Vertebral Body Height Research Articles

Risk factors of recurrent kyphosis in thoracolumbar burst fracture patients treated by short segmental pedicle screw fixation

OBJECTIVE To analyze the risk factors of recurrent kyphosis after removal of short segmental pedicle screw fixation in patients with thoracolumbar burst fractures. METHODS Retrospective analysis was conducted of 144 cases of thoracolumbar burst fractures without neurological impairment treated in Peking University Third Hospital from January 2010 to December 2017. There were 74 males and 70 females, with an average age of (39.1±13.2) years. The distribution of the injured vertebrae was T12: 42, L1: 72 and L2: 30, with fracture types of A3: 90, B1: 25 and B2: 29. The patients were divided into two groups: Recurrent kyphosis group (n=92) and non-recurrent kyphosis group (n=52). SPSS 26.0 software was used for univariate analysis and Logistic regression analysis. RESULTS The average follow-up time was 28 (20-113) months. The imaging indexes of pre-operation, 3 days post-operation, 12 months post-operation and the last follow-up were measured and compared. Anterior vertebral body height, segmental kyphosis, vertebral wadge angle and Gardner deformity were significantly improved after operation (P < 0.05), and there were some degrees of loss in the 1-year follow-up; anterior vertebral body height and vertebral wadge angle were no longer changed after the removal of the screws; however, segmental kyphosis and Gardner deformity were still aggravated after the removal of the screws (P < 0.05). There were some degrees of collapse of the height of the upper and lower discs during the follow-up. Univariate analysis showed that there were statistically significant differences (P < 0.05) between the two groups in gender, age (36.9 years vs. 43.0 years), upper disc injury, CT value (174 vs. 160), segmental kyphosis (16.6° vs. 13.3°), vertebral wadge angle (16.7° vs. 13.6°), Gardner deformity (19.1° vs. 15.2°) and ratio of anterior vertebral body height (0.65 vs. 0.71). Logistic regression analysis showed that male (OR: 2.88, 95%CI: 1.196-6.933), upper disc injury (OR: 2.962, 95%CI: 1.062-8.258) and injured vertebral wedge angle were risk factors of recurrent kyphosis after removal of internal fixation for thoracolumbar burst fracture (P < 0.05). CONCLUSION The patients with thoracolumbar burst fracture can obtain satisfactory effect immediately after posterior short segmental pedicle screw fixation, however, there may be some degree of loss during the follow-up. Male, upper disc injury and injured vertebral wedge angle are the risk factors of recurrent kyphosis after removal of internal fixation for thoracolumbar burst fracture.

Role of Combined Vertebroplasty and Spinal Decompression in the Management of Aggressive Vertebral Hemangiomas.

Background:There are different surgical modalities designed to manage aggressive vertebral hemangioma (VH) that causes neurological symptoms. The selection of the best approach is still controversial. It is crucial to safely achieve neurological recovery with the elimination of the risk of recurrence. The combined use of surgical decompression and vertebroplasty is one of the surgical modalities that are used to manage these cases.Patients and Methods:From January 2012 to January 2019, nine patients with aggressive VH were retrospectively included in the study. All of them were operated upon using combined surgical decompression and vertebroplasty. We evaluated all the patients preoperatively, immediate postoperative, 1 month, and 12 months later. Clinical and radiological outcomes were assessed.Results:Affected spinal levels were dorsal in six cases and lumbar in three cases. There was no postoperative worsening of the preoperative neurological status. For the cases presented with sciatica, the mean VAS score has dropped from 8.33 preoperatively to 2.67 postoperatively. One month later, all of them are free from the radicular pain. For the cases presented with myelopathy, they regain their motor power in both lower limbs over a period of 4 weeks with a mean Nurick grade of 1.17. The postoperative radiological studies revealed near total occlusion of the VH with the maintenance of the vertebral body height. No clinical or radiological signs of spinal instability or recurrence are observed over the period of follow-up.Conclusions:The combined use of surgical decompression and vertebroplasty is considered a safe and effective modality in the management of aggressive VHs.

Radiological features of traumatic vertebral endplate fracture: an analysis of 194 cases with 263 vertebral fractures.

BackgroundThe importance of identifying osteoporotic vertebral endplate or/and cortex fracture (ECF), which primarily includes endplate fracture (EPF) and vertebral anterior cortex buckling, has been recognized. However, some old traumatic ECFs with healing process in the elderly may be mistaken as osteoporotic. This study analyzes the radiological features of traumatic EPF.MethodsThis was a retrospective analysis of 194 spine trauma patients with 263 vertebral fractures (mean age: 42.11 ± 9.82 years, 118 males and 76 females). All patients had traumatic EPF identified by X-ray/CT/MRI.ResultsThe involved vertebra was mostly L1 (29.7%), followed by T12 and L2. Except EPFs involved both superior and inferior endplates (12.6%), only 1.9% involved inferior endplate alone, with the majority involved superior endplate. If each endplate was divided into five segments of equal lengths (from anterior to posterior: a1, a2, m, p2, p1), the most depressed point of superior EPFs was mostly at segment-a2 (approximately 45%), followed by segment-a1 (approximately 20%) or segment-m (approximately 20%), and very rarely at segment-p1. The upper 1/3 of anterior vertebral wall was more likely to fracture, followed by middle 1/3 of anterior wall. For posterior vertebral wall fracture, 68.5% broke the bony wall surrounding the basivertebral vain. 58.6%, 30.0%, and 11.4% of vertebral fractures had <1/5, 1/5–1/3, and >1/3 vertebral body height loss. As the extent of vertebral height loss increased, the chance of having both superior and inferior EPFs also increased; however, the chance of having inferior EPF alone did not increase.ConclusionTraumatic EPF features are characterized, which may help the differentiation of traumatic and osteoporotic EPFs.

The Impact of Bone Mineral Density on Bone Metabolism and the Fracture Healing Process in Elderly Chinese Patients With Osteoporotic Vertebral Compression Fractures

Background: The aim of this study was to investigate the effect of bone mineral density (BMD) on bone histomorphological parameters and bone turnover markers (BTMs) following osteoporotic vertebral compression fracture (OVCF) and to determine the correlation between BMD and the percentage of middle height compression during the healing process. Methods: A total of 206 patients with OVCFs were included in this study. Bone biopsy specimens were acquired during surgery. Blood samples were obtained to determine the serum concentrations of BTMs. The patients were divided into 2 groups according to BMD.Results: The concentrations of N-terminal propeptide of type I collagen (PINP) in the T-score ≤ −2.5 group (50.92 ± 12.78 ng/ml) were significantly lower than those in the T-score > −2.5 group (68.75 ± 28.66 ng/ml, p = 0.025) 3–6 mo after fracture. Moreover, the volume of necrotic bone in the T-score ≤ −2.5 group (15.15 ± 5.44%) was higher than that (1.67 ± 0.79%, p < 0.001) in the T-score > −2.5 group during the same period. BMD was statistically correlated with cancellous bone content (RS = 0.761, p <0.001), PMHC (RS = 0.85, p < 0.001), fibrous tissue volume (RS = −0.376, p < 0.001), and necrotic bone content (RS = −0.487, p < 0.001).Conclusions: The healing process of OVCFs in the setting of low bone mass frequently occurs in the presence of decreased bone formation abilities, severe vertebral body height loss and a large amount of necrotic bone.

Clinical efficacy and safety of bone cement combined with radiofrequency ablation in the treatment of spinal metastases

BackgroundTo investigate the clinical efficacy and safety of bone cement combined with radiofrequency ablation (RFA) in the treatment of spinal metastases.MethodsThe medical records of patients with spinal metastatic tumor admitted to our hospital from January 2016 to December 2018 were retrospectively analyzed. Based on different surgical methods, the patients were divided into groups A (treated with RFA combined with bone cement) and B (treated with bone cement only). Group A included 35 patients with 47 segments of diseased vertebral bodies. Group B consisted of 52 patients with 78 vertebral segments. Pain, quality of life score, vertebra height, bone cement leakage, postoperative tumor recurrence, and complications were assessed 3 days and 1 and 6 months after surgery.ResultsAll the patients had smooth operation without paraplegia, spinal cord injury, and perioperative death. Visual analogue scales (VAS) and Oswestry Disability Index (ODI) scores of the two groups significantly improved 3 days and 1 month after surgery compared with those before surgery (P < 0.05), but no significant difference was observed between the two groups (P > 0.05). Six months after surgery, the VAS and ODI scores of patients in group A were lower than those in group B, with statistically significant differences (P < 0.05). The postoperative vertebral body height of the two groups significantly increased compared with that before surgery, and the difference was statistically significant (P < 0.05). Meanwhile, no significant difference was observed between the two groups (P > 0.05). Postoperative bone cement permeability in group A was 6.4%, and postoperative tumor recurrence rate was 11.4%. The permeability of bone cement in group B was 20.5%, and the tumor recurrence rate was 30.8%. The bone cement permeability and tumor recurrence rate in group A were lower than those in group B, with statistically significant differences (P < 0.05).ConclusionsBone cement combined with RFA for the treatment of spinal metastases can achieve good efficacy, desirable analgesic effect, low incidence of complications, small surgical trauma, and high safety. The proposed method has the value of clinical popularization and application.

Relationship Between the OF Classification and Radiological Outcome of Osteoporotic Vertebral Fractures After Kyphoplasty.

Study Design:Retrospective cohort study.Objectives:The OF classification is a new classification for osteoporotic vertebral fractures. The aim of this study was to clarify the relationship between preoperative OF subgroups and the postoperative outcome after kyphoplasty in patients with such fractures.Methods:Patients who underwent kyphoplasty of a single osteoporotic vertebral fracture were included and divided into groups according to the OF subgroups. Pre- and postoperative plain radiographs were analyzed in regard to the restoration of vertebral body height and local kyphotic angle (LKA). Additionally, clinical data including pre- and postoperative Visual Analogue Scale pain scores was documented. The clinical and radiological results were compared pre- and postoperatively within groups and between groups.Results:A total of 156 patients from OF subgroups 2 to 4 were included (OF 2: n = 58; OF 3: n = 36; OF 4: n = 62). Patients from all groups experienced significant pain relief postoperatively (P < .001). Patients with OF 2 fractures showed a repositioning of the vertebral body height in the anterior and middle portions (both P < .001), but no significant improvement in LKA. For OF 3 and 4 fractures, there was a significant restoration of vertebral body height (P < .001 for both) and a significant improvement of LKA (P < .001 for both). The highest average restoration was noted in the OF 4 group.Conclusions:A higher OF subgroup is related to a higher radiological benefit from kyphoplasty. This confirms that the OF classification is an appropriate tool for the preoperative assessment of osteoporotic fractures.

Lumbo-peritoneal Shunt Ventral Catheter Placement Using the Lateral Approach without Repositioning

We reported 10 cases of lumbo-peritoneal(L-P)shunt placement using the lateral approach without repositioning. Each patient was placed in a left lateral position under general anesthesia and fixed so that the spine did not rotate. The skin incision on the flank was made at the height of the L4 vertebral body, 4 cm in the left-right direction and 3cm in front of the vertebral body. The external oblique, internal oblique, and transverse abdominal muscles were dissected to reach the peritoneum and confirm that the intestinal tract was peristaltic below the peritoneum. The peritoneum was lifted with hooked tweezers in order to separate them from the intestinal tract, and the peritoneum was incised with a scalpel to reach the peritoneal cavity. Using a finger and a shunt passer, the ventral catheter was guided between the muscle layers. Preoperative abdominal CT showed that all 10 kidneys in this case series were cephalic from the predicted approach route. The ascending colons of three patients were partially in contact with the predicted approach route. During surgery, a ventral catheter could be inserted in all 10 cases. Postoperative abdominal CT showed no intraperitoneal hemorrhage or invasion into the retroperitoneal cavity of the ventral catheter. During the follow-up period, no invasion into the abdominal wall or infection was observed. The average operation time was 52.2 minutes. In order to avoid invasion into the retroperitoneal cavity, a surgical incision was performed without complications by incising the outer side of the lower abdomen and approaching via the external oblique aponeurosis.

Therapeutic Effect of Teriparatide for Osteoporotic Thoracolumbar Burst Fracture in Elderly Female Patients.

ObjectiveTeriparatide is known as an effective anabolic agent not only for severe osteoporosis but also for bone healing and union. We explored the possibility of teriparatide as an alternative treatment option for osteoporotic thoracolumbar (TL) burst fracture. MethodsThis retrospective study enrolled 35 female patients with mean age of 73.77±6.71 years (61–88) diagnosed as osteoporotic TL burst fracture with ≥4 of thoracolumbar injury classification and severity (TLICS) score and no neurological deficits. All patients were treated by teriparatide only (12 of group A), teriparatide plus vertebroplasty (12 of group B), or surgical fixation with fusion (11 of group C), and followed up for 12 months. Radiological outcomes were evaluated using radiological parameters including kyphotic angle (KA), segmental vertebral kyphotic angle (SVKA), compression ratio (CR), and vertebral body height (anterior [AH], middle [MH], posterior [PH]). Functional outcomes were evaluated using visual analog scale (VAS) and Macnab classification (MC). ResultsThere were no statistical significant differences in age, bone mineral density (-3.36±0.73), and TLICS score (4.34±0.48) among the three groups (p>0.05). Teriparatide was administered during 8.63±2.32 months in group A and B. In 12-month radiological outcomes, there were significant restoration in SVKA, CR, AH, and MH of group B and KA, SVKA, CR, AH, and MH of group C compared to group A with no radiological changes (p<0.05). All groups showed similar significant improvements in 12-month functional outcomes, although group B and C showed a better 1-month VAS, 1-month MC, 3-month MC compared to group A (p<0.05). ConclusionNon-surgical treatment with teriparatide showed similar 12-month functional outcomes compared to surgical fixation with fusion. The additional vertebroplasty to teriparatide and surgical fixation with fusion were more helpful to improve short-term functional outcomes with structural restoration compared to teriparatide only.

Does Graft Position Affect Subsidence After Anterior Cervical Discectomy and Fusion?

Study Design:Retrospective cohort study.Objective:Implant subsidence is an important prognostic factor after anterior cervical discectomy and fusion (ACDF). Our purpose in this study was to investigate whether graft position affects subsidence after ACDF and to determine if there is a difference in clinical results based on allograft subsidence and position.Methods:We reviewed 92 patients who underwent single-level ACDF with allograft and plate between January 2012 and October 2018. Treatment levels were divided based on allograft position within 2 mm of the posterior margin of the augmented plate (Anterior group) or at greater than 2 mm (Center group). Subsidence was defined as segmental vertebral body height decrease of 2 mm or more at 1 year compared to 1 week after surgery.Results:Overall subsidence prevalence was 15 (16%) cases. Subsidence was 11% in the Anterior group (8/73) and 39% in the Center group (7/19; P = .012). The subsidence group showed smaller graft footprint size (graft/endplate ratio) compared with the nonsubsidence group, and pseudarthrosis occurred frequently in the subsidence. There was no significant difference in clinical results according to graft position. These findings indicate that anterior graft position reduces risk of subsidence (95% confidence interval = 0.085-0.949).Conclusion:To minimize risk of subsidence, the graft should be positioned on the anterior position of the surgical-level endplate. In addition, using a graft appropriate for endplate size will further reduce subsidence.

Spinal changes after craniospinal irradiation in pediatric patients.

To evaluate long-term degenerative changes in bone and soft tissue after craniospinal irradiation (CSI). An analysis was performed for 892 vertebral bodies in 220 pediatric patients treated with CSI. To analyze vertebral growth, vertebral body height was calculated. Signal changes for vertebral bodies on MRI, scoliosis and kyphosis, degenerative changes of vertebral bones and discs, and wedging or vertebral height loss were analyzed on images, and factors that influenced these changes were investigated. Vertebral growth was significantly correlated with radiation dose and growth hormone (GH) deficiency. Growth rate was significantly worse at a dose >39Gy. Fatty marrow change was found in 83% of patients, 31% had disc degenerative changes, 13% had degenerative changes of spinal bones, 17% had wedging or spinal height loss, and 27% had scoliosis. Vertebral bone growth was significantly reduced when high doses were administered, and adequate GH replacement was important for bone growth. Even with symmetrical irradiation, the risk of scoliosis is high after CSI. There was also frequent progression of spinal demineralization and degenerative changes after CSI. Therefore, careful attention should be paid to spinal symptoms as pediatric patients grow into adulthood.

Thoracic vertebral morphology in normal and scoliosis deformity in skeletally immature rabbits: A Longitudinal study.

ObjectiveTo measure age‐related changes in thoracic vertebral body heights (VBH) in skeletally immature normative and scoliotic rabbits to assess how VBH change during growth. To examine the potential link between the moment‐arm of the rib tether and vertebral wedging as well as the sum of the curvature angles at the apical level (T7). To assess the correlation between the magnitude of initial spine curve and final spine curve in the scoliotic group.MethodsEight healthy, skeletally immature normative New Zealand rabbits and ten skeletally immature scoliotic rabbits which underwent unilateral rib tethering were included retrospectively. Each rabbit was scanned at two to four time points (at 7, 11, 14 and 28 weeks). Three dimensional bone models of thoracic vertebrae (T1‐T12) were digitally segmented and reconstructed. VBH were calculated using surface landmark points from each thoracic vertebra. Apical level (T7) ± 2 levels in scoliotic rabbits were compared to their corresponding levels and time points in the normative group. The moment‐arms between the centroids of 2D projections of T3‐T9 vertebral bodies and the line which connects the centroids of the end levels were calculated.ResultsBilateral left‐right (L‐R) symmetry and anterior‐posterior (A‐P) asymmetry were observed in normative VBH. Bilateral concave‐convex (CC‐CX) asymmetry and (A‐P) asymmetry were observed in scoliotic VBH. No significant differences in growth rates were found between the normative and scoliotic groups. Vertebral wedging as well as curvature magnitude were positively correlated with the moment‐arms.ConclusionUnilateral rib tether applies compressive forces on both concave and convex sides, whereas compressive forces are lower on the latter. Knowing the amount of vertebral wedging or curve magnitude would enable us to predict the applied force (moment‐arms), which is important for planning a corrective surgery.

The value of contrast-enhanced three-dimensional isotropic T2-weighted turbo spin-echo SPACE sequence in the diagnosis of patients with lumbosacral nerve root compression

To investigate the diagnostic value of contrast-enhanced three-dimensional (3D) T2-weighted turbo spin-echo SPACE (T2-SPACE) sequence in LNRC. A total of 90 surgically confirmed LNRC patients with 165 explored nerve roots were enrolled in this study. Diagnostic values were quantified using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. The consistency between 2D MRI and 3D T2-SPACE MRI was quantified using kappa test. The compression of specific branch in nerve root was evaluated on 2D MRI, 3D T2-SPACE MRI, and surgical findings. The pedicle height, vertebral body height (VH), proximal tilting angle of nerve root (PTA) were measured on MR images. The sensitivity, specificity, PPV, NPV, and accuracy by 2D MRI were 78.3%, 72.7%, 94.9%, 34.0%, and 77.6%, respectively. For 3D T2-SPACE MRI imaging, the sensitivity, specificity, PPV, NPV, and accuracy were 91.6%, 86.4%, 97.8%, 61.3%, and 90.9%, respectively. 2D MRI and 3D T2-SPACE MRI for detection of intra-foramen and extra-foramen nerve compression showed poor homogeneity (Kappa = 0.333, Kappa = 0.276, respectively). Smaller VHs and larger PTAs could be indicators for the diagnosis of foraminal nerve root compression. 3D T2-SPACE MRI had a higher sensitivity, specificity, PPV, NPV, and accuracy than 2D MRI for detecting LNRC. The 3D T2-SPACE scan could be a good substitute to routine 2D MRI in LNRC diagnosis, especially for foraminal nerve root compression patients. III.

The Early Results of Vertebral Pathological Compression Fracture of Extra- nodal Lymphoma with HIV-positive Patients Treated by Percutaneous Kyphoplasty.

Vertebral pathological compression fracture involving extra-nodal lymphoma impacts negatively on the quality of life of HIV-positive patients. The choice of a safe and effective approach to palliative care in this condition remains a challenge. The purpose of this study was to investigate the safety and efficacy of percutaneous kyphoplasty (PKP) in the treatment of vertebral pathological compression fracture of extra-nodal lymphoma in HIV-positive patients. A retrospective analysis, from January 2016 to August 2019, was performed on 7 HIVpositive patients, 3 males and 4 females, with extra-nodal lymphoma with a vertebral pathological compression fracture. The patients were treated using percutaneous kyphoplasty in our hospital. Preoperative assessment of the patients was conducted regarding their hematological profile, biochemical indicators, liver and kidney function, blood coagulation function, CD4+T lymphocyte count and viral load. Subsequently, the patients were placed on highly active antiretroviral therapy (HAART) and rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (RCHOP) regimen. Besides, antibiotics, nutritional support and immune-modulating drugs were also administered, rationally. Postoperatively, the height of the anterior edge of the injured vertebrae, Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) values were evaluated. Patients were also monitored for any complications related to the operation. The average CD4+T cell count for the patients was 164 (range 114 ~247 / ul), while the viral load was 26,269 (range 5,765 ~82,321 copies/ul). All patients received nutritional and immune support and registered significant improvements in the levels of ALB and Hb (P<0.05). In all cases, the operation was uneventful with neither cement leakage nor toxic reactions observed. Similarly, no opportunistic infections, other complications or deaths were reported. The height of the anterior vertebral body and the ODI score of the injured vertebrae were significantly improved immediately after surgery (P<0.05). Compared to the preoperative VAS (7.71±1.11), postoperative values were significantly reduced immediately after surgery (3.85±0.90) and at 2 weeks, 1 month and 6 months post-surgery: 2.71±0.76, 3.29±1.11, and 4.00±0.82, respectively (P<0.01). Supported with appropriate perioperative treatment measures, PKP is safe and effective in the treatment of pathological vertebral compression fracture due to extra-nodal lymphoma in HIV-positive patients.

Prospective Nonrandomized Analytical Comparative Study of Clinicoradiological Relationship and Quality of Life between Lumbar Interbody Fusion and Posterolateral Lumbar Fusion.

Study Design:This prospective, nonrandomized, analytic comparative study analyzed the outcome of 100 patients who underwent spinal fusion surgeries (Posterolateral fusion (PLF) and posterior lumbar interbody fusion [PLIF]) with 6 months of follow-up.Objective:The aim of our study was to compare clinicoradiological outcome of the lumbar spinal fusion surgeries (PLF vs. PLIF/transforaminal lumbar interbody fusion [TLIF]), to assess the quality of life pre- and post-operatively in all patients, and to compare the results within the groups.Summary of Background Data:We retrieved the articles related to posterolateral fusion (PLF) and PLIF/TLIF through computer-assisted PubMed and Cochrane database search. Most of the studies in previous literature did not show any significant difference in the success of fusion between the two groups. However, the global outcome in terms of clinical and radiological parameters was good in all the studies.Materials and Methods:Senior neurosurgeons who are part of the study treated 100 patients presented with degenerative disc disease (DDD). Patients underwent two types of spinal fusion surgeries: Posterolateral fusion (PLF) and PLIF/TLIF, and those two groups were compared for clinicoradiological outcome, successful fusion, and quality of life at 6 months of follow-up. Results were analyzed statistically using SPSS version 21.0 and presented in terms of frequency, percentage, mean, and standard deviation. Measurements were compared between groups using the Student's t-test (independent and paired) for normally distributed variables. Percentage was compared with Chi-square test in various parameters. Statistical significance was determined with P values; P < 0.05 was considered statistically significant.Results:Patients aged between 30and 65 years with lumbar DDD who met the inclusion criteria were included in the study. Patients were operated for 1–3 vertebral levels and showed clinical satisfactory outcome on visual analog scale (P = 0.004) and modified-Oswestry low back pain disability questionnaire (Oswestry disability index) (P = 0.000) at 6 months as compared to the preoperative data, which was statistically significant. Radiological outcome in terms of lumbar lordotic angle (LLA, P = 0.000) and ratio of disc space height (DSH) and height of immediate superior vertebral body (P = 0.000) at 3 months of follow-up was also statistically significant. All of our patients showed a well-placed implant (screws and cage) in the follow-up period. Our patients showed successful fusion more in the PLIF group (81.25%) as compared to the PLF group (67.30%), but those results are not statistically significant (P = 0.112), and all of our patients showed statistically significant difference (P = 0.000) in quality of life score at 6 months of follow-up when compared with the preoperative score.Conclusions:We concluded from our study and after the review of literature that the patients with lumbar DDD should undergo spinal instrumentation surgery either PLF or PLIF as per the requirement as these surgeries provide good clinical and radiological outcomes in terms of pain, disability index, LLA, and maintenance of DSH. Although both the groups have few degrees of risks and complications, these are not major one and can be managed easily. The fusion rates are similar in both the groups (PLF and PLIF). Quality of life index showed significant difference within 1 week, after 3 months, and after 6 months of surgery in all of our patients.

Comparison of Clinical and Radiologic Outcome Between Mini-Open Wiltse Approach and Fluoroscopic-Guided Percutaneous Pedicle Screw Placement: A Randomized Controlled Trial

To compare clinical efficacy, radiographic outcome, and radiation exposure between mini-open pedicle screw (MPS) fixation with the Wiltse approach and percutaneous pedicle screw (PPS) fixation in treatment of young and middle-aged patients with thoracolumbar burst fractures. Of 60 patients with thoracolumbar vertebrae fractures treated in our hospital from January 2017 to January 2018, 30 were randomly assigned to the MPS group and 30 were randomly assigned to the PPS group. Clinical efficacy, radiographic outcome, and radiation exposure were compared between the 2 groups. The average age of patients was 42.2 ± 6.7 years in the MPS group and 43.0 ± 6.9 years in the PPS group (P= 0.668). There was no significant difference between the 2 groups in blood loss, hospital stay, postoperative visual analog scale score for back pain, and Oswestry Disability Index score. The vertebral body height and vertebral body angle of the MPS group were significantly better than those of the PPS group at the last follow-up. There was no significant difference in the accuracy rate of pedicle screw placement between the MPS group and the PPS group; the facet joint violation was significantly higher in the PPS group. The average radiation exposure dosage was lower in the MPS group. Both MPS fixation with the Wiltse approach and PPS fixation are safe and effective in the treatment of single-segment thoracolumbar vertebral fractures. Nevertheless, considering the surgical duration, radiation exposure, facet joint violation, vertebral body height, and vertebral body angle at the last follow-up, MPS fixation with the Wiltse approach is a better choice than PPS.

Severe Spinal Infection after Vertebral Fracture Stabilization: A Narrow Escape

AbstractSpinal cord injury is typical following fall from height. The thoracolumbar vertebra undergoes maximum fracture following trauma. A 26-year-old man was brought to the emergency department with a history of fall from height. Clinical examination showed weakness in lower limbs with the inability to pass urine. Magnetic resonance imaging (MRI) of spine done elsewhere was suggestive of loss of second lumbar (L2) vertebral body height with compression over the lower end of the cord. Computed tomography (CT) scan of the spine revealed a burst fracture of L2 vertebra with bone fragments protruding into the spinal canal. The patient was taken up for spinal decompression with stabilization. His hospital stay was uneventful, and two weeks after discharge he was readmitted with wound bulge over the operative site. We started him on intravenous antibiotics and did regular debridement of the wound. Later on, he underwent wound closure with flap rotation.At last follow-up, he was ambulant with bladder and bowel control. During treatment, the titanium implants were left in situ. The decision for implant removal in early wound infection is at the discretion of the operating surgeon, along with the timing and nature of the disease.

Utility of Esophagrams to Detect Prevertebral Invasion in Hypopharyngeal Squamous Cell Carcinoma.

Prevertebral fascia invasion is a feature of advanced hypopharyngeal squamous cell carcinoma (HPSCC) that predicts surgical futility. Magnetic resonance and computed topography imaging are used to identify prevertebral involvement, but reliable prediction remains a challenge. Our aims were to describe a new indication for esophagrams and assess its ability to detect prevertebral invasion preoperatively. Retrospective Review. A retrospective review of advanced HPSCC patients from 2001 to 2019. Thirty-one patients underwent curative treatment (21 surgically, 10 with chemoradiation) with a preoperative esophagram. Operative and pathology reports, and fluoroscopic images were collected from the medical record. Esophagrams were read independently by two blinded radiologists. Excursion of the laryngeal complex was quantified relative to the height of vertebral bodies; <0.5 bodies was considered positive for fixation. Surgery or comparative imaging modalities were the gold-standard comparisons. Mean age at diagnosis was 63 years. Twenty-one patients underwent surgical treatment with laryngopharyngectomies. One patient had prevertebral invasion during surgical exploration. Ten patients underwent chemoradiation therapy, and three of these had prevertebral invasion. The average hyolaryngeal elevation was 1.05 vertebral bodies (standard deviation = 0.5). There was a strong correlation between radiologists (R = 0.80, P < .0001). Compared to the gold standard, esophagrams had sensitivity of 75%, specificity of 93%, positive predictive value of 60%, and a negative predictive value (NPV) of 96%. This study highlights the utility of a common radiologic modality in assessing prevertebral fascia invasion in an advanced-stage HPSCC cohort undergoing surgical treatment. With a high NPV and specificity, the esophagram's potential to rule out prevertebral fascia invasion is a useful predictor of resectability. 4 Laryngoscope, 131:800-805, 2021.

Percutaneous vertebroplasty with high- versus low-viscosity bone cement for osteoporotic vertebral compression fractures

ObjectiveThere is no consensus on the best choice between high- and low-viscosity bone cement for percutaneous vertebroplasty (PVP). This study aimed to compare the clinical and radiological outcomes and leakage between three cements with different viscosities in treating osteoporotic vertebral compression fractures.MethodsThis is a prospective study comparing patients who were treated with PVP under local anesthesia: group A (n = 99, 107 vertebrae) with high-viscosity OSTEOPAL V cement, group B (n = 79, 100 vertebrae) with low-viscosity OSTEOPAL V cement, and group C (n = 88, 102 vertebrae) with low-viscosity Eurofix VTP cement. Postoperative pain severity was evaluated using the visual analog scale. Cement leakage was evaluated using radiography and computed tomography.ResultsThere was no significant difference in the incidence of cement leakage between the three groups (group A 20.6%, group B 24.2%, group C 20.6%, P = 0.767). All three groups showed significant reduction in postoperative pain scores but did not differ significantly in pain scores at postoperative 2 days (group A 2.01 ± 0.62, group B 2.15 ± 0.33, group C 1.92 ± 0.71, P = 0.646). During the 6 months after cement implantation, significantly less reduction in the fractured vertebral body height was noticed in group B and group C than in group A (group A 19.0%, group B 8.1%, group C 7.3%, P = 0.009).ConclusionsLow-viscosity cement has comparable incidence of leakage compared to high-viscosity cement in PVP for osteoporotic vertebral compression fractures. It also can better prevent postoperative loss of fractured vertebral body’s height.

Efficacy of Postural Reduction of Vertebral Compression Fracture with Extension Lateral Radiograph Before Vertebroplasty

This retrospective comparative study aimed to evaluate the efficacy of postural reduction of vertebral compression fracture (VCF) using the hyperextension posture before vertebroplasty (VP). Sixty-five consecutive patients who underwent VP were retrospectively reviewed. Thirty patients who underwent passive expansion of compression fracture before VP (postural reduction vertebroplasty [PRV] group) were compared with 35 patients who underwent in situ vertebroplasty (ISV group). Patient characteristics, complications, local kyphosis angle (LKA), Cobb angle, sagittal index (SI), anterior body height (ABH), and posterior body height were assessed. LKA and SI significantly improved from preoperative measurements at the final follow-up in the ISV and PRV groups. ABH significantly improved only in the PRV group and ABH improvement at the final follow-up was significantly greater in the PRV group. However, there were no significant differences in LKA, Cobb angle, SI, ABH, and posterior body height at the final follow-up. Within the subgroup analysis of patients with preoperative ABH ≤15 mm, ABH and amount of ABH improvement at final follow-up were significantly greater in the PRV group. Hyperextension postural reduction showed superior ABH improvement. It also showed higher ABH at the final follow-up when performed on patients with preoperative ABH ≤15 mm. Although routine hyperextension postural reduction should be carefully approached, postural reduction using supine extension lateral radiography would provide more effective vertebral body height restoration in patients with moderate collapse of vertebral compression fracture with ABH ≤15 mm.

Mechanical loading influences the lumbar intervertebral disc. A cross-sectional study in 308 athletes and 71 controls.

There is evidence in animal populations that loading and exercise can positively impact the intervertebral disc (IVD). However, there is a paucity of information in humans. We examined the lumbar IVDs in 308 young athletes across six sporting groups (baseball, swimming, basketball, kendo, soccer, and running; mean age 19 years) and 71 nonathletic controls. IVD status was quantified via the ratio of IVD to vertebral body height (IVD hypertrophy) and ratio of signal intensity in the nucleus to that in the annulus signal (IVD nucleus hydration) on sagittal T2-weighted magnetic resonance imaging. P values were adjusted via the false discovery rate method to mitigate false positives. In examining the whole collective, compared to referents, there was evidence of IVD hypertrophy in basketball (P ≤ .029), swimming (P ≤ .010), soccer (P = .036), and baseball (P = .011) with greater IVD nucleus hydration in soccer (P = .007). After matching participants based on back-pain status and body height, basketball players showed evidence of IVD hypertrophy (P ≤ .043) and soccer players greater IVD nucleus hydration (P = .001) than referents. Greater career duration and training volume correlated with less (ie, worse) IVD nucleus hydration, but explained less than 1% of the variance in this parameter. In this young collective, increasing age was associated with increased IVD height. The findings suggest that basketball and soccer may be associated with beneficial adaptations in the IVDs in young athletes. In line with evidence on other tissues, such as muscle and bone, the current study adds to evidence that specific loading types may beneficially modulate lumbar IVD properties.