Vertebral Spinous Processes Research Articles

Trans-spinal magnetic stimulation combined with kinesiotherapy as a new method for enhancing functional recovery in patients with spinal cord injury due to neuromyelitis optica: a case report

BackgroundExperimental studies have shown that repetitive trans-spinal magnetic stimulation (TsMS) decreases demyelination and enables recovery after spinal cord injury (SCI). However, the usefulness of TsMS in humans with SCI remains unclear. Therefore, the main objective of this study is to evaluate the effects of TsMS combined with kinesiotherapy on SCI symptoms. We describe a protocol treatment with TsMS and kinesiotherapy in a patient with SCI due to neuromyelitis optica (NMO)-associated transverse myelitis.Case presentationA 23-year-old white male with NMO spectrum disorders started symptoms in 2014 and included lumbar pain evolving into a mild loss of strength and sensitivity in both lower limbs. Five months later, the symptoms improved spontaneously, and there were no sensorimotor deficits. Two years later, in 2016, the symptoms recurred with a total loss of strength and sensitivity in both lower limbs. Initially, physiotherapy was provided in 15 sessions with goals of motor-sensory recovery and improving balance and functional mobility. Subsequently, TsMS (10 Hz, 600 pulses, 20-seconds inter-trains interval, at 90% of resting motor threshold of the paravertebral muscle) was applied at the 10th thoracic vertebral spinous process before physiotherapy in 12 sessions. Outcomes were assessed at three time points: prior to physiotherapy alone (T-1), before the first session of TsMS combined with kinesiotherapy (T0), and after 12 sessions of TsMS combined with kinesiotherapy (T1). The patient showed a 25% improvement in walking independence, a 125% improvement in balance, and an 18.8% improvement in functional mobility. The Patient Global Impression of Change Scale assessed the patient’s global impression of change as ‘much improved’.ConclusionTsMS combined with kinesiotherapy may safely and effectively improve balance, walking independence, and functional mobility of patients with SCI due to NMO-associated transverse myelitis.

Prevalence of bifidity of the seventh cervical vertebral spinous process in southwestern Nigeria: a computed tomography based study

Palpation of the seventh cervical vertebra (C7) is an important landmark for counting vertebrae for vertebral spine surgical instrumentation. However, studies have shown that the spinous process of C7 displays an anatomical deviation among individuals, which may mislead a surgeon who is not aware of this, and there have been no such studies among southwest Nigerians. The present study aimed to examine the incidence of bifidity in the C7 spinous process and their variation among 48 subjects with the aid of a three-dimensional (3D) computed tomography. The 48 subjects who had undergone cervical spine computed tomography studies comprised the pooled data of ages between 12 and 55 years of black race in southwest Nigeria from the radiology department of the Trauma and Surgical Centre, Ondo State, Nigeria. A series of multivariate and discriminant statistical tests were performed on the measurement data to determine the occurrence of bifid spinous processes at C7 in southwestern Nigeria. The results show about 10% bifidity in the C-7 vertebra and no bifidity in the first cervical vertebra and the highest rate in the C-6 vertebra in the study population. The incidence in this study is significantly higher than findings in previous works. Thus, there is a need for clinicians to pay more attention to this variation when using C7 as a landmark especially in the studied population.

Immunohistochemical and Histopathological Characterization of Spina Bifida Defect Tissues Removed After Prenatal and Postnatal Surgical Repair

Background: Myelomeningocele or spina bifida is an open neural tube defect that is characterized by protrusion of the meninges and the spinal cord through a deformity in the vertebral arch and spinous process. Myelomeningocele of post-natal tissue is well described; however, pre-natal tissue of this defect has no known previous histologic characterization. We compared the histology of different forms of pre-natal myelomeningocele and post-natal myelomeningocele tissue obtained via prenatal intrauterine and postnatal surgical repairs. Methods: Pre-and post-natal tissues from spina bifida repair surgeries were obtained from lipomyelomeningocele, myeloschisis, and myelomeningocele spina bifida defects. Tissue samples were processed for H&E and immunohistochemical staining (KRT14 and p63) to assess epidermal and dermal development. Results: Prenatal skin near the defect site develops with normal epidermal, dermal, and adnexal structures. Within the grossly cystic specimens, histology shows highly dense fibrous connective tissue with complete absence of a normal epidermal development with a lack of p63 and KRT14 expression. Conclusion: Tissues harvested from prenatal and postnatal spina bifida repair surgeries appear as normal skin near the defect site. However, cystic tissues consist of highly dense fibrous connective tissue with complete absence of normal epidermal development.

Morphological examination of abdominal vertebral bodies from grass carp using high-resolution micro-CT scans.

The vertebral column, a defining trait of all vertebrates, is organized as a concatenated chain of vertebrae, and therefore its support to the body depends on individual vertebral morphology. Consequently, studying the morphology of the vertebral centrum is of anatomical and clinical importance. Grass carp (GC) is a member of the infraclass Teleostei (teleost fish), which accounts for the majority of all vertebrate species; thus, its vertebral anatomical structure can help us understand vertebrate development and vertebral morphology. In this study, we have investigated the morphology and symmetry of the grass carp vertebral centrum using high-resolution micro-CT scans. To this end, three abdominal vertebrae (V9, V10, & V11) from eight grass carp were micro-CT scanned and then segmented using Dragonfly (ORS Inc.). Grass carp vertebral centrum conformed to the basic teleost pattern and demonstrated an amphicoelous shape (biconcave hourglass). The centrum's cranial endplate was smaller, less circular, and shallower compared to the caudal endplate. While the vertebral centrum demonstrated bilateral symmetry along the sagittal plane (left/right), the centrum focus was shifted dorsally and cranially, breaking dorsoventral and craniocaudal symmetry. The sum of these findings implies that the caudal aspect of grass carp vertebral centrum is bigger and more robust. Currently, we have no information whether this is due to nature, for example, differences in gene expression, or nurture, for example, environmental effect. As the vertebral parapophyses and spinous processes are slanted caudally, the direction of muscle action during swimming may create a gradient of stresses from cranial to caudal, resulting in a more robust caudal aspect of the vertebral centrum. Expanding our study to include additional quadrupedal and bipedal (i.e., human) vertebrae, as well as testing if these morphological aspects of the vertebrae are indeed plastic and can be affected by environmental factors (i.e., temperature or other stressors) may help answer this question.

Use of wound infusion catheters for delivery of local anesthetic following standing partial ostectomy of thoracolumbar vertebral spinous processes in horses is not associated with increased surgical site infections.

Wound infusion catheters (WICs) have been used in humans and some veterinary species for post-operative local anesthetic administration following a variety of surgical procedures, aiming to reduce post-operative analgesia requirements and improve patient comfort. Benefit in reduction in pain, post-operative analgesia requirements and length of hospital stay are well documented in humans, but use of WICs may not have been widely adopted in veterinary species due to the concern of increased complications, such as dehiscence or surgical site infection (SSI), creating a barrier to their use. This study aimed to evaluate the use of WICs in horses undergoing standing partial ostectomy surgeries, document complications and investigate if the incidence of SSI was equivalent between those horses that did and did not have a WIC. Clinical records were searched between January 2010-December 2023 for horses undergoing standing partial ostectomy surgery of thoracolumbar vertebral spinous processes at one institution. Population variables (age, breed, bodyweight), placement of a WIC or not, post-operative complications, analgesia protocols and surgical time were recorded. Horses received up to 0.1 mg kg-1 bupivacaine (0.5 mg mL-1) every 6-8 h via the WIC where one was placed. To compare SSI complication incidence between using or not using a WIC, a proportional independent equivalence test was used. There were 64 horses included in the final analysis with a WIC placed in 29/64 horses (45.3%) and 35/64 (54.7%) having no WIC placed at surgery. Incidence of short-term SSI was 11.4% (no WIC used) and 13.8% (WIC used), respectively. The difference in proportion of SSI between the presence or absence of a WIC was not significant [-0.024 (90% CI -0.181; 0.133); p = 0.94]. The incidence of SSIs was equivalent between groups whether a WIC was used or not. WICs should be considered as part of a multi-modal analgesic approach in the post-operative period. Further research into local anesthetic dosing and its impact on rescue analgesia requirements and pain-scores is warranted.

Fusion of the 2nd with the 3rd Cervical Vertebrae (C2-C3): A Case Series with Possible Clinical Significance

Purpose. The current case series describes three cases of fusion between the 2nd cervical vertebra, the axis (C2), and the 3rd cervical vertebra (C3), creating a C2-C3 osseous complex and highlighting its morphological type of fusion (partial or complete) and morphometric details. The developmental background of this complex is emphasized, pointing out the possible clinical significance. Materials and Methods. The osseous complexes were derived from disarticulated skeletons of body donors and were collected from the osseous collection of the Anatomy Department of the Medical School of the National and Kapodistrian University of Athens. Results. Three blocked vertebral complexes (2 partial and 1 complete C2-C3 osseous masses) were identified. In two cases, the vertebral bodies were partially fused and in one case were completely fused. In the 1st case, the C2-C3 complex had fused spinous processes and distinct transverse processes. Facets were completely fused on the left and partially fused on the right side. In the 2nd case, the C2-C3 complex had partially fused vertebral bodies and distinguishable spinous processes. In the 3rd case, the C2-C3 complex had completely fused vertebral bodies, facets, laminae, and transverse and spinous processes. Conclusions. Among the three (C2-C3) fused osseous complexes, the two were partially and the one was completely ossified. The fused vertebrae were characterized by osteophytic formations (at the dens and C3 area) and osteoporotic lesions. Taking into consideration the C2-C3 fusion, and possible coexisted variants, particular caution should be made in the upper cervical area, to interpret possible neurological manifestations and to reach a safe surgical plan.

The frequency and presentation of upper thoracic spinous process deviations, their relationship to articular morphology, and the potential influence on static palpation techniques

BackgroundStatic palpation of vertebral spinous process deviations from the midline are often utilized by manual therapists as a means to determine area for treatment of manipulable lesions. Previous research has discussed the diagnostic validity of this technique, but no correlation to vertebral morphology has been presented. AimTo evaluate the frequency and presentation of vertebral spinous process deviations and their relationship with articular morphology, and the impact this may have in terms of static palpation techniques in the upper thoracic spine. SettingThis study was conducted on human T1-T6 vertebrae. MethodA skeletal sample consisting of 58 humans T1-T6 vertebrae were photographed and linear and angular measurements taken utilizing ImageJ software and non-metric visual observations. ResultsSpinous process deviations in the entire sample group (n = 348) were found to occur in a frequency ranging from 19% (n = 11) at T1 to 41.4% (n = 24) at T3. However, when evaluated in terms of frequency within an individual's T1-T6, 83.3% (n = 25) of males and 67.86% (n = 19) of females demonstrated this feature, with an overall incidence of 77.59% (n = 45). Age of individuals did not show an increase in frequency, and no clear pattern could be identified regarding metric measurements and its presence. ConclusionSpinous process deviations in the upper thoracic spine are most probably the result of random normal variations between individuals and are more frequent in males. Static palpation without pain criteria is not a reliable diagnostic technique to determine areas needing manual treatment, as these may be considered normal osseous anatomical variations.

Injury patterns of the spine following blunt trauma: A per-segment analysis of spinal structures and their detection rates in CT and MRI

Rationale and objectivesTo provide a detailed analysis of injury patterns of the spine following blunt trauma and establish the role of supplementary MRI by evaluating discrepancies in the detection rates of damaged structures in CT and MRI. Method216 patients with blunt trauma to the spine who underwent CT followed by supplementary MRI were included in this study. Two board-certified radiologists blinded to clinical symptoms and injury mechanisms independently interpreted all acquired CT and MRI images. The interpretation was performed using a dedicated catalogue of typical findings associated with spinal trauma and assessed for spinal stability using the AO classification systems. ResultsLesions to structures associated with spinal instability were present in 31.0% in the cervical spine, 12.3% in the thoracic spine, and 29.9% in the lumbar spine. In all spinal segments, MRI provided additional information regarding potentially unstable injuries. Novel information derived from supplementary MRI changed clinical management in 3.6% of patients with injury to the cervical spine. No change in clinical management resulted from novel information on the thoracolumbar spine. Patients with injuries to the vertebral body, intervertebral disc, or spinous process were significantly more likely to benefit from supplementary MRI. ConclusionIn patients that sustained blunt spinal trauma, supplementary MRI of the cervical spine should routinely be performed to detect injuries that require surgical treatment, whereas CT is the superior imaging modality for the detection of unstable injuries in the thoracolumbar spine.

Effects of tracer position on screw placement technique in robot-assisted posterior spine surgery: a case–control study

IntroductionRobot-assisted spine surgery is increasingly used in clinical work, and the installation of tracers as a key step in robotic surgery has rarely been studied.ObjectiveTo explore the potential effects of tracers on surgical outcomes in robot-assisted posterior spine surgery.MethodsWe reviewed all patients who underwent robotic-assisted posterior spine surgery at Beijing Shijitan Hospital over a 2-year period from September 2020 to September 2022. Patients were divided into two groups based on the location of the tracer (iliac spine or vertebral spinous process) during robotic surgery and a case–control study was conducted to determine the potential impact of tracer location on the surgical procedure. Data analysis was performed using SPSS.25 statistical software (SPSS Inc., Chicago, Illinois).ResultsA total of 525 pedicle screws placed in 92 robot-assisted surgeries were analyzed. The rate of perfect screw positioning was 94.9% in all patients who underwent robot-assisted spine surgery (498/525). After grouping studies based on the location of tracers, we found there was no significant difference in age, sex, height and body weight between the two groups. The screw accuracy (p < 0.01)was significantly higher in the spinous process group compared to the iliac group (97.5% versus 92.6%), but the operation time (p = 0.09) was longer in comparison.ConclusionPlacing the tracer on the spinous process as opposed to the iliac spine may result in longer procedure duration or increased bleeding, but enhanced satisfaction of screw placement.

A Morphometric Study of Typical and Atypical Lumbar Vertebrae in South Indian Population

Introduction: The lumbar vertebrae are affected in conditions such as congenital defects, degenerative diseases, accidents, and cancer metastasis. A thorough knowledge of the morphometry of typical and atypical lumbar vertebrae in adults of South Indian population is needed for lumbar spine surgeries. Materials and Methods: A descriptive study was done on 200 dry lumbar vertebrae, of which 100 were typical and 100 were atypical lumbar vertebrae. The following dimensions of both typical and atypical lumbar vertebrae were measured with digital vernier calipers: anteroposterior and transverse diameters of the body; anterior and posterior body heights; anteroposterior and transverse diameters of vertebral foramen; height, breadth, and width of the laminae; length, height, and width of the pedicles; transverse processes and spinous process; distance between the two superior articular processes; and the distance between the two inferior articular processes. All the measurements were tabulated. The mean and standard deviation were calculated for each of the parameters and the results were statistically analyzed. Results: The anteroposterior and transverse diameters of the body, the height of the laminae on both sides, the length and height of the spinous process, and the distance between the superior articular facets were significantly longer in atypical lumbar vertebrae than that of typical lumbar vertebrae (P &lt; 0.05). There was no significant difference in measurements between both sides. Conclusion: The dimensions of vertebral foramen, transverse processes, spinous processes, and distance between articular processes were different from the dimensions of previous studies. The morphometric data obtained will be useful for orthopedic procedures on the lumbar vertebrae in South Indian population.

Forward Stepping Evoked by Transvertebral Stimulation in the Decerebrate Cat

ObjectivesImplantation of stimulating electrodes into the basement of the vertebral spinous process allows the electrodes to be quickly and stably fixed relative to the spinal cord. Using this approach, we have previously shown the selectivity of rat muscle activation during transvertebral stimulation (TS). In this work, we investigated the TS to induce forward stepping of the cat's hindlimbs in comparison with epidural stimulation (ES). Materials and MethodsTS was performed with an electrode placed in the VL3–VL6 vertebrae in five decerebrated cats. ES was performed on the same cats in L5–L7 segments. Kinematic parameters of stepping were recorded in addition to electromyographic activity of musculus (m.) iliopsoas (IP), m. tibialis anterior (TA), and m. gastrocnemius lateralis (GL) of both hindlimbs. ResultsWith VL3–VL4 TS, all five animals were capable of bipedal forward stepping, whereas VL5 and VL6 TS led to the forward stepping in 3 of 5 and 1 of 5 animals, respectively. Well-coordinated muscle activity led to a high level of intra- and interlimb coordination. Kinematic parameters of TS-induced stepping were similar to those obtained with ES. The TS of the VL3 vertebra causes the frequency lock with the integer multiple of the stimulation frequency. Similarly to the rat model, TS-evoked muscle responses were site specific. They were minimal during VL3 TS and were maximal during VL4–VL5 TS (IP) and VL5–VL6 TS (TA, GL). ConclusionsThe obtained results support hypotheses about the location of the central pattern generators in the upper lumbar spinal segments. The proposed approach of electrode placement is surgically easier to perform than is ES. This approach is useful for studying site-specific neuromodulation of the spinal sensorimotor networks and for investigating new strategies of locomotor recovery in animal models.

Thoracolumbar retrolaminar block in seven dogs undergoing spinal surgery

BackgroundThoracolumbar intervertebral disc extrusion is a common neurologic complaint in dogs and is associated with debilitating pain that requires careful analgesic management to avoid the transition to a chronic pain state. Recently, there has been an increased effort to incorporate regional anaesthetic techniques whenever possible, both for perioperative analgesia management and for prevention of chronic pain. A novel regional anaesthetic technique named retrolaminar block is a fascial plane block where the local anaesthetic is injected directly on top of the dorsal aspect of the vertebral lamina, in the fascial plane between the lamina and the epaxial muscles. The technique was recently described in humans and it is claimed to provide analgesia in patients undergoing thoracic and lumbar procedures. To the authors’ knowledge, the retrolaminar block has not been previously reported in live dogs.Case presentationSeven dogs presented to our hospital for suspected thoracolumbar intervertebral disc extrusion were anaesthetised using an anaesthetic premedication and induction protocol tailored for each individual animal. Once the suspected diagnosis was confirmed, all seven dogs were placed in sternal recumbency, and the target thoracolumbar vertebral spinous process was identified with palpation. A unilateral retrolaminar block was performed in all dogs with 2 mg/kg of 0.25% bupivacaine. Physiologic parameters, as well as responses to nociceptive stimuli, were monitored throughout the anaesthetic event.Intraoperatively, one dog required a bolus of fentanyl to control nociceptive stimulation while the epaxial muscles were retracted. No further intraoperative rescue analgesia was required in any of the cases. The postoperative pain was assessed using the Short Form of Glasgow Composite Measure Pain Scale for dogs every four hours for the duration of the dogs’ hospitalization. The retrolaminar block reduced the intraoperative requirement for systemic opioids and other adjunct analgesic agents and all dogs were comfortable throughout their hospitalization and up until the time of their discharge.ConclusionsThis case report presents the performance of the retrolaminar block technique as part of multimodal analgesia management in seven dogs undergoing thoracolumbar spinal surgery.

Morphological Examination of Vertebral Bodies (Centrum) From Grass Carp (Ctenopharyngodon idella) Using High‐Resolution Micro‐CT Scans

The vertebral column, a defining trait of all vertebrates, is organized as a concatenated chain of vertebrae, and therefore its support to the body depends on individual vertebral morphology. Consequently, studying the morphology of the vertebral body (centrum) is of anatomical and clinical importance. In this study, we have investigated the morphology of Grass carp (Ctenopharyngodon idella) vertebral centrum using high‐resolution micro‐CT scans. Grass carp is a member of the interclass Teleostei (teleost fish), part of the class Actinopterygii, which accounts for the majority of all vertebrate species; thus, Grass carp vertebral morphology can help us understand normal vertebrate vertebral morphology and development. Based on previous studies done on teleost fish, we hypothesized that vertebral centrum will demonstrate bilateral symmetry along the sagittal (left/right) and transverse (cranial/caudal) planes. To this end, three vertebrae (numbers V9‐11) from eight Grass carps that were housed in a Living Stream Systems for 8 weeks at 15⁰C were harvested and micro‐CT scanned at a resolution of 19.29 µm (SkyScan1173, Bruker Inc). The scans were reconstructed into 16‐bit TIFF image stacks and then imported into Dragonfly (ORS Inc.) for segmentation using an Otsu algorithm. After centering each vertebrae along its three principal axes various morphological measurements were performed. Grass carp vertebral centrum demonstrated an hourglass shape where both endplates are concave. While the vertebral centrum demonstrated bilateral symmetry along the sagittal plane (left/right, in line with our hypothesis), vertebral centrum demonstrated deviation from bilateral symmetry along the transverse plane (cranial/caudal, refuting our hypothesis). The vertebral centrum cranial endplate size (perimeter and area) was found to be smaller and less circular compared to the caudal endplate. This implies that the vertebral body tapers off from caudal to cranial. In addition, the cranial endplate was found to be shallower (i.e. more obtuse angles, α &gt; β, see figure 1) compared to the caudal endplate. As a result of the shallower cranial endplate, the center of the vertebrae (narrowest part of the hourglass, between the two endplates) was shifted cranially (A &lt; B, see figure 1). The sum of these findings implies that the caudal aspect of Grass carp vertebral centrum is bigger and more robust. Currently we have no information whether this is due to nature, e.g. differences in gene expression, or nurture, e.g. environmental effect. As the vertebral transverse and spinous processes are slanted caudally, the direction of muscle action during swimming may create a gradient of stresses from cranial to caudal, resulting in a more robust caudal aspect of the vertebral centrum. Expanding our study to include additional quadrupedal and bipedal (i.e. humans) vertebrae, as well as testing if these morphological aspects of the vertebrae are indeed plastic and can be affected by environmental factors (i.e. temperature or other stressors) may help answering this interesting question.

18F-fluorodeoxyglucose-positron emission tomography/computed tomography delineates involved sites in the cervical spine in Langerhans cell histiocytosis.

Langerhans cell histiocytosis (LCH), a granulomatous tumorous lesion consisting of CD1a-positive clonal immature dendritic cells in association with various inflammatory cells, develops in tissues including bone, skin, lungs, and lymph nodes. When bone LCH exhibits osteolytic lesions, the spine is often involved, and each part of the vertebral body, vertebral arch, and vertebral spinous process can be affected. Such vertebral LCH can occur at the onset of disease and in relapse. To confirm pathological sites, a computed tomography (CT) scan is generally used to characterize lytic lesions of vertebrae, while MRI is suitable for delineating marrow and soft tissue. Additionally, to identify specific locations, 18F-fluorodeoxyglucose-positron emission tomography/CT (FDG-PET/CT) is useful. We describe three LCH cases showing characteristic cervical spinal involvement. Case 1: A 39-year-old woman complained of right temporal pain and was found to have osteolytic lesions of right temporal/sphenoid/petrous bones. She also had central diabetes insipidus (CDI). After the diagnosis of LCH from biopsied tissue, she was treated with chemotherapy and attained remission. Four years later, she complained of neck/shoulder pain associated with herpes zoster in the right arm. PET/CT revealed a cervical spine (C3)-vertical body lesion (Figure 1A). With a revised chemotherapy regimen, she attained a second remission. Case 2: A 70-year-old man, a heavy smoker for more than 40 years, complained of shortness of breath, and a chest X-ray revealed characteristic honeycomb lungs. PET/CT showed hot lesions in the lungs, cervical spine (C3) right vertebral arch (Figure1B), and ribs. Lung lesion biopsy confirmed the diagnosis of LCH. He had no CDI and was treated with irradiation to the cervical spine and with chemotherapy. Case 3: A 40-year-old man who had severe atopic dermatitis since the age of 20 complained of nuchal pain after a traffic accident. He was also noted to have lymphadenopathy in the bilateral axillary and inguinal areas. PET/CT revealed hot signals at the spinous process of the cervical spine (C6) (Figure 1C) and lymph node lesions. Biopsy of the C6 lesion confirmed LCH. He attained a remission treated with chemotherapy and zoledronic acid. Three years later, relapse at the lymph nodes was noted, but not in the C6 lesion. He was treated with chemotherapy for refractory LCH and attained a second remission. An analysis of 76 cases of vertebral LCH by Huang et al. [1] consisted of 40 children and 36 adults, with a male to female ratio of 55:21. Lesions were predominantly in the cervical spine, followed by the thoracic and lumbosacral spines. In an analysis of 30 LCH patients with cervical spine involvement by Jiang et al. [2], 14 had atlantoaxial lesions (C1 and C2), and 16 had sub-axial (C3–C7) lesions. Chemotherapy is recommended for the management of cervical spine lesions in cases of multifocal LCH. In our three cases, two patients had spinal involvement at onset while the other developed it at relapse. All received chemotherapy because of multifocal LCH lesions. In summary, as an imaging study of cervical spine involvement in LCH, PET/CT seems to be useful for pinpointing the involved sites of vertebrae. None The authors declare no conflict of interest.

Investigation of postero-anterior mobilization in the lumbar spine: A finite element analysis study

Background/Aim: Postero-anterior (PA) mobilization is a non-invasive treatment method traditionally used to treat low back pain (LBP) in many countries. However, the effects of PA mobilization on lumbar spine biomechanics are still unknown. The aim of this study is to determine the maximum von Mises stresses on the lumbar vertebra (L5), with force applied at different angles during PA mobilization therapy using finite element analysis (FEA). Methods: L5 vertebra CT images of a 30-year-old male patient were modeled in three dimensions (3D) with MIMICS software to examine the PA mobilization biomechanics. The resulting L5 spine model was submitted to the finite element software ANSYS (version 19) to evaluate the effects of PA mobilization. To simulate PA mobilization on the L5 vertebra, a static force of 100 N was applied over the spinal process in three different directions. The distribution of von Mises stresses occurring in the L5 spine was determined in the analyses. Results: During PA mobilization, the stress distributions on the vertebrae caused by the static force applied in three different directions in the L5 vertebra spinal process was determined. As a result of the analysis, higher stress values were found in the posterior elements of the vertebrae in all directions compared to the vertebral corpus. However, when compared according to the direction of application, the lowest stress values were detected in the pedicles and laminas in PA mobilization applied toward the spine center. Conclusion: Vertebral pedicles, laminae, and spinous process are critical areas prone to fracture. It was argued that the change in the direction of PA mobilization applied in the L5 vertebral spinal process affects the von Mises stress distributions occurring in the pedicles and laminae.

MRI-based synthetic CT of the lumbar spine: Geometric measurements for surgery planning in comparison with CT

PurposeMRI is the imaging modality of choice for soft tissue-related spine disease. However, CT is superior to MRI in providing clear visualization of bony morphology. The purpose of this study is to test equivalency of MRI-based synthetic CT to conventional CT in quantitatively assessing bony morphology of the lumbar spine. MethodA prospective study with an equivalency design was performed. Adult patients who had undergone MRI and CT of the lumbar spine were included. Synthetic CT images were generated from MRI using a deep learning-based image synthesis method. Two readers independently measured pedicle width, spinal canal width, neuroforamen length, anterior and posterior vertebral body height, superior and inferior vertebral body length, superior and inferior vertebral body width, maximal disc height, lumbar curvature and spinous process length on synthetic CT and CT. The agreement among CT and synthetic CT was evaluated using equivalency statistical testing. ResultsThirty participants were included (14 men and 16 women, range 20–60 years). The measurements performed on synthetic CT of pedicle width, spinal canal width, vertebral body height, vertebral body width, vertebral body length and spinous process length were statistically equivalent to CT measurements at the considered margins. Excellent inter- and intra-reader reliability was found for both synthetic CT and CT. ConclusionsEquivalency of MRI-based synthetic CT to CT was demonstrated on geometrical measurements in the lumbar spine. In combination with the soft tissue information of the conventional MRI, this provides new possibilities in diagnosis and surgical planning without ionizing radiation.

Using acupuncture to manage wound healing and chronic back pain in a guinea pig

Acupuncture is being increasingly used in veterinary medicine in the management of wound healing and chronic pain. In this case study, a guinea pig responded to chronic back pain caused by fractures to multiple thoracic vertebral spinous processes and subsequent vertebral luxation, with severe compulsive self-injurious behaviour. This resulted in a large, full thickness skin wound. Wound healing was managed with a combination of support dressings, multi-model analgesia and manual acupuncture. The underlying back pain was initially managed with manual acupuncture and multimodal analgesia, then subsequently successfully managed long term with non-steroidal anti-inflammatories and electroacupuncture.

Bone Marrow Aspiration and Biopsy in Critical Pediatric Patients: A Pathologist's Perspective.

Bone marrow aspiration (BMA) and bone marrow biopsy (BMB), are medical modalities for the detection of non-malignant diseases as well as hematological malignancies in children. BMA attained momentum in the past few years owing to the possibility of achieving hematopoietic stem cells. Liquid bone marrow is aspirated through posterior/anterior iliac crest, tibia, and vertebral spinous process during BMA procedure in children for assessment of morphology at the microscopic level while BMB allows for cytological evaluation of marrow. It is also used for molecular genetics, immune-phenotypic, cytogenetics, and other specialized examinations. Additionally, BMA is also helpful in the reconstruction of tissue. These procedures should be performed by a specialist who has knowledge about the indication, contradictions, and hazards of these procedures due to their invasive nature. Still, there are no transparent guidelines available especially in the case of BMA for children. The purpose of this overview article is to focus on the specific guidelines to carry out the BMA and BMB in children and the techniques as well as complications associated with the BMA and BMB.

The new imaging findings: "Passing spine" without kissing.

Case-control studies by examining the lumbar spine computed tomography (CT) findings focusing on the spinous processes.“Passing spine” was defined as a lumbar degenerative change observed on CT images. In contrast, kissing spine, which is also an image finding, has been acknowledged as an established clinical condition. Therefore, we compared the passing spine group and the kissing spine group to investigate whether the 2 groups belong to a similar disease group; this would help explain the clinical and imaging characteristics of patients with passing spine.Previous studies have described the gradual increase in the height and thickness of the lumbar vertebral spinous processes that can occur in individuals aged >40 years, and reported that this progressive degeneration can lead to a condition termed “kissing spine.”We examined the CT imaging of 373 patients with lumbar spinal disease and divided patients into 2 groups, the kissing spine (K) group and the passing spine (P) group, and compared the clinical (age, sex, presence/absence of lower extremity pain) and imaging data (localization of kissing or passing spine, intervertebral disc height at the level of kissing or passing spine, lumbar lordosis (LL) angle, presence/absence of vacuum phenomenon (VP) in the intervertebral discs and spondylolisthesis at the level of kissing or passing spine between the 2 groups.Compared with patients with kissing spine, patients with passing spine had an increased incidence of lower extremity pain, lower intervertebral disc height at the level of passing spine, relatively static LL, and VP commonly observed in the intervertebral discs at the level of passing spine.Because the clinical and imaging characteristics of patients with passing spine are different from those of patients with kissing spine, passing spine might be a pathological condition distinct from kissing spine.

Lumbar Malignant Peripheral Nerve Sheath Tumor in a Young Dog

Background: The most common location of malignant tumors of the peripheral nerve sheath in the spinal cord is the intradural-extramedullary region, and is rare in the spinal nerve roots in the lumbar region. They mainly affect large female dogs over six years of age. Imaging tests assist in the presumptive diagnosis, but confirmation requires histopathological and immunohistochemical examination. The prognosis is guarded. Diagnostic imaging, anatomopathological and immunohistochemical findings of a malignant tumor of the intradural-extramedullary peripheral nerve sheath with medullary infiltration in the lumbar region in a young dog are reported.Case: A body of a 6-year-old Poodle dog was donated for necropsy and diagnostic clarification. In the history, there was a suspicion of lumbar intramedullary neoplasia, detected by computed tomography (CT), with a 4 years progressive chronic evolution. Additionally, the dog had hidden spina bifida (L7 to S3), as detected by radiography and CT. On post mortem radiographic examination (X-ray), there was an enlargement of the vertebral canal (T10 to S2), intense osteolysis (L1 to S2), spinous processes (L5 to L7), and ankylosis (L3 to L7). Necropsy revealed ankylosis (L3 to L7) and intradural-extramedullary mass (9.5 × 2.6 × 2.3 cm) (L2 to L6). No metastases were identified. On microscopy, there was neoplastic proliferation of cells with intense pleomorphism, arranged in bundles interlaced in palisades and sometimes solid mantles. The mitotic index was high, ranging from 10 to 12 mitoses per field. There was also necrosis, hemorrhage, edema, and focal axonal demyelination of the adjacent white matter in the spinal cord. Masson Trichrome staining highlighted an intense diffuse conjunctive stroma. There was a suspicion of a malignant tumor of the peripheral nerve sheath and an immunohistochemical panel was performed for confirmation. There was strong and diffuse positivity for vimentin and S-100 and partial positivity for neuron-specific enolase (NSE), negative for anti-factor VIII, glial fibrillary acidic protein (GFAP), α-actin for smooth muscle, cytokeratin, neurofilament, and desmin. Thus, the diagnosis of malignant neoplasm of the peripheral nerve sheath was confirmed.Discussion: Peripheral nerve sheath tumors are classified as benign or malignant. In dogs, they are frequent in elderly, females, and large breeds. In this case report, the animal was young, female, and small breed. The location of the spinal nerve roots is uncommon, and is more commonly found in the brachial plexus. In the animal reported, the tumor was observed as lumbar swelling. Clinical signs vary with the affected region, however, neurogenic claudication and muscle atrophy are more frequent, as observed in this report. Imaging examinations such as X-rays and CT assist in the presumptive diagnosis. In this case report, spina bifida was identified on radiography, and CT suggested the presence of intramedullary neoplasia and allowed to monitor tumor growth. Post mortem X-ray imaging revealed intense osteolysis and ankylosis, which were confirmed at necropsy, which also elucidated its intradural-extramedullary location with infiltration into the spinal cord. The confirmation of the neoplasm was made by histopathological and immunohistochemical examination; the latter should be made a panel, not restricted to the use of antibodies S-100 and vimentin only. The prognosis of malignant peripheral nerve sheath tumors (MPNST) of the spinal cord is poor, and although there are palliative methods, there is no curative treatment, as complications can interfere with the quality of life of the animal. MPNST should be included in the differential diagnosis of spinal disorders, even in young dogs and small breeds. CT helps in early diagnosis to make decisions aimed at the animal's well-being.