Vertebral Body Fractures Research Articles

Experience in using artificial intelligence services for diagnosing compression fracture of vertebral body based on computed tomography – from testing to trials

Backgraund:Osteoporosis (OP) is often diagnosed at the stage of complications. Compression fractures (CF) of the vertebral bodies, complications of OP, and predictors of subsequent fractures are often asymptomatic. CF can be detected on CT scan performed for other indications. We have analyzed approaches to using artificial intelligence services (AI services) generated for diagnosing CF of the vertebral bodies. Aims:Testing AI services to identify CF based on chest CT and to assess the possibility of their implementation into the practice of medical facilities of the Moscow Healthcare Department. Materials and methods:For setting a clinical task for AI services, basic diagnostic requirements in the direction of “Osteoporosis” are formed. AI services go through the following stages: self-testing, functional and calibration testing, trial and trial operation. The first three stages of testing are carried out on previously generated datasets. At the stages of trial and trial operation, AI services analyze CT examinations performed in medical facilities. An expert group of radiologists evaluates the diagnostic accuracy and functional capacity of AI services at all stages. The obtained quantitative metrics of the accuracy of AI services are compared with the target values ​​specified in the requirements. Results:From June 2021 to June 2022, two AI services (AI service №1 and AI service №2) which used different methods for identifying a presence of CF were tested. AI services successfully passed the self-testing stage (6), functional (5) and calibration (100) testing. The ROC AUC for AI service №1 was 0.99 and for AI service №2–0.91. The AI service №1 passed the trial stage without any significant remarks, while AI service №2 was sent for revision. After the trial operation stage, the following accuracy metrics were obtained: the ROC AUC for AI service №1 was 0.93; for AI service №2–0.92. At all stages, both AI services showed sufficient metrics for clinical validation. Conclusions:A testing of the performance of AI services in the direction of “Osteoporosis” was carried out. A high quality of diagnosis was demonstrated. AI services can act as an auxiliary tool in the medical decision support system.

ANALYSIS OF THE EFFECTIVENESS OF INDIRECT SPINAL CANAL DECOMPRESSION IN THE TREATMENT OF BURST FRACTURES AT THE THORACOLUMBAR JUNCTION

Indirect decompression of the spinal canal through ligamentotaxis is one of the methods for remodeling the spinal canal in traumatic stenosis. Objective: To evaluate the effectiveness of indirect decompression of the spinal canal for different morphological types of burst fractures of vertebral bodies at the thoracolumbar junction. Methods. A preoperative and postoperative analysis of computed tomography scans was performed on 59 patients who were treated at the«Romodanov Neurosurgery Institute, National Academy of Medical Sciences of Ukraine» for burst fractures at the thoracolumbar junction. The criterion for the effectiveness of indirect decompression was the area of the spinal canal, measured at the level of injury in the zone of maximum compression. The grading of burst fractures was performed using the classification by F. Magerl et al. (1994). Results. In the preoperative period, the median degree of stenosis in the group of patients was 43.47 % (95 % confidence interval (CI): 37.53–46.22 %). For damage type A3.1, it was 36.9 % (95 % CI: 28.1‒40.5 %), for type A3.2 — 46.1 % (95 % CI: 32.1‒54.5 %), and for type A3.3 — 47.6 % (95 % CI: 37.5‒56.5 %). After surgical treatment, the degree of stenosis decreased by 20.14 % (95 % CI: 15.93‒21.56 %). For type A3.1, the effectiveness was 20.1 % (95 % CI: 9.5‒22.7 %), for type A3.2 — 15.2 % (95 % CI: 7.51‒17.3 %), and for type A3.3 — 21.7 % (95 % CI: 20.8‒26.4 %). The difference between types A3.2 and A3.3 was statistically significant (p = 0.0018). It was found that indirect decompression is most effective with higher degrees of stenosis. For Grade I by D. Wolter (1988), the canalexpansion achieved was 7.07 % (95 % CI: 5.69‒8.65 %), for Grade II — 21.6 % (95 % CI: 20.4‒22.7 %), and for Grade III — 30.3 % (95 % CI: 27.0‒33.6 %). Conclusions. Closed remodeling of the spinal canal with transpedicular fixation and the effect of ligamentotaxis is an effective method for correcting traumatic spinal canal stenosis at the thoracolumbar junction. The effectiveness of the technique is determined by many factors, including the type of burst fracture, the initial degree of stenosis, and the level of injury.

Discospondylitis, osteomyelitis and sublumbar abscessation with a pathological vertebral fracture in a dog managed by ventral omentalisation and concurrent dorsal vertebral stabilisation

AbstractThis report describes a chronic case of discospondylitis and sublumbar abscessation managed with a combination of omentalisation and vertebral stabilisation. Although there are previous reports of omentalisation in patients presenting with sublumbar abscesses, there are no documented cases of these surgeries being combined with stabilisation of a vertebral body fracture secondary to discospondylitis. This case specifically discusses an initial conservative approach and subsequent surgical intervention. A 5‐year‐old, female, neutered, cocker spaniel presented with a 2‐month history of lethargy, non‐localised pain, reluctance to move and pyrexia. Diagnostic investigations revealed a fracture of the third lumbar vertebrae, associated discospondylitis and sublumbar abscessation due to suspected foreign material. Conservative management with rest and antimicrobial therapy was initiated; however, after worsening of clinical signs, surgery was subsequently carried out. We report post‐operative follow‐up of 4 years, which revealed an overall positive outcome, with no long‐term recurrence of clinical signs or adverse effects.

The clinical effect of different vertebral body height restoration rates after percutaneous kyphoplasty for osteoporotic vertebral compression fractures

ObjectiveThis study aimed to evaluate the clinical effect of different vertebral body heights restoration rate after percutaneous kyphoplasty (PKP) for the treatment of osteoporotic vertebral compression fractures (OVCF).MethodsThe patients were divided into two groups according to the height restoration rate of the anterior edge of the vertebral body fracture after PKP operation using X-Ray imaging. The group A was below 80%, and the group B was above 80%. Clinical preoperative and postoperative efficacy (1st day, 1st month, 6th month, and 12th month after surgery) were evaluated according to VAS, Oswestry Disability Index(ODI), Quality of Life Questionnaire of the European Foundation for Osteoporosis(QUALEFFO), and Back Pain Life Disorder Questionnaire(RQD). Simultaneously, the preoperative and postoperative local Cobb angles and changes in the injured vertebrae in the two groups were calculated and analyzed.ResultsThe postoperative Cobb angle in group A was significantly higher than that in group B. The correction rate in group B was significantly better than that in group A. The VAS, ODI, QUALEFFO, and RQD scores of group B patients were significantly lower than those of patients in group A at each follow-up time point. The correlation coefficients of vertebral body height restoration rate and VAS, ODI, QUALEFFO, and RQD scores at the last follow-up were − 0.607 (P < 0.01), -0.625 (P < 0.01), -0.696 (P < 0.01), and − 0.662 (P < 0.01), respectively.ConclusionsThe results of the correlation analysis between the vertebral body height restoration rate and the above clinical efficacy scores show that increasing the vertebral body anterior height restoration rate is beneficial for pain relief and improves the clinical efficacy of patients. Simultaneously, improving the height restoration rate of the anterior edge of the vertebral body and restoring the normal spinal structure is beneficial for reducing the incidence of refracture of the adjacent vertebral body.

An improved understanding of paediatric chronic nonbacterial osteomyelitis (CNO) pathophysiology informs current and future treatment.

Chronic nonbacterial osteomyelitis (CNO) is an autoinflammatory bone disease that primarily affects children and young people. It can cause significant pain, reduced function, bone swelling and even (vertebral body) fractures. Because of a limited understanding of its pathophysiology, the treatment of CNO remains empiric and is based on relatively small case series, expert opinion and personal experience. Several studies linked pathological NLRP3 inflammasome activation and the resulting imbalance between pro- and anti-inflammatory cytokine expression with CNO. This agrees with elevated pro-inflammatory (mostly) monocyte-derived protein signatures in the blood of CNO patients that may be used as future diagnostic and/or prognostic biomarkers. Recently, rare variants in the P2RX7 gene, encoding for an ATP-dependent trans-membrane channel, were linked with increased NLRP3 inflammasome assembly and prolonged monocyte/macrophage survival in CNO. While the exact molecular mechanisms remain unclear, this will inform future target-directed and individualized treatment. This manuscript reviews most recent developments and their impact on diagnostic and therapeutic strategies in CNO.

Skin Adhesive Tapes: An Effective Wound Closure Method for Percutaneous Vertebral Body Stenting.

Background Skin adhesive tapes (SATs) are hypoallergenic adhesive tapes commonly used for wound closure in percutaneous vertebroplasty (PVP). Vertebral body stenting (VBS) is a metallic balloon-expandable stent used to treat vertebral body fractures. Its balloon and stent deployment involves a larger stab incision and pedicle bore tract than PVP, increasing the risk of bleeding and wound complications. This study evaluated the outcome and complications of VBS wound closure with SAT and the reasons for conversion to conventional suture closure (SC). Material and methods A retrospective series of patients who underwent VBS from May 2019 to March 2021 were identified from review of computerized medical records. Data were collected for wound closure method, reason for SC, number of operative levels, postoperative wound complications of contact dermatitis, tension blisters, tape dislodgement, surgical site infection, wound dehiscence, symptomatic hematoma and return to operating theater. The wounds were assessed for complete healing and cosmesis at outpatient follow-up visits. Results A total of 36 patients were identified. SAT closure was performed in 33 (91.6%) patients, while SC was performed in three (8.3%) patients. Unplanned conversion to SC was required in two (5.5%) patients due to continued intraoperative wound bleeding, while one (2.7%) patient had planned SC as part of a staged operation. Uneventful closures occurred in 32 (97.0%) of SAT closures. One (3%) SAT closure patient developed postoperative blood-soaked dressings and tape dislodgement, requiring reapplication of the SATs at the ward with uneventful recovery thereafter. No patient with SAT closure developed contact dermatitis, tension blisters, surgical site infection, wound dehiscence, symptomatic hematoma, or required return to theater. All SAT closure patients had complete wound healing at outpatient follow-up at six weeks. No SAT closure was found to be cosmetically unacceptable or required wound revision for any reason at up to one year postoperatively. Conclusion SATs are a safe and reliable means of wound closure for VBS. Conversion to SC due to continued intraoperative wound site bleeding is rarely required.

Comparative analysis of surgical treatment results for osteoporotic burst fractures of thoracolumbar vertebral bodies

Introduction Surgical methods for osteoporotic burst vertebral body fracture repair have their advantages and shortcomings. The use of circumferential stabilization and corrective vertebrotomies in elderly patients is highly invasive and carries great surgical risk. On the other hand, minimally invasive methods lead to recurrence of the deformity. Thus, in the treatment of patients with such pathology, it is necessary to choose a surgical method that allows achieving optimal results.Purpose of the work was to compare the results of surgical treatment for osteoporotic burst fractures in thoracolumbar vertebral bodies using the developed method and methods of circular and hybrid stabilization based on clinical and radiological criteria.Materials and methods The study was retrospective. Three groups of patients were formed according to the type of surgical intervention. Inclusion criteria were patients with primary osteoporosis who did not receive osteotropic therapy before surgery, with osteoporotic fractures (type OF3 and OF4) of the vertebral bodies of the thoracolumbar location (Th10–L2). The follow-up period was 12 months. The following criteria were assessed: the amount of kyphosis correction (according to the Cobb method), the amount of residual postoperative kyphotic deformity, as well as its recurrence in the long-term postoperative period; sagittal balance of the torso (Barrey index), subjective evaluation of the patient’s condition (VAS). Quality of life assessment was not performed.Results There were no statistically significant differences in the dynamics of sagittal balance during the follow-up period between the groups (p &gt; 0.99). There was no difference between groups in clinical outcomes (VAS) at follow-up (p &gt; 0.05). A statistically significant difference in the magnitude of kyphotic deformity and its correction in the specified postoperative periods was revealed between the hybrid fixation groups and the corrective vertebrotomy group. No difference was found with the circular stabilization group.Discussion Due to the high risks of poor outcomes of anterior spinal fusion, in particular, implant subsidence, to avoid anterior spinal fusion, we used a method of focal kyphosis correction and posterior spinal fusion with autologous bone. The method proposed by the authors for the correction of focal kyphotic deformity in the treatment of patients with osteoporotic burst fractures of the vertebral bodies combines satisfactory correction of focal kyphosis with minimal surgical invasiveness, which reduces the risks of complications and poor outcomes. The proposed method may also be combined with hybrid fixation.Conclusion The developed method for focal kyphotic deformity correction in the treatment of osteoporotic burst fractures of vertebral bodies provides satisfactory correction of focal kyphosis, reduces the risks of complications and poor outcomes in comparison with circular and hybrid stabilization.

Development of a deep learning model for detecting lumbar vertebral fractures on CT images: An external validation

ObjectiveTo develop and externally validate a binary classification model for lumbar vertebral body fractures based on CT images using deep learning methods. MethodsThis study involved data collection from two hospitals for AI model training and external validation. In Cohort A from Hospital 1, CT images from 248 patients, comprising 1508 vertebrae, revealed that 20.9% had fractures (315 vertebrae) and 79.1% were non-fractured (1193 vertebrae). In Cohort B from Hospital 2, CT images from 148 patients, comprising 887 vertebrae, indicated that 14.8% had fractures (131 vertebrae) and 85.2% were non-fractured (756 vertebrae). The AI model for lumbar spine fractures underwent two stages: vertebral body segmentation and fracture classification. The first stage utilized a 3D V-Net convolutional deep neural network, which produced a 3D segmentation map. From this map, region of each vertebra body were extracted and then input into the second stage of the algorithm. The second stage employed a 3D ResNet convolutional deep neural network to classify each proposed region as positive (fractured) or negative (not fractured). ResultsThe AI model’s accuracy for detecting vertebral fractures in Cohort A’s training set (n = 1199), validation set (n = 157), and test set (n = 152) was 100.0 %, 96.2 %, and 97.4 %, respectively. For Cohort B (n = 148), the accuracy was 96.3 %. The area under the receiver operating characteristic curve (AUC-ROC) values for the training, validation, and test sets of Cohort A, as well as Cohort B, and their 95 % confidence intervals (CIs) were as follows: 1.000 (1.000, 1.000), 0.978 (0.944, 1.000), 0.986 (0.969, 1.000), and 0.981 (0.970, 0.992). The area under the precision-recall curve (AUC-PR) values were 1.000 (0.996, 1.000), 0.964 (0.927, 0.985), 0.907 (0.924, 0.984), and 0.890 (0.846, 0.971), respectively. According to the DeLong test, there was no significant difference in the AUC-ROC values between the test set of Cohort A and Cohort B, both for the overall data and for each specific vertebral location (all P>0.05). ConclusionThe developed model demonstrates promising diagnostic accuracy and applicability for detecting lumbar vertebral fractures.

Keeping it "straight": how to do spinal tumor ablation with vertebral augmentation

This technical review provides a comprehensive overview of spinal tumor ablation and vertebral augmentation. These percutaneous minimally invasive procedures offer significant survival and palliative pain relief benefits for patients with pathological vertebral fractures. Vertebral augmentation, which includes vertebroplasty and kyphoplasty, involves injecting cement into fractured vertebral bodies to restore height. While vertebroplasty involves the direct injection of cement into a fractured vertebral body, kyphoplasty involves using a balloon to create a low-pressure cavity to allow for cement injection to restore the vertebral body height. Over the years, this technique has evolved into a straightforward process, though it presents certain technical challenges discussed in this article.

Computed Tomographic Scan for Head Injury Patients: Any Justification for Adapting Routine Cranio-Cervical Examination Irrespective of Clinical Severity?

This study aimed to assess the prevalence of concomitant cervical spine and head injury at our University Teaching Hospital in Nigeria and attempted to justify examining patients' head and cervical spine using computed tomography (CT) scan at presentation irrespective of the head injury severity by clinical assessment using Glasgow Coma Scale (GCS). All eligible patients, 1-80 years of age who presented with head injuries in the accident and emergency (A&E) unit during the study period, were included if they satisfied the inclusion criteria. Post-resuscitation GCS was assessed clinically, and head and cervical spine injury (CSI) were observed radiologically on cranio-cervical CT scan for all patients. The presence of cervical spine fractures, subluxation or dislocation was considered a confirmation of CSI. There were 143 patients with head injuries studied; 90.2% of them were males. The mean age of the patients was 28.87 ± 15.93 years. The most common cause of injury was road traffic accidents in 110 (76.90%). The prevalence of CSI was 11.2%. Majority of the patients with CSI in this study (56.25%) had a mild head injury, 25% had a moderate head injury, and 18.75% had a severe head injury. The lower cervical spine was the most frequently injured segment in this study, involving 10 patients. Multi-level cervical vertebral body fractures of C3 to C6 were the most common form of CSI in this segment. The prevalence of concomitant cervical spine and head injury was significant in this study. This was confirmed among study subjects with a clinical diagnosis of mild-to-moderate head injury as compared with moderate-to-severe head injury. Therefore, all patients who sustained a head injury irrespective of severity are required to have a complete and rapid evaluation of the cervical spine.

Biomechanical effects of posterior lumbar interbody fusion with vertical placement of pedicle screws compared to traditional placement.

The pedicle screw technique is widely employed for vertebral body fixation in the treatment of spinal disorders. However, traditional screw placement methods require the dissection of paraspinal muscles and the insertion of pedicle screws at specific transverse section angles (TSA). Larger TSA angles require more force to pull the muscle tissue, which can increase the risk of surgical trauma and ischemic injury to the lumbar muscles. To study the feasibility of zero-degree TSA vertical pedicle screw technique in the lumbosacral segment. Finite element models of vertebral bodies and pedicle screw-rod systems were established for the L4-S1 spinal segments. A standard axial load of 500 N and a rotational torque of 10 N/m were applied. Simulated screw pull-out experiment was conducted to observe pedicle screw resistance to pull-out, maximum stress, load-displacement ratio, maximum stress in vertebral bodies, load-displacement ratio in vertebral bodies, and the stress distribution in pedicle screws and vertebral bodies. Differences between the 0-degree and 17-degree TSA were compared. At 0-degree TSA, the screw pull-out force decreased by 11.35% compared to that at 17-degree TSA (P < 0.05). At 0-degree and 17-degree TSA, the stress range in the screw-rod system was 335.1-657.5 MPa and 242.8-648.5 MPa, separately, which were below the fracture threshold for the screw-rod system (924 MPa). At 0-degree and 17-degree TSA, the stress range in the vertebral bodies was 68.45-78.91 MPa and 39.08-72.73 MPa, separately, which were below the typical bone yield stress range for vertebral bodies (110-125 MPa). At 0-degree TSA, the load-displacement ratio for the vertebral bodies and pedicle screws was slightly lower compared to that at 17-degree TSA, indicating slightly lower stability (P < 0.05). The safety and stability of 0-degree TSA are slightly lower, but the risks of screw-rod system fracture, vertebral body fracture, and rupture are within acceptable limits.

Intervertebral Disc Degeneration Induced by Vertebral Body Fracture Associated with Microcirculation Disruption of the Subendplate

Among the causes of the progression of intervertebral disc (IVD) degeneration (IDD) is the loss of nutrient intake to the IVD through the microcirculation disruption of the subendplate. Also, the vertebral body fracture intervenes in the degeneration the adjacent IVD. This research aimed to create an animal model of IDD using these 2 strategies. Thirty male Sprague-Dawley rats were split into 3 groups: a control group, a middle vertebral body injury (MI) associated with ethanol injection (MI+EtOH) group, and an MI associated with phosphate-buffered saline injection group. A vertebral body fracture with or without endplate injection of ethanol was generated by either drilling a hole in the center of a caudal rat vertebral body to form a fracture with an unabated endplate or drilling a hole in the center of a rat coccygeal vertebral body with endplate injection of ethanol to establish a vertebral body fracture with endplate damage. X-ray, macroscopic, histologic, and biochemical evaluations were utilized to assess IDD at weeks 3 and6. According to X-ray findings, the MI+EtOH group demonstrated a significant decrease in intervertebral space height over time in comparison to the 2 other groups. The water content also was significantly decreased. Macroscopic and histological analysis demonstrated progressive degenerative changes in the IVD of the MI+EtOH group. The caudal vertebra fracture with ethanol injection is more likely to induce degeneration of adjacent IVD. This model effectively reproduced IDD, which may serve as a theoretical basis for future clinical intervention for IDD.

Hip Fracture and The Associated Risk Factors among Egyptian Males

Abstract Background Fragility fractures caused by osteoporosis are well-known to increase the risk of further fragility fractures; a history of the wrist, vertebral body, or hip fractures increases the risk of further fractures accordingly. Fragility fractures induce lower activities of daily living (ADL), and repeated fractures further reduce mobility. Studies found that persons who experienced at least one vertebral body fracture had a higher mortality rate than persons without vertebral body fractures. Also, the one year survival rate of patients with hip fractures was lower than that of the general population. The objective of this study was to find the proportion of concomitant hidden vertebral fractures among males with fragility hip fracture. Patients and Methods Observational analytical case control study, on 150 male cases of osteoporotic hip fractures with matching 150 controls, 40 years of age and older, presented to orthopedic emergency room in the period from Jan, 2019 to Jan, 2020. Cases and controls underwent structured interview questionnaire including all medical and socio- demographic characteristics. Cases in addition underwent plain x-ray for lumbosacral vertebra to assess for concomitant hidden vertebral fractures, in addition. Results We had 150 patients conforming to our inclusion criteria, visiting the orthopedic emergency department, of a total number 48000 patients, only 13000 of them are males during the study period, from Jan 2019 to Jan. 2020. The proportion of fragility hip fracture among males was 1.2%, with mean age 74.32 +/- 10.7. Cases also had a number of co- morbidities ranging from 4-7 chronic diseases. Of those cases, 26% had a concomitant hidden vertebral fracture. Conclusion Concomitant vertebral fracture is prevalent among males with other fragility fractures, especially hip fracture, which warrants identification and management to evade complications and mortality.

Effects of tramadol hydrochloride preemptive analgesia in kyphoplasty of thoracolumbar osteoporotic fractures under local anesthesia

To explore preemptive analgesic effect of preoperative intramural tramadol injection in percutaneous kyphoplasty (PKP) of vertebrae following local anesthesia. From August 2019 to June 2021, 118 patients with thoraco lumbar osteoporotic fractures were treated and divided into observation group and control group, with 59 patients in each gruop. In observation group, there were 26 males and 33 females, aged from 57 to 80 years old with an average of (67.69±4.75)years old;14 patients on T11, 12 patients on T12, 18 patients on L1, 15 patients on L2;tramadol with 100 mg was injected intramuscularly half an hour before surgery in observation group. In control group, there were 24 males and 35 females, aged from 55 to 77 years old with an average of (68.00±4.43) years old;19 patients on T11, 11 patients on T12, 17patients on L1, 12 patients on L2;the same amount of normal saline was injected intramuscularly in control group. Observation indicators included operation time, intraoperative bleeding, visual analogue scale (VAS) evaluation and recording of preoperative (T0), intraoperative puncture(T1), and working cannula placement (T2) between two groups of patients, at the time of balloon dilation (T3), when the bone cement was injected into the vertebral body (T4), 2 hours after the operation (T5), and the pain degree at the time of discharge(T6);adverse reactions such as dizziness, nausea and vomiting were observed and recorded;the record the patient's acceptance of repeat PKP surgery. All patients were successfully completed PKP via bilateral pedicle approach, and no intravenous sedative and analgesic drugs were used during the operation. There was no significant difference in preoperative general data and VAS(T0) between two groups (P>0.05). There was no significant difference in operation time and intraoperative blood loss between the two groups (P>0.05). VAS of T1, T2, T3, T4 and T5 in observation group were all lower than those in control group(P<0.05), and there was no significant difference in T6 VAS (P>0.05). T6 VAS between two groups were significantly lower than those of T0, and the difference was statistically significant (P<0.05). There was no significant difference in incidence of total adverse reactions between two groups (P>0.05). There was a statistically significant difference in the acceptance of repeat PKP surgery (P<0.05). Half an hour before operation, intramuscular injection of tramadol has a clear preemptive analgesic effect for PKP of single-segment thoracolumbar osteoporotic fracture vertebral body under local anesthesia, which could increase the comfort of patients during operation and 2 hours after operation, and improve patients satisfaction with surgery.

Steel bar penetrating cervical spinal canal without neurological injury: A case report

BACKGROUND We report a rare case of cervical spinal canal penetrating trauma and review the relevant literatures. CASE SUMMARY A 58-year-old male patient was admitted to the emergency department with a steel bar penetrating the neck, without signs of neurological deficit. Computed tomography (CT) demonstrated that the steel bar had penetrated the cervical spinal canal at the C6–7 level, causing C6 and C7 vertebral body fracture, C6 left lamina fracture, left facet joint fracture, and penetration of the cervical spinal cord. The steel bar was successfully removed through an open surgical procedure by a multidisciplinary team. During the surgery, we found that the cervical vertebra, cervical spinal canal and cervical spinal cord were all severely injured. Postoperative CT demonstrated severe penetration of the cervical spinal canal but the patient returned to a fully functional level without any neurological deficits. CONCLUSION Even with a serious cervical spinal canal penetrating trauma, the patient could resume normal work and life after appropriate treatment.

In vivo evaluation of hyaluronic acid–polyethylene glycol amended PMMA bone cement for orthopaedic application

The utilization of polymethyl methacrylate (PMMA) bone cement is employed for the purpose of stabilizing fractured vertebral bodies. The existence of a mechanical imbalance in hard polymethylmethacrylate (PMMA) bone cement has the potential to increase the likelihood of a fracture occurring in the neighbouring vertebral body. In order to reduce potential difficulties, the primary goal of this study is to investigate the potential benefits of increasing PMMA bone cement’s bioactivity and lowering its elastic modulus. The incorporation of a 10% volume fraction of hyaluronic acid (HyA) and polyethylene glycol (PEG) into the bone cement led to an improvement in the bioactivity and decreasing of elastic modulus of polymethylmethacrylate (PMMA). The integration of HyPE gel phase presents several advantages over pure PMMA bone cement, including enhanced setting parameters, improved degradability, and increased biocompatibility. The gel phase is additionally accountable for a reduction in the elastic modulus of polymethylmethacrylate (PMMA) bone cement. In addition, the existence of a porous structure that arises from the degradation of the HyPE gel phase delivers a significant amount of room, thereby enhancing the process of bone regeneration when implanted in the femur of rabbits. The utilization of HyPE in PMMA has been shown through comprehensive µ-CT analysis to enhance bone formation, thereby promoting osteointegration at the implantation site. Furthermore, the histological analysis demonstrated the existence of osteogenic activity in the PMMA polyethylene glycol supplemented with 10% HyA and 10% PEG after a 2-month period subsequent to implantation.

The safety and efficacy of the Stryker OptaBlate™ Bone Tumor Ablation system for vertebral body metastases.

Metastatic spinal lesions are a significant cause of morbidity and decreased quality of life in those with a high tumor burden. Despite treatment modalities such as medical therapy (e.g., chemotherapy, steroids), spinal augmentation procedures, and radiation therapy, many patients still experience refractory back pain due to neoplastic infiltration of the vertebral body and/or pathologic compression fractures. With the aim to address refractory pain in patients who have exhausted conventional treatment options, Stryker developed the OptablateTM Bone Tumor Ablation system (BTA; Stryker Corporation, Kalamazoo, MI), which delivers radiofrequency energy to pathologic vertebral body lesions. In this preliminary single-institution study, we characterize the use of the BTA system in 11 patients undergoing kyphoplasty for pathologic spinal lesions with the goal to demonstrate the impact of this novel technology on refractory pain in this challenging clinical setting. A single-center retrospective chart review was performed on all patients identified as those receiving tumor ablation/kyphoplasty for spinal neoplasms using the OptablateTM BTA system performed by a single surgeon at the University of Oklahoma Medical Center. Sex, age, primary lesion type, presenting symptomatology, spinal level, time of follow-up, and outcome were obtained from the electronic medical record (EMR). Eleven patients (4 males, 7 females) with a mean age of 62 (range, 38-82) years had an average follow-up time of 6 months. Presenting symptoms attributed to spinal pathology included back pain (n = 11, 100%), pathologic fracture (n = 6, 55%), and lower extremity weakness (n = 3, 27%). A total of 20 lesions were ablated at 12 vertebral levels. Eight patients (73%) had improved pain. No complications were reported. This preliminary study documents the safety of the BTA system, in addition to its diverse use across many levels. The majority of patients reported improvement in their pain. Further study is required to fully characterize the use of the BTA system in those with neoplastic spinal pathology.

Adjacent vertebral fractures in the lumbar and thoracic spine after balloon kyphoplasty: A finite element analysis.

The purpose of the present study was to mechanically verify after vertebral augmentation (AVA) scores using a finite element method (FEM) with accurate material constants of balloon kyphoplasty (BKP) cement. Representative cases with AVA scores of 1 (case 1), 3 (case 2), and 5 (case 3) among patients with vertebral body fractures who underwent BKP were analyzed. A FEM model consisting of 5 vertebral bodies was created, including the injured vertebral body in each case. The amount of displacement for each load (up to 4000 N) between the upper and lower vertebral bodies of each model was measured. Young modulus of the BKP cement was calculated from actual measurements using the EZ-Test EZ-S (Shimadzu Corporation, Kyoto, Japan). In all cases, the number of shell elements (209,296-299,876), solid elements (1913,029-2417,671), and nodes (387,848-487,756) were similar, indicating that FEM modeling was comparable among the cases. Young modulus of BKP cement, calculated using EZ-Test EZ-S, was 572 MPa. Fractures were detected by compressive forces of 3300 N (upper) and 3300 N (lower), 3000 N (upper) and 3100 N (lower), and 1200 N (upper) and 1200 N (lower) in cases 1, 2, and 3, respectively. The AVA scoring system was mechanically verified using the accurate material constants of BKP cement. A multicenter survey and external validation are therefore required for the clinical implementation of the AVA score.

Comparison of Adult Female and Male PMHS Pelvis and Lumbar Response to Underbody Blast.

The goal of this study was to gather and compare kinematic response and injury data on both female and male whole-body Post-mortem Human Surrogates (PMHS) responses to Underbody Blast (UBB) loading. Midsized males (50th percentile, MM) have historically been most used in biomechanical testing and were the focus of the Warrior Injury Assessment Manikin (WIAMan) program, thus this population subgroup was selected to be the baseline for female comparison. Both small female (5th percentile, SF) and large female (75th percentile, LF) PMHS were included in the test series to attempt to discern whether differences between male and female responses were predominantly driven by sex or size. Eleven tests, using 20 whole-body PMHS, were conducted by the research team. Preparation of the rig and execution of the tests took place at the Aberdeen Proving Grounds (APG) in Aberdeen, MD. Two PMHS were used in each test. The Accelerative Loading Fixture (ALF) version 2, located at APG's Bear Point range was used for all male and female whole-body tests in this series. The ALF was an outdoor test rig that was driven by a buried explosive charge, to accelerate a platform holding two symmetrically mounted seats. The platform was designed as a large, rigid frame with a deformable center section that could be tuned to simulate the floor deformation of a vehicle during a UBB event. PMHS were restrained with a 5-point harness, common in military vehicle seats. Six-degree-of-freedom motion blocks were fixed to L3, the sacrum, and the left and right iliac wings. A three-degree-of freedom block was fixed to T12. Strain gages were placed on L4 and multiple locations on the pelvis. Accelerometers on the floor and seat of the ALF provided input data for each PMHS' feet and pelvis. Time histories and mean peak responses in z-axis acceleration were similar among the three PMHS groups in this body region. Injury outcomes were different and seemed to be influenced by both sex and size contributions. Small females incurred pelvis injuries in absence of lumbar injures. Midsized males had lumbar vertebral body fractures without pelvis injuries. And large females with injuries had both pelvis and lumbar VB fractures. This study provides evidence supporting the need for female biomechanical testing to generate female response and injury thresholds. Without the inclusion of female PMHS, the differences in the injury patterns between the small female and midsized male groups would not have been recognized. Standard scaling methods assume equivalent injury patterns between the experimental and scaled data. In this study, small female damage occurred in a different anatomical structure than for the midsized males. This is an important discovery for the development of anthropomorphic test devices, injury criteria, and injury mitigating technologies. The clear separation of small female damage results, in combination with seat speeds, suggest that the small female pelvis injury threshold in UBB events lies between 4 - 5 m/s seat speed. No inference can be made about the small female lumbar threshold, other than it is likely at higher speeds and/or over longer duration. Male lumbar spine damage occurred in both the higher- and lower lower-rate tests, indicating the injury threshold would be below the seat pulses tested in these experiments. Large females exhibited injury patterns that reflected both the small female and midsized male groups - with damaged PMHS having fractures in both pelvis and lumbar, and in both higher- and lower- rate tests. The difference in damage patterns between the sex and size groups should be considered in the development of injury mitigation strategies to protect across the full population.

ANALYSIS OF THE RESULTS OF PERCUTANEOUS VERTEBROPLASTY OF COMPRESSION FRACTURES OF BODIES OF CHEST AND LUMBAR VERTEBRAE ON THE BACKGROUND OF OSTEOPOROSIS

It is well known that the most frequent complication of osteoporosis is compression fractures of vertebral bodies. In addition to brittleness of the bones and mechanical stress, more and more evidence approving that compression fractures of vertebral bodies are related to many risk factors, such as aging, sex, concomitant morbidities of cardiovascular and cerebrovascular diseases and lifestyle (chronic smoking and alcohol consumption) are collected. Objective. Analyzing the condition of spines of the patients suffering from compression fractures of vertebral bodies on the background of osteoporosis after the performed Percutaneous vertebroplasty (PV). Methods. 553 patients who underwent hospital treatment at the spine pathology clinic of the Sytenko Institute of Spine and Joint Pathology (2005–2022) and underwent PV were examined. Results. The patients were divided into three groups depending on the number of damaged vertebrae. The 1st group included the patients with compression fractures of one vertebra (185 — 33.4 %); the 2nd group included the patients having 2 or 3 deformed vertebrae (216 — 39 %); and the 3rd group included the patients with 4–5 damaged vertebrae (152 — 27.4 %). Stages of compression of vertebral bodies during the X-ray morphometry was as follows before the surgery: I — 349 (24 %) vertebrae; II — 494 (34 %); III — 552 (38 %); and IV — 58 (4 %). We achieved the reduction of the level of compression of vertebral bodies as a result of PV in 20 % of cases (patients who noticed the manifestation of the pain syndrome within 2 weeks mostly suffered from these deformations). Conclusions. The results of analysis of PV of 553 patients with composite material and bone cement in the near and far future provide us an opportunity to state that this surgical treatment is an efficient and safe treatment method (despite the materials used). 40 (24 %) patients out of 165 patients of the group I, 52 (33 %) patients out of 157 patients of the group II and 54 (44 %) patients our of 133 patients of the group III were diagnosed with repeated compression fractures. Summarizing all the above, we should note that the more compression fractures the patient has, the higher the risk of further augmentation of other deformations of vertebral bodies is.