Fractured Vertebra Research Articles

Regional variations in the intra- and intervertebral trabecular microarchitecture of the osteoporotic axial skeleton.

Trabecular structures in vertebral bodies are unequally distributed in the cervical, thoracic and lumbar spine, and also within individual vertebrae. Knowledge of the microstructure of these entities could influence our comprehension and treatment of osteoporotic fractures, and even surgical procedures. Appropriate investigations may clarify the pathomechanisms of various osteoporotic fractures (fish, wedge-shaped, and flat vertebrae). We obtained three cancellous bone cylinders from the centers and margins of cervical vertebra 3 to lumbar vertebra 5, and investigated these in regard of bone volume fraction, trabecular thickness, separation, trabecular number, trabecular bone pattern factor, connectivity density, and degree of anisotropy. Using a Jamshidi needle®, we obtained samples from three quadrants (QI: right-sided edge, QII: central, QIII: left-sided edge) of 242 prepared vertebrae, and investigated these on a micro-CT device. In all, 726 bone samples were taken from eleven body donors. Bone volume fraction, trabecular thickness, and the degree of anisotropy were significantly lower in QII than in QI and QIII. Trabecular pattern factor, however, was significantly higher in QII than in QI and QIII. The results helped to explain fish vertebrae. Wedge fractures and flat vertebrae are most likely caused by the complex destruction of trabecular and cortical structures. The higher bone volume fraction in the cervical spine compared to the thoracic and lumbar spine accounts for the small number of fractures in the cervical spine. The marked trabecular pattern factor in the center of thoracic and lumbar vertebrae could be a reason for the surgeon to use different screw designs for individual vertebrae.

Prediction of subsequent vertebral compression fractures after thoracolumbar kyphoplasty: a multicenter retrospective analysis.

Second fractures at the cemented vertebrae (SFCV) are often seen after percutaneous kyphoplasty, especially at the thoracolumbar junction. Our study aimed to develop and validate a preoperative clinical prediction model for predicting SFCV. A cohort of 224 patients with single-level thoracolumbar osteoporotic vertebral fractures (T11-L2) from 3 medical centers was analyzed between January 2017 and June 2020 to derive a preoperative clinical prediction model for SFCV. Backward-stepwise selection was used to select preoperative predictors. We assigned a score to each selected variable and developed the SFCV scoring system. Internal validation and calibration were conducted for the SFCV score. Among the 224 patients included, 58 had postoperative SFCV (25.9%). The following preoperative measures on multivariable analysis were summarized in the 5-point SFCV score: bone mineral density (≤-3.05), serum 25-hydroxy vitamin D3 (≤17.55 ng/mL), standardized signal intensity of fractured vertebra on T1-weighted images (≤59.52%), C7-S1 sagittal vertical axis (≥3.25 cm), and intravertebral cleft. Internal validation showed a corrected area under the curve of 0.794. A cutoff of ≤1 point was chosen to classify a low risk of SFCV, for which only 6 of 100 patients (6%) had SFCV. A cutoff of ≥4 points was chosen to classify a high risk of SFCV, for which 28 of 41 (68.3%) had SFCV. The SFCV score was found to be a simple preoperative method for identification of patients at low and high risk of postoperative SFCV. This model could be applied to individual patients and aid in the decision-making before percutaneous kyphoplasty.

Treatment and Outcome of Osteoporotic Thoracolumbar Vertebral Fractures With Anterior or Posterior Tension Band Failure (OF 5): Short-Term Results From the Prospective EOFTT Multicenter Study

Subgroup analysis of a multicenter prospective cohort study. To analyse surgical strategies applied to osteoporotic thoracolumbar osteoporotic fracture (OF) 5 injuries with anterior or posterior tension band failure and to assess related complications and clinical outcome. A multicenter prospective cohort study (EOFTT) was conducted at 17 spine centers including 518 consecutive patients who were treated for an osteoporotic vertebral fracture (OVF). For the present study, only patients with OF 5 fractures were analysed. Outcome parameters were complications, Visual Analogue Scale (VAS), Oswestry Disability Questionnaire (ODI), Timed Up & Go test (TUG), EQ-5D 5L, and Barthel Index. In total, 19 patients (78 ± 7 years, 13 female) were analysed. Operative treatment consisted of long-segment posterior instrumentation in 9 cases and short-segment posterior instrumentation in 10 cases. Pedicle screws were augmented in 68 %, augmentation of the fractured vertebra was performed in 42%, and additional anterior reconstruction was done in 21 %. Two patients (11 %) received short-segment posterior instrumentation without either anterior reconstruction or cement-augmentation of the fractured vertebra. No surgical or major complications occurred, but general postoperative complications were observed in 45%. At a follow-up of mean 20 ± 10 weeks (range, 12 to 48 weeks), patients showed significant improvements in all functional outcome parameters. In this analysis of patients with type OF 5 fractures, surgical stabilization was the treatment of choice and lead to significant short-term improvement in terms of functional outcome and quality of life despite a high general complication rate.

O-Arm- and Guide-Device-Assisted Personalized Percutaneous Kyphoplasty for Thoracolumbar Osteoporotic Vertebral Compression Fractures.

With the ageing of the global population, the incidence of osteoporotic vertebral compression fractures (OVCFs) is increasing. To assess the safety and efficacy of O-arm- and guide-device-assisted personalized percutaneous kyphoplasty (PKP) for treating thoracolumbar OVCFs, a total of 38 consecutive thoracolumbar OVCF patients who underwent bilateral PKP assisted with an O-arm and a guide device (O-GD group, n = 16) or traditional fluoroscopy (TF group, n = 22) from January 2020 to December 2021 were retrospectively reviewed, and their epidemiologic, clinical and radiological outcomes were analysed. The operation time was significantly decreased (p < 0.001) in the O-GD group (38.3 ± 12.2 min) compared with the TF group (57.2 ± 9.7 min). The number of intraoperative fluoroscopy exposures was significantly decreased (p < 0.001) in the O-GD group (31.9 ± 4.5) compared with the TF group (46.7 ± 7.2). Intraoperative blood loss was significantly decreased (p = 0.031) in the O-GD group (6.9 ± 2.5 mL) compared with the TF group (9.1 ± 3.3 mL). No significant difference (p = 0.854) in the volume of injected cement was observed between the O-GD group (6.8 ± 1.3 mL) and the TF group (6.7 ± 1.7 mL). Both the clinical and radiological outcomes, including the visual analogue scale score for pain, Oswestry Disability Index and anterior height and local kyphotic angle of the fractured vertebrae, were significantly improved at the postoperative and final follow-up but did not differ between the two groups. The incidence of cement leakage and refracture of the vertebral body was similar in the two groups (p = 0.272; p = 0.871). Our preliminary study demonstrated that O-GD-assisted PKP is a safe and effective procedure that presents a significantly shorter operation time, fewer intraoperative fluoroscopy exposures and less intraoperative blood loss than the TF technique.

Association of Healthful Plant-based Diet Adherence With Risk of Mortality and Major Chronic Diseases Among Adults in the UK

Plant-based diets have gained popularity for both environmental and health reasons, but a comprehensive assessment of their quality in relation to risk of mortality and major chronic diseases is lacking. To examine whether healthful vs unhealthful plant-based dietary patterns are associated with mortality and major chronic diseases among UK adults. This prospective cohort study used data from adults in the UK Biobank, a large-scale population-based study. Participants were recruited between 2006 and 2010 and followed up using record linkage data until 2021; follow-up for different outcomes ranged between 10.6 and 12.2 years. Data analysis was conducted from November 2021 to October 2022. Adherence to a healthful vs unhealthful plant-based diet index (hPDI vs uPDI) derived from 24-hour dietary assessments. The main outcomes were hazard ratios (HRs) and 95% CIs of mortality (overall and cause specific), cardiovascular disease (CVD [total, myocardial infarction, ischemic stroke, and hemorrhagic stroke]), cancer (total, breast, prostate, and colorectal), and fracture (total, vertebrae, and hip) across quartiles of hPDI and uPDI adherence. This study included 126 394 UK Biobank participants. They had a mean (SD) age of 56.1 (7.8) years; 70 618 (55.9%) were women. The majority of participants (115 371 [91.3%]) were White. Greater adherence to the hPDI was associated with lower risks of total mortality, cancer, and CVD, with HRs (95% CIs) of 0.84 (0.78-0.91), 0.93 (0.88-0.99), and 0.92 (0.86-0.99), respectively, for participants in the highest hPDI quartile compared with the lowest. The hPDI was also associated with lower risks of myocardial infarction and ischemic stroke, with HRs (95% CIs) of 0.86 (0.78-0.95) and 0.84 (0.71-0.99), respectively. By contrast, higher uPDI scores were associated with higher risks of mortality, CVD, and cancer. The associations observed did not show heterogeneity across strata of sex, smoking status, body mass index, or socioeconomic status or with polygenic risk scores (specifically with regard to CVD end points). The findings of this cohort study of middle-aged UK adults suggest that a diet characterized by high-quality plant-based foods and lower intakes of animal products may be beneficial for health, irrespective of established chronic disease risk factors and genetic predisposition.

Revision Reconstruction of the Cervical Spine in a Patient With Early Deep Surgical Site Infection Complicated by Angular Kyphosis: Case Report and Review

Background. Deep surgical site infection (DSSI) is one of the most severe complications in spinal surgery. The timing and nature of DSSI are the determining criteria in the choice of treatment tactics. The uniqueness of the clinical observation is the combination of early DSSI, epidural abscess and angular kyphotic deformity formed after a course of conservative antibacterial therapy in a patient who underwent surgery for degenerative-dystrophic disease of the cervical spine. Correction of angular kyphosis, removal of fractured vertebrae, interbody implants and three-column cervical reconstruction were performed in one surgical session.&#x0D; Case presentation. A 57-year-old patient was admitted to the clinic after staged surgical interventions on the cervical spine for multilevel degenerative stenosis of the spinal canal. The primary surgical interventions were complicated by DSSI in the early period after the second surgery with formation of angular kyphosis of the cervical spine. The patient underwent revision one-stage reconstructive intervention to correct the deformity, decompress the spinal canal, and three-column reconstruction of C3-7 segments. Long-term follow-up showed persistent reduction of pain syndrome, improved quality of life and absence of recurrence of DSSI.&#x0D; Conclusion. The presented case illustrates the possibilities of one-stage revision three-column cervical spine reconstruction for correction of sagittal profile, decompression of intracanal neural structures and ensuring stability of operated segments. Use of DSSI treatment algorithms based on Prinz V. and Vajkoczy P. classification contributes to the selection of the optimal tactics of patient management.

The association between paraspinal muscle degeneration and osteoporotic vertebral compression fracture severity in postmenopausal women.

According to reports in the literature, osteoporotic vertebral compression fracture (OVCF) is associated with paraspinal muscle degeneration; however, the association between the severity of OVCF and paraspinal muscle degeneration is not clear. The purpose of this study was to investigate the association between paraspinal muscle degeneration and OVCF severity in postmenopausal women. Three hundred and seventy-six MRI images from 47 patients were collected and analyzed. Sagittal and axial coronal T2-weighted images were used to measure the fractured vertebra sagittal cross-sectional area (FSCSA), the adjacent normal vertebral body sagittal cross-sectional area (NSCSA), paraspinal muscle cross-sectional area (CSA), and the fat cross-sectional area (FCSA). The ratio of fractured vertebra compressed sagittal cross-sectional area (RCSA) and fatty infiltration ratio (FIR) was subsequently calculated. The formulas for RCSA and FIR calculations are as follows: RCSA = (NSCSA-FSCSA)/NSCSA; FIR = FCSA/CSA. RCSA and FIR represent the severity of OVCF and paraspinal muscle degeneration, respectively. The correlation between paraspinal muscle degeneration and OVCF severity was analyzed using the Pearson correlation, and multiple regression analysis was performed to explore related risk factors. OVCF severity was closely associated with paraspinal muscle degeneration (L3/4 FIR r= 0.704, P< 0.05; L4/5 FIR r= 0.578, P< 0.05; L5/S1 FIR r= 0.581, P< 0.05). Multiple regression analysis demonstrated that the risk factor for OVCF severity was L3/4 FIR (β= 0.421, P= 0.033). OVCF severity was associated with the FIR of paraspinal muscles, and L3/4 FIR was a predictive factor for OVCF severity in postmenopausal women.

Correction loss following short-segment posterior fixation for traumatic thoracolumbar burst fractures related to endplate and intervertebral disc destruction

BackgroundThere has been widespread use of short-segment posterior fixation (SSPF) for traumatic thoracolumbar burst fractures. The relationship between the destruction of the vertebral endplate and adjacent disc and postoperative correction loss has been studied in only a few studies. This study investigated the risk factors for correction loss following SSPF.MethodsForty-eight patients (mean age 35.0 years) who underwent SSPF for thoracolumbar burst fractures were enrolled. The mean follow-up period was 25.7 months (12–98 months). The neurological status and postoperative back pain were assessed by the medical records. Segmental kyphotic angle (SKA) and anterior vertebral body height ratio (AVBHR) were measured radiographically to assess indirect vertebral body reduction and local kyphosis. Preoperative Sander’s traumatic intervertebral disc lesion (TIDL) classification and AO classification were used to evaluate the severity of disc and vertebral endplate injury. The corrective loss was considered present if ΔSKA was ≥10°. A multivariate logistic regression analysis was performed to identify the risk factors associated with postoperative loss of correction.ResultsThe fracture distribution was as follows: 10 at T12, 17 at L1, 10 at L2, 9 at L3, and 2 at L4. Vertebral fractures were classified in the following way: A3 in 13 patients, A4 in 11, B1 in 11, and B2 in 13. In 47 patients (98%), a union of the fractured vertebrae was achieved. SKA and AVBHR improved significantly after surgery from 11.6° to 3.5° and from 67.2 to 90.0%, respectively. However, the correction loss at follow-up was 10.4° and 9.7%, respectively. Twenty patients (42%) had severe TIDL (grade 3). Postoperative ΔSKA and ΔAVBHR were significantly higher in patients with TIDL grade 3 than with TIDL grade 0–2. The presence of cranial TIDL grade 3 and older age were significant risk factors for ΔSKA ≥10° on multivariate logistic regression analysis. All patients could walk at follow-up. TIDL grade 3 and ΔSKA ≥10° were associated with severe postoperative back pain.ConclusionsRisk factors for loss of correction after SSPF for thoracolumbar burst fractures were severe disc and endplate destruction at the time of injury and older age.

Prognostic factors of balloon kyphoplasty for osteoporotic vertebral fractures with diffuse idiopathic skeletal hyperostosis.

The authors aimed to determine the poor prognostic factors of balloon kyphoplasty for the treatment of fractures of the most distal or distal-adjacent vertebrae in ankylosing spines with diffuse idiopathic skeletal hyperostosis (DISH). Eighty-nine patients with fractures of the most distal or distal-adjacent vertebrae of ankylosing spines with DISH were included and divided into two groups: those with (n = 51) and without (n = 38) bone healing 6 months postoperatively. Clinical evaluation included age, sex, time from onset to surgery, the visual analog scale score for low-back pain, and the Oswestry Disability Index (ODI). The VAS scores and ODI were measured both preoperatively and at 6 months postoperatively. Radiological evaluations included bone density; wedge angles of the fractured vertebrae in the supine and sitting positions on lateral radiographs; differences in the wedge angles (change in wedge angle); and the amount of polymethylmethacrylate used. The preoperative ODI, vertebral wedge angles in the supine and sitting positions, change in wedge angle, and amount of polymethylmethacrylate were significantly different between the two groups and were significantly associated with delayed bone healing in univariate logistic regression analysis. Multivariate logistic regression analysis showed that only a change in the wedge angle was significantly associated with delayed healing, with a cutoff value of 10°, sensitivity of 84.2%, and specificity of 82.4%. Treatment with balloon kyphoplasty alone should be avoided in patients with a difference ≥ 10° in the wedge angle of the fractured vertebrae between the supine and sitting positions.

Outcomes of Treatment of Spinal Fractures with the SpineJack System

Background. The use of SpineJack implants in patients with stable spinal fractures and without neurological deficits enables restoration of the shape of the fractured vertebra and significantly accelerates restoration of normal function. In unstable spinal fractures, additional posterior fixation is recommended. This is not recommended in patients with traumatic spinal stenosis. The aim of the study was to evaluate the surgical and functional outcomes of treatment of patients with the SpineJack implant.Material and methods. The objectives of this paper were accomplished on the basis of an evaluation of the outcomes of treatment of 39 patients operated on at the Orthopaedic Oncology Department in Brzozw and the Department of Orthopaedics and Traumatology in the District Hospital in Stalowa Wola in the years 2020-2021. 71% of patients were men; the mean age of women was 54 years and the mean age of men was 41 years. A total of 30 patients suffered traumatic fractures, while 9 patients suffered non-traumatic (pathological) fractures. Fractures were most often located in the lower parts of the thoracic and upper lumbar spine. Patient radiographs taken on the day before, the first day after and 3 months following the surgery were evaluated to assess the correction of vertebral wedging and cement leakage. Functional status was assessed using ODI, the quality of life was assessed with the EQ-VAS and the severity of pain was measured with a VAS.Results. Pain intensity, measured with a VAS scale after the surgery, significantly decreased from the mean preoperative 6.9 to 2.4 three months post-op. The mean functional status of patients (ODI) before surgery was 74.4, compared to 14.8 at 3 months post-op. Mean Quality of life (EQ-VAS) was 56.4 before the surgery and 72.4 at 3 months post-op. The vertebral wedge angle decreased after surgical treatment, from a mean value of 15.8 degrees before surgery to 8.8 degrees after surgical treatment. At three months following the surgery, the mean loss of correction was 2.2 degrees and occurred in 4 patients. The most frequent complication was cement leakage into the disc and into the spinal canal, occurring in 4 and 2 patients, respectively. Conclusions. 1. The use of SpineJack implants in the treatment of stable vertebral fractures enables the restoration of the shape and reduction of the vertebral wedge angle. 2. The quality of life of patients after vertebral fracture treatment with SpineJack implants assessed using the EQ-VAS improved significantly. The severity of pain assessed on a VAS scale decreased significantly and the patients functional status improved according to the ODI. 3.Complications observed during treatment with SpineJack implants include fractures of the vertebral endplate and cement leakage, mostly asymptomatic.

Unilateral Percutaneous Kyphoplasty Using a Novel Guide Device for Thoracolumbar Osteoporotic Vertebral Fracture.

Unilateral percutaneous kyphoplasty (UPKP) has been effective in reducing the operative time, cement volume, and cement leakage (CL) rate compared with bilateral kyphoplasty. However, no device can help to determine the trajectory during operation, especially the inner inclination angle. To assess the safety and efficacy of a novel guide device (GD) for UPKP in the treatment of thoracolumbar osteoporotic vertebral fractures (TLOVFs). From January 2019 to May 2021, 31 patients diagnosed with single TLOVF who underwent UPKP were retrospectively reviewed. The patients were divided into two groups: traditional UPKP (UPKP group, 15 patients) and UPKP assisted with GD (UPKP-GD group, 16 patients). Pre-procedure demographic, clinical and radiologic characteristics, operative procedure details, and clinical and radiologic outcomes at 1 day and 12months post-procedure were collected. Statistical analyses were carried out using SPSS 24.0. The baseline characteristics of the two groups were compared by the independent sample t test or the χ2 test. The anterior height or local kyphotic angle (LKA) of the fractured vertebrae, visual analog scale (VAS) score, and Oswestry Disability Index (ODI) within groups were compared using the paired t test. A total of 31 patients (five men and 26 women; age range: 58-90 years) completed the full 12-month postoperative follow-up schedule. No significant differences were observed between treatment groups with respect to sex, age, body mass index, preoperative bone mineral density, or surgical level. Compared with the UPKP group, the operation time in the UPKP-GD group was significantly shorter (40.8 ± 5.5min vs. 48.5 ± 8.5min, p=0.005), and the number of intraoperative fluoroscopy times in the UPKP-GD group was significantly decreased (20.6 ± 4.5 vs. 25.2 ± 2.4, p=0.001). Five (31.3%) patients in the UPKP-GD group and four (26.7%) patients in the UPKP group had bone CL. The VAS and ODI scores, anterior height and LKA of the fractured vertebrae were significantly improved after surgery in each group. No significant differences in postoperative VAS and ODI scores, anterior height or LKA of the fractured vertebrae, volume of injected cement or CL were observed between the two groups. Unilateral puncture using a novel GD is a safe and effective technique for patients with TLFs and UPKP assisted with a novel GD is associated with fewer intraoperative fluoroscopy times and shorter operation time.

Percutaneous Kyphoplasty to Relieve the Rib Region Pain in Osteoporotic Thoracic Vertebral Fracture Patients Without Local Pain of Fractured Vertebra

BACKGROUND: Osteoporotic vertebral compression fractures (OVCF) are common. A few patients with thoracic vertebral fracture show pain in the bilateral rib region but not at the fracture site. The point of specific tenderness in the rib region cannot be located. It is not clear whether percutaneous kyphoplasty (PKP) can relieve the pain in the bilateral rib region in these patients. OBJECTIVE: To check whether PKP can alleviate the rib region pain in thoracic vertebral fracture patients without local pain at the fractured vertebra. STUDY DESIGN: Retrospective study. SETTING: The study was carried out at a university hospital. METHODS: We performed a retrospective analysis of thoracic vertebral fracture patients admitted to our hospital for PKP surgery between January 2018 and June 2022. The main clinical manifestations of these patients were pain in the bilateral rib region but no local tenderness and percussion pain at the fractured vertebra. CT and MRI examinations of the thoracic vertebrae were performed after admission. PKP was performed under general anesthesia after no surgical contraindication. Visual analog scale (VAS) scores and heights of the anterior, middle, and posterior edges of the fractured vertebra before the surgery, one day after surgery, and one month after surgery were compared. Also, the Cobb angles formed by the upper and lower endplate of the fractured vertebra before the surgery, one day after surgery, and one month after surgery were compared. RESULTS: A total of 50 patients were included in this study (3 men and 47 women, with an average age of 72.46 ± 8.15 years), of which 7 patients had 2 segmental fractures, so a total of 57 vertebrae were included. The VAS scores on day one and one month after the surgery were significantly lower than that before the surgery. The heights of the anterior, middle, and posterior edges of the fractured vertebra on day one after the surgery were significantly higher than those before the surgery. The Cobb angle of the fractured vertebra on day one after the surgery was lower than that before the surgery. The vertebrae of 23 patients were examined using x-ray one month after the surgery. The heights of the anterior, middle, and posterior edges of the fractured vertebra one month after the surgery were also significantly higher than those before the surgery but significantly lower than those one day after the surgery. Also, the Cobb angle of the fractured vertebra one month after the surgery was significantly lower than that before the surgery. LIMITATIONS: This was a retrospective study, which may be prone to selection and recall bias. Single-center non-controlled studies may also introduce bias. CONCLUSION: The exact location of the pain in the rib region caused by thoracic fracture cannot be identified usually. PKP can alleviate the rib region pain caused by the thoracic fracture. KEY WORDS: Percutaneous kyphoplasty, rib region pain, osteoporosis, thoracic vertebra, compression fractures, local pain

Facet joint violation after open and percutaneous posterior instrumentation: a comparative study

PurposePosterior instrumentation is the state-of-the-art surgical treatment for fractures of the thoracic and lumbar spine. Options for pedicle screw placement comprise open or minimally invasive techniques. Open instrumentation causes large approach related muscle detachment, which minimally invasive techniques aim to reduce. However, concerns of accurate pedicle screw placement are still a matter of debate. Beside neurological complications due to pedicle screw malplacement, also affection of the facet joints and thus motion dependent pain is known as a complication. The aim of this study was to assess accuracy of pedicle screw placement concerning facet joint violation (FJV) after open- and minimally invasive posterior instrumentation.MethodsA retrospective data analysis of postoperative computer tomographic scans of 219 patients (1124 pedicle screws) was conducted. A total of 116 patients underwent open screw insertion (634 screws) and 103 patients underwent minimally invasive, percutaneous screw insertion (490 screws). ResultsIn the lumbar spine (segments L3, L4, L5), there were significantly more and higher grade (open = 0.55 vs. percutaneous = 1.2; p = 0.001) FJV’s after percutaneously compared to openly inserted screws. In the thoracic spine, no significant difference concerning rate and grade of FJV was found (p > 0.56).ConclusionFJV is more likely to occur in percutaneously placed pedicle screws. Additionally, higher grade FJV’s occur after percutaneous instrumentation. However, in the thoracic spine we didn’t find a significant difference between open and percutaneous technique. Our results suggest a precise consideration concerning surgical technique according to the fractured vertebrae in the light of the individual anatomic structures in the preop CT.

Short-segment fixation and transpedicular bone grafting for the treatment of thoracolumbar spine fracture.

Thoracolumbar fracture is one of the most common fractures of spine. And short-segment posterior fixation including the fractured vertebra (SSPFI) is usually used for the surgical treatment of it. However, the outcomes of SSPFI for different types of thoracolumbar fractures are not clear, and whether it is necessary to perform transpedicular bone grafting is still controversial. This study was conducted to determine the clinical efficacy of SSPFI for the treatment of different types of single-level thoracolumbar fracture, and make clear what kind of fractures need transpedicular bone grafting during the surgery. Patients with single-level thoracolumbar fracture undergoing SSPFI surgery between January 2013 and June 2020 were included in this study. The operative duration, intraoperative blood loss, anterior vertebral height ratio (AVHR) and anterior vertebral height compressive ratio (AVHC) of the fractured vertebra, local kyphotic Cobb angle (LKA), vertebral wedge angle (VWA) and correction loss during follow up period were recorded. Outcomes between unilateral and bilateral pedicle screw fixation for fractured vertebra, between SSPFI with and without transpedicular bone grafting (TBG), and among different compressive degrees of fractured vertebrae were compared, respectively. A total of 161 patients were included in this study. All the patients were followed up, and the mean follow-upped duration was 25.2 ± 3.1 months (6-52 months). At the final follow-up, the AVHR was greater, and the LKA and VWA were smaller in patients with bilateral fixation (6-screw fixation) than those with unilateral fixation (5-screw fixation) of AO type A3/A4 fractures (P < 0.001). The correction loss of AVHR, LKA and VWA in fractured vertebra were significantly great when preoperative AVHC was >50% (P < 0.05). For patients with AVHC >50%, the correction loss in patients with TBG were less than those without TBG at the final follow-up (P < 0.05). SSPFI using bilateral fixation was more effective than unilateral fixation in maintaining the fractured vertebral height for AO type A3/A4 fractures. For patients with AVHC >50%, the loss of correction was more obvious and it can be decreased by transpedicular bone grafting.

The role of endplate injury in intervertebral disc degeneration after vertebral augmentation in OVCF patients.

Whether vertebral augmentation can induce or aggravate the degeneration of adjacent intervertebral discs remains controversial. The purpose of this study is to explore the role of endplate injury in intervertebral disc degeneration after vertebral augmentation. The imaging data of patients with single-segment osteoporotic vertebral compression fractures (OVCFs) were retrospectively analyzed. The upper and lower discs of the fractured vertebrae were defined as cranial and caudal discs, and the discs adjacent to the cranial discs were defined as control discs. According to the integrity of the cranial and caudal endplates, they were divided into an injury group and a noninjury group. At follow-up, the increase in the modified Pfirrmann score on MRI compared with the baseline grade was defined as the occurrence of a degenerative disc change (DDC). The changes in the disc height and the number of DDC cases on MRI during the follow-up in each group were analyzed. A total of 56 patients with OVCFs were included in this study, with an average follow-up time of 18.8 ± 14.1 months (3-62 months). In the cranial and caudal discs, the number of DDC cases in the endplate injury group was significantly higher than that in the noninjury group (P = 0.007 and P = 0.018). However, the number of DDC cases in the whole endplate injury group (including the cranial and caudal endplates) was significantly higher than that of the whole noninjury group (P = 0.000) and the control group (P = 0.000). The number of DDC cases in the whole noninjury group was not different from that of the control group (P = 0.192). At follow-up, the disc height of the cranial and caudal endplate injury group was significantly lower than the baseline (P = 0.000 and P = 0.001), but the disc height of the noninjury group was not significantly lower than the baseline (P = 0.074 and P = 0.082). Endplate injury is associated with adjacent intervertebral disc degeneration in OVCF patients after vertebral augmentation. Evaluation of endplate damage before vertebral enhancement in OVCF patients has an important reference value for predicting the outcome of adjacent intervertebral discs after surgery.

Multilevel unilateral versus bilateral pedicular percutaneous vertebroplasty for osteoporotic vertebral compression fractures.

Retrospective study. Controversy exists over the need for unilateral vs. bilateral pedicular percutaneous vertebroplasty (PVP) for patients with osteoporotic vertebral compression fractures (OVCFs). Clinical research is scarce comparing two approaches for multi-level PVP. This study aimed at evaluating the clinical and radiographic outcomes of multi-level PVP using two approaches for OVCFs. Seventy-eight patients with OVCFs undergoing multi-level PVP were enrolled including 36 patients undergoing unilateral PVP and 42 undergoing bilateral PVP. The clinical and radiological assessments including the Visual Analogue Scale (VAS), sagittal and coronal segmental Cobb, vertebral compression ratio (VCR), and vertebral sides ratio (VSR) were evaluated preoperatively and postoperatively. All patients achieved a minimum 2-year follow-up. A total of 164 fractured vertebrae were enrolled. Regarding clinical efficacy, the VAS score improved in both groups after surgery, but the two groups did not differ significantly. The changes tendency in Sagittal Segmental Cobb, VSR, and VCR were similar postoperatively, and no statistically significant difference between groups. As for the Coronal Segmental Cobb angle, patients in unilateral and bilateral groups were shown to have 5.0° ± 4.0° and 2.6° ± 2.2° degrees loss of correction at a minimum 2-years follow-up duration, respectively. The loss of correction in the Coronal Segmental Cobb of unilateral group was significantly greater than that of bilateral group. Both multi-level unilateral and bilateral pedicular PVP achieved significant pain reduction and vertebral height restoration. Moreover, the bilateral PVP has shown advantages in stabilizing Coronal Cobb angle in patients with OVCFs.

In-Fracture Pedicular Screw Placement During Ligamentotaxis Following Traumatic Spine Injuries, a Randomized Clinical Trial on Outcomes.

To investigate the efficacy and safety of two different techniques for spinal ligamentotaxis. Spine ligamentotaxis reduces the number of retropulsed bone fragments in the fractured vertebrae. Two different ligamentotaxis techniques require clinical evaluation. This was a randomized clinical trial. The case group was defined as one pedicular screw insertion into a fractured vertebra, and the control group as a no-pedicular screw in the index vertebra. Spine biomechanical values were defined as primary outcomes and complications as secondary outcomes. A total of 105 patients were enrolled; 23 were excluded for multiple reasons, and the remaining were randomly allocated into the case (n=40) and control (n=42) groups. The patients were followed up and analyzed (n=56). The postoperative mid-sagittal diameter of the vertebral canal (MSD), kyphotic deformity correction, and restoration of the anterior height of the fractured vertebrae showed equal results in both groups. Postoperative retropulsion percentage and pain were significantly lower in the case group than in the control group (p=0.003 and p=0.004, respectively). There were no group preferences for early or long-term postoperative complications. Regarding clinical and imaging properties, inserting one extra pedicular screw in a fractured vertebra during ligamentotaxis results in better retropulsion reduction and lower postoperative pain.

Observational study of short-segment pedicle screw fixation for dorsolumbar spine injury: A prospective study

Background: Traumatic injury of dorsolumbar spine is one of the most common sites of spinal injuries because of its location between rigid kyphotic thoracic and mobile lordotic lumbar spine. Its treatment by pedicle screw fixation by short segment (one level above and below the fractured vertebra) or long segment (two levels above and below the fractured vertebra) has always remained a matter of debate. The aim of this study was to assess the functional outcome of short-segment fixation in dorsolumbar spine injury.Materials and Methods: This prospective study was conducted on thirty, single-level, unstable dorsolumbar spine fracture patients, who underwent short-segment pedicle screw instrumentation at Indira Gandhi Institute of Medical Sciences, Patna, between October 2019 and September 2021. All the patients were operated by posterior approach and stabilized the vertebrae with short-segment pedicle screw instrumentation. All patients were followed up for 1 year.Results: Thirty patients (21 males and 9 females) of mean age 34.2 ± 11.74 years were included in the study. The most common mode of injury was fall from height (24 patients, 80%), followed by road traffic accident (six patients, 20%). The most common fracture pattern was compression fractures in 23 (76.67%) patients, followed by burst fractures in 7 (23.33%) patients. The most common level of injury was L1, followed by D12. Neurological improvement of at least one level was seen in 21 patients, and nine patients had no neurological improvement. There was a statistically significant correction of kyphotic angle of 14.9°. At 1 year of follow-up, 21 (70%) patients had <40% Oswestry Disability Index (ODI) and 9 (30%) patients had more than 40% ODI. Out of 30 patients, 2 (6.67%) patients had bedsore, 1 (3.33%) patient had superficial infection, and 1 (3.33%) patient had implant failure.Conclusion: The short-segment posterior instrumentation system is a very stable construct. It maintained the corrected deformity after fracture reduction and spares the motion segment which is sacrificed in the conventional long-segment fixation. The soft tissue dissection, blood loss, and duration of surgery are less in this procedure.

Post-operative MRSA Infection of the Lumbar Spine in a Misdiagnosed Case of Spine Trauma – A Case Report and Review of Literature

A 56-year-old male patient sustained a fracture of the body of L3 vertebral body following a trivial road traffic accident. He underwent laminectomy L3 and stabilization of L2 and L4 with pedicle screws, in a different hospital. 70 days after the index surgery, the patient presented with severe back pain throughout the day and night. Upon, evaluation he was found to have an abscess at the operation site due to an MRSA infection. On further evaluation, he was diagnosed with multiple myeloma. Six weeks after the abscess drainage and implant removal he underwent re-instrumentation, two levels above and below the fractured vertebrae (L3). He underwent chemotherapy for multiple myeloma. Eight months after the second surgery, the patient presented with surgical site infection, abscess, and implant loosening. The Abscess was drained and the implants were removed. Later on, the patient developed hyponatremia. Later he was taken to another hospital and died 5 days later. Keywords: Spine trauma, Multiple myeloma, MRSA infection, Implant loosening, Plasmacytosis.

TREATMENT OF THORACOLUMBAR FRACTURES BY CLOSED REDUCTION VIA A PERCUTANEOUS SOLID PEDICLE SCREW.

Investigate the effect of closed reduction and per- cutaneous pedicle screw fixation in treating thoracolumbar fractures. This retrospective study analyzed 12 cases of single-segment thoracolumbar spine fractures without spinal cord and nerve injury at our department from March 2016 to September 2017. Patients were treated with closed reduction, percutaneous reduction, and internal fixation with solid pedicle screws. The operation time, intraoperative blood loss, anterior vertebral body height ratio (AVHR), Cobb angle (CA) of sagittal kyphosis, and VAS of back pain were determined and statistically compared. The average operation time was 147.2 ± 45.6 min, and the average intraoperative bleeding was 67.8 ± 34.2 mL. All fractured vertebrae were completely reduced, their height was restored, and kyphosis was corrected. The average follow-up period was 10.6 ± 2.7 months, with significant improvements seen in the AVHR, CA of sagittal kyphosis, and VAS score (P < 0.01). One case had a broken rod after three months, and another had a postoperative infection. All the patients achieved bony healing. The treatment of thoracolumbar fractures by closed reduction and internal fixation with a percutaneous solid pedicle screw is simple, effective, and economical. Level of Evidence VI; Therapeutic Study, Case Series .