Vertebral Body Height Research Articles

Management of fractures of thoraco lumbar spine with pedicle screw fixation

<p class="abstract"><strong>Background:</strong> Thoraco-lumbar fractures are serious injuries of concern, if left untreated may result in marked morbidity and disability to the patient. To study the efficacy of pedicular screw and rod fixation system (ZETA system) in achieving ‘stabilization’ in thoracic and lumbar fractures of the spine.</p><p class="abstract"><strong>Methods:</strong> This was a prospective comparative on-randomized study of 20 patients who underwent pedicle screws and rod fixation in Goverment District headquarters hospital Nagapattinam with a follow-up ranging from September 2018 to December 2018 duration of 4 months. Patient selection was according to the inclusion and exclusion criteria and was surgically treated with pedicle screw and rod system (ZETA).<strong></strong></p><p class="abstract"><strong>Results:</strong> In 75% of the patients, the fractures were reduced by using polyaxial implants and in 25% of the patients both monoaxial and polyaxial implants were used. The average regional angle during the pre-operative stage was 16.50±5.020 and 4.450±4.150 during the 1-year post-operative period. There was a significant difference between pre-op and post-operative regional angles.</p><p class="abstract"><strong>Conclusions:</strong> There is a very high statistical significant restoration of vertebral body height, mean regional angle, and mean anterior wedge angle with this procedure in thoracolumbar fractures. Neurological recovery was seen significantly when all cases with neurological deficits were clubbed together.</p>

Analysis of outcome of percutaneous versus open pedicle screw fixation in the treatment of thoraco-lumbar spine fractures: a prospective comparative study

<p><strong>Background:</strong> Aim of the study was to evaluate the effectiveness between percutaneous and open pedicle screw fixation in the treatment of traumatic thoracolumbar burst fractures with spinal injury.</p><p><strong>Methods:</strong> A prospective comparative study including thirty patients with thoracolumbar burst fracture were equally divided into an open pedicle screw fixation (OPSF) group and a percutaneous pedicle screw fixation (PPSF) group. Demographic characteristics, clinical and radiological outcomes, and adverse events were assessed and compared between the 2 groups.</p><p><strong>Results:</strong> Demographic and clinical features including age, gender, fracture level, mechanism of injury and neurological status in both groups were not significantly different (all p>0.05). The PPSF group exhibits significantly lower operative time, intraoperative blood loss, and hospital stay compared with the OPSF group (all p<0.05). There was no significant difference in the sagittal Cobb′s angle (CA), fracture vertebral body angle (VBA), anterior vertebral body height (AVBH) on pre-operative, immediate post-operative and final follow up between the two surgical techniques (all p>0.05). Visual analogue scale (VAS) remarkably decreased in both groups after surgery but difference was not statically significant (p=0.808). Common postoperative complications in both groups were superficial infections, pressure ulcer and urinary tract infection (UTI) worsening. Hardware failure was seen only in one case of PPSF group.</p><p><strong>Conclusions:</strong> Patients with thoracolumbar burst fractures can be effectively managed with PPSF/OPSF. There were no significant differences in radiological and clinical outcomes and post-op complications between 2 groups but blood loss, operative time and hospitalization stay were less in percutaneous group, which may represent a potential benefit.</p><p><strong> </strong></p>

Vertebral body changes after continuous spinal distraction in scoliotic children

PurposeGrowth-friendly spinal implants (GFSI) were established for scoliotic children as an interim solution until definite spinal fusion could be performed during puberty. While deformity control was clearly proven, the effects on vertebral shape and morphology are still unclear. Our prospective study assesses the effect of GFSI with continuous distraction on vertebral body shape and volume in SMA children in comparison with previously untreated age-matched SMA patients.MethodsCohort I (n = 19, age 13.2 years) were SMA patients without prior surgical scoliosis treatment. Cohort II (n = 24, age 12.4 years) were children, who had continuous spinal distraction with GFSI for 4.5 years. Radiographic measurements and computed tomography (CT) 3D volume rendering were performed before definite spinal fusion. For cohort II, additional radiographs were analyzed before the first surgical implantation of GFSI, after surgery and every year thereafter.ResultsOur analysis revealed decreased depth and volume in scoliotic patients with prior GFSI compared to scoliotic patients without prior implants. This difference was significant for the lower thoracic and entire lumbar spine. Vertebral body height and pedicle size were unchanged between the two cohorts.ConclusionCT data showed volume reduction in the vertebral body in scoliotic children after GFSI treatment. This effect was more severe in the lumbar and lower thoracic area. While vertebral height was identical in both groups, vertebral depth was reduced in the GFSI-treated group. Reduced vertebral depth and altered vertebral morphology should be considered before instrumenting the spine in previously treated scoliotic SMA children.Level of evidence IIIDiagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.

Early loss of angular kyphosis correction in patients with thoracolumbar vertebral burst (A3-A4) fractures who underwent percutaneous pedicle screws fixation

PurposePercutaneous trans-pedicle screws represent a surgical option frequently performed in patients affected by thoracolumbar vertebral burst fractures (A3-A4). The aim of the study was to evaluate the early loss of kyphosis correction and its clinical correlations in a cohort of patients affected by burst spinal fracture treated with percutaneous trans-pedicle screws fixation. MethodsThe present investigation consists in a retrospective one center analysis. The primary outcome was the evaluation of the early loss of correction. Secondary outcomes were the bi-segmental kyphosis change, the clinical outcome and the correlation between clinical outcome and the loss of correction. ResultsAmong 435 patients 97 were included in the study. A mean 3.3° of early loss of correction was observed between postoperative and 1 month follow-up evaluations. The mean anterior vertebral body height change was 3.8 mm. No statistical differences were found in clinical and functional outcomes between patients with >2° or <2° of kyphosis loss of correction. ConclusionNo statistical differences were found between 1 e 6 months postoperative kyphosis loss of correction. The amount of loss of correction seems not to influence clinical outcomes after percutaneous trans-pedicle screw fixation in patients with vertebral burst fractures.

Changes in peri-apical vertebral body and intervertebral disc shape in both the sagittal and coronal planes correlate with scoliosis severity: a 3D study of 397 patients.

To evaluate associations between vertebrae and disc shape asymmetry and adolescent idiopathic scoliosis (AIS) curve severity. Analysis included normal screening referrals and patients with right, main thoracic AIS who underwent upright, biplanar radiographs with 3D reconstruction at a single institution from 2010 to 2015. Peri-apical anterior, posterior, right, and left vertebral body heights (aVBH, pVBH, rVBH, lVBH) and intervertebral disc heights (DH) were measured, and ratios of these measurements were calculated in sagittal and coronal planes. Correlations were performed between curve severity and height measurements. Sagittal and coronal plane components of these measurements were compared between normal controls with coronal curve measurements < 11° and patients with moderate (11°-49°) and severe curves (≥ 50°), with tolerance intervals established for the normal controls. The analysis included a total of 397 patients. Patients with AIS had coronal curve measurements ranging from 11° to 101°. Greater coronal curve severity strongly correlated with smaller pVBH relative to aVBH and moderately correlated with smaller pDH relative to aDH (r = - 0.643, r = - 0.305, respectively). aVBH was greater for larger curves; pVBH remained stable. Scoliosis severity strongly correlated with right relative to left VBH and DH ratios (r = 0.919, r = 0.865 respectively). In comparison of normal controls to severe curves, severe curves had significantly greater aVBH and aDH, while pVBH was not significantly different and pDH was significantly less. Nearly half (46.9%) of the severe curves were below the range of normal for PA vertebral height ratio. In right, main thoracic AIS, greater main thoracic curve severity is associated with greater sagittal and coronal plane asymmetry of both the vertebral bodies and the discs. Severity more strongly correlates with vertebral changes in symmetry than with disc changes, though both are present.

The clinical results of treating Kummell's disease with mineralized collagen modified polymethyl methacrylate.

To investigate the clinical results of treating Kummell's Disease by using mineralized collagen modified polymethyl methacrylate bone cement, 23 cases (23 vertebras) who sustained Kummell's Disease treated with mineralized collagen modified polymethyl methacrylate bone cement from July 2017 to February 2019 were reviewed retrospectively. The visual analogue scale, vertebral body height, Cobb angle, CT values pre-operation and post-operation as well as incidence of complications were observed. All the patients were successfully followed up with an average period of 11.3 months (ranging from 6 to 12 months). The patients could ambulate on the second day after the operation. The visual analogue scale scores significantly decreased from two days after the operation to the last follow-up compared with that before the operation (p < 0.05); the average vertebral height and local Cobb angle had significant recovery (p < 0.05); the CT value of the treated vertebra significantly increased compared with that before the operation (p < 0.05). Bone cement leakage occurred in one case, anterior edge leakage occurred in one case, and no clinical symptoms caused by bone cement leakage occurred. No re-fracture of the treated vertebral body or adjacent vertebral bodies were observed in the follow-ups. With good osteogenic activity and degradable absorption characteristics, mineralized collagen was compounded with the existing polymethyl methacrylate bone cement to reduce its strength in the vertebral body and enhance biocompatibility, the incidence of adjacent vertebral fractures and re-fractures within the injured vertebrae is significantly reduced, and good clinical results are obtained, which is worthy of popularization.

Research of the Clinical Effect of Kyphoplasty in the Treatment of Multiple Senile Osteoporotic Spinal Fractures

Objective: To evaluate the clinical effect of kyphoplasty in the treatment of multiple osteoporotic vertebral fractures in the elderly. Methods: The duration of the study was selected from January 2018 to December 2020, and 38 patients with multiple osteoporotic spinal fractures were selected for study evaluation. All patients were treated with kyphoplasty. The clinical indicators of the two groups were compared and analyzed. Results: The total effective rate was 94.7% and the complication rate was 5.3%. The height of midline, anterior and posterior vertebral body, Cobb angle, VAS score, ODI score and ADL score of 38 patients before and after treatment were compared, which were significantly better than those before treatment (P&lt;0.05). Conclusion: The clinical effect of kyphoplasty in the treatment of elderly patients with multiple osteoporosis is significant, which can be promoted in all levels of medical institutions.

Fourth lumbar vertebral parameters in predicting the gender, height and age in Iranian population

IntroductionLumbar vertebral dimensions can be considered as a criterion to diagnose unidentified individuals with severe burning or corpses. The aim of this study was to evaluate gender, age, and height using the parameters of fourth lumbar vertebral (L4). MethodsThis cross-sectional study was carried out on 106 volunteers. Lumbar diameters of L4 were measured in the two sagittal and horizontal sections by three-dimensional CT scan with reconstruction and volume rendering. The measured parameters were Upper end plate depts (EPD); Upper end plate widths (EPW); Anterior height of vertebral body (VBH); Foramen diameter (depts.) (FDS); Foramen diameter (widths) (FDC); Pedicle height (PH); Pedicle widths (PW); Articular process height (APH); Maximum distance between (ADM); Transverse process distance (TDM); Spinal process height (SPH); Spinal process lengths (SPL); and Vertebral lengths (VL). These parameters were compared. The relationship of each parameter was evaluated with age, height and gender. ResultsTotally, the mean parameters of L4 was higher in men compared to women, but this difference was not significant in FDS, APHI, and SPL. In the study of the correlation of diameters with age, only EPD and SPL parameters were significant, but in the linear regression model to predict age, only the FDS index showed a significant relationship. All parameters except APHS, APHI, SPL, and VL showed a significant and positive correlation with height. But in the linear regression model to predict height, only a significant relationship was reported for EPD. ConclusionIt was shown that the parameters of the fourth lumbar vertebra can be helpful to determine the age, height, and gender.

Height and volume restoration in osteoporotic vertebral compression fractures: a biomechanical comparison of standard balloon kyphoplasty versus Tektona\xae in a cadaveric fracture model

BackgroundStandard balloon kyphoplasty represents a well-established treatment option for osteoporotic vertebral compression fractures. Aim of the present study was to evaluate two different methods of percutaneous augmentation (standard balloon kyphoplasty (BKP) versus Tektona® (TEK)) with respect to height restoration.MethodsFour-teen vertebral bodies of two female cadavers were examined. Fractures were created using a standardized protocol. CT-scans were taken before and after fracture, as well as after treatment. Afterwards two groups were randomly assigned in a matched pair design: 7 vertebral bodies (VB) were treated with BKP (Kyphon, Medtronic) and 7 vertebral bodies by TEK (Spineart, Switzerland) Anterior, central and posterior vertebral body heights were evaluated by CT-scans. Volumetry was performed using the CT-scans at three different timepoints.ResultsValues before fracture represent 100%. The anterior height after fracture was reduced to 75.99 (± 4.8) % for the BKP group and to 76.54 (± 9.17) % in the TEK Group. Statistically there was no difference for the groups (p = 1). After treatment the values increased to 93.06 (± 5) % for the BKP Group and 87.71 (± 6.2) % for the TEK Group. The difference before and after treatment was significant for both groups (BKP p = 0.0006; TEK p = 0.03). Within the groups, there was no difference (p = 0.13).The Volume of the vertebral body was reduced to 82.29 (± 8.4) % in the BKP Group and to 76.54 (± 8.6) % in the TEK Group. After treatment the volume was 89.26 (± 6.9) % for the BKP Group and 88.80 (± 8.7) % for the TEK Group. The difference before and after treatment was significant only for the TEK group (BKP p = 0.0728 n.s.; TEK p = 0.0175). Within the groups, there was no difference (p = 0.2).The average cement volume used was 6.1 (range 3.6–9 ml) for the BKP group and 5.3 (3–7.2 ml) for the TEK group respectively.ConclusionsBased on our results the new System Tektona® in osteoporotic compression fractures might represent a promising alternative for the clinical setting, especially preserving bone. Further biomechanical tests and clinical studies have to proof Tektona®`s capabilities.

Reducción abierta de fracturas toracolumbares y corrección del balance sagital usando tornillos Schanz

IntroductionThe correction of thoracic and lumbar spine fractures with a short instrumentation using Schanz screws, is an effective method for stabilization and sagittal balance restoration. Materials and methodsBidirectional observational study, included patients undergoing arthrodesis with Schanz screws to manage thoracic and lumbar fractures, the general characteristics, type, and location of the fracture, besides the gain in height of the vertebral body and segmental angle were analyzed. before and after surgery. Clinical and imaging control was performed postoperatively and 1 month after this. p-value < .05 was statistically significant. ResultsOf 35 patients undergoing arthrodesis, 13 were excluded due to the absence of images and follow-up. There was a higher proportion of men, the main location of the fracture and AO spine classification was in T12 and type A4/B1 respectively, there was no intraoperative complication, no transfusion was required, and a short hospital stay. A mild complication was presented in the follow-up. The average pre and postoperative change was 12 degrees in the Cobb angle and 5.2 mm vertebral body height in the fractured vertebra, these changes were statistically significant. ConclusionThoracolumbar and lumbar spine fracture correction with short segment fixation using Schanz screws, is an effective, safe and fast, showing significantly vertebral height gain and segmental angle correction, as a consequence, a correction of the balance and alignment of the spine.

Morphometric Study of Atypical Lumbar Vertebrae and their Clinical Significance

Introduction: Lumbar pedicles are short and strong. They form an important part of lumbar spine and play role in transmission of weight from neural arch to the anterior part of vertebral column. Fractures, tumours and degenerative diseases of lumbar vertebrae are common. Pedicle screw fixation is needed to stabilise the vertebrae if required. Only few studies are available for atypical lumbar vertebrae. Aim: To determine the various morphometric measurements of fifth lumbar vertebrae and to discuss the various applied aspects of the study. Materials and Methods: This cross-sectional study was conducted for a period of one year from March 2016 to February 2017. Eighty-five adult human fifth lumbar vertebrae were identified with its atypical features and were examined. Various morphometric measurements- pedicle length, pedicle height and pedicle width, inter pedicle distance, transverse pedicle angle, sagital pedicle angle, chord length, vertebral body height, vertebral body width and vertebral canal measurements were taken using sliding vernier caliper with a least count of 0.1 mm. The data were entered in Microsoft excel and were analysed. Results: A total of 85 fifth lumbar vertebrae were examined. Mean Pedicle Height of L5 vertebrae on both the sides were equal (8.4±3.74). Mean pedicle length of L5 vertebrae and mean transverse pedicular angle of L5 vertebrae were more on the right side than on the left side. Mean pedicle width, mean sagital pedicular angle and chord length of L5 vertebrae were more on the left side than on the right side in this study. All the measurements were compared with previous authors and found to have similar results. Conclusion: Various morphometric measurements of pedicle of fifth lumbar vertebrae were taken in this study. These morphometric knowledge of the pedicles may be helpful for the orthopaedic surgeons and radiologists for proper selection of the pedicle screw and operative repair.

Optimization design and development of UHF omnidirectional wideband antenna for PD detection in substation

In order to meet the requirements of partial discharge (PD) detection of electrical equipment in substation station area, the ultra-high frequency (UHF) antenna with broadband, high gain and horizontal plane (H-plane) omnidirectional is studied and designed as a PD sensor. By analyzing the characteristic impedance and structural characteristics of the biconic antenna, it is determined to be an UHF omnidirectional wideband antenna for detecting PD. The influence of structural parameters such as half-cone angle and vertebral body height on the antenna performance is simulated. At last, a double cone antenna is made and its bandwidth, directional pattern, gain and equivalent height are tested.

A study on the relationship between the rate of vertebral body height loss before balloon kyphoplasty and early adjacent vertebral fracture

The number of patients with an osteoporotic vertebral compression fracture, which is often accompanied by lower back pain and restrained activities, is growing. Balloon kyphoplasty involves the inflation of a balloon to restore height and reduce kyphotic deformity before stabilization with polymethylmethacrylate. However, there is a great deal of debate about whether balloon kyphoplasty also increases fracture morbidity by either inducing or facilitating subsequent adjacent vertebral fractures. To evaluate the relationship between the rate of vertebral body height loss before balloon kyphoplasty and the etiology of early adjacent vertebral fracture after augmentation. A total of 59 patients with osteoporotic vertebral compression fractures who underwent kyphoplasty were enrolled. This study defined early adjacent segmental fractures as new fractures occurring within three months after surgery. This study included the rate of vertebral body height loss. Early adjacent vertebral fractures were diagnosed in nine (15%) of the 59 patients. The patients were divided into two groups, with and without adjacent vertebral fractures. There was no significant difference in terms of age, body mass index, bone mineral density, local kyphotic angle, Cobb's angle, cement volume, cement leakage, and percent height restored between the groups with fractures and without fractures. There was a statistically significant difference between the two groups in the rate of vertebral body height loss. The rate of vertebral body height loss was significantly higher in the fracture group than in the without fracture group. A high rate of vertebral body height loss increased the risk of early adjacent vertebral fractures after balloon kyphoplasty.

Minimally invasive surgery for spinal fractures due to multiple myeloma.

Background:Multiple myeloma (MM) presents with spinal lesions in 60% of cases. The combination of osteolytic lesions with multifactorial osteopenia raises specific surgical treatment challenges. Minimally invasive spine surgery (MISS) could be a potential option for MM spinal lesions treatment.Objective:The objective of this study is to evaluate MISS techniques to treat patients presenting with spine fractures due to MMMethods:Retrospective analysis of consecutive patients with histology-proven pathological fractures caused by MM treated with MISS between 2009 and 2018. We collected the data from the clinical records on epidemiology, topography of spine lesions, surgical techniques, blood loss, operation time, complications, mean in-hospital time, and clinical evolution.Results:Twenty-one patients were studied – 13 males and 8 females, with a mean age of 64 years (range 43–83). Mean preoperative spinal instability neoplastic score was 9.8 ± 6 (range 5–16). All cases had a thoracolumbar location – 15 patients underwent kyphoplasty (KP) or vertebroplasty (VP) and 6 were treated with other more complex procedures. All patients had a reduction of pain and/or analgesic load. Vertebral body height increased by a mean of 2.9 mm after VP/KP. Mean hospital stay was 1.3 days for KP/VP and 5.0 days for other MISS procedures. Three patients had complications.Conclusions:The heterogeneity of techniques used reflected the variety of spine involvement by MM. KP and VP led to shorter hospital stays and less complications, being adequate for lesions without major instability. More complex MISS techniques offer an effective treatment with short delay for starting MM adjuvant treatment.

Clinical study of unilateral Percutaneous vertebra plasty(PVP) in the treatment of Osteoporotic vertebral compression fractures(OVCF) in the elderly

Objective To study the clinical effect of unilateral percutaneous vertebra plasty (PVP) in the treatment of osteoporotic lumbar compression fracture (OVCF) in the elderly. Methods 84 elderly patients with OVCF who were treated in our hospital from January 2017 to December 2020 were included and divided into unilateral group (n=42) and bilateral group (n=42) according to the random number table method. Unilateral PVP treatment was performed in the unilateral group, and bilateral PVP treatment was performed in the bilateral group. Observed two groups of X-ray machine, bone cement dosage irradiation time and operation time indicators such as surgery, preoperative and postoperative and postoperative convex Cobb Angle, after 1 years of vertebral body lesions vertebral body height and body function, preoperative and postoperative 7d and postoperative pain degree and 1 year serum Norepinephrine (NE) and Serotonin (5-HT) and Substance P (SP) and so on pain factor levels, postoperative complications and other indicators; Results the time of X-ray machine irradiation, amount of bone cement and operation time in theunilateral group were all lower than those in the bilateral group (P&lt;0.05). After surgery and 1 year after surgery, there was no difference in Cobb Angle of kyphotic vertebra, height of diseased vertebra and limb function between the two groups (P&gt;0.05).There was no difference in VAS scores and 5-ht, SP and NE levels between the two groups after and 1 year after surgery(P&gt;0.05).The incidence of postoperative complications in the unilateral group (19.05%) was lower than that in the bilateral group (47.62%) (P&lt;0.05). Conclusion unilateral PVP can achieve the same effect as bilateral PVP in the treatment of elderly OVCF. Small trauma, easy to operate, can effectively relieve patients' pain, safe and reliable, worthy of clinical recommendation.

Vesselplasty for the treatment of osteoporotic vertebral compression fractures with peripheral wall damage: a retrospective study

Study design A retrospective study. Objective The clinical efficacy of vertebroplasty and kyphoplasty treating osteoporotic vertebral compression fractures (OVCF) has been widely recognized in recent years. However, there are also disadvantages of bone cement leakage (BCL), limited correction of kyphosis and recovery of vertebral height. Nowadays, in view of these shortcomings, vesselplasty has been widely used in clinical practice. The objective of this study is to assess its clinical effect and application value for the treatment of OVCF with peripheral wall damage. Methods 62 patients (70 vertebrae) treated for OVCF with peripheral wall damage using vesselplasty retrospectively reviewed. The data collection included operation time, volume of bone cement, relevant surgical complications, visual analog scale (VAS), Oswestry disability index (ODI), vertebral body height and kyphosis Cobb angle. Results The volume of bone cement was 3–8 (5.3 ± 1.3) ml. There were 3 vertebrae of BCL (4.3%). VAS and ODI at different time points after operation were decreased compared with before operation (all p < 0.05). There were no statistical differences between VAS or ODI at different postoperative time points (p > 0.05). Vertebral body height and Cobb angle at different time points after operation were improved compared with before operation (all p < 0.05). There were no statistical differences between vertebral body height or Cobb angle at different postoperative time points (all p > 0.05). Conclusions Vesselplasty may reduce the risk of BCL and better control the dispersion of bone cement in the treatment of OVCF. It relieves pain, restores vertebral body height and corrects kyphosis, especially in OVCF with peripheral wall damage. Therefore, vesselplasty is safe and worthy of clinical application.

Spinal motor mapping by epidural stimulation of lumbosacral posterior roots in humans.

SummaryEpidural electrical stimulation of the spinal cord is an emergent strategy for the neurological recovery of lower-extremity motor function. Motoneuron pools are thought to be recruited by stimulation of posterior roots. Here, we linked electromyographic data of epidurally evoked lower-extremity responses of 34 individuals with upper motoneuron disorders to a population model of the spinal cord constructed using anatomical parameters of thousands of individuals. We identified a relationship between segmental stimulation sites and activated spinal cord segments, which made spinal motor mapping from epidural space possible despite the complex anatomical interface imposed by the posterior roots. Our statistical approach provided evidence for low-threshold sites of posterior roots and effects of monopolar and bipolar stimulation previously predicted by computer modeling and allowed us to test the impact of different upper motoneuron disorders on the evoked responses. Finally, we revealed a statistical association between intraoperative and postoperative mapping of the spinal cord.

X-ray and Computed Tomography Analysis of Spinal Joint Injuries

Objective: The X-ray and CT features of minimally invasive percutaneous pedicle screw for open reduction and internal fixation and traditional open reduction and internal fixation for thoracolumbar fractures were compared. Methods: Sixty-two patients with thoracolumbar fractures were analyzed with single vertebral body injury without obvious osteoporosis. Patients were randomly divided into two groups. In group A, minimally invasive percutaneous pedicle screws were used for open reduction and fixation. Group B was treated with thoracolumbar vertebral fracture with traditional incision and reduction and internal fixation with posterolateral fusion. Both groups followed standard surgical methods and methods, the same postoperative treatment and functional exercise plan. Results: During a 9-month follow-up, X-ray and computed tomography were used to analyze fracture joint motion injuries. The recovery rate of vertebral height in group A was significantly better than that in group B. At 9 months after operation, the recovery rate of vertebral height in group A increased. The neural function was similar, but the improvement rate in group A was significantly better than that in group B. Conclusions: Minimally invasive percutaneous pedicle screws for open reduction and internal fixation are compared with traditional open reduction and internal fixation for thoracolumbar fractures. Vertebral body height, symptom improvement, and neurological recovery after a lumbar fracture. However, minimally invasive percutaneous pedicle screws for open reduction and internal fixation can immediately increase the compression stability of the anterior spine and reduce complications such as nail and rod rupture due to excessive fixation pressure.

Результаты применения промежуточных транспедикулярных винтов при повреждениях переходного грудопоясничного отдела позвоночника

Background Short-segment transpedicular screw fixation (SSTSF) is the preferred treatment option for thoracolumbar burst fractures. Adding screws in the fractured body may be helpful in achieving and maintaining fracture reduction. However, the operative approach is disputed. Objective To compare clinical outcomes of transpedicular fixation with and without screws in the fractured vertebral body after isolated uncomplicated fractures at the thoracolumbar junction. Material and methods A retrospective cohort study enrolled 62 patients with Th11–L2 thoracolumbar burst fractures (AOSpine A3, A4) who underwent SSTSF with (n = 32) and without (n = 30) pedicle screws at the fracture level. Demographic data of the patients, operating time and blood loss were registered. Clinical evaluation using Visual analogue scale (VAS ) for pain, Oswestry Disability Index (ODI) to quantify disability and imaging parameters of segmental kyphosis, loss of correction, anterior vertebral body height (AVBH) at the fracture level, spinal canal stenosis (SCS) were measured preoperatively, at one week, 1 month, 6 and 12 months postoperatively. Results The patients of the two groups showed no statistically significant differences in the demographic data, VAS and ODI scores, measurements of kyphotic angle, AVBH, SCS preoperatively (p &gt; 0.05). Screws at the fracture level did not affect the operating time and intraoperative blood loss relative to conventional no-screw group. Benefits with fracture screws were evident at 7 days (p &lt; 0.01) measuring SCS, at 6 months (p &lt; 0.01) and 12 (p &lt; 0.01) months measuring kyphotic angle. There was better kyphosis correction (p &lt; 0.01) and AVBH (p = 0.034) seen at 12 months after surgery. Conclusion Reinforcement of a broken vertebra with fracture-level screws has been shown to provide better stability of clinical and radiographic results as compared to those with conventional SSTSF.

Oral Calcitriol Use, Vertebral Fractures, and Vitamin K in Hemodialysis Patients: A Cross-Sectional Study.

Fractures and vascular calcifications (VCs) are common in patients with chronic kidney disease (CKD). They are related to abnormalities in vitamin D metabolism, calcium, phosphorus, parathyroid hormone, and fibroblast growth factor 23 (FGF23)/Klotho that occur with CKD. Impaired vitamin D metabolism and abnormal levels of calcium, phosphate, parathyroid hormone (PTH), and FGF23/Klotho drive bone and vascular changes in CKD. It is unclear if oral calcitriol safely mitigates fracture risk without increasing the burden of calcifications. Therefore, we investigated whether treatment with calcitriol affected the prevalence of fractures and VC progression in hemodialysis (HD) patients. This report is a secondary analysis of the Vitamin K Italian (VIKI) study, a cross-sectional study involving 387 HD patients. We assessed vitamin 25(OH)D, alkaline phosphatase, PTH, calcium, phosphate, osteocalcin or bone Gla protein, matrix Gla protein, and vitamin K levels. Vertebral fractures (VFs) and VCs were determined by spine radiograph. A reduction of >20% of vertebral body height was considered a VF. VCs were quantified by the length of calcific lesions along the arteries. The patients treated with oral calcitriol were 177 of 387 patients (45.7%). The prevalence of VF was lower in patients receiving oral calcitriol than in those untreated (48.6% versus 61.0%, p=0.015), whereas the presence of aortic and iliac calcifications was similar (aortic: 81.9% versus 79.5%, respectively, p=0.552; iliac: 52.0% and 59.5%, respectively, p=0.167). In multivariable logistic regression analysis, oral calcitriol was associated with a 40.2% reduced odds of fracture (OR 0.598; 95% confidence interval [CI], 0.363-0.985; p=0.043). In conclusion, we found a significant association between oral calcitriol and lower VF in HD patients without an increase in the burden of VC. Further prospective and interventional studies are needed to confirm these findings. © 2021 American Society for Bone and Mineral Research (ASBMR).