨 水泥椎间隙渗漏，未引起临床症状；1例术后3个月出现邻近椎体骨折，行椎体后凸成形治疗后治愈；②28例患者术后1 d、术后1年时的目 测类比评分、Oswestry功能障碍指数评分与局部后凸角均低于术前(P < 0.05)，术后1 d、术后1年时的椎体前缘、中间及后缘高度均高于术 前(P < 0.05)；③结果表明，高黏度骨水泥椎体后凸成形可有效缓解患者腰背痛、改善患者生活能力、恢复椎体高度、减小后凸畸形、恢复 脊柱矢状序列，是治疗无神经症状Ⅲ期Kummell病的有效方法之一. (Chinese) [ABSTRACT FROM AUTHOR] Copyright of Chinese Journal of Tissue Engineering Research / Zhongguo zu zhi gong cheng yan jiu is the property of Chinese Journal of Tissue Engineering Research and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A Preoperative Predictive Model of Lower Lumbar Spine Instability Based on Three-Dimensional Computed Tomography: A Retrospective Case-Control Pilot Study.

ObjectiveThis study aimed to build a predictive model of lower lumbar instability.MethodsThis retrospective study included 199 patients. Patients were divided into the lower lumbar instability group (LLIG) (n = 98) and lower lumbar stability group (LLSG) (n = 101). All participants of LLIG were recruited over a 2‐year period (2015–2017) from the patients who accept lumbar surgery at the First Hospital of Jilin University. The LLSG was selected from outpatients who had underwent lumbar spine computed tomography (CT) and Flexion and extension radiographs (FER) at the First Hospital of Jilin University from 2015 to 2017. Several lower lumbar parameters were measured, including Lordosis angle (LA), intervertebral height (IH), ratio of anterior height to posterior height (APR), angle between endplate and anterior edge of vertebral body (AEPVa), sagittal slip ratio (SSR), and angle between the upper endplate and z‐axis on sagittal plane (AUEZS). These parameters were keyed into the SPSS software to create a predictive model for classification. Sensitivity, specificity, predictive accuracy, and Kappa value were used to evaluate the predictive model.ResultsCompared with LLSG, the LA of LLIG decreased by 3.49° (126.54° vs 130.3°). Similarly, the IH of LLIG decreased by 1.23°mm, 1.66°mm, and 0.71°mm at L3‐4, L4‐5, and L5‐S1. Compared with LLSG, the SSR of LLIG is higher at L3‐4, L4‐5, and L5‐S1 (0.54 vs 0.51, 0.57 vs 0.46, and 0.59 vs 0. 47). Moreover, the APR of LLIG is higher than those of LLSG at L3‐4, L4‐5, and L5‐S1 (1.97 vs 1.81, 2.40 vs 1.97, and 2.69 vs 2.26). The LLIG has bigger AEPVa than LLIG at L3‐4, L4‐5, and L5‐S1. Compared with LLSG, the AUEZS of LLIG is bigger at L3‐4 (91.75° vs 90.81°) and smaller at L4‐5 and L5‐S1(84.63° vs 85.85° and 73.27° vs 75.01°). The SSR (L4) show highest predictive accuracy (83%) when every parameter was fed to LDA classifier to generate a univariate model. All parameters represent a statistically significant difference (P < 0.05) between LLSG and LLIG. The model including LA, APR (L5‐S1), IH (L4‐5), SSR (L5), AUEZS (L5) has highest predictive accuracy of 88.2%. The sensitivity, specificity, and Kappa value are 88.7%, 93.1%, and 0.77.ConclusionThe predictive model has good classification performance and can be an auxiliary tool for clinicians to evaluate lumbar instability in preoperative patients with severe pain aggravated by lumbar movement.

Clinical efficacy of posterior percutaneous endoscopic cervical discectomy for single level cervical spondylopathy with intraspinal ossification

To evaluate the effectiveness and security of posterior percutaneous endoscopic cervical discectomy (PPECD) in the treatment of single level cervical spondylopathy with intraspinal ossification. Twenty three patients with single level cervical spondylopathy with intraspinal ossification were treated by posterior percutaneous endoscopic cervical discectomy between August 2017 and July 2019. There were 16 males and 7 females, aged from 29 to 74 years old with an average of (50±13) years.The disease duration were 3 to 120 months with a median of 6 months. There were 9 cases of cervical spondylotic radiculopathy, 6 cases of cervical spondylotic myelopathy, and 8 cases of mixed cervical spondylopathy. According to the characteristics of ossification, 17 cases were osteophytes on the posterior edge of the vertebral body;3 cases were protrusion ossification;3 cases were posterior longitudinal ligament ossification. According to the position of ossification in spinal canal, 14 cases were medial and lateral type, 5 cases were central type, and 4 cases were mixed type. Posterior percutaneous cervical endoscopic cervical discectomy in patients performed by the same surgeon. Japanese Orthopaedic Association (JOA) score and visual analogue scale(VAS) were compared separately before and after operation. At 3 months after operation, clinical effect was assessed according to modified Macnab standard. All operations were successful. The operative time was 30 to 155 (69.1±27.2) min. The bedridden time was 2 to 3(3.0±0.9) h, length of postoperative hospitalization was 2 to 7(4.1± 1.5) d. Three dimensional CT reconstruction of the cervical spine at 3 days after operation showed that ossified tissue of 13 cases were completely removed, and 10 cases were left after operation, and the residual was located at the posterior edge and/or center of the upper vertebral body. VAS score at discharge from hospital was significantly lower than that before operation (t=9.35, P<0.001), and 21 cases had a score of 0 to 3. Postoperative JOA score was significantly higher (t=7.29, P<0.001). At 3 months after operation, according to modified Macnab standard to evaluate clinical effect, 18 cases got exellent results, 4 good and 1 fair, with an excellent and good rate of 95.6%(22/23). For an experienced surgeon, percutaneous posterior cervical endoscopic discectomy is safe and reliable in treating single level cervical spondylopathy with intraspinal ossification, and can obtain good clinical results.

Clinical efficacy of endoscopy in the treatment of lumbar disc herniation combined with posterior apophyseal ring separation

To investigate the efficacy and safety of total spine endoscopy in the treatment of lumbar disc herniation combined with posterior apophyseal ring separation. From January 2015 to January 2018, a total of 21 patients with lumbar disc herniation complicated with posterior apophyseal ring separation were treated with total spine endoscopy via interlamina approach. There were 17 males and 4 females. The age ranged from 18 to 48 years old and the median age was 27 years old. All were single segment unilateral disc herniation, interlaminar approach was adopted, and the herniated disc was removed unilaterally at the symptomatic side under the microscope, and all or part of the broken bonewas removed. There were no complications such as incision infection, intervertebral space infection, intestinal injury, dural injury and cerebrospinal fluid leakage. The operation time ranged from 32 to 92 minutes and the median time was 57 minutes. Postoperative imaging examination showed that 2 patients had complete resection of osteotomy of posterior edge of vertebral body, 16 patients had partially resection and 3 patients had no resection. All intervertebral discs were completely removed. All 21 patients were followed up, and the duration ranged from 12 to 36 months, with a median of 15 months. The VAS of lumbago was 7.10±1.20 before surgery, 3.46±0.23 on the 3rd day after surgery, 2.36±0.19 on the 6th month after surgery; and the VAS of leg pain was 8.80±0.55 before surgery, 3.54±0.28 on the 3rd day after surgery, and 2.59±0.26 on the 6th month after surgery. The Oswestry Disability Index score was (69.71±9.37)% before surgery, (32.19±6.95)% on the 6th month after surgery, and (20.95± 6.16)% at the latest follow up. Onthe 1st year after operation, 16 patients got an excellent result, 4 good and 1 fair according to Macnab evaluation system. Total spine endoscopy via interlaminal approach can be used as an option in the treatment of lumbar disc herniation combined with vertebral posterior margin dissociation, which can reduce trauma and injury to the lumbar dorsal muscle and achieve similar decompression effect as open surgery. The long term efficacy needs to be further proved by prospective randomized controlled studies with larger sample size.

Anatomical Study of the Lumbar Segmental Arteries in Relation to the Oblique Lateral Interbody Fusion Approach

To use computed tomography angiography to evaluate the regional anatomy of the lumbar segmental arteries (LAs) associated with the surgical field in oblique lateral interbody fusion (OLIF). Computed tomography angiography images from 50 patients were reviewed. In the sagittal plane, distances from the LA to the upper and inferior edges of the vertebral body were measured in the anterior quarter of the anterior and median lines of the intervertebral disc (IVD). LAs were classified as types I-IV based on the zone in which they passed through the vertebral body. The LA branch angles were acute (<90°) at L1-L3 and blunt (>90°) at L4-L5. The average distances from the LA to the upper and inferior edges of the vertebral body in the anterior quarter position revealed that La1.2 > Lb1.2 andLb3.4.5 > La3.4.5. For the IVD of L1-L2, Lb1 < La2; IVD of L2-L3, Lb2 < La3; IVD of L3-L4, Lb3 > La4; IVD of L4-L5, Lb4 >La5. In zone I, the most frequent LA type was type IV at L1 (n= 41; 85.4%) and L2 (n= 42; 84.0%), type III at L3 (n=20; 40.0%), and type II at L4 (n= 36; 80.0%) and L5 (n= 5; 83.3%). In zone II, the most frequent LA type was type III at L1 (n= 38; 79.2%), L2 (n= 39; 78.0%), L3 (n= 43; 86.0%), and L4 (n= 28; 62.2%), whereas type II was the most frequent LA type at L5 (n= 5; 83.3%). In zone III, type III was the most frequent LA type at L1-L4. In zone IV, type IV was the most frequent LA type at L3 (n= 44; 88.0%), L4 (n= 42; 93.3%), and L5 (n= 6; 100%). The risk of LA injury during OLIF is the least when the cage is placed in zones II and III. Care is required during OLIF in zone IV of L3-L5. The fixation pin should be fixed on the upper edge of the lower vertebral body at L1-L2 and L2-L3, and on the lower edge of the upper vertebral body at L3-L4 and L4-L5.

Correlation between cone-beam CT images of the third and fourth cervical vertebrae and age in female skeletal class Ⅰ patients aged between 9 and 17 years in Qingdao

Objective: To analyze the correlation between the age and the cone-beam CT (CBCT) images of the third and fourth cervical vertebrae in female skeletal class Ⅰ patients aged between 9 and 17 years, and to establish a quantitative evaluation method for calculating the age. Methods: CBCT images of 108 female skeletal class Ⅰ patients aged between 9 and 17 years were collected from Qingdao Stomatological Hospital from September, 2017 to March, 2019. The two-dimensional linear values (AH: height of anterior edge of vertebral body; H: height of middle part of vertebral body; PH: height of posterior edge of vertebral body; AP: width of vertebral body), the two-dimensional linear ratio values (AH/PH, AH/AP, AH/H, H/AP, H/PH, PH/AP) and the three-dimensional volume values of the third vertical vertebrae (C3) and the fourth vertical vertebrae (C4) were measured. By Exponential transformation of measurements and multiple linear regression analysis, the optimal index for evaluating age were screened, and the fitting degree of multiple linear regression equation (R(2)) and the accuracy of age estimation (SEE) were compared. CBCT images of 27 female skeletal class Ⅰ patients aged from 9 to 17 years were added from Qingdao Stomatological Hospital between April, 2019 and July, 2019, by which the accuracy of the regression equation was verified. Results: Multiple linear regression equation for age estimation based on two-dimensional linear indexes was as follows: Y=-113.928+33.743×e(AH)(3)(/100)+58.844×e(PH)(4)(/100)+20.590×e(AP)(4)(/100)( "e" was a natural constant, e≈2.718), R(2)=0.745, SEE=1.31. Multiple linear regression equation for age estimation based on two-dimensional linear ratio indexes was as follows: Y=-0.076-2.284×e(A)H(3)/PH(3)+3.227×e(A)H(3)/AP(3)+2.149×e(A)H(3)/H(3)+1.961×e(A)H(4)/H(4), R(2)=0.576, SEE=1.70. Multiple linear regression equation of age estimation by the volume index was as follows: Y=-16.828+22.184×e(V)(3)(/10 000), R(2)=0.555, SEE=1.71. The data of 27 new patients were tested. The CBCT measurement index of C3 and C4 vertebral bodies inferred the fitting degree (R(2)) and accuracy (SEE) of the equation of the age estimation. The two-dimensional linear value was superior to the two-dimensional linear ratio and the latter was superior to the three-dimensional volume value. The standard error of the estimate about them was 1.74, 2.00 and 2.37, respectively. Conclusions: The two-dimensional linear index of CBCT images of C3 and C4 could be used to estimate the age of 9 to 17-year-old female skeletal class Ⅰ patients, and the accuracy of the method was higher than that of two-dimensional ratio index and three-dimensional volume index.

Finite element analysis of bending and standing manipulation in the treatment of lumbosacral joint disorder

To analyze the displacement, stress and mechanism of lumbosacral joint disorder patients after bending and standing manipulation in the finite element model. A three-dimensional finite element model of a patient with lumbosacral joint disorder was established. The finite element analysis method was used to observe and analyze the three loading conditions of the model:axial, 34 degree inclined upward and vertical upward. In the lumbosacral joint disorder model, the L₅ vertebral body was concentrated in the middle of the lower endplate, the intervertebral disc was concentrated in the center of the intervertebral disc, and the stress of S₁ and related structures were concentrated in the anterior and posterior edges of the vertebral body. After simulated manipulation, stress mainly concentrated in the anterior, posterior and central circular areas of L₅ vertebral upper endplate. The posterior structures of vertebral body concentrated in the ventral part of pedicle, isthmus and dorsal part of lamina. The stress of intervertebral disc dispersed in the posterior edge of vertebral body. Displacement results:In the lumbosacral joint disorder model, the left transverse process, the upper and lower articular process and the left part of spinous process were significantly displaced to the left, and the intervertebral disc was protruded forward. After simulated manipulation, the lower notch of L₅ vertebral body moved forward and upward; the area of intervertebral foramen increased; the inferior articular process of L₅ vertebral body moved forward; the superior articular process of sacrum moved forward and downward; the distance of articular process joints increased; and the displacement of sacrum concentrated on the posterior edge of vertebral body and the median sacral crest. Successful lumbosacral joint modeling can be carried out by finite element analysis, and the mechanism of bending and erecting manipulation is clear, which is effective and safe for the treatment of lumbosacral joint disorders.

The descending thoracic aorta morphological characteristics

Abstract Our study was conducted by consulting angioCT sites made on a CT GE LightSpeed VCT64 Slice CT and a CT GE LightSpeed 16 Slice CT, following the path and relationships of the descending thoracic aorta against the vertebral column, outside diameters thereof at the thoracic vertebrae T4, T7, T12 and posterior intercostal arteries characteristics. The origin of of the descending thoracic aorta we found most commonly on the left flank of the lower edge of the vertebral body T4, but I have encountered cases where it had come above the lower edge of T4 on level of intervertebral disc T4-T5 or even at the upper edge of T5 vertebral body. At thoracic vertebra T4, on a total of 30 cases, the descending thoracic aorta present a diameter of 20.0 to 32.6 mm, values that correspond to male gender and to females diameter ranging from 25.5 to 27, 4 mm. At level of T7 thoracic vertebra, thoracic aorta present a diameter of 19.6 to 29.5 mm, values found in men, in women the diameter being from 21.9 to 25.2 mm. At thoracic vertebra T12, on a total of 27 cases, the descending thoracic aorta present a diameter of 17.6 to 27.7 mm, in males the diameter was from 17.6 to 27.7 mm and females diameter ranging from 21.1 to 25.2. The length of the descending thoracic aorta was from 18.40 to 19.41 cm.

Vertebral body morphology is associated with incident lumbar vertebral fracture in postmenopausal women. The OFELY study.

We investigate the predictive role of vertebral anterior cortical curvature and height heterogeneity in the occurrence of vertebral fractures in postmenopausal women. Women who will fracture had shorter vertebral height, greater heterogeneity of height than those who will not fracture, and their anterior vertebral body edge was less concave. Vertebral morphology has been demonstrated to be associated with further risk of fracture. The aim of this study was to analyze vertebral anterior cortical curvature (Ct.curv) and vertebral height heterogeneity in postmenopausal women before the occurrence of a vertebral fracture. This case-control study included 29 postmenopausal women who have underwent incident lumbar vertebral fractures (mean age 71 ± 9years, mean time to fractures 9 ± 4years), age-matched with 57 controls. From lateral X-rays of lumbar spine radiographs (T12 to L4), the following parameters were measured: (1) the posterior, middle, and anterior vertebral heights; (2) the heterogeneity of heights evaluated by the coefficient of variation of these three variables; (3) antero-posterior width, a 2D estimator of cross-sectional area; and (4) Ct.curv. Mean vertebral heights were significantly lower among women who fractured than in controls (p < 0.05). The anterior and middle heights were significantly lower at L4 and L3 levels in fracture group (p = 0.02). The heterogeneity of vertebral height was significantly greater in the fracture group (p = 0.003). In addition, fractured patients had a significantly higher Ct.curv on L3 (p = 0.04). After adjustment for bone mineral density (BMD), only the heterogeneity of vertebral height remained significant (p = 0.005). The current case-control study confirmed the association between vertebral height and occurrence of future vertebral fracture in postmenopausal women. The vertebrae with the smallest Ct.curv tended to fracture less often, and the heterogeneity of vertebral heights was associated with future fracture independently of BMD. An additional validation in a prospective study would be needed to confirm these initial results.

Brucellar and tuberculous spondylitis: a comparative study of their imaging features

Objective To analyze and discuss the different characteristics of clinical imaging of Brucellar and tuberculous spondylitis, and to improve the diagnostic performance of the image of Brucellar spondylitis. Methods A retrospective analysis at Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University was conducted from January 2011 to December 2013. X-ray, computer tomography (CT) and magnetic resonance imaging (MRI) data of 46 cases of Brucellar spondylitis and 40 cases of tuberculous spondylitis were compared. Results The lumbar spine, especially L4, was usually involved in brucellosis, characterized with multiple small lesions mostly confined to the edge of vertebral body and surrounded by the hyperplasia and sclerosis. New damaged foci were formed in the new bone tissue and intervertebral discs destruction was slight with hyperplasia and sclerosis of articular surface. Few or no paravertebral abscesses were seen. In contrast, thoracic and lumbar spines were more usually affected in tuberculosis featured with destruction of vertebra and intervertebral discs. There could be dead bone formation. Paravertebral abscesses and osteoporosis were frequent. Conclusion The different imaging characteristics of Brucellar and tuberculous spondylitis could favor the differential diagnosis. Key words: Brucella spondylitis; Tuberculosis, spinal; Imaging; Research

The Effect of Percutaneous Vertebral Augmentation on Stable and Unstable Vertebral Fracture Nonunion: A Three-Dimensional Finite Element Study

Introduction Our previous study suggested that vertebral fracture nonunion(VFNU) could be classified into stable and unstable types based on whether there are fracture fragment in the middle column of fractured vertebrae, and we hypothesize that vertebral augmentation could restore the stability of fractured vertebrae in unstable type of VFNU, this study is to determine the effect of percutaneous vertebral augmentation on stable and unstable vertebral fracture nonunion by three-dimensional finite element analysis. Material and Methods An elderly senior, who suffers from osteoporosis, but owns the normal alignment and profile of thoracolumbar spine was included into this finite element study and accepted CT examination. The finite element three-dimension model of physiological thoracolumbar spine (T11-L3) was established and investigated with Mimics, Rapidform, and Abaqus softwares, then wedge-shaped osteotomy was performed in L1 vertebral body to stimulate intravertebral bone defect, which is the main feature of VFNU, to make the pathological finite element model of type A VFNU, which is named pathological model A. Furthermore, the posterior–inferior region of vertebral body was cut to build a piece of separated fracture, with the purpose of simulation of the pathological feature of type B VFNU and establishment of corresponding Finite element model which is called as Pathological model B. After that, imitated bone cement augment was performed in pathological model A and B, distributing cement in the whole intervertebral cleft or 5 mm ahead posterior edge of vertebral body, to establish four therapy finite element model, which were called as therapy model A1, B1, A2, and B2. All of the models were calculated under the same axial loads of 400 N, to investigate the validity of physiological model and compare the mechanical status of different models. Results The physiological finite element model owns good mechanic conformity with the reported models. Compared with physiological model, there was notable stress, strain concentration in the L1 vertebral body of pathological model A, mainly distributing beside the posterior cortex and in the posterior inferior part of the vertebral body, which indicated that there was a risk of further fracture in this model. Although there was also stress and strain concentration in pathological model B, the extent and level of stress and strain were lower than the corresponding value in the pathological model A, furthermore, concentration mainly located in the posterior–inferior fracture piece, which implied that the separated posterior–inferior fracture piece of vertebral body intended to dislocate, and the stress, strain concentration were dispersed after pathological Model A became Model B. According to calculation of therapy model A1, A2, the stress and strain concentration could be dispersed with bone cement augmentation, and the mechanic conduction function of L1 vertebral body could be restored after imitated PVP, which indicated that vertebroplasty could be used effectively in VFNU patients with reliable mechanic stability. However, on the basis of the calculation of therapy model B1 and B2, the tendency of stress, strain concentration, and displacement of posterior–inferior fracture piece could be found, even though the whole concentration could be dispersed by cement augmentation, which implied that there was risk of dislocation of posterior–inferior fracture piece after bone cement augmentation in pathological model B. Conclusion A favorable mechanical performance was revealed in stable VFNU after PVA, but the risk of redislocation of posterior–inferior bony fragments might be increased result from PVA.

Application of in vivo pelvis and abdominal-pelvic arterial network digital three-dimensional model for uterine artery embolization in surgical approach planning

To investigate the construction and significance of in vivo pelvis and abdominal-pelvic arterial vascular network in digital three-dimensional (3D) model for uterine artery embolization (UAE) in the application of surgical approach planning based on computerized tomographic angiography(CTA). A series of digital imaging and communications in medicine 3.0 (Dicom 3.0) were obtained from a woman with myoma of uterus by CTA scanning. Then the software Mimics Version 10.01 was used to construct the pelvic and the arterial vascular network 3D model. The digital model could clearly display the abdominal aorta, bilateral common iliac arteries, left and right external iliac artery, internal iliac artery and its branches around the stage; the right uterine artery emitted in the inferior gluteal artery opening below 15.91 mm, the left uterine artery in inferior gluteal artery below the opening of 15.21 mm, the adjacent artery of internal pudendal artery. At the same time, the artery length and angle of bifurcation were accurately measured. The bifurcation angle of abdominal aorta in fifth lumbar vertebral body edge, was 66.58°, the bifurcation angle of right internal iliac artery was 46.23°, the length of right common iliac artery was 51.43 mm, the bifurcation angle between left and external internal iliac artery was 36.45°, the length of left common iliac artery and 67.50 mm. According to the preoperative approach planning, guided wire across the inferior gluteal artery to the lower 15.00 mm and rotating digital subtraction angiography (DSA) tube, could clearly display the uterine artery opening outward by rotating guide wire, which was relatively easy to enter the uterine artery. The female pelvic arterial network model in vivo could be successfully constructed by using Mimics Version 10.01 software with database collected through CTA, which may contribute to the materialization of digital models and be used for preoperative surgical simulator.

Treatment of thoracolumbar fracture with pedicle screws at injury level: a biomechanical study based on three-dimensional finite element analysis

The aim of this study was to investigate the biomechanical mechanisms of treatment of thoracolumbar compression fracture with pedicle screws at injury level based on a three-dimensional finite element method. We constructed one three-dimensional finite element model of T11-L1 in a patient with a compression fracture of the T12 vertebral body(anterior edges of vertebral body were compressed to 1/2, and kyphosis Cobb angle was 18.6°) fixed by four pedicle screws and another model fixed by six pedicle screws at the injured vertebrae, and then assigned different forces to the two models to account for axial compression, flexion, extension, left lateral bending, and rightward axial rotation by Ansys software. After different loading forces were applied to the models, we recorded stress measurements on the vertebral pedicle screws, as well as the maximum displacement of T11. The stress distribution suggested that stress concentration was appreciable at the root of the pedicle screws under different loading modalities. Under axial compression, flexion, extension, left lateral bending, and rightward axial rotation load, the stress for the superior screw was significantly greater than the stress for the inferior screw (P < 0.05). The stress in the six pedicle screw fixation model was significantly decreased compared to the four screw interbody fusion model (P < 0.05), but the maximum displacement of T11 between two models under different loadings was not statistically different. The use of pedicle screws at injured vertebral bodies may optimize internal fixation load and reduce the incidence of broken screws.

Claustrophobia

Case-control study. The aim of this study was to assess the levels of psychological distress in patients with back pain who expressed claustrophobia at the time of their magnetic resonance imaging (MRI) scan, compared with sex and age-matched normal controls who did not exhibit claustrophobia. The secondary aim was to document the level of disability and intervention rates in this group. Psychosocial factors influence the outcomes of low back pain treatment with psychological distress being associated with poorer surgical outcomes in patients with low back pain. Up to 14% of patients experience claustrophobia during MRI scans requiring sedation to complete the scan. The effect of claustrophobia on back pain disability and outcomes has not been previously reported. Twenty females and 13 males all requiring MRI scan under sedation for claustrophobia (group 1) were compared with an age and sex-matched cohort that had MRI scan without sedation (group 2). Both groups were drawn from a chronic back clinic. Average age in both groups was 54 years (range, 27 to 79 y). Both groups had standard conservative therapy, together with psychometric evaluation: Zung Depression Index and Modified Somatic Perception Questionnaire. Disability was measured by Oswestry Disability Index. Primary outcome measures were intervention rates (surgery, injections, and physiotherapy sessions) and prevalence of psychological distress. Mean Zung Depression Index in group 1 was significantly higher than in group 2 (59.5 vs. 28.9, P<0.05) as was the mean Modified Somatic Perception Questionnaire score (13.3 vs. 9.2, P<0.05.) Prevalence of psychological distress was higher in group 1 (75.8% vs. 18.2%, P<0.05). Oswestry Disability Index was the same in both groups (50% vs. 48%). Group 1 had 13 interventions (13 patients=39.4%) compared with 26 in group 2 (26 patients=78.8%) (P< 0.05). Twenty-two patients (66.7%) in group 1 were discharged after their MRI scan with no intervention compared with 7 patients (21.2%) in group 2 (P<0.05). Claustrophobic patients with back pain showed higher levels of depression than nonclaustrophobic patients, with a higher rate of psychological distress. Disability, however, was not higher. The majority of claustrophobic patients did not require surgical intervention. The reasons for this are unclear and require further investigation. Claustrophobia requiring sedation for MRI scans may be a proxy for psychological distress in these patients and psychometric testing is advised during assessment to help with surgical decision making.

Design of a surgical instrument for removing bone to provide screw access to a spinal fusion cage

A surgical instrument to aid implantation of a range of lumbar spinal fusion cages has been developed. Once the cage is in position, the entrance to screw holes is partially blocked by the edge of the vertebral body. In order to insert fixation screws to secure the cage between the vertebrae, some part of the blocking edge has to be removed. Rongeurs are currently being used, but they can be time consuming and have the disadvantage that they may remove more bone than is necessary and may cause damage to the fusion cage if not used with care. In addition, access around some of the screw holes may be difficult. The aim of this instrument was to overcome these shortcomings. This paper describes the design of a surgical instrument for cutting edges from vertebral bodies. The development and evaluation of concept designs are presented and discussed. Potential risks were considered and modifications were performed on the selected concept. Functional prototypes were manufactured and tested on sheep lumbar vertebrae. The results showed that the newly designed cutting instrument functions as required and removes the required amount of bone from the vertebral body edge.

Anterior Approach Versus Posterior Approach With Subtotal Corpectomy, Decompression, and Reconstruction of Spine in the Treatment of Thoracolumbar Burst Fractures

A randomized, controlled follow-up study. The objective of this study was to compare the results of anterior approach versus posterior approach with subtotal corpectomy, decompression, and reconstruction of spine in the treatment of thoracolumbar burst fractures. Burst fractures are frequently associated with instability or neurological deficit. Anterior subtotal corpectomy, decompression, and reconstruction with instrumentation are an established method for a highly unstable burst fracture. In the past few years, subtotal corpectomy, decompression, and reconstruction of spine could be completed by posterior approach. Posterior segmental pedicle screw instrumentation, with its more rigid fixation and less technically demanding, could offer potential advantages. A total of 64 patients with thoracolumbar burst fractures were divided into 2 groups randomly. Group A was treated by anterior approach and group B was treated by posterior approach with subtotal corpectomy, decompression, and reconstruction of spine. During the minimum 24 months (range, 24 to 72 mo) follow-up period, all patients were prospectively evaluated for clinical and radiologic outcomes. The intraoperative blood loss, operative time, complications of operation, pulmonary function, Frankel scale, and the American Spinal Injury Association (ASIA) motor score were used for clinical evaluation, whereas the heights of anterior edge of vertebral body and the Cobb angle were examined for radiologic outcome. RESULTS: All patients in this study achieved solid fusion, with significant neurological improvement. The intraoperative blood loss (P<0.05) and complications of operation were less, the operative time was shorter (P<0.05), and the pulmonary function after operation was better in the group B (P<0.05). The Frankel scale, the ASIA motor score, and the radiologic results were not significantly different (P<0.05) at all time points between the 2 groups A and B. But the 2 groups improved in their neurological function by approximately 1.3 Frankel grade and 15.6 ASIA motor scores at final follow-up. Anterior approach and posterior approach with subtotal corpectomy, decompression, and reconstruction of spine are sufficient for surgical treatment of thoracolumbar burst fractures. Less intraoperative blood loss and complications, shorter operative time, and better pulmonary function after operation are the significant advantages of posterior surgery.