Vertebral Body Fractures Research Articles

Treatment strategy for osteoporotic vertebral body fractures in the lumbar spine: a case report and literature review

This report describes the successful treatment of an osteoporotic compression fracture. A 74-year-old woman presented with severe low back pain and left sciatica that had lasted for 6 weeks. Four week of conservative treatment was not effective. The patient was bedridden and had difficulty walking. A past history of osteoporosis was noted. Multilevel compression fractures, central stenosis, and spondylolisthesis with overt instability were evident in the preoperative images. Decompression and fusion surgery, vertebroplasty, and preoperative and postoperative teriparatide administration were planned. A severe endplate injury in the lower vertebral body was detected during interbody fusion surgery using an anterior approach. Additional screw insertion with posterolateral fusion was planned to prevent aggravation of cage subsidence. Postoperative magnetic resonance imaging, computed tomography (CT), and X-ray images revealed sufficient decompression, no cement leakage, and no nerve injury. On the first postoperative day, the patient reported that the left sciatica symptoms had improved. Satisfactory ambulation was observed at the outpatient department after 6 months. Fusion in progress was evident on follow-up CT and X-ray images. This case offers insights into possible treatment strategies for osteoporotic compression fractures with severe endplate injury, overt instability, and radiculopathy of the lower lumbar spine.

Preoperative Scoring System for Prediction of Early Adjacent Vertebral Body Fracture After Balloon Kyphoplasty Using X-Rays Taken in a Non-Weight-Bearing Position

Prevention of adjacent vertebral body fracture (AVF) following balloon kyphoplasty (BKP) is a key challenge. The objective of this study was to develop a scoring system that could be more extensively and effectively used to determine the surgical indications for BKP. The study involved 101 patients aged 60years or older who had undergone BKP. Logistic regression analysis was used to identify risk factors for early AVF within 2months following BKP. Scoring was based on the odds ratio for risk factors, and cut-off values were determined from the receiver operating characteristics curve. The correlation between the total scores and the incidence of early AVF, and the area under the curve for the logistic regression model predicting early AVF using the scoring system were investigated. 29 cases (28.7%) experienced early AVF after BKP. The scoring system was created as follows: 1) age (<75years: 0 points (P), ≥75years: 1P), 2) number of previous vertebral fractures (0: 0P, 1 or more: 2P), and 3) local kyphosis (<7°: 0P, ≥7°: 1P). The total scores were found to be positively correlated with the incidence of early AVF (r= 0.976, P= 0.004). The area under the curve of the scoring system for predicting early AVF was 0.796. The incidence of early AVF was 4.2% at ≤1P and 44.3% at ≥2P (P < 0.001). A scoring system which can be applied to a broader patient population was developed. In cases where the total score is 2P or more, alternatives to BKP should be considered.

Herniation of intervertebral disc into thoracolumbar fracture vertebral body leads to malunion of fracture and decrease of intervertebral space height

To analyze the clinical characteristics of intervertebral disc tissue injury and herniation into the vertebral body in thoracolumbar fracture on fracture healing, vertebral bone defect volume and intervertebral space height. From April 2016 to April 2020, a total of 140 patients with thoracolumbar single vertebral fracture combined with upper intervertebral disc injury treated with pedicle screw rod system reduction and internal fixation in our hospital. There were 83 males and 57 females, aged from 19 to 58 years old, with an average age of (39.33±10.26) years old. All patients were followed up regularly 6 months, 12 months and 18 months after surgery. The patients with injured intervertebral disc tissue not herniated into the fractured vertebral body were the control group, and the patients with injured intervertebral disc and herniated into the fractured vertebral body were the observation group. By detecting the thoracolumbar AP and lateral X-ray films, CT and MRI of the thoracolumbar segment at different follow-up time, calculate the changes of the wedge angle of the fractured vertebral body, the sagittal kyphosis angle and the height of the superior adjacent intervertebral space, the changes of the fracture healing and bone defect volume after the reduction of the vertebral body, and the changes of the intervertebral disc degeneration grade. The prognosis was evaluated by visual analogue scale(VAS) and Oswestry disability index(ODI). Finally, the differences of the above results among different groups were comprehensively analyzed. All the patients had normal wound healing without complications. A total of 87 patients received complete follow-up data, at least 18 months after internal fixation. Thoracolumbar AP and lateral X-ray films showed that 18 months after the reduction and internal fixation operation, the vertebral wedge angle, sagittal kyphosis angle and the height of the upper adjacent intervertebral space in the observation group were greater than those in the control group(P<0.05). CT scanning showed that the deformity of the fracture healed 12 months after the vertebral body reduction in the observation group and formed a "cavity" of bone defect connected with the intervertebral space, and its volume was significantly increased compared with that before (P<0.05). MRI scanning showed that the degeneration rate of injured intervertebral discs in the observation group was more serious than that in the control group 12 months after operation(P<0.05). However, there was no significant difference in VAS and ODI score at each time. Herniation of injured intervertebral disc tissue hernias into the fractured vertebral body leads to increased bone resorption defect volume around the fracture and forms a malunion "cavity" connected with the intervertebral space. This may be the main reason for the change of vertebral wedge angle, the increase of sagittal kyphosis angle and the decrease of intervertebral space height after removal of internal fixation devices.

Interspinous ligamentoplasty for symptomatic lumbar spinal stenosis coexisting with mild segmental instability and vertebral body fracture: a report of 2 cases and a literature review

This report aimed to present successfully treated cases of lumbar spinal stenosis coexisting with mild segmental instability and vertebral body fracture. Two patients presented with chief complaints of sciatica and back pain that had lasted for 2 months. Preoperative images revealed lumbar spinal stenosis with mild segmental instability and compression fracture. Interspinous ligamentoplasty was done under general anesthesia. Treatment outcomes were assessed by numeric rating scale (NRS) scores, postoperative magnetic resonance imaging (MRI), and X-ray examinations. Favorable treatment outcomes were observed: Sciatica and back pain improved and the patients’ NRS scores also improved. Postoperative MRI showed sufficient decompression, and X-rays showed stabilization at the index level. Postoperative complications were not reported. Interspinous ligamentoplasty can be a good surgical option for lumbar spinal stenosis that coexists with mild segmental instability and vertebral body fracture.

Morphological Features and Clinical Results of C2 Vertebral Body Fractures

Type of study: Retrospective study. Objectives: To classify and analyze the morphological patterns of vertebral body fractures and report the clinical results. Summary of literature review: There have not been many reports on the classification of vertebral body fractures and treatment results, and it remains a matter of debate. Materials and methods: Among 107 patients diagnosed with an axis fracture from 2005 to 2019, 53 patients with fracture involving the vertebral body were selected. After the exclusion of 9 patients with a history of cervical spine surgery or who were lost to follow-up, 44 consecutive patients were enrolled in this retrospective study. Patients were classified into 5 groups (coronal, sagittal, transverse, avulsion, and complex) according to the main fracture line. The demographic data, injury mechanism, discoligamentous injury, combined injury, neurological symptoms, and clinical treatment results were analyzed. Results: Patients’ average age was 61.7 years (range, 25–81 years). 24 patients were male and 20 were female. The average follow-up period was 14.2 months (range, 7–33 months). The coronal, sagittal, transverse, avulsion, and complex groups contained 5, 5,8, 7, and 19 patients, respectively. Six patients were injured by slip-down accidents, 12 patients by falling height, and 26 patients by traffic accidents. Eighteen patients were presented with a discoligamentous injury. Twenty-five patients showed a combination of fractures of cervical vertebrae and bones. Thirteen patients presented neurological symptoms. 16 patients were treated with a neck collar and 28 patients were treated with a halo-vest. Two patients eventually required surgical fusion because union was not achieved with conservative management. In the final follow-up, all neurological symptoms were resolved; however, 4 patients still complained of a mild tingling sensation in the upper extremity. Pin site infection occurred in 3 patients who were treated with a halo-vest, but it was controlled after antibiotic administration. Conclusion: Vertebral body fractures accounted for almost 50% of axis fractures in this study. Vertebral body fractures can be classified into 5 groups (coronal, sagittal, transverse, avulsion, and complex) according to the morphological pattern. Non-operative management can be a reasonable treatment option with good clinical results and bone union.

Spinal epidural empyema in a colobus monkey

AbstractA 10‐year‐old, male colobus monkey presented with a kyphotic appearance. Lumbar spinal pain was suspected, and the colobus was started on a course of meloxicam. With no improvement noted, it was sedated for examination. Haematology revealed a neutrophilia. An empirical course of clavulanate potentiated amoxicillin was started. With no improvements seen after a 10‐day course, clinical examination was repeated. Abdominal ultrasound and abdominal radiographs revealed an abdominal effusion near the lumbar vertebrae, and haematology revealed a neutrophilia with toxic neutrophils. An enrofloxacin course was started. Three days later, the colobus presented with acute paraplegia with neurolocalisation to the T3–L3 spinal cord segments. A magnetic resonance imaging of the vertebral column was performed. Magnetic resonance imaging revealed multifocal osteolytic vertebral body lesions, compression fractures of multiple vertebral bodies and ventral spinal cord compression. Differential diagnosis included infectious osteomyelitis with spinal epidural empyema or less likely, neoplasia. Due to the poor prognosis, euthanasia was elected.

Analysis of the causes and clinical results of vertebral fracture during oblique lateral lumbar interbody fusion

To analyze the causes of vertebral fracture during oblique lateral interbody fusion in the treatment of lumbar spondylopathy, summarize the clinical results, and propose preventive measures. Retrospective analysis was made on the data of 8 cases of lumbar spondylopathy and vertebral fracture treated by oblique lateral interbody fusion in three medical centers from October 2014 to December 2018. All were female, aged from 50 to 81 years with an average of 66.4 years. Disease types included 1 case of lumbar degenerative disease, 3 cases of lumbar spinal stenosis, 2 cases of lumbar degenerative spondylolisthesis and 2 cases of lumbar degenerative scoliosis. Preoperative dual energy X-ray bone mineral density test showed that 2 cases had T-value >-1 SD, 2 cases had T-value -1 to -2.5 SD, and 4 cases had T-value <-2.5 SD. Single segment fusion was in 5 cases, two segment fusion in 1 case and three segment fusion in 2 cases. Four cases were treated with OLIF Stand-alone and 4 cases were treated with OLIF combined with posterior pedicle screw fixation. Postoperative imaging examination showed vertebral fracture, and all of them were single vertebral fracture. There were 2 cases of right lower edge fracture of upper vertebral body at fusion segment, 6 cases of lower vertebral body fracture at fusion segment, and 6 cases with endplate injury and fusion cage partially embedded in vertebral body. Three cases of OLIF Stand-alone were treated with pedicle screw fixation via posterior intermuscular approach, while one case of OLIF Stand-alone and four cases of OLIF combined with posterior pedicle screw fixation were not treated specially. The 5 cases of initial operation and 3 cases of reoperation did not show wound skin necrosis or wound infection. The follow-up time was from 12 to 48 months with an average of 22.8 months. Visual analogue scale (VAS) of low back pain was preoperative decreased from 4 to 8 points (averagely 6.3 points) and postoperative 1 to 3 points (averagely 1.7 points) at the final follow-up. Oswestry disability index (ODI) was preoperative 39.7% to 52.4% (averagely 40.2%), and postoperative 7.9% to 11.2% (averagely 9.5%) at the final follow-up. During the follow-up, there was no loosening or fracture of the pedicle screw system, and no lateral displacement of the fusion cage;however, the fusion cage at the vertebral fracture segment had obvious subsidence. The intervertebral space height of vertebral fracture segment was preoperaive 6.7 to 9.2 mm (averagely 8.1 mm), and postoperative 10.5 to 12.8 mm (averagely 11.2 mm). The improvement rate after operation was 37.98% compared to preoperative. The intervertebral space height at final follow-up was 8.4 to 10.9 mm (averagely 9.3 mm), and the loss rate was 16.71% compared with that after operation. At the final follow-up, interbody fusion was achieved in all cases except for one that could not be identified. The incidence of vertebral fracture during oblique lateral interbody fusion in the treatment of lumbar spondylopathy is lower, and there are many reasons for fracture, including preoperative bone loss or osteoporosis, endplate injury, irregular shape of endplate, excessive selection of fusion cage, and osteophyte hyperplasia at the affected segment. As long as vertebral fracture is found in time and handled properly, the prognosis is well. However, it still needs to strengthen prevention.

Comparative study between vertebroplasty and kyphoplasty in management of osteoporotic vertebral body fractures

BackgroundPercutaneous vertebroplasty and percutaneous kyphoplasty are effective minimally invasive procedures in reducing pain and improving the quality of life in patients with osteoporotic vertebral compression fractures with different degrees, but it may lead to serious neurological complications.ResultsTwenty-five patients were included in our study. Both techniques were done under local anesthesia using bi-pedicular approach. All cases were assessed using plain radiographs pre- and post-operative, Visual Analogue Scale for pain, and modified Oswestry Disability Index for functional disability. Thirteen patients had vertebroplasty and 12 patients had kyphoplasty. The mean age for vertebroplasty group was 66.94 ± 6.71, while in kyphoplasty group, the mean age was 70.38 ± 9.21. In vertebroplasty group, there were ten females and three males, while in kyphoplasty group, there were nine females and three males. All cases had single vertebral level affection except one patient in the vertebroplasty group that had double-level affection. In vertebroplasty group, ten patients had lumbar spine affection, two patients had dorsal spine affection and one patient had combined dorsal and lumbar spine affection. In kyphoplasty group, ten patients had lumbar spine affection and two patients had dorsal spine affection. The mean post-operative Visual Analogue Scale was 0.46 and 0.50 in vertebroplasty and kyphoplasty groups, respectively. The mean post-operative modified Oswestry Disability Index became 4.15 and 4 in vertebroplasty and kyphoplasty groups, respectively. The mean post-operative local kyphotic angle was 6.0° and 6.50° in vertebroplasty and kyphoplasty groups, respectively. The mean vertebral height became 73.15% and 75% post-operatively in vertebroplasty and kyphoplasty groups, respectively. The intra-operative cement leakage occurred in three cases of vertebroplasty group and one case of kyphoplasty group (P = 0.644). The cost of kyphoplasty was very high in comparison with vertebroplasty.ConclusionsThere is no difference between vertebroplasty and kyphoplasty as regard pain relief, improved quality of life, correction of kyphotic angle, vertebral height restoration and the incidence of cement leakage except that kyphoplasty has a very high cost than vertebroplasty. Therefore, both techniques have an equal effect in treating osteoporotic vertebral compression fractures.

Laparoscopic Surgical Treatment of Hiatal Hernia with Gastric Volvulus: Report of a Case

Paraesophageal hernias represent 5 to 10% of all hiatal hernias. Mainly because of the ageing of the population, their incidence is increasing: the etiopathogenesis is defined in fact by weakening of the diaphragmatic esophageal ligament, dilatation of the esophageal hiatus due to vertebral body fracture, gibbus deformity, obesity, and an increase in abdominal pressure [2]. They are classified into four types [1]:

The effect of type 2 diabetes mellitus on the prognosis of osteoporotic vertebral compression fracture with osteoporotic fracture classification after vertebroplasty

BackgroundTo analyze the clinical and radiological effects of type 2 diabetes mellitus on the prognosis of osteoporotic vertebral compression fracture after percutaneous vertebroplasty, and explore the prognostic value of osteoporotic fracture classification.MethodsOsteoporotic vertebral compression fracture patients who received vertebroplasty from January 1, 2016 to June 30, 2021 were divided into type 2 diabetes mellitus group and control group in this retrospective cohort study. Visual analogue scale, Oswestry Disability Index, bone cement leakage, new compression fracture, anterior, middle, and posterior portion heights of vertebral body and local Cobb angle on X-ray before surgery, 2 days after surgery, 6 months, and 12 months after surgery were recorded, and the osteoporotic fracture classification was performed. P < 0.05 was set as statistical significance.ResultsA total of 261 vertebral bodies were included, containing 68 in the type 2 diabetes mellitus group and 193 in the control group. There were no differences in baseline characteristics between the two groups. At 6 months after vertebroplasty, the local Cobb angle of the type 2 diabetes mellitus group was 8.29 ± 4.90° greater than that of the control group 6.05 ± 5.18° (P = 0.002). At 12 months, compared with pre-operation, the anterior portion height recovered 8.13 ± 12.90%, which was less than 12.51 ± 14.92% of the control group (P = 0.032), and 19.07 ± 16.47% of the middle portion height recovery was less than the control group’s 24.63 ± 17.67% (P = 0.024). Compared with the control group, osteoporotic fracture 2 vertebral bodies of the type 2 diabetes mellitus group at 12 months postoperatively in middle portion height (14.82 ± 14.71% vs 24.78 ± 18.16%, P = 0.023) and local Cobb angle (5.65 ± 4.06° vs 3.26 ± 4.86°, P = 0.043) restored significantly worse. Besides, osteoporotic fracture 3 with type 2 diabetes mellitus restored worse in anterior portion height (5.40 ± 11.02% vs 13.57 ± 12.79%, P = 0.008), middle portion height (11.22 ± 15.53% vs 17.84 ± 12.36%, P = 0.041) and local Cobb angle (10.85 ± 3.79 vs 7.97 ± 3.83°, P = 0.002) at 12 months postoperatively. There was no difference in radiological outcomes of osteoporotic fracture 4 between the two groups.ConclusionsThe degree of fractured vertebral compression, the recovery of the height and angle obtained immediately after surgery and the clinical symptoms in type 2 diabetes mellitus patients were not different from those in the control. However, vertebral body morphology of type 2 diabetes mellitus patients was worse since the sixth month after surgery. Osteoporotic fracture classification has a good prognostic reference value for both the control and the type 2 diabetes mellitus population.

Endovascular Repair of Traumatic Infrarenal Aortic Injury in an 8-Year-Old.

The patient is an 8 year-old male presenting to outside facility following high-speed motor vehicle collision in which he was a restrained passenger. CT imaging at that time demonstrated a traumatic infrarenal aortic pseudoaneurysm, extensive pneumoperitoneum and free fluid, and an unstable L2 vertebral body fracture. He underwent exploratory laparotomy with small bowel resection prior to transfer. The patient was left in discontinuity and temporary closed. Vascular surgery was consulted upon arrival to tertiary care children's hospital. The decision was made to proceed with emergent endovascular repair. An aortogram confirmed the location of the aortic disruption well below the renal arteries, superior to the bifurcation. An 11 mm × 5 cm Viabahn covered stent was placed across the injury with adequate proximal and distal seal. This is a case of seatbelt-related pediatric infrarenal aortic injury in the setting of polytrauma. Endovascular repair was pursued in this damage-control setting.

Improvement of vertebral body fracture reduction utilizing a posterior reduction tool: a single-center experience

BackgroundExtensive research regarding instabilities and prevention of kyphotic malalignment in the thoracolumbar spine exists. Keystones of this treatment are posterior instrumentation and anterior vertebral height restoration. Anterior column reduction via a single-stage procedure seems to be advantageous regarding complication, blood loss, and OR-time. Mechanical elevation of the anterior cortex of the vertebra may prevent the necessity of additional anterior stabilization or vertebral body replacement. The purpose of this study was to examine (1) if increased bony reduction in the anterior vertebral cortex could be achieved by utilization of an additional reduction tool, (2) if postoperative loss of vertebral height could be reduced, and (3) if anterior column reduction is related to clinical outcome.MethodsFrom one level I trauma center, 173 patients underwent posterior stabilization for fractures of the thoracolumbar region between 2015 and 2020. Reduction in the vertebral body was performed via intraoperative lordotic positioning or by utilization of an additional reduction tool (Nforce, Medtronic). The reduction tool was mounted onto the pedicle screws and removed after tightening of the locking screws. To assess bony reduction, the sagittal index (SI) and vertebral kyphosis angle (VKA) were measured on X-rays and CT images at different time points ((1) preoperative, (2) postoperative, (3) ≥ 3 months postoperative). Clinical outcome was assessed utilizing the Ostwestry Disability Index (ODI).ResultsBisegmental stabilization of AO/OTA type A3/A4 vertebral fractures was performed in 77 patients. Thereof, reduction was performed in 44 patients (females 34%) via intraoperative positioning alone (control group), whereas 33 patients (females 33%) underwent additional reduction utilizing a mechanical reduction tool (instrumentation group). Mean age was 41 ± 13 years in the instrumentation group (IG) and 52 ± 12 years in the control group (CG) (p < 0.001). No differences in terms of gender and comorbidities were found between the two groups. Preoperatively, the sagittal index (SI) was 0.69 in IG compared to 0.74 in CG (p = 0.039), resulting in a vertebral kyphosis angle (VKA) of 15.0° vs. 11.7° (p = 0.004). Intraoperatively, a significantly greater correction of the kyphotic deformity was achieved in the IG (p < 0.001), resulting in a compensation of the initially more severe kyphotic malalignment. The SI was corrected by 0.20–0.88 postoperatively, resulting in an improvement of the VKA by 8.7°–6.3°. In the CG, the SI could be corrected by 0.12–0.86 and the VKA by 5.1°–6.6°. The amount of correction was influenced by the initial deformity (p < 0.001). Postoperatively, both groups showed a loss of correction, resulting in a gain of 0.08 for the SI and 4.1° in IG and 0.03 and 2.0°, respectively. The best results were observed in younger patients with initially severe kyphotic deformity. Considering various influencing factors, clinical outcome determined by the ODI showed no significant differences between both groups.ConclusionUtilization of the investigated reduction tool during posterior stabilization of vertebral body fractures in a suitable collective of young patients with good bone quality and severe fracture deformity may lead to better reduction in the ventral column of the fractured vertebral body and angle correction. Therefore, additional anterior stabilization or vertebral body replacement may be prevented.

Treatment and Outcome of Osteoporotic Thoracolumbar Vertebral Body Fractures With Deformation of Both Endplates With or Without Posterior Wall Involvement (OF 4): Short-Term Results from the Prospective EOFTT Multicenter Study.

Multicenter prospective cohort study. To analyse therapeutical strategies applied to osteoporotic thoracolumbar OF 4 injuries, to assess related complications and clinical outcome. A multicenter prospective cohort study (EOFTT) including 518 consecutive patients who were treated for an Osteoporotic vertebral compression fracture (OVCF). For the present study, only patients with OF 4 fractures were analysed. Outcome parameters were complications, Visual Analogue Scale, Oswestry Disability Questionnaire, Timed Up & Go test, EQ-5D 5L, and Barthel Index after a minimum follow-up of 6weeks. A total of 152 (29%) patients presented with OF 4 fractures with a mean age of 76years (range 41-97). The most common treatment was short-segment posterior stabilization (51%; hybrid stabilization in 36%). Mean follow up was 208 days (±131days), mean ODI was 30 ± 21. Dorsoventral stabilized patients were younger compared to the other groups (P < .001) and had significant better TuG compared to hybrid stabilization (P = .049). The other clinical outcomes did not differ in the therapy strategies (VAS pain: P = 1.000, ODI: P > .602, Barthel: P > .252, EQ-5D 5L index value: P > .610, VAS-EQ-5D 5L: P = 1.000). The inpatient complication rate was 8% after conservative and 16% after surgical treatment. During follow-up period 14% of conservatively treated patients and 3% of surgical treated patients experienced neurological deficits. Conservative therapy of OF 4 injuries seems to be viable option in patients with only moderate symptoms. Hybrid stabilization was the dominant treatment strategy leading to promising clinical short-term results. Stand-alone cement augmentation seems to be a valid alternative in selected cases.

Automated detection and classification of acute vertebral body fractures using a convolutional neural network on computed tomography.

Acute vertebral fracture is usually caused by low-energy injury with osteoporosis and high-energy trauma. The AOSpine thoracolumbar spine injury classification system (AO classification) plays an important role in the diagnosis and treatment of the disease. The diagnosis and description of vertebral fractures according to the classification scheme requires a great deal of time and energy for radiologists. To design and validate a multistage deep learning system (multistage AO system) for the automatic detection, localization and classification of acute thoracolumbar vertebral body fractures according to AO classification on computed tomography. The CT images of 1,217 patients who came to our hospital from January 2015 to December 2019 were collected retrospectively. The fractures were marked and classified by 2 junior radiology residents according to the type A standard in the AO classification. Marked fracture sites included the upper endplate, lower endplate and posterior wall. When there were inconsistent opinions on classification labels, the final result was determined by a director radiologist. We integrated different networks into different stages of the overall framework. U-net and a graph convolutional neural network (U-GCN) are used to realize the location and classification of the thoracolumbar spine. Next, a classification network is used to detect whether the thoracolumbar spine has a fracture. In the third stage, we detect fractures in different parts of the thoracolumbar spine by using a multibranch output network and finally obtain the AO types. The mean age of the patients was 61.87 years with a standard deviation of 17.04 years, consisting of 760 female patients and 457 male patients. On vertebrae level, sensitivity for fracture detection was 95.23% in test dataset, with an accuracy of 97.93% and a specificity of 98.35%. For the classification of vertebral body fractures, the balanced accuracy was 79.56%, with an AUC of 0.904 for type A1, 0.945 for type A2, 0.878 for type A3 and 0.942 for type A4. The multistage AO system can automatically detect and classify acute vertebral body fractures in the thoracolumbar spine on CT images according to AO classification with high accuracy.

The late-term results in our patients operated for lumbar spine fractures

Aim: The current study aimed to evaluate the late-term results of patients operated for lumbar spine fractures in our clinic. &#x0D; Material and Method: 134 patients from January 2012 to January 2020 were treated with “short-segment pedicle instrumentation” for lumbar fractures in our neurosurgery department. Patients with a burst fracture of a single lumbar vertebra were included. The final sample consisted of 67 patients who were followed up over the years with radiographs before and after surgery and CT scans at the final follow-up. &#x0D; Results: The results showed that 60% of the patients were rated as Denis P1, 35% as P2, and 5% as P3. Screw breakage was observed in seven patients, and 67 patients underwent revision surgery. Furthermore, the fractured vertebral body’s height was improved at the final follow-up stage, and an increase was witnessed from the preoperative figure of 16.4 mm to 25.8 at the final follow-up. At the final follow-up, the average Cobb angle was -11.6° preoperatively, and 6.3° after the operation and the correction loss was 12.1° which was severe in the middle part of the vertebra. By the final follow-up, disc spaces were narrowed below and above the fractured vertebra, and no correlation was found between clinical outcomes and adjacent disc degeneration. &#x0D; Conclusion: We concluded that short-segment pedicle instrumentation produced satisfactory long-term results for lumbar fractures. To achieve adequate outcomes, correct management of complications and evaluation of various factors must be focused on.

Robot-Assisted Kyphoplasty versus Fluoroscopy-Assisted Kyphoplasty: A Meta-Analysis of Postoperative Outcomes.

Osteoporotic vertebral compression fractures are the most common manifestation of osteoporosis. Percutaneous kyphoplasty (PKP) can lead to both pain improvement and correction of kyphosis secondary to collapsed vertebral bodies. Robot-assisted (RA) PKP has been reported to provide better vertebral body fracture correction than conventional fluoroscopy-assisted (FA) PKP. The aim of this meta-analysis is to compare clinical outcomes of RA PKP versus FA PKP. The Pubmed, Embase, and MEDLINE electronic databases were searched from January 1900 to December 2022, with no language restrictions for relevant articles. We extracted the preoperative and postoperative mean pain score and standard deviation from the included studies and pooled them using an inverse variance method. Statistical analyses were performed using functions available in the metafor package in R software. The results of this meta-analysis were summarized with weighted mean differences (WMDs). Our search strategy identified 181 references from the Pubmed, Embase, and MEDLINE electronic databases. We excluded duplicates and irrelevant references, after screening titles and abstracts. The remaining 12 studies were retrieved for full-text review, and, finally, we included five retrospective cohort studies from 2015 to 2021, comprising 223 patients undergoing RA PKP and 246 patients undergoing FA PKP. No difference was found in subgroup analysis based on the timing of postoperative pain assessment, despite the overall estimate of postoperative pain indicating a significant difference between the RA PKP and FA PKP groups (WMD, -0.22; 95% CI, -0.39 to -0.05). The long-term pain assessment revealed a significantly lower VAS in the RA PKP group than the FA PKP group at six months postoperatively (WMD, -0.15; 95% CI, -0.30 to -0.01), but no difference between the subgroups at three (WMD, 0.06; 95% CI, -0.41 to -0.54) and twelve months (WMD, -0.10; 95% CI, -0.50 to 0.30) postoperatively. Our meta-analysis revealed no significant difference in postoperative pain between RA PKP and FA PKP. Patients undergoing RA PKP had better pain improvement compared to FA PKP at 6 months postoperatively. However, further studies focusing on long-term outcomes in patients undergoing RA PKP are warranted to clarify its benefit, given the small number of included studies.

Radiofrequency Ablation in Vertebral Body Metastasis with and without Percutaneous Cement Augmentation: A Systematic Review Addressing the Need for SPINE Stability Evaluation

Vertebral body metastases (VBM) are one of the most frequent sites of bone metastasis, and their adequate therapeutic management still represents an insidious challenge for both oncologists and surgeons. A possible alternative treatment for VBM is radiofrequency ablation (RFA), a percutaneous technique in which an alternating current is delivered to the tumor lesion producing local heating and consequent necrosis. However, RFA alone could alter the biomechanics and microanatomy of the vertebral body, thus increasing the risk of post-procedure vertebral fractures and spine instability, and indeed the aim of the present study is to investigate the effects of RFA on spine stability. A systematic review according to PRISMA-P guidelines was performed, and 17 papers were selected for the systematic review. The results show how RFA is an effective, safe, and feasible alternative to conventional radiotherapy for the treatment of VBM without indication for surgery, but spine stability is a major issue in this context. Although exerting undeniable benefits on pain control and local tumor recurrence, RFA alone increases the risk of spine instability and consequent vertebral body fractures and collapses. Concomitant safe and feasible therapeutic strategies such as percutaneous vertebroplasty and kyphoplasty have shown synergic positive effects on back pain and improvement in spine stability.

Aspects of vertebral column resection in patients with rigid kyphotic and kyphoscoliotic deformities of different genesis of the thoracolumbar spine: multicenter retrospective observational cohort study

BACKGROUND: Vertebral column resection (VCR) as a type of spinal osteotomy is characterized by maximum possibilities of three-dimensional correction of various etiologies: congenital, post-tuberculous, iatrogenic (after other interventions on the spine), degenerative, and vertebral spondyloptosis caused by Kmmels disease, and primary, and metastatic tumor lesions of the spine. Nowadays, the use of single-level VCR is far beyond its initial purpose.&#x0D; OBJECTIVE: The study aimed to compare features of VCR for rigid deformities of various etiologies and management of erythrocyte blood products in the perioperative period.&#x0D; MATERIALS AND METHODS: A multicenter retrospective observational cohort study analyzed data from 53 adult (aged 18 years) patients with kyphotic and kyphoscoliotic deformities of the thoracic and lumbar spine, distributed into four comparison groups according to the deformity genesis, namely, impaired spinal development, traumatic genesis, degenerative or idiopathic, and neoplasms of the vertebral bodies. The characteristics of VCR in these patients were compared.&#x0D; RESULTS: The surgery duration was longer in VCR for spinal neoplasms (p 0.05) than for high-energy burst compression fractures of vertebral bodies and scoliotic deformities (grade IV). On average, this group also had the most cranial osteotomy level among the study groups. VCR for idiopathic scoliotic deformities is characterized by a larger intraoperative blood loss volume than other nosologies, and the differences were statistically significant. In male patients of this group, the hemoglobin level on day 1 after surgery was statistically significantly lower than in those who underwent VCR for compression fractures of the vertebral bodies or impaired vertebral development. During resection of the vertebral column for burst compression fractures of the vertebral bodies, the fixation length was less (p 0.05), with a similar intervention for developmental anomalies, deformities of postoperative genesis, and grade IV idiopathic scoliosis. VCR for grade IV idiopathic scoliosis requires a larger (p 0.05) volume of the reinfused autologous blood than for intervention for acute traumatic pathologies (burst compression fractures of the vertebral bodies).&#x0D; CONCLUSION: The versatility of clinical tasks for which resection of the spinal column can be performed using the VCR technique also determines the significant heterogeneity of the patients who undergo such treatment. Knowledge of the interventions in various nosologies is very useful in vertebrological practice.

Does Erector Spinae Plane Block Decrease Analgesia Requirements After Minimal-Invasive Posterior Transpedicular Stabilization in Patients With Vertebral Body Fracture? A Prospective, Randomized, Double-Blind Controlled Study.

Prospective randomized placebo controlled double blind trial. To examine the effect of ESP block after minimally invasive posterior stabilization for vertebral fractures on opioid consumption, pain, blood loss, disability level, and wound healing complications. Patients indicated for minimal invasive posterior stabilisation were included to the study. Our primary outcome was the opioid consumption and Visual Analogue Scale (VAS) measured during the first 48 hours. Secondary outcomes used to measure the short-term outcome included Oswestry Disability Index (ODI) and Patient Reported Outcome Spine Trauma (PROST). In total, 60 patients were included with a 93.3% follow-up. Average morphine consumption during the PACU (Post Anaesthesia Care Unit) period was 5.357mg in ESP group and 8.607mg in placebo group (P = .004). Average VAS during first 24hour was 3.944 in ESP group and 5.193 in placebo group (P = .046). Blood loss was 14.8g per screw in ESP group and 15.4g in placebo group (P = .387). The day2 PROST value was 33.9 in ESP group and 28.8 in placebo group (P = .008) and after 4 weeks 55.2 in ESP group and 49.9 in placebo group (P = .036). No significant differences in ODI were detected. The use of ESP block in minimally invasive spinal surgery for posterior fracture stabilization leads to a significant reduction of opioid consumption during PACU stay by 37.7%. Reduction of opioid consumption was accompanied with lower pain (VAS). We found positive effect of the ESP block on short term outcome scores, but no effect on perioperative blood loss and wound healing.

Biomechanical Comparison Between Posterior Long-Segment Fixation, Short-Segment Fixation, and Short-Segment Fixation With Intermediate Screws for the Treatment of Thoracolumbar Burst Fracture: A Finite Element Analysis.

Posterior long-segment (LS) fixation, short-segment (SS) fixation, and short segment fixation with intermediate screws (SI) have shown good outcomes for the treatment of thoracolumbar burst fractures. However, limited data compared the biomechanical properties between LS fixation and SI. The purpose of this study was to compare the von Mises stresses on the pedicular screw system and bone between posterior LS fixation, SS fixation, and SI for the treatment of thoracolumbar burst fracture. The finite element model of thoracolumbar spines from T11 to L3 was created based on the computed tomography image of a patient with a burst fracture of the L1 vertebral body. The models of pedicular screws, rods, and locking nuts were constructed based on information from the manufacturer. Three models with different fixation configurations-that is, LS, SS, and SI-were established. The axial load was applied to the superior surface of the model. The inferior surface was fixed. The stress on each screw, rod, and vertebral body was analyzed. The motion of the spine in SS (0.5 mm) and SI (0.9 mm) was higher than in LS (0.2 mm). In all models, the lowest pedicle screws are the most stressed. The stress along the connecting rods was comparable between SI and LS (50 MPa). At the fracture level, stress was found at the pedicles and vertebral bodies in SI. There was relatively little stress around the fractured vertebral body in LS and SS. Posterior SI preserves more spinal motion than the LS. In addition, it provides favorable biomechanical properties than the SS. The stress that occurred around the pedicle screws in SI was the least among the 3 constructs, which might reduce complications such as implant failure. SI produces more stress in the fractured vertebral body than LS and SS, which could potentially aid in bone healing according to the Wolff law. SI has proved to be a biomechanically favorable construct and helps preserve the spinal motion segment. It could be an alternative surgical option for treating patients who present with thoracolumbar burst fractures.