Vertebral Reconstruction Research Articles

Percutaneous transpedicular intracorporeal cage grafting for Kümmell disease.

Osteonecrosis with progressive collapse and segmental kyphosis can lead to intersegmental instability in some osteoporotic vertebral compression fractures (OVCFs). These conditions are known as Kümmell's disease and often require anterior column reconstruction in elderly patients. We attempted anterior column reconstruction by percutaneous transpedicular intracorporeal cage grafting (PTICG) with short-segment pedicle screw fixation and described the steps, with discussions on the surgical indications and pros and cons. PTICG is expected to be an alternative to vertebral anterior column reconstruction, which can preserve the thoracolumbar posterior arch and paravertebral musculature.

Anterior Placement of Cemented Fenestrated Screws in Conjunction with Anterior Reconstruction in Elderly Patients with Severe Vertebral Collapse and Paraparesis

Background: Elderly patients with severe osteoporosis are prone to sustain osteoporotic vertebral compression fractures (OVCF’s). Sometimes, they undergo significant vertebral collapse and kyphosis, leading to significant canal compromise and neurological deterioration. Case Description: We present a case series of three patients, of which two had OVCF’s of L1 and L3, respectively, while one patient had Koch’s spine D12 and L1. All three cases had severe vertebral collapse leading to kyphosis, severe pain, and canal compromise, neurological deterioration with paraparesis, and bowel bladder involvement. Surgery warranted total corpectomy of fractured vertebrae (anterior vertebral column resection) and reconstruction of the anterior column. Due to the significant degree of osteoporosis, fenestrated screws with bone cement (poly methyl acrylate) were used anteriorly along with vertebral body reconstruction with cage, through a purely anterior approach. This is the first instance of fenestrated screws being used anteriorly to reduce screw pull-out. In view of the strong anterior construct, a posterior surgery to supplement the fixation could be avoided in these thoracolumbar junctional cases. Results: No patient experienced loosening of implants, nor did any patient experience cement-related complications. Although the present follow-up of these patients is short (12 months), the patients are pain free and independently ambulatory. Conclusion: Using fenestrated screws in an anterior location allow vertebral reconstruction with a single surgery in elderly patients with severe osteoporosis, reducing chances of screw pull-out. Bone plugs at the tip to help prevent cement extravasation from the vertebral body. Keywords: Anterior fenestrated screws, Bone cement, Corpectomy, Osteoporotic vertebral compression fracture, Koch’s spine, Screw pull-out.

Hypothermia as a potential remedy for canine and feline acute spinal cord injury: a review

Severe spinal cord injury (SCI) resulting in permanent sensory-motor and autonomic dysfunction caudal to a damaged spinal cord (SC) segment is a catastrophic event in human as well as in veterinary medicine. The situation of paraplegic/tetraplegic people or animals is further impaired by serious complications and often displays an image of permanent suffering. Therapeutic hypothermia (TH) has shown neuroprotective capacity in numerous experimental and several clinical studies or case reports. Hence, the method draws increasing attention of neuroscientists as well as health care workers. While systemic TH is a too complex procedure for veterinary practice, local application of TH with a reduced risk of the whole body temperature fluctuations and minimal side effects can become one of the therapeutic tools considered in the treatment of acute traumatic SCIs in bigger animals, especially when surgical decompression of spinal medulla and vertebral column reconstruction is indicated. Still, additional large prospective randomized studies are essential for the standardization of therapeutic protocols and the introduction of the method into therapeutic armamentarium in canine and feline spinal traumatology. The research strategy involved a PubMed, MEDLINE (Ovid), EMBASE (Ovid), and ISI Web of Science search from January 2000 to July 2021 using the terms “canine and feline spinal cord injuryˮ, “hypothermiaˮ, and “targeted temperature managementˮ in the English language literature; also references from selected studies were scanned and relevant articles included.

Posterolateral approach to the thoracic spine for spinal tuberculosis: A Technical Note and an Analysis of Results

Surgical pathologies in the thoracic spine are principally located anteriorly within the vertebral body resulting in vertebral body destruction, kyphotic deformity, and anterior or anterolateral compression of the spinal cord. Adequate decompression of the neural elements and vertebral body reconstruction requires access to the anterior spinal column. The posterolateral approach through a posterior midline incision allows circumferential spinal cord decompression, anterior column reconstruction, correction of thoracic kyphosis, and posterior spinal stabilization to be safely performed through a single incision, at a single sitting with excellent outcomes.

Spinal Hydatid Disease of Cervico-Thoracic in Pregnant Women: A Case Report and Review

Background. Spinal hydatid disease is an extremely rare pathology that could leads to the serious orthopedics and neurological complications. Conservative antimicrobial therapy is not effective for spinal echinococcus. This case is unique for the next reasons: disease manifestation during pregnancy, a long period from a spine decompression to a reconstruction procedure and a technique of the surgery. Case description. A 27 year-old lady at 34 gestation weeks, previously operated on the urgent indications of paraplegia with neurogenic bladder dysfunction after 1 year and 10 months follow-up suffered vertebral column reconstruction due to recurrence of the cervico-thoracic hydatid disease, complicated by angular kyphosis. The echinococcus cyst had a closed contact with a right brachiocephalica vein, compressed the spinal canal and leads to three-column spine instability. Conclusion. Three-column spine reconstruction with anterior corpectomy, cystectomy and fusion provide resolution of the back pain syndrome, improve neurological status and achieve local control of the infectious process in patients with echinococcosis of the spine. In the postoperative period, staged therapy with antiparasitic drugs should be prescribe.

Comparative analysis of long-term outcome of anterior reconstruction in thoracic tuberculosis by direct anterior approach versus posterior approach

Study Design:Retrospective study.Aim:To retrospectively evaluate and compare the long-term outcome of anterior vertebral body reconstruction in tuberculosis (TB) of the dorsal spine by direct anterior-versus-posterior approach.Materials and Methods:A total of 127 patients operated by posterior approach, 118 by anterior for TB-thoracic spine with at least 1-year follow-up were included and retrospectively analyzed. Patients were assessed clinically, radiologically and data regarding age, sex, levels involved, surgical approach, operative time, blood loss, neurological recovery using Frankel grade, pre- and post-operative kyphosis, % correction of kyphosis, time for fusion, fusion grading using Bridwell criteria, % loss of correction, mobilization time and complications if any were collected, analyzed, compared in anterior-v/s-posterior approaches.Results:The mean age in anterior-approach was 36.03 and 39.83 years in posterior. Mean operative time in anterior-approach was 6.11 and 5 h in posterior. Mean blood loss of 1.6 L in anterior approach and 1.11 L in posterior. Mean preoperative kyphosis angle in posterior-approach was 34.803°and 11.286° (P < 0.001) at 3 months postopandtotal correction of 67.216%. Mean preoperative kyphosis angle in anterior-approach was 41.154° and 9.498° at 3 months postopandtotal correction of 77.467% (P < 0.001). Mean loss of correction at 1 year was 4.186°in posterior-approach and 6.184°in anterior. The mean time for fusion was 4.69 months in anterior-approach while 6.34 months in posterior as per Bridwell criteria. Meantime for mobilization in posterior-approach was 1.18 and 2.51 weeks in anterior. Significant improvement in neurology was seen in patients operated by either approach, slightly better in anterior. Complications were more in posterior-approach.Conclusions:Anterior-approach allows for thorough debridement, neural decompression, better anterior column reconstruction, and deformity correction under direct vision than posterior. Direct cord visualization while correcting kyphosis reduces the chances of neurological complications significantly. Both approaches have unique advantages and limitations. Though the posterior approach is easy to master, results shown by the anterior cannot be overseen. To conclude, better functional outcome and significantly better kyphosis correction are seen with anterior-approach, which are strong pointers favoring it.

Comparison of Outcomes between Minimally Invasive Lateral Approach Vertebral Reconstruction Using a Rectangular Footplate Cage and Conventional Procedure Using a Cylindrical Footplate Cage for Osteoporotic Vertebral Fracture.

The aim of the current study was to compare outcomes between lateral access vertebral reconstruction (LAVR) using a rectangular footplate cage and the conventional procedure using a cylindrical footplate cage in patients with osteoporotic vertebral fracture (OVF). We included 46 patients who underwent anterior–posterior combined surgery for OVF: 24 patients underwent LAVR (Group L) and 22 underwent the conventional procedure (Group C). Preoperative, postoperative, and 1- and 2-year follow-up X-ray images were used to measure local lordotic angle, correction loss, and cage subsidence (>2 mm in vertebral endplate depression). In anterior surgery, the operation time was significantly shorter (183 vs. 248 min, p < 0.001) and the blood loss was significantly less (148 vs. 406 mL, p = 0.01) in Group L than in Group C. In Group C, two patients had anterior instrumentation failure. Correction loss was significantly smaller in Group L than in Group C (1.9° vs. 4.9° at 1 year, p = 0.02; 2.5° vs. 6.5° at 2 years, p = 0.04, respectively). Cage subsidence was significantly less in Group L than in Group C (29% vs. 80%, p < 0.001). LAVR using a rectangular footplate cage is an effective treatment for OVF to minimize surgical invasiveness and postoperative correction loss.

Minimally Invasive Reconstruction of Vertebral Arch in Spondylolisthesis in Children and Adolescents.

The aim of the study was to assess the effectiveness of the minimally invasive technique used to reconstruct the vertebral arch with a pedicle screw hook system in grade I isthmic spondylolisthesis in comparison with the traditional technique of segment stabilization with interbody fusion.Materials and MethodsThe study included 26 patients aged from 11 to 17 years. The follow-up period lasted from 1 to 7 years. Two groups were formed: in group 1 (n=6), segments L5–S1 were stabilized using the traditional technique; in group 2 (n=20), the arch of the L5 vertebra was reconstructed by means of minimally invasive surgery. The pain syndrome was assessed in each study group using the visual analogue scale and Macnab criteria before and after surgery; blood loss, duration of surgery in minutes, and hospitalization in days were also measured.ResultsAccording to the Macnab scale, the two presented techniques did not show any statistically significant differences; however, when the arch synthesis technique was employed the spinal motion segment remained intact. Furthermore, in group 2, the volume of blood loss was smaller (44.0±19.6 compared to 300.0±130.4 ml, p<0.0001), the duration of the operation was 176.0±41.6 compared to 349.2±93.2 min, p<0.0001, and hospital stay was 6.9±1.6 compared to 10.0±2.1 days, p=0.0025 in the control group.ConclusionThe technique of vertebral arch reconstruction by a minimally invasive access gives the possibility to stabilize the spinal motion segment and to preserve biomechanics and movements in the spine. This technique allows for shorter inpatient stays for patients as well as earlier recovery and rehabilitation due to reduced surgery time and blood loss.

Wnt/β-Catenin Pathway Balances Scaffold Degradation and Bone Formation in Tissue-Engineered Laminae.

Tissue engineering provides a promising way for the regeneration of artificial vertebral laminae. Previous studies have confirmed the feasibility of reconstructing vertebral laminae via hydroxyapatite-collagen I scaffolds and mesenchymal stromal cells. However, there were no studies exploring the degradation of hydroxyapatite-collagen I scaffolds and the function of Wnt/β-catenin pathway in the process. In this study, tissue-engineered laminae (TEL) were constructed by nanohydroxyapatite/collagen I scaffolds and umbilical cord Wharton's Jelly mesenchymal stromal cells (WJ-MSCs). Cell attachment was observed by scanning electron microscopy, and cell viability was confirmed by Live/Dead staining. The rat models were randomly divided into control and β-catenin inhibition groups. Vertebral lamina defect rat models were made on the fifth lumbar vertebrate, and TEL was implanted into the defect site. After 14 weeks, the newborn laminae were harvested for microcomputed tomography, histology, or transcriptional profile analysis. We found that, for the control group, the newborn lamina formation matched with the scaffold degradation and complete newborn laminae formed at the 14th week; for the β-catenin inhibition group, the scaffold degradation rate overrated the lamina formation and no complete artificial laminae were formed at the 14th week. In addition, the osteoclastic genes, such as Cathepsin K or RANKL, in the control groups were significantly lower than the β-catenin inhibition group, and the antiosteoclastic gene, OPG, in the control group was significantly higher than the β-catenin inhibition group. In conclusion, inhibition of Wnt/β-catenin pathway led to speedy scaffold degradation and deferred artificial lamina formation. Wnt/β-catenin pathway played a critical role in maintaining the balance between scaffold degradation and bone formation in the process of vertebral lamina reconstruction.

Integrated Custom Composite Polyetheretherketone/Carbon fiber (PEEK/CF) Vertebral Body Replacement (VBR) in the Treatment of Bone Tumors of the Spine: A Preliminary Report From a Multicenter Study.

Retrospective, multicenter chart, and radiologic review. To present the first case series of bone tumors of the spine surgically reconstructed with a new custom, fully radiolucent, polyetheretherketone/carbon fiber (PEEK/CF) vertebral body replacement (VBR) integrated system. Surgical resections of spinal tumors result in large defects and local recurrence remains a concern. Current titanium-based implants adversely affects postoperative imaging, directly affects ability to identify tumor recurrence, and for delivery of radiotherapy treatments. PEEK/CF spinal implants allows for improved tumor surveillance, precise pre-radiation Computed Tomography planning, and reduces interference with post-reconstructive adjuvant radiotherapy. Thirteen patients with spinal tumors underwent vertebral body resection and reconstruction with an integrated, fully radiolucent, custom PEEK/CF vertebral body replacement, and radiolucent posterior PEEK/CF screw-rod system and/or radiolucent anterior PEEK/CF plate system. Clinical and radiographic data were tabulated. Need for adjuvant radiotherapy determined based on final tissue histology and extent of surgical margins. Postoperative surveillance imaging were reviewed for local tumor recurrence. The ability to integrate the PEEK/CF VBR connected to either the posterior screw-rod system, or anterior plate system provided immediate stability. The VBR was placed directly on cancellous vertebral body surface in 46.2% of cases. Loosening of the distal, or proximal, aspect of posterior system was seen in 15.4% of cases. There was no clinical or radiographic evidence of VBR migration and subsidence at latest follow up. Local recurrence occurred in one (7.7%) patient. This is the first series to describe the use of a fully-radiolucent, integrated, PEEK/CF implant system for spinal tumor reconstruction. The use of a PEEK/CF VBR system integrated to either the anterior plate, or posterior screw-rod system is feasible and allows for superior postoperative surveillance imaging and effective delivery of postoperative adjuvant radiotherapy.Level of Evidence: 4.

Evaluation of long-term surgical treatment outcomes of thoraco-lumbar spinal fractures - follow-up period of over 10 years.

Agricultural accidents often result in spinal injuries, particularly in fractures of the thoraco-lumbar spine. Surgical treatment of thoraco-lumbar fractures continues to comprise a major medical problem. The aim of this study was to assess and compare the long-term effects of surgical treatments of thoracic and lumbar spinal fractures treated with transpedicular stabilization, combined with posterior interbody spinal fusion (PLIF, also known as spondylodesis) or Daniaux reconstruction. A retrospective analysis was conducted on 66 patients with a thoracic or lumbar spinal fracture (Th10-L3) type A in the AO classification system, operated in 2000-2005. All patients underwent a short segment transpedicular stabilization, which in 36 patients was combined with posterior interbody spinal fusion, and in 30 other patients combined with Daniaux reconstruction. Radiological assessment was performed based on X-ray imaging. A lateral X-ray image of the spine was used to measure the vertebral wedging angle of the fractured vertebrae, the height ratio of the anterior to posterior vertebral body, and the angle of segmental kyphotic deformation. Subjective long-term assessment of the patient was conducted using the Oswestry Instability Score. The results were analyzed for statistical significance. In both groups, similar improvements in all measured parameters were observed. Despite all patients losing some of the correction in the long-term, this loss was significantly smaller following Daniaux reconstruction. Spinal stabilization combined with vertebral reconstruction allows for long-term and improved treatment results for thoraco-lumbar fracture than posterior interbody spinal fusion (spondylodesis).

Biportal endoscopic posterior lumbar decompression and vertebroplasty for extremely elderly patients affected by lower lumbar delayed vertebral collapse with lumbosacral radiculopathy

BackgroundLower lumbar osteoporotic vertebral compression fracture in extremely elderly patients can often lead to lumbosacral radiculopathy (LSR) due to delayed vertebral collapse (DVC). Surgical intervention requires posterior instrumented lumbar fusion as well as vertebral augmentation or anterior column reconstruction depending on the cleft formation and intravertebral instability. However, it is necessary to decide on surgery in consideration of the patient’s frail status, surgical invasiveness, and rehabilitation. In the lower lumbar DVC without intravertebral instability, biportal endoscopic posterior lumbar decompression and vertebroplasty (BEPLD + VP) can be simultaneously attempted. This study aimed to assess the clinical outcomes of BEPLD + VP for the treatment of DVC-related LSR.MethodsThis retrospective case series enrolled 18 consecutive extremely elderly (aged ≥ 75-year-old) patients (6 men and 12 women) who had lower lumbar (at or below L3) DVC-related LSR. Patients who require anterior column reconstruction, such as cleft formation accompanied by intravertebral instability and patients who have not been followed for more than 6 months, were excluded from this study. All patients underwent BEPLD + VP under epidural anesthesia. Clinical results were evaluated by the visual analog scale (VAS) score and the modified Japanese Orthopedic Association (mJOA) scores.ResultsMost of the patients had DVC affecting level L4, with the deformation being a flat type or concave type rather than a wedge type. The VAS score (back and leg) significantly decreased from 7.78 ± 1.17 and 6.89 ± 1.13 preoperatively to 2.94 ± 0.64 and 2.67 ± 1.08 within 2 postoperative days (p < 0.001). The mJOA score significantly improved from 4.72 ± 1.27 preoperatively to 8.17 ± 1.15 in the final follow-up (p < 0.001). The mean recovery rate (RR) in the last follow-up was 56.07% ± 9.98. Incidental durotomy was reported in two patients and epidural hematomas in another two patients; however, all patients improved with conservative treatment, and no re-operation was required.ConclusionsBELPD + VP was a type of salvage therapy that reduces surgical morbidity, requires major spine surgery under general anesthesia and provides good clinical outcomes in extremely elderly patients with DVC-related LSR.

Design of Customize Interbody Fusion Cages of Ti64ELI with Gradient Porosity by Selective Laser Melting Process.

Intervertebral fusion surgery for spinal trauma, degeneration, and deformity correction is a major vertebral reconstruction operation. For most cages, the stiffness of the cage is high enough to cause stress concentration, leading to a stress shielding effect between the vertebral bones and the cages. The stress shielding effect affects the outcome after the reconstruction surgery, easily causing damage and leading to a higher risk of reoperation. A porous structure for the spinal fusion cage can effectively reduce the stiffness to obtain more comparative strength for the surrounding tissue. In this study, an intervertebral cage with a porous gradation structure was designed for Ti64ELI alloy powders bonded by the selective laser melting (SLM) process. The medical imaging software InVesalius and 3D surface reconstruction software Geomagic Studio 12 (Raindrop Geomagic Inc., Morrisville, NC, USA) were utilized to establish the vertebra model, and ANSYS Workbench 16 (Ansys Inc., Canonsburg, PA, USA) simulation software was used to simulate the stress and strain of the motions including vertical body-weighted compression, flexion, extension, lateral bending, and rotation. The intervertebral cage with a hollow cylinder had porosity values of 80–70–60–70–80% (from center to both top side and bottom side) and had porosity values of 60–70–80 (from outside to inside). In addition, according to the contact areas between the vertebras and cages, the shape of the cages can be custom-designed. The cages underwent fatigue tests by following ASTM F2077-17. Then, mechanical property simulations of the cages were conducted for a comparison with the commercially available cages from three companies: Zimmer (Zimmer Biomet Holdings, Inc., Warsaw, IN, USA), Ulrich (Germany), and B. Braun (Germany). The results show that the stress and strain distribution of the cages are consistent with the ones of human bone, and show a uniform stress distribution, which can reduce stress concentration.

Solitary spinal metastasis of renal cell carcinoma and en-bloc resection-A case report

Renal Cell Carcinoma is a challenging condition for clinicians because of its poor response to radiotherapy, chemotherapy and even immunotherapy. Spine is the second most common site of metastasis and is also an indicator of poor prognosis. There is a significant dilemma for brain and spine surgeons about when to undergo aggressive surgical treatment, such as en-bloc resection of oligo-spine metastasis compared to conventional tumor excision by curettage. Here, we report a case of 60-year old female, a diagnosed case of renal cell carcinoma who had undergone right sided nephrectomy (with adrenalectomy) 5 years ago. She presented with history of pain over upper back. MRI revealed metastatic lesion over the thoracic T-7 vertebra. She underwent en-block total vertebral resection and reconstruction with titanium cage and pedicle screw fixation of the T-7 vertebra which healed with good results.

Cerebrospinal Fluid Pulsation Stress Promotes the Angiogenesis of Tissue-Engineered Laminae.

Background Angiogenesis is a prerequisite step to achieve the success of bone regeneration by tissue engineering technology. Previous studies have shown the role of cerebrospinal fluid pulsation (CSFP) stress in the reconstruction of tissue-engineered laminae. In this study, we investigated the role of CSFP stress in the angiogenesis of tissue-engineered laminae. Methods For the in vitro study, a CSFP bioreactor was used to investigate the impact of CSFP stress on the osteogenic mesenchymal stem cells (MSCs). For the in vivo study, forty-eight New Zealand rabbits were randomly divided into the CSFP group and the Non-CSFP group. Tissue-engineered laminae (TEL) was made by hydroxyapatite-collagen I scaffold and osteogenic MSCs and then implanted into the lamina defect in the two groups. The angiogenic and osteogenic abilities of newborn laminae were examined with histological staining, qRT-PCR, and radiological analysis. Results The in vitro study showed that CSFP stress could promote the vascular endothelial growth factor A (VEGF-A) expression levels of osteogenic MSCs. In the animal study, the expression levels of angiogenic markers in the CSFP group were higher than those in the Non-CSFP group; moreover, in the CSFP group, their expression levels on the dura mater surface, which are closer to the CSFP stress stimulation, were also higher than those on the paraspinal muscle surface. The expression levels of osteogenic markers in the CSFP group were also higher than those in the Non-CSFP group. Conclusion CSFP stress could promote the angiogenic ability of osteogenic MSCs and thus promote the angiogenesis of tissue-engineered laminae. The pretreatment of osteogenic MSC with a CSFP bioreactor may have important implications for vertebral lamina reconstruction with a tissue engineering technique.

Giant calcified thoracic disk herniations: ossification of PLL or autonomous entity?

Giant calcified thoracic disk herniation (GCTD) is an uncommon event, which requires surgical treatment in less than 1% of patients. GCDTs are a specific subgroup of herniated thoracic disks occupying more than 40% of the spinal canal showing calcifications associated with a certain degree of ossification. In this paper, we are reporting our whole experience in the surgical management of GCTDs through anterior approaches. We believe that they present characteristics that associate them to the circumscribed type of ossified posterior longitudinal ligament (OPLL) with a possible common pathophysiology consisting in the dural violation. Twenty-three consecutive patients with GCDTs were managed through anterior approaches during the period 1996-2019 at the Niguarda Hospital, Milan, Italy. Clinical data, radiological features, surgical reports, histological findings, and outcomes were reviewed. There was no mortality, whereas permanent morbidity consisted of 1 case of worsened paraparesis due to accidental spinal cord contusion. One patient required reoperation to repair a postoperative cerebrospinal fluid (CSF) leakage. All patients underwent postoperative MRI which showed excellent decompression of cord and dural sac in all cases. Histological study of en-bloc removed GCTD showed typical calcification patterns of the PLL. GCDTs may be assimilated to the so-called "circumscribed type" of OPLL. The GCDTs may show the same radiological CT and MRI pattern of OPLL. The anterior accesses now represent the standard of care for GCTDs. The use of operative microscope and intraoperative monitoring is mandatory. The risk of CSF leakage can be markedly reduced by meticulous reconstruction of the dura and the placement of spinal drainage. Adequate exposition may sometimes require one or two levels of corpectomy with consequent vertebral body reconstruction and fixation of anterior column of the spine.

MRI-SegFlow: a novel unsupervised deep learning pipeline enabling accurate vertebral segmentation of MRI images.

Most deep learning based vertebral segmentation methods require laborious manual labelling tasks. We aim to establish an unsupervised deep learning pipeline for vertebral segmentation of MR images. We integrate the sub-optimal segmentation results produced by a rule-based method with a unique voting mechanism to provide supervision in the training process for the deep learning model. Preliminary validation shows a high segmentation accuracy achieved by our method without relying on any manual labelling.The clinical relevance of this study is that it provides an efficient vertebral segmentation method with high accuracy. Potential applications are in automated pathology detection and vertebral 3D reconstructions for biomechanical simulations and 3D printing, facilitating clinical decision making, surgical planning and tissue engineering.

Surgical management of Gorham-Stout syndrome involving the cervical spine with bilateral pleural effusion: A case report and literature review.

Gorham-Stout syndrome (GSS) is a rare disease characterized by spontaneous and progressive osteolysis caused by benign proliferation of lymphatic vessels or capillaries. It most commonly occurs in children or young individuals without any inherited predisposition. GSS most commonly affects the shoulder girdle, pelvis, ribs and skull. Its diagnosis is mainly based on radiological and pathological findings. The present study reports on the case of a 22-year-old male patient diagnosed with GSS involving the C1-T1 vertebrae accompanied by bilateral pleural effusion. Resection of the occipital and cervical vertebral lesions and spinal reconstruction using an internal fixator were successfully performed via the posterior approach. After the surgery, the patient received bisphosphonate treatment and vitamin D supplementation. The pleural effusion gradually decreased. At the 18-month follow-up visit, no evidence of new bone obstruction was present and the patient had no neurological sequelae.

Application of 3D printed porous artificial vertebra in reconstruction of thoracolumbar tumor

Objective To evaluate the clinical effectiveness of the reconstruction of the thoracic and lumbar spine using the 3D-printed vertebral body after total en bloc spondylectomy. Methods From December 2016 to September 2019, 33 patients with spinal tumors were treated with total en bloc spondylectomy, including 25 males and 8 females with an average age of 58.0 years(range, 15 to 76). The locations of the lesions contained: 29 in the thoracic and 4 in the lumbar. The surgical segments includeda single vertebra in 30 cases, 2 vertebrae in 2 cases, and 3 vertebrae in 1 case. The tumor type: the primary malignant tumor in 6 cases, the metastatic tumor in 27 cases. The preoperative Tomita score was 2-5 points (mean 3.9 points), while Tokuhashi score was 9-15 points (average 11.1 points). Divided into two groups according to different reconstruction methods during total spinal resection, 33 patients with thoracolumbar vertebral body malignant tumors were divided into 3D printed artificial vertebral body reconstruction group (21 patients, 3D printed artificial vertebral body was used for anterior column reconstruction) and titanium Mesh reconstruction group (12 cases, titanium mesh implanted with allograft bone was used for reconstruction). The main observation indicators included the degree of spinal nerve damage and pain recovery, the local tumor control rate, and the incidence of prosthesis sinking. The visual analogue scale (VAS) at 24 hours and 3 months after operation was compared with that before operation using paired design t test. Results All cases were followed up for 3 to 31 months. There was no statistically significant difference in intraoperative blood loss (t=2.042, P>0.05), surgical time (t=0.591, P>0.05), and postoperative drainage (t=0.118, P>0.05) between the two groups. The visual analogue scale (VAS) between the two groups at preoperative, 24 hours and 3 months after operation was not statistically different (P<0.05). The Frankel grading of 31 patients (97.0%) had at least one grade improvement 3 months after operation. During the follow-up period, 12 patients (41.7%) who underwent reconstruction with titanium mesh showed different degrees of subsidence in imaging, and 21 patients who used 3D printed artificial vertebral reconstruction did not exhibit prosthetic deposition. Chi-square test results of postoperative sink rate of the two methods was statistically different (χ2=10.313, P=0.013). Conclusion This preliminary report suggests the 3D-printed vertebral body has good biocompatibility and mechanical stability, which can be used for reconstruction after total en bloc spondylectomy. Key words: Spinal neoplasms; Spinal fusion; Prostheses and implants

Evaluation of the effectiveness of expandable cages for reconstruction of the anterior column of the spine.

For anterior spine column reconstruction after corpectomy, expandable cages offer solid anterior support and allow correction of deformity, providing excellent primary stability. To provide a larger body of clinical observations concerning the effectiveness of the approach, this retrospective study examines patients treated by corpectomy and reconstruction with an expandable cage for different pathologies. Across 5 years, 39 patients underwent vertebral reconstruction with expandable cages after single (n = 34), double (n = 4), or triple (n = 1) corpectomy. Pathologies were tumors (n = 21), fractures, or deformities in traumatic injuries (n = 14), degenerative pathology (n = 2), and infection (n = 2). Levels were cervical (n = 10), thoracic (n = 14), and lumbar (n = 15). All patients were evaluated clinically and radiographically. There were no cases of neurologic deterioration. Nurick grade showed significant improvement at 3 months postoperative versus preoperative (p < 0.01). Visual analog scale significantly improved preoperatively versus 3 and 12 months postoperatively (both p = 0). Regional angulation was significantly corrected, from preoperative to 3 and 12 months postoperative, at cervical, thoracic, and lumbar levels. We achieved reconstruction of the normal local anatomy with full recovery of the height of the vertebral body. Six patients (15.4%) had complications and two (5.1%) underwent revision surgery. In our experience, expandable cages confer stable anterior support, providing significant improvement of the segmental kyphosis angle and restoration of the original somatic height. Our clinical results are favorable, and the low rate of complications and revision accentuates the expandable cage as a valuable tool to replace the vertebral body in diverse pathologies and different spine levels.