Vertebral Body Fractures Research Articles

Vertebral refracture after percutaneous vertebroplasty for osteoporotic vertebral compression fractures with and without brace wearing: A retrospective study of 300 patients.

The aim of the study was to examine the clinical incidence rate of vertebral body fractures after percutaneous vertebroplasty (PVP) with and without brace wearing and provide a new guiding ideology for preventing vertebral fractures after clinical surgeries. The retrospective analysis included 100 outpatients who underwent PVP between January 2017 and December 2018 without bracing after PVP surgeries (non-brace-wearing group). In total, 100 patients were paired into the rigid brace group and 100 patients were paired into the soft braces group according to propensity score matching. Seven independent variables were used in the soft and rigid brace group: age, sex, body mass index (BMI), visual analog scale (VAS), Oswestry Disability Index (ODI), and Cobb angle. The VAS, ODI, and Japanese Orthopaedic Association (JOA) scores were recorded preoperatively on the second day, after 1 month, after 3 months, and during the last follow-up postoperatively. We recorded the incidence of vertebral refracture in each of the three groups of patients and evaluated the effect of braces on postoperative fractures based on the ODI, VAS, and JOA scores. All patients were followed up for 8-24 months (mean 22.4 months). Compared with the preoperative values, the age, sex, BMI, bone density, ODI, VAS, and Cobb angle between refracture and non-refracture were not statistically significant. The VAS, ODI, and JOA scores significantly increased in the brace-wearing group compared with those of the non-brace-wearing group (p < 0.05). The incidence of vertebral refracture in the brace-wearing group was lower than that in the non-brace-wearing group, between which there was a significant difference (p < 0.05). Three months postoperatively, the JOA score of the soft brace group was significantly higher than that of the rigid brace group (p < 0.05). During the last follow-up, it was found that there was no difference in the VAS score, the incidence of refracture, or ODI between the soft brace group and the rigid brace group (p > 0.05). The improvement in the JOA score of the soft brace group was better than that of the rigid brace group, between which there was a significant difference (p < 0.05). Braces can improve the prognosis of quality of life and postoperative subjective perception, whose presence can relieve postoperative residual pains. In contrast, patients can have a better medical experience wearing a soft brace.

Effect of hormone replacement therapy on intervertebral disc height

Objective Intervertebral discs act as shock absorbers, thereby helping to reduce the risk of vertebral body fractures. Previous studies have shown that estrogen loss following menopause is associated with disc height reduction whereas treatment with hormone replacement therapy (HRT) helps to maintain disc height. This study reports the effect of HRT on disc height from a post hoc analysis of a prospective randomized clinical trial of the effect of HRT on bone density. Methods A total of 355 healthy postmenopausal women aged (mean ± standard deviation) 55.4 ± 4.8 years were randomized to HRT with oral 1 mg or 2 mg estradiol plus dydrogesterone or placebo. Dual-energy X-ray absorptiometry measurements (Lunar DPX) were obtained at baseline and following 2 years of treatment. Intervertebral disc height was measured in discs between T12 and L3 using the bone densitometer ruler. Results Compared with baseline, treatment with HRT resulted in a significant increase in total disc height with 1 mg estradiol (0.16 ± 0.65 cm, p = 0.015) and with 2 mg estradiol (0.21 ± 0.86 cm, p = 0.006) whilst there was no significant increase with placebo (0.13 ± 0.65 cm, p = 0.096). Between-group differences were not statistically significant. Conclusions These results are consistent with previous findings of a beneficial effect of estrogen on discs. This may be in part responsible for the anti-fracture efficacy of HRT on vertebral fractures.

Risk factors and strategies for recovery quality, postoperative pain, and recurrent fractures between percutaneous kyphoplasty and percutaneous vertebroplasty in elderly patients with thoracolumbar compression fractures: a retrospective comparative cohort study.

With the increase of clinical cases and the improvement of operation, we found that recurrent fracture of the adjacent vertebral body is a common long-term complication of percutaneous kyphoplasty (PKP). However, the mechanism of re-fracture of adjacent vertebrae after PKP has not been unified. Therefore, through retrospective study, this paper discussed the risk factors and countermeasures affecting the quality of rehabilitation, postoperative pain and recurrent fracture in elderly PKP patients. From December 2019 to May 2021, 313 patients with osteoporotic spinal fractures were analyzed retrospectively. Cases were allocated to percutaneous vertebroplasty (PVP; n=130) and PKP (n=183) groups according to the modes of operation. Visual analogue scale (VAS), Cobb angle, and Oswestry disability index (ODI) were evaluated. Based on the occurrence of new fractures, the PKP cohort (n=15) and control cohort (n=32) were classified. Questionnaires analyzed the postoperative re-fractures of people with different characteristics, and the influencing factors of postoperative re-fracture were measured by multivariate logistic regression analysis. The postoperative VAS scores were significantly lower in the PKP group. The ODI scores in the PKP group were considerably lower than those in the PVP group after surgery. Univariate analysis indicated that age, number of injured vertebrae, history of complicated fracture, number of operative vertebrae, and bone mineral density (BMD) were remarkably correlated with recurrent fracture after PKP. Logistic regression analysis indicated that age, operative vertebral body, BMD, and the number of injured vertebrae were independent risk factors for recurrent fracture after PKP. BMI, BMD, low back soft tissue injury, postoperative vertebral height recovery rate, sagittal Cobb angle improvement rate, total diffusion coefficient of bone cement, short-term complications, non-union, and recurrent fracture were the main risk factors of residual low back pain after PKP. The clinical efficacy of PKP in elderly patients with thoracolumbar vertebral compression fracture is superior to that of PVP. Clinical attention should be paid to identifying high-risk factors for complications after PKP, and preventive measures should be implemented to help reduce the occurrence of recurrent fractures and postoperative residual pain.

Новый способ короткосегментарной мультистержневой задней инструментальной фиксации переломов тел поясничных позвонков: разработка технологии и случай из практики

A new method of short segmental multi-rod posterior instrumental fixation of lumbar vertebral body fractures (groups A3 and A4 according to the AO classification) characterized by the combined use of two short transpedicular screws with maximum lateralization of their heads fixing the injured and adjacent vertebrae and two short laminar implants in the form of distractors and contractors installed according to a standard technique with their positioning symmetrically to the spinous processes was developed. If transpedicular fixation of the fractured vertebra is impossible, both laminar systems are installed in the form of staples with circular coverage of the corresponding half-arc of the adjacent vertebrae due to supra- and infralaminar arrangement of standard hooks. The method involves the use of standard vertebrological instruments as well as widely available licensed implants and the classic technique of their installation. A clinical case of surgical treatment of a 27-year-old victim with a comminuted compression fracture (group A3 according to the AO classification) of the 3rd lumbar vertebra is reported. An excellent clinical and radiological result was obtained.

Kummell's Disease is Becoming Increasingly Important in an Aging Society: A Review.

Kummell's disease (KD) is referred to as delayed posttraumatic vertebral collapse, avascular necrosis of vertebrae, or ischemic vertebral collapse. KD is no longer rare in an aging society. It is mainly caused by minor trauma, and nonunion occurs secondary to avascular necrosis at the vertebral body fracture site, which can lead to vertebral kyphosis or intravertebral instability. Clinical symptoms of KD range from no symptoms to severe paralysis due to nerve injury. KD is considered a complication of osteoporotic vertebral compression fractures, and conservative treatment, including osteoporosis treatment, is important. Timely interventions such as vertebral augmentation or surgery, with active regular follow-up are necessary before the onset of neurological deficits due to osteonecrotic collapse in patients with suspected KD. In this study, we summarize the pathogenesis, diagnosis, and treatment of KD, which is showing increasing prevalence in an aging society. We have presented a literature review and discussed clinical guidelines and therapeutic strategies to reduce the morbidity and mortality associated with KD.

Cervical Kyphoplasty and OsteoCoolTM Radiofrequency Ablation for Painful Cervical Metastasis: A Case Report and Novel Approach for Pain Relief

Background: Metastatic bone pain is very difficult to treat and challenging to manage for health care professionals. Kyphoplasty or vertebroplasty has been used to reinstate the height of a compressed fractured vertebral body. OsteoCoolTM radiofrequency ablation (RFA) is a relatively new ablation technique and at present, current literature only supports its role for thoracic and lumbar vertebral metastases. Case Report: In the present case report, we utilized OsteoCoolTM RFA using anterolateral cervical kyphoplasty for cervical spinal metastasis with intractable pain and limited range of motion. Discussion: A successful palliative treatment was provided with a combination of kyphoplasty and OsteoCoolTM RFA. The patient has had great relief of pain and an increased range of motion of the cervical spine post procedure. Conclusion: Anterolateral balloon kyphoplasty provides stability to fractured vertebrae and when combined with OsteoCoolTM RFA, it potentially can provide effective pain relief in patients who have failed radiation and for whom surgery is contraindicated. Key words: Cervical kyphoplasty, cervical vertebral metastasis, kyphoplasty, OsteoCoolTM

Videothoracoscopic removal of a foreign body (arrow-shaped element) of gunshot origin from the vertebral body, using radiation and magnetic technologies

Gunshot wounds to the chest have always occupied a special place among the entire set of gunshot wounds on the human body. Today, the one of the important challenges before the Navy of the Armed Forces of Ukraine, - not only to restore the damaged anatomical structures of the chest, but also to create optimal conditions for the restoration of the functional component. This will make possible to reduce the treatment period of a wounded serviceman and return him to the formation (or to the occupied position) as soon as possible. The use of minimally invasive methods (videothoracoscopy, radiation control and magnetic technologies) during the treatment of a wounded person with a penetrating gunshot wound of the chest is the key in the surgeon’s hands whose task is to save life and eliminate the defect (formed as a result of the wound). This approach is not only an example of highly specialised surgical care for the wounded in the navy, but also demonstrates the high quality of the proposed care scheme. Purpose - practically implement new organisational, tactical and professional approaches to the treatment of gunshot wounds to the thorax using a clinical case study. It is presented the clinical case of wounded man Sh., 35 years old, with a gunshot fragmentation blind wound of the posterior surface of the thorax, gunshot fracture of the Th7 vertebral body on the background of a foreign body (metal arrowhead). In the current world literature, there are many options for surgical tactics for the treatment of wounded patients with penetrating gunshot wounds to the chest. However, our clinical case draws attention to the high relevance of applying and combining minimally invasive techniques (video-othoracoscopy, radiation control and magnetic technology). This makes it possible to reduce the time (or duration) of surgical intervention, perform an «extended» revision of the pleural cavity, examine and assess the condition of the wound canal, remove a foreign body (shrapnel, bullets, arrowhead component), compensate for respiratory failure phenomena as quickly as possible and restore the integrity and function of the thoracic cells. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Effects of the "Spinomed active" orthosis on chronic back pain in kyphotic women with osteoporotic vertebral fractures three months and older: A randomized controlled study.

Vertebral fractures are frequent clinical consequences of osteoporosis. Considering the demographic change in Europe, the number of vertebral fractures will quite likely increase during the next decades. Apart from pharmaceutic agents and physiotherapy, spinal orthoses are established elements of conservative therapy for vertebral (body) fractures. Recent studies on acute vertebral fractures reported positive effects on back pain, kyphosis and functional disabilities, but the efficacy of active strengthening spinal orthoses in vertebral fractures ≥6 months remains to be established. Eighty hyperkyphotic, community-dwelling women ≥65 years with chronic back pain and vertebral fractures occurred ≥3 months ago were randomly allocated to a group which wore the "Spinomed active" orthoses 2 × 2-3 h/d for 16 weeks (SOG: n = 40) or an untreated control group (CG: n = 40). Study outcomes were back pain intensity, kyphosis angle, trunk strength, back pain induced- and general function and disability, functional ability (chair-rise test) and respiratory function. We applied an intention-to-treat analysis; data were consistently adjusted for baseline values applying an ANCOVA. Observing a compliance of 82 ± 14% with the wearing protocol, we determined large and significant favorable effects for back pain (p = .008), back pain-induced physical disability (p < .001) and kyphosis angle (p < .001). We also demonstrated positive effects on trunk strength (p = .049), functional ability (p = .062) and general function and disability (p = .057), although not all of the parameters reach significance. No relevant changes were observed for respiratory function. After a few further individual adjustments of the orthosis (n = 2), no adverse effects were reported. In summary, the present study provided evidence for the efficacy of an active strengthening spinal orthosis ("Spinomed active") in people with vertebral fractures ≥6 months. Based on our results, we recommend expanding the application of the "Spinomed active" orthosis, which was previously validated for acute vertebral fractures, also to older hyperkyphotic women with osteoporotic vertebral fractures ≥3 months.

OF spine classification of osteoporotic thoracolumbar vertebral body fractures by MRI and conventional radiographs only leads to high inter-observer agreement rates-an additional CT adds limited information for the of classification and the OF score

ObjectivesThe purpose of this study was to investigate whether the addition of computed tomography (CT) to magnetic resonance imaging (MRI) improves the accuracy of classifying osteoporotic vertebral body fractures (OVBF).MethodsA retrospective analysis of a prospective single-center database has been performed. All consecutive patients who had suffered an acute thoracolumbar OVBF in one level II spine center between 2017 and 2019 were analyzed. Thereby, fractures of type OF 1 and OF 5 were excluded. All fractures were initially classified by 5 board-certified orthopaedic surgeons based on MRI and conventional radiographs. Afterwards a reclassification including CT scans were performed. Differences in OF classification and OF score values between both measurements were analyzed.ResultsA total of 61 patients were analyzed with a mean age 75.8 years (SD: 8.8 years). In 82.9% of the cases, there was no difference in OF classification comparing classification based only on MRI versus MRI + CT. A difference of more than two OF types was observed in less than 1% of all ratings. The inter-rater reliabilities of the OF classification based on CT + MRI and MRI alone were 0.63 and 0.49, respectively. In 97.5% of the cases there was no therapy-relevant difference of the treatment recommendation with respect of a surgical or nonoperative treatment recommendation based on the OF score.ConclusionIn terms of the OF classification and the OF score, the addition of CT add limited value compared to conventional radiographs and MRI only. Additionally, there is only a minor rate of disagreement in treatment recommendations when adding a CT.

Bionate Lumbar Disc Nucleus Prosthesis: Biomechanical Studies in Cadaveric Human Spines.

cadaveric spine nucleus replacement study. determining Bionate 80A nucleus replacement biomechanics in cadaveric spines. in cold preserved spines, with ligaments and discs intact, and no muscles, L3-L4, L4-L5, and L5-S1 nucleus implantation was done. Differences between customized and overdimensioned implants were compared. Flexion, extension, lateral bending, and torsion were measured in the intact spine, nucleotomy, and nucleus implantation specimens. Increasing load or bending moment was applied four times at 2, 4, 6, and 8 Nm, twice in increasing mode and twice in decreasing mode. Spine motion was recorded using stereophotogrammetry. Expulsion tests: cyclic compression of 50-550 N for 50,000 cycles, increasing the load until there was extreme flexion, implant extrusion, or anatomical structure collapse. Subsidence tests were done by increasing the compression to 6000 N load. nucleotomy increased the disc mobility, which remained unchanged for the adjacent upper level but increased for the lower adjacent one, particularly in lateral bending and torsion. Nucleus implantation, compared to nucleotomy, reduced disc mobility except in flexion-extension and torsion, but intact mobility was no longer recovered, with no effect on upper or lower adjacent segments. The overdimensioned implant, compared to the customized implant, provided equal or sometimes higher mobility. Lamina, facet joint, and annulus removal during nucleotomy caused more damaged than that restored by nucleus implantation. No implant extrusion was observed under compression loads of 925-1068 N as anatomical structures collapsed before. No subsidence or vertebral body fractures were observed under compression loads of 6697.8-6812.3 N. nucleotomized disc and L1-S1 mobility increased moderately after cadaveric spine nucleus implantation compared to the intact status, partly due to operative anatomical damage. Our implant had shallow expulsion and subsidence risks.

Effect of subsequent vertebral body fractures on the outcome after posterior stabilization of unstable geriatric fractures of the thoracolumbar spine

PurposeThe purpose of this study was analyzing the effect of subsequent vertebral body fractures on the clinical outcome in geriatric patients with thoracolumbar fractures treated operatively.MethodsRetrospectively, all patients aged ≥ 60 with a fracture of the thoracolumbar spine included. Further inclusion parameters were acute and unstable fractures that were treated by posterior stabilization with a low to moderate loss of reduction of less than 10°. The minimal follow-up period was 18 months. Demographic data including the trauma mechanism, ASA score, and the treatment strategy were recorded. The following outcome parameters were analyzed: the ODI score, pain level, satisfaction level, SF 36 score as well as the radiologic outcome parameters.ResultsAltogether, 73 patients were included (mean age: 72 years; 45 women). The majority of fractures consisted of incomplete or complete burst fractures (OF 3 + 4). The mean follow-up period was 46.6 months. Fourteen patients suffered from subsequent vertebral body fractures (19.2%). No trauma was recordable in 5 out of 6 patients; 42.8% of patients experienced a low-energy trauma (significant association: p < 0.01). There was a significant correlation between subsequent vertebral body fracture and female gender (p = 0.01) as well as the amount of loss of reduction (p = 0.02). Thereby, patients with subsequent vertebral fractures had significant worse clinical outcomes (ODI: 49.8 vs 16.6, p < 0.01; VAS pain: 5.0 vs 2.6, p < 0.01).ConclusionPatient with subsequent vertebral body fractures had significantly inferior clinical midterm outcome. The trauma mechanism correlated significantly with both the rate of subsequent vertebral body fractures and the outcome. Another risk factor is female gender.

Balloon kyphoplasty versus percutaneous vertebroplasty for osteoporotic vertebral body compression fractures: clinical and radiological outcomes

Osteoporotic vertebral body compression fracture are the commonest fractures amongst the other osteoporotic fracture sites. These fragility fractures are the result of low energy mechanical forces that that would not ordinarily result in fracture. Percutaneous vertebroplasty and balloon kyphoplasty has been widely used as minimally invasive procedures to treat painful vertebral compression fractures. Aim of the present study was to evaluate radiological, clinical and functional outcome of patients with osteoporotic vertebral body fractures treated with Balloon Kyphoplasty and Vertebroplasty. Prospective cohort study PATIENT SAMPLE: 40 patients (Male:15, Female: 25) with average age of 56 +/- 8 years diagnosed with osteoporotic vertebral body compression fracture on clinical and radiological evaluation with no neurological deficit and no other associated fractures were included. Operative time, cost for the procedure, gain in vertebral body height, reduction in pain, ability to perform daily routine activities, risk of cement leakage and any other systemic complications were evaluated and compared in both the study groups. All the patients underwent conventional Xray, MRI (to rule out acute from chronic fracture, to check compromise of spinal canal and calculate collapse in vertebral body height), Visual analog scaling for severity of pain and difficulty in daily routine activities by Oswestry disability index preoperatively. Post operative clinal, functional, radiological outcome and complications were compared in patients treated with percutaneous vertebroplasty and balloon kyphoplasty. There was significant difference in intraoperative time period and procedure cost for the patients treated with Vertebroplasty(50.75min, 25k) in comparison to balloon kyphoplasty (71.95, 50k) with p value being < .001 There was significant difference between preoperative and postoperative study parameters in both the study groups but there was no significant difference in post operative study parameters amongst both the study groups with p values >.05 for different parameters, 0.381(Gain in vertebral height), 0.108 (pain relief), 0.846(Oswestry disability index) and 0.197(risk of cement leakage) CONCLUSION: : Our study suggested that percutaneous vertebroplasty requires less operative time and is more economical than balloon kyphoplasty. Increase in intraoperative time increases the risk of infection. Though the cases of Intraoperative operative cement leakage were more in percutaneous vertebroplasty but is was not significant. However the final radiological, clinical, functional outcome and overall complications were found to be similar in both the groups. Balloon kyphoplasty provided no added benefit over percutaneous vertebroplasty. A study with larger sample size will be needed to warrant one surgical procedure superior to other in the treatment of osteoporotic vertebral body compression fracture.

Alteration in the Cross-sectional Area (CSA) Ratio of the Paraspinal Muscles following Vertebral Insufficiency Fractures.

Background Vertebral insufficiency fractures in the elderly are associated with increased morbidity and mortality. Early diagnosis is essential to direct patient-specific rehabilitation. Aims We hypothesize that in patients with vertebral insufficiency fractures, there is atrophy of the psoas and paraspinal muscles with alteration in the cross-sectional area (CSA) of the muscles. Materials and Methods Magnetic resonance imaging (MRI) studies for 100 consecutive patients, older than 60 years presenting with lower back pain, were included in the study. For each MRI study, the CSA of the psoas and paraspinal muscles (multifidus) at the level of L4/5-disc space was measured to calculate the cross-sectional area ratio (CSAR) by two readers. One reader repeated the measurements after an interval of 2 weeks. We divided the patients ( n = 100) into various groups based on the number of vertebral fractures. Results In total, 77 patients with vertebral body fractures (48 with one, 16 with two and 13 with more than two fractures) were identified with a mean age of 73 (range 60-92) years. The ratio of multifidus CSA to psoas CSA was calculated with mean values of each group (1-4) as 2.56, 1.89, 2.09 and 2.16, respectively. There was statistically significance difference of the CSAR between the cohorts ( p -value = 0.0115). Conclusion Vertebral insufficiency fractures in the elderly are associated not only with atrophy of psoas and the multifidus group of muscles as evident by the CSA values, but they also affect the CSAR depending on the number of fractures. This finding may help to direct targeted patient-specific physiotherapy rehabilitation and interventions to prevent further such fractures.

Surgical outcomes for spinal deformity in osteogenesis imperfecta.

IRB approved retrospective review of the the SHOnet (Shriners Health Outcomes Network). Osteogenesis imperfecta (OI) is the most prevalent genetic disorder of bone and connective tissue in the pediatric population, with an incidence of 1/15,000-20,000. Scoliosis has been reported to be present in 39-100% of OI patients and may continue to progress into adulthood but there is little information on the perioperative outcomes, rates of revision surgery and complications in this fragile population. The purpose of this study is to examine the prevalence of scoliosis in the OI population across a tertiary care multihospital system. The rate at which these patients progress to surgery, the perioperative complication rate and if there is an association between complications and age at surgical intervention, pre-operative Cobb angle, number of fractures, and type of OI. Incidence of scoliosis in OI may be lower than previously reported, many may never require surgical intervention and those that do require surgical intervention have an 8% reoperation rate at an average of 3.3years postop. IRB approved retrospective review of the the SHOnet (Shriners Health Outcomes Network), electronic health record data warehouse from January 1, 2011 and December 31, 2017. Inclusion criteria included International Classification of Diseases (ICD) code for osteogenesis imperfecta and scoliosis. The data warehouse was queried for age, gender, presence of vertebral body fractures, proximal junctional kyphosis, basilar invagination, bisphosphonate use, and perioperative complications including postoperative infection. There were 2372 patients with osteogenesis imperfecta, 429 or 18.1% also had a diagnosis of scoliosis, while 81.9% did not (see Table 1). Only 74 patients (17.2%) of the patients that had scoliosis underwent spine surgery, 12 of which had staged surgery with an average preop thoracic Cobb 58.18 (range 7-115), and thoracolumbar Cobb 59.83 (range 5-145). Six patients (8%) required revision spine surgery. Average time to revision was 3.88years (6.9-69mo). Bisphosphonate use was present in 35.5% of patients that did not require surgery and in 40.5% that did. With over 2300 patients, this is the largest study to date on scoliosis in patients with OI. We found that contrary to prior studies which had indicated the incidence of scoliosis ranges from 39 to 100% that it was only present in 18% of our patients. This indicates that the incidence of scoliosis in OI is potentially lower than previously reported, though due to the nature of this study it may be underreported. Furthermore, only 17% of those patients in our study with scoliosis eventually underwent surgery. It is important to note that many patients treated non-operatively had deformity within the operative range, which may indicate that they were not considered good candidates for surgical intervention. Lastly, we found that bisphosphonate use did not appear to affect the likelihood of progression to surgery in this group of patients, though this may be due to later initiation of the bisphosphonate use.

M2ABQ-a proposed refinement of the modified algorithm-based qualitative classification of osteoporotic vertebral fractures.

The current methods to classify osteoporotic vertebral body fractures are considered ambiguous; there is no reproducible, accepted gold standard. The purpose of this study is to refine classification methodology by introducing clear, unambiguous rules and a refined flowchart to allow consistent classification of osteoporotic vertebral body fractures. We developed a set of rules and refinements that we called m2ABQ to classify vertebrae into five categories. A fracture-enriched database of thoracic and lumbar spine radiographs of patients 65years of age and older was retrospectively obtained from clinical institutional radiology records using natural language processing. Five raters independently classified each vertebral body using the m2ABQ system. After each annotation round, consensus sessions that included all raters were held to discuss and finalize a consensus annotation for each vertebral body where individual raters' evaluations differed. This process led to further refinement and development of the rules. Each annotation round showed increase in Fleiss kappa both for presence vs absence of fracture 0.62 (0.56-0.68) to 0.70 (0.65-0.75), as well as for the whole m2ABQ scale 0.29 (0.25-0.33) to 0.54 (0.51-0.58). The m2ABQ system demonstrates moderate interobserver agreement and practical feasibility for classifying osteoporotic vertebral body fractures. Future studies to compare the method to existing studies are warranted, as well as further development of its use in machine learning purposes.

A case report of multiple Mycobacterium Kansasii bone infection with pathological fracture of T11 vertebral body and thoracic spinal cord injury

Rationale: Cases of vertebral infection with bone destruction and spinal cord injury caused by Mycobacterium kansasii infection are rarely reported, and the infection is usually associated with severe immunosuppression. Patient concerns: A 62-year-old male patient was hospitalized for 10 days due to recurrent low back pain with diminished skin sensation below the umbilical level. Diagnosis: The patient had no underlying disease. MRI showed multiple bone destruction lesions throughout the body, pathological fractures of the T11 vertebral body, and compression and degeneration of the thoracic spinal cord. Complete back abscess puncture examination, CT-guided vertebral puncture examination, metagenomic next-generation sequencing and bone marrow puncture and other examinations to confirm the diagnosis of Mycobacterium kansasii infection. Intervention: According to the drug susceptibility test of pathogenic bacteria, combined antiinfective treatment was given. After 3 weeks of drug treatment, the patient underwent thoracic posterior debridement, spinal canal decompression, and pedicle screw internal fixation. Outcome: The skin sensation of the patient’s lower limbs was improved 1 month after the operation compared with that before the operation. After adhering to oral drug treatment, the inflammatory index decreased steadily. Four months after the operation, the skin sensation of the patient’s lower extremities returned to normal. Lessons: Regular, adequate, and full course of drug treatment is the key to the treatment of Mycobacterium kansasii infection. Next-generation metagenomic sequencing can improve the efficiency and accuracy of the detection of Mycobacterium kansasii. For patients with abscesses and spinal nerve compression, surgical decompression and abscess removal are effective treatment options.

Case-control study on endplate injury of lumbar spine with two different intervertebral fusion methods

To summarize and compare the endplate injury occurrence characteristics and clinical results of transforaminal intervertebral fusion combined with pedicle screw fixation through intermuscular approach and oblique lateral intervertebral fusion combined with pedicle screw fixation in the treatment of lumbar disease. A retrospective analysis of 213 cases of lumbar disease admitted from January 2016 to June 2019, including 73 males and 140 females. The age ranged from 24 to 81 years old, with an average of(54.9±10.5) years old. The courses of disease ranged from 6 to 180 months, with an average of (40.30±28.71) months. There were 35 cases of degenerative lumbar intervertebral disc disease, 22 cases of giant lumbar disc herniation, 15 cases of discogenic low back pain, 9 cases of primary lumbar intervertebral inflammation at the turn of inflammation, 52 cases of lumbar spinal stenosis, 47 cases of lumbar degenerative spondylolisthesis, 33 cases of lumbar spondylolysis with or without spondylolisthesis. There were 191 cases of single-segment lesions, including 5 cases on L2, 3, 24 cases on L3, 4, 162 cases on L4, 5. And there were 22 cases of two-segment lesions, including 3 cases on L2, 3 and L3, 4, and 19 cases on L3, 4 and L4, 5. One hundred and ten cases were taken by bilateral pedicle screw fixation and interbody fusion under the posterior muscle space approach (abbreviated as posterior fusion group), and 103 cases were taken by oblique lateral interbody fusion combined with bilateral pedicle screw fixation under the posterior muscle space approach (oblique lateral fusion group). Observed the characteristics of endplate injury in the two groups, and compared the clinical and imaging results and complications of the two groups. There were 8 cases of endplate injury occurred in 9 segments in the posterior fusion group. According to the number of cases, the incidence rate was 7.27%(8/110), 1 case was male, 7 cases were female, with an average age of (63.22±3.51) years old. Among the 8 cases, there were 7 cases of bone loss or osteoporosis before the operation, 5 cases using banana fusion cages, 3 cases using anatomical fusion cages. Three cases occurred in the upper endplate of the vertebral body and 6 cases in the inferior endplate of the vertebral body. In the oblique lateral fusion group, there were 21 cases of endplate injury in 24 segments, and the incidence rate was 20.39%(21/103). There were 4 males and 17 females, with an average age of (62.50±5.02) years old. Among the 21 cases, 16 cases were bone loss or osteoporosis before operation. There were 5 cases used large fusion cages, 4 cases had abnormal endplate anatomy, and 3 cases had iliac crest hypertrophy. It occurred in 20 segments of the upper endplate of the vertebral body, and 4 segments of the lower endplate of the vertebral body. Two of the 21 cases of endplate injury combined with vertebral body fractures. The incidence of endplate injury of the posterior fusion group was significantly lower than that of the oblique lateral fusion group. No incision infection occurred in the two groups, the follow-up time was ranged from 12 to 48 months, and the median follow-up period was 12 months. In the follow-up, 22 cases occurred fusion cage subsidence in the posterior fusion group, 43 cases in the oblique lateral fusion group, and 1 case in each group occurred fusion cage displacement. There was no loosening, displacement or breakage of the internal fixation. The incidence of complications in the oblique lateral fusion group 33.98%(35/103) was significantly higher than that in the posterior fusion group 23.64%(26/110), P=0.039. The height of the intervertebral space in both groups recovered well after the operation, but it was lost to varying degrees during follow-up. The fusion rate of the posterior fusion group was 94.5%(104/110), and 96.1%(99/103) in the oblique lateral fusion group(P=0.083). At the latest follow-up, the clinical symptoms of the two groups of patients were significantly improved. Two methods in treating single or two-segment lumbar spine lesions obtained good clinical effects. The characteristics of endplate injury in the two fusion methods are not completely the same. Although the endplate injury did not affect the final clinical results of the two fixed fusion methods, it still needs to be paid attention to and emphasize the prevention and effective treatment of endplate injury, especially for oblique lateral intervertebral fusion.

Delayed diagnosis of blunt thoracic aortic injury due to thoracic vertebral fracture: A case report and literature review.

Blunt vascular injury of the aorta combined with thoracolumbar fracture is rare. Delayed diagnosis may have a catastrophic outcome. We present a case of blunt thoracic aortic injury combined with a vertebral body fracture at T10 after a fall from height in which the diagnosis was delayed. After consultation with the vascular and spinal surgeons, we performed a thoracic endovascular aortic repair. When the patient's condition had stabilized, the fractures were reduced using posterior vertebral instrumentation. Prolonged compression of the thoracic aorta resulted in extensive necrosis of muscle tissues in the right lower leg. Fortunately, clinical and radiological examinations performed 7 months and 1 year later did not reveal any further damage. Cases of thoracic vertebral fracture with concomitant blunt thoracic aortic injury reported in the literature are reviewed. Thoracic endovascular aortic repair is a feasible, safe, and effective minimally invasive treatment for aortic injury when combined with thoracic vertebral fracture.

Does Calcium Phosphate Cement Kyphoplasty Cause Intervertebral Disk Degeneration in Adolescents?

Balloon kyphoplasty with polymethylmethacrylate (PMMA) represents the standard procedure for the treatment of thoracic and lumbar type A compression fractures. However, an increased degeneration in adjacent intervertebral disks following PMMA kyphoplasty has been demonstrated in elderly patients. Calcium phosphate cement (CPC) appears to be superior to PMMA for the intravertebral stabilization in younger patients. It remains unkown whether CPC kyphoplasty causes degeneration of adjacent disks in adolescents. Seven adolescents with thoracolumbar spine fractures underwent kyphoplasty at a mean age of 14.5 years (range 10-18). At a mean follow-up of 3.7 years (range 1 to 4.8) postoperatively, 3.0 Tesla magnetic resonance imaging (MRI) of the spine was performed to assess intervertebral disk degeneration by quantitative T2 relaxation maps and subjective ratings using modified Pfirrmann scores. A total of 56 intervertebral disks was analyzed. Initial computed tomography (CT) examinations served as basis to assess the severity of adjacent endplate injuries in terms of articular step-offs. Initial imaging detected 18 thoracolumbar vertebral body fractures of which 9 were treated with CPC kyphoplasty. Quantitative follow-up MRI revealed signs of degeneration in 10 (17.9%) of the examined 56 intervertebral disks, 7 of them adjacent to a previously fractured vertebral body. Signs of disk degeneration were significantly higher in caudal endplates with articular step-offs larger than 5 mm compared to fractured vertebral bodies without endplate step-offs. Quantitative MRI follow-ups did not suggest CPC-related intervertebral disk degradations following thoracolumbar kyphoplasty in adolescents, but indicated disk alterations correlating to adjacent endplate fracture severity.

Percutaneous Uniplanar Pedicle Screw-Rod System with Injured Vertebra Fixation for Thoracolumbar Burst Fracture and Technique Notes.

To evaluate the efficacy of percutaneous uniplanar pedicle screw (PUPS) combined with injured vertebra fixation for treating thoracolumbar burst fracture and provide technique notes. A descriptive study. Department of Orthopaedics, General Hospital of Central Theater Command, Wuhan, China, from February 2019 to December 2021. Patients who had undergone PUPS internal fixation for thoracolumbar burst fracture were followed up for more than 12 months in the General Hospital of Central Theater Command, Wuhan, China. The operation time, intraoperative blood loss, and hospital stay were recorded. Visual analysis scale (VAS), score of low back pain, ODI (oswestry disability endex), anterior vertebral height (AVH), Cobb angle were documented before and after the operation, Also, the complications and postoperative tail shank angles (TSA) were documented. All 23 patients were followed up for more than 12 months without re-fracture, loosening or breakage of the screw and rod. The operation time, intraoperative blood loss, and hospital stay were 51.34±8.30 minutes, 75.67±16.55 minutes, and 9.86±1.96 days respectively. VAS and ODI scores after the operation were significantly lower than before (p <0.05). The AVH and Cobb angle after operation were significantly better as compared with those before the operation (p <0.05), but no statistically significant difference was found in those two values at 1 week, 3 months, and 12 months after operation (p >0.05). No statistically significant difference was found in TSA after the operation (p >0.05). PUPS combined with injured vertebra fixation reveals satisfactory efficacy for thoracolumbar burst fracture with well reduction of the fracture, the AVH, and Cobb angle maintenance. Percutaneous uniplanar pedicle screw, Minimally invasive surgery, Thoracolumbar vertebral body fracture, Injured vertebra fixation.