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Marie-Hardy L, Mohsinaly Y, Pietton R, Bonaccorsi R, Vialle R, Pascal-Moussellard H. Defining threshold for sagittal correction in lumbar fractures. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1550-1555. [PMID: 38315226 DOI: 10.1007/s00586-024-08138-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 12/04/2023] [Accepted: 01/10/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE Surgical indications for thoraco-lumbar fractures are driven both by neurological status, fractures instability and kyphotic deformity. Regarding kyphotic deformity, an angulation superior to 20° is considered by many surgeons as a surgical indication to reduce the disability induced by post-traumatic kyphosis. However, there is a lack of data reporting the ideal or theoretical lordosis that one must have in a particular lumbar segment on CT-scan. The main goal of this study was to determine the mean value for segmental lumbar lordosis according to pelvic incidence (PI) on a cohort of normal subjects. METHODS The consecutive CT-scan of 171 normal adult subjects were retrospectively analyzed. The PI and the segmental lordosis (L4S1, L3L5, L2L4, L3L1, L2T12 and T11-L1) were measured on all CT-scan. The mean values were calculated for the global cohort and a sub-group analysis according to IP ranges (< 45°, 45 < IP < 60° and > 60°) was performed. RESULTS The mean angular values for the whole cohort were IP: 54, 9°; L4S1: - 38, 1°; L3L5: - 30, 6°; L2L4: - 14, 1°; L1L3: - 4, 9°; T12L2: + 1, 9° and T11L1: + 5, 4°. The segmental values vary significatively with PI ranges, as for L3L5: - 26, 8° (PI < 45°); - 30° (45 < PI < 60°) and - 35, 1° (PI > 60°). CONCLUSION These results provide a referential of theoretical values of segmental lordosis according to PI. This abacus may help spinal surgeon in their decision-making process regarding lumbar fractures, to determine the amount of sagittal correction needed, according to the PI range, to be adapted to the sagittal morphology of the patient. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Laura Marie-Hardy
- Spine Surgery Unit, Orthopaedic Department, Pitié-Salpétrière Hospital, 43-87 Bd de l'Hôpital, 75013, Paris, France.
| | - Yann Mohsinaly
- Spine Surgery Unit, Orthopaedic Department, Pitié-Salpétrière Hospital, 43-87 Bd de l'Hôpital, 75013, Paris, France
| | - Raphaël Pietton
- Spine Surgery Unit, Orthopaedic Department, Pitié-Salpétrière Hospital, 43-87 Bd de l'Hôpital, 75013, Paris, France
| | - Raphaël Bonaccorsi
- Spine Surgery Unit, Orthopaedic Department, Pitié-Salpétrière Hospital, 43-87 Bd de l'Hôpital, 75013, Paris, France
| | - Raphaël Vialle
- Pediatric Orthopaedic Department, Trousseau Hospital, 26 Av. du Dr Arnold Netter, 75012, Paris, France
| | - Hugues Pascal-Moussellard
- Spine Surgery Unit, Orthopaedic Department, Pitié-Salpétrière Hospital, 43-87 Bd de l'Hôpital, 75013, Paris, France
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Puhakka J, Jeszenszky D, Mannion AF, Loibl M, Kleinstück F, Fekete TF, Haschtmann D. Patient-reported outcomes 1 and 2 years after transforaminal thoracic interbody fusion (TTIF). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1089-1097. [PMID: 37987852 DOI: 10.1007/s00586-023-08042-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 10/06/2023] [Accepted: 11/04/2023] [Indexed: 11/22/2023]
Abstract
STUDY DESIGN Retrospective Cohort Study with prospectively collected data. PURPOSE Transforaminal interbody fusion was initially designed for the lumbar spine. A similar approach was later introduced for the thoracic spine (TTIF). Here we report the surgical technique and the Core Outcome Measures Index (COMI) at 1-year and 2-year follow-ups, as well as the sagittal radiographic kyphosis correction of TTIF, achieved at 1 year and the latest follow-up. METHODS All TTIF procedures from 2012 to 2020 were included. COMI scores were collected preoperatively and at 1- and 2-year follow-ups. The sagittal angle between the upper and lower endplates at the segment where TTIF was performed was measured on preoperative, 1-year postoperative, and last available radiographs. RESULTS Seventy-nine TTIF procedures were performed for 64 patients (36% males; mean age 67.5 (SD 15.3) years). COMI score reduced from a mean value of 8.1 (SD 1.4) preoperatively to 4.7 (SD 2.7) at 1-year follow-up and 4.7 (SD 2.7) at 2-year follow-up. The mean correction of segmental kyphosis was 10.8 (SD 7.3, p < 0.0001) degrees at 1-year follow-up and 9.3 (SD 7.0, p < 0.0001) degrees at the final follow-up 3.4 (SD 1.4) years after the operation. Kaplan-Meier analysis for reoperations showed a 5-year survival of 91% (95% CI 0.795-1) for primary TTIF operations and survival of 77% (95% CI 0.651-0.899) for TTIFs performed after earlier fusion operations. CONCLUSIONS TTIF is a feasible procedure in the thoracic spine. Kyphosis correction of approximately 10° was maintained at 1-year and final follow-up. Over 69% at 1-year and 61% at 2-year follow-up achieved MCID for COMI.
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Affiliation(s)
- Jani Puhakka
- Spine Center, Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland.
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Department of Orthopaedics and Traumatology, University of Helsinki, Helsinki, Finland.
| | - Dezsö Jeszenszky
- Spine Center, Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland
| | - Anne F Mannion
- Spine Center, Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland
| | - Markus Loibl
- Spine Center, Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland
| | - Frank Kleinstück
- Spine Center, Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland
| | - Tamás F Fekete
- Spine Center, Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland
| | - Daniel Haschtmann
- Spine Center, Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Crim J, Atkins N, Zhang A, Moore DK. Thoracic and lumbar spine trauma classification systems fail to predict post-traumatic kyphotic deformity. NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2022; 11:100134. [PMID: 35783007 PMCID: PMC9240640 DOI: 10.1016/j.xnsj.2022.100134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/10/2022] [Accepted: 06/07/2022] [Indexed: 12/03/2022]
Abstract
Background Post-traumatic kyphosis of the thoracic and lumbar spine can lead to pain and decreased function. MRI has been advocated to assess ligament integrity and risk of kyphosis. Methods All thoracic and lumbar spine MRI performed for evaluation of trauma over a 3-year period at a single institution were reviewed. Patients were included if there was an MRI showing a vertebral body fracture and follow-up radiographs. Two observers retrospectively reviewed all radiographs, CT and MRI scans, and classified injuries based on the Denis, TLICS, AO and load sharing classification systems. Change in kyphosis between injury and follow-up studies was measured. The initial radiology reports made at time of patient injury were compared to the retrospective interpretations. Results There were 67 separate injuries in 62 patients. Kyphosis measuring ≥ 10° developed despite an intact PLC in 6/14 nonoperative cases, and 3/7 surgically treated cases; when PLC was partially injured, it developed in 6/10 cases (8 treated nonoperatively, 2 treated operatively. Thirty injuries had complete disruption of PLC by MRI, 24 treated with fusion. Kyphosis ≥ 10° developed in 3/6 treated nonoperatively, and 8/24 treated with fusion. Development of kyphosis was independent of degree of vertebral body comminution. It developed equally in patients with Grade 2 and Grade 3 Denis injuries. It developed in patients with intact PLC when multiple vertebrae were involved and/or there was compressive injury to anterior longitudinal ligament (ALL). There was high interobserver variability in assessment of severity of ligamentous injury on MRI. Conclusions Classification systems of thoracic and lumbar spine injury and integrity of the PLC failed to predict the risk of development of post-traumatic kyphotic deformity.
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Affiliation(s)
- Julia Crim
- University of Missouri, 1 Hospital Dr., Columbia, MO 65212, United States
- Corresponding author.
| | - Naomi Atkins
- University of Missouri, 1 Hospital Dr., Columbia, MO 65212, United States
| | - Anqing Zhang
- George Washington University School of Medicine, United States
| | - Don K. Moore
- University of Missouri, 1 Hospital Dr., Columbia, MO 65212, United States
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Cianfoni A, Delfanti RL, Isalberti M, Scarone P, Koetsier E, Bonaldi G, Hirsch JA, Pileggi M. Minimally Invasive Stent Screw-Assisted Internal Fixation Technique Corrects Kyphosis in Osteoporotic Vertebral Fractures with Severe Collapse: A Pilot "Vertebra Plana" Series. AJNR Am J Neuroradiol 2022; 43:776-783. [PMID: 35450859 PMCID: PMC9089263 DOI: 10.3174/ajnr.a7493] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 02/09/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Fractures with "vertebra plana" morphology are characterized by severe vertebral body collapse and segmental kyphosis; there is no established treatment standard for these fractures. Vertebroplasty and balloon kyphoplasty might represent an undertreatment, but surgical stabilization is challenging in an often elderly osteoporotic population. This study assessed the feasibility, clinical outcome, and radiologic outcome of the stent screw-assisted internal fixation technique using a percutaneous implant of vertebral body stents and cement-augmented pedicle screws in patients with non-neoplastic vertebra plana fractures. MATERIALS AND METHODS Thirty-seven consecutive patients with vertebra plana fractures were treated with the stent screw-assisted internal fixation technique. Vertebral body height, local and vertebral kyphotic angles, outcome scales (numeric rating scale and the Patient's Global Impression of Change), and complications were assessed. Imaging and clinical follow-up were obtained at 1 and 6 months postprocedure. RESULTS Median vertebral body height restoration was 7 mm (+74%), 9 mm (+150%), and 3 mm (+17%) at the anterior wall, middle body, and posterior wall, respectively. Median local and vertebral kyphotic angles correction was 8° and 10° and was maintained through the 6-month follow-up. The median numeric rating scale score improved from 8/10 preprocedure to 3/10 at 1 and 6 months (P < .001). No procedural complications occurred. CONCLUSIONS The stent screw-assisted internal fixation technique was effective in obtaining height restoration, kyphosis correction, and pain relief in patients with severe vertebral collapse.
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Affiliation(s)
- A Cianfoni
- From the Department of Neuroradiology (A.C., R.L.D., M.I., M.P.)
- Department of Interventional and Diagnostic Neuroradiology (A.C.), Inselspital University Hospital of Bern, Bern, Switzerland
| | - R L Delfanti
- From the Department of Neuroradiology (A.C., R.L.D., M.I., M.P.)
| | - M Isalberti
- From the Department of Neuroradiology (A.C., R.L.D., M.I., M.P.)
| | | | - E Koetsier
- Pain Management Center (E.K.), Neurocenter of Southern Switzerland, Lugano, Switzerland
- Faculty of Biomedical Sciences (E.K.), Università della Svizzera Italiana, Lugano, Switzerland
| | - G Bonaldi
- Neurosurgical Department (G.B.), Casa di Cura Igea, Milan, Italy
| | - J A Hirsch
- Department of Radiology (J.A.H.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - M Pileggi
- From the Department of Neuroradiology (A.C., R.L.D., M.I., M.P.)
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Vendeuvre T, Brossard P, Pic JB, Billot M, Gayet LE, Pries P, Teyssédou S, Germaneau A, Rigoard P. Vertebral balloon kyphoplasty versus vertebral body stenting in non-osteoporotic vertebral compression fractures at the thoracolumbar junction: a comparative radiological study and finite element analysis (BONEXP study). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:3089-3098. [PMID: 33661396 DOI: 10.1007/s00586-021-06785-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 01/18/2021] [Accepted: 02/19/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To compare radiologically balloon kyphoplasty (BKP) and vertebral compression fracture (VCF) expansion and corroborate with a finite element (FE) analysis. The principle of BKP is to stabilize VCF by restoring vertebral body anatomy using bone expansion and cement filling. More recently, vertebral body stenting (VBS) has been developed to reduce the loss of vertebral height observed after balloon deflation. METHODS A retrospective, monocentric and continuous study of 60 non-osteoporotic fractures of the thoracolumbar junction treated by vertebral bone expansion was carried out over three years. The main endpoint was radiological correction of vertebral kyphosis (VK) at 3 months. The other studied parameters were vertebral height, index of Farcy, index of Beck, cement leakages and their location. A FE model was developed to analyze effects linked to the stent during cement injection, specifically throughout the risk of cement leakage evaluation. RESULTS After three months, average reduction of VK was 4.73° ± 4.8° after BKP, and 4.63° ± 2.7° after VBS. There was no difference between the two techniques, but cement leakage was significantly greater with BKP (41.7%) than with VBS (4.2%). FE analysis showed substantial changes of the cement flow orientation in the presence of a stent. CONCLUSION BKP and VBS offer comparable expansion with no added value of VBS in non-osteoporotic VCF reduction. VBS technique appears to prevent cement leakage due to its mesh architecture hindering the leaking process. In counterpart, such balloon expansion is likely to require higher pressure to deploy the stent. This could be an important parameter to take into account in young patients with high bone density.
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Affiliation(s)
- Tanguy Vendeuvre
- Department of Spine, Neuromodulation and Rehabilitation, Poitiers University Hospital, Poitiers, France.,PRISMATICS Lab, Poitiers University Hospital, Poitiers, France.,Department of Orthopaedic Surgery and Traumatology, Poitiers University Hospital, Poitiers, France.,Institut Pprime UPR 3346 CNRS, Université de Poitiers - ISAE-ENSMA, Bd Marie et Pierre Curie, Futuroscope, 86000, Poitiers, France
| | - Paul Brossard
- Department of Spine, Neuromodulation and Rehabilitation, Poitiers University Hospital, Poitiers, France.,PRISMATICS Lab, Poitiers University Hospital, Poitiers, France.,Department of Orthopaedic Surgery and Traumatology, Poitiers University Hospital, Poitiers, France
| | - Jean-Baptiste Pic
- Department of Spine, Neuromodulation and Rehabilitation, Poitiers University Hospital, Poitiers, France.,PRISMATICS Lab, Poitiers University Hospital, Poitiers, France.,Department of Orthopaedic Surgery and Traumatology, Poitiers University Hospital, Poitiers, France
| | - Maxime Billot
- PRISMATICS Lab, Poitiers University Hospital, Poitiers, France
| | - Louis-Etienne Gayet
- Department of Orthopaedic Surgery and Traumatology, Poitiers University Hospital, Poitiers, France
| | - Pierre Pries
- Department of Spine, Neuromodulation and Rehabilitation, Poitiers University Hospital, Poitiers, France.,Department of Orthopaedic Surgery and Traumatology, Poitiers University Hospital, Poitiers, France
| | - Simon Teyssédou
- Department of Spine, Neuromodulation and Rehabilitation, Poitiers University Hospital, Poitiers, France
| | - Arnaud Germaneau
- Institut Pprime UPR 3346 CNRS, Université de Poitiers - ISAE-ENSMA, Bd Marie et Pierre Curie, Futuroscope, 86000, Poitiers, France.
| | - Philippe Rigoard
- Department of Spine, Neuromodulation and Rehabilitation, Poitiers University Hospital, Poitiers, France.,PRISMATICS Lab, Poitiers University Hospital, Poitiers, France.,Institut Pprime UPR 3346 CNRS, Université de Poitiers - ISAE-ENSMA, Bd Marie et Pierre Curie, Futuroscope, 86000, Poitiers, France
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Starlinger J, Lorenz G, Fochtmann-Frana A, Sarahrudi K. Bisegmental posterior stabilisation of thoracolumbar fractures with polyaxial pedicle screws: Does additional balloon kyphoplasty retain vertebral height? PLoS One 2020; 15:e0233240. [PMID: 32421734 PMCID: PMC7233542 DOI: 10.1371/journal.pone.0233240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 04/30/2020] [Indexed: 11/18/2022] Open
Abstract
We retrospectively evaluated single-level compression fractures (T12-L3) scheduled for a short-segment POS (posterior-only stabilization) using polyaxial screws. Patients averaged 55.7 years (range, 19–65). Patients received either POS or, concomitantly, BK (balloon kyphoplasty) of the fractured vertebrae as well. Primary endpoint was the radiological outcome at the last radiographic follow-up prior to implant removal. POS together with BK of the fractured vertebrae resulted in a significant improvement of the local kyphosis angle and vertebral body compression rates immediately post-OP. During the further course of FU, a considerable loss of correction was observed post-OP in both groups. (Local KA: pre-OP/ post-OP/ FU: 12.6±4.8/ 3.35±4.8/ 11.6±6.0; anterior vertebral body compression%: pre-OP/post-OP/ FU: 71.94±12.3/ 94.78±19.95/ 78.17±14.74). VAS was significantly improved from 7.2±1.3 pre-OP to 2.7±1.3 (P<0.001) at FU. We found a significant restoration of the vertebral body height by BK. Nevertheless, follow-up revealed a noticeable loss of reduction. Given the fact that BK used together with polyaxial screws did not maintain intra-operative reduction, our data do not support this additional maneuver when used together with bi-segmental polyaxial pedicle screw fixation.
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Affiliation(s)
- Julia Starlinger
- Department for Orthopedics, Mayo Clinic, Rochester, MN, United States of America
- Department for Orthopedics and Trauma Surgery, Medical University Vienna, Vienna, Austria
- * E-mail:
| | | | | | - Kambiz Sarahrudi
- Department for Trauma Surgery, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
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Xin Z, Zheng G, Huang P, Zhang X, Wang Y. Clinical results and surgery tactics of spinal osteotomy for ankylosing spondylitis kyphosis: experience of 428 patients. J Orthop Surg Res 2019; 14:330. [PMID: 31640803 PMCID: PMC6805318 DOI: 10.1186/s13018-019-1371-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 09/11/2019] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To report the clinical results and surgical tactics of spinal osteotomy for ankylosing spondylitis (AS) kyphosis based on the experiences of 428 patients. METHODS From January 2003 to January 2015, a total of 428 patients suffering from AS kyphosis who underwent a one- or two-level pedicle subtraction osteotomy (PSO) or vertebral column decancellation (VCD) osteotomy in our hospital were reviewed. Pre- and postoperative radiological parameters and the chin-brow vertical angle (CBVA) were measured. Intraoperative, postoperative, and general complications were recorded. RESULTS All patients could walk with horizontal vision and lie on their backs postoperatively. The pre- and postoperative average global kyphosis (GK) angles were corrected from 82.6 to 12.7° (p = 0.000) in the two-level group and from 55.8 to 9.6° (p = 0.000) in the one-level group, respectively. The mean sagittal vertical axis (SVA) improved from 29.4 to 8 cm (p = 0.000) in the two-level group and from 18.0 to 4.3 cm (p = 0.000) in the one-level group. The CBVA improved from 68.3 to 8.2° (p = 0.000) in the two-level group and from 46.2 to 4.2° (p = 0.000) in the one-level group. Although no major acute complications such as death or complete paralysis occurred, the complication rate was 6.5% in the one-level group and 23.6% in the two-level group. CONCLUSION Spinal osteotomy, such as PSO and VCD, can improve the quality of life of AS patients as well as correct kyphotic deformities. The one-level spinal osteotomy showed a lower complication rate, while two-level spinal osteotomy was a relatively aggressive procedure that was more suitable in correcting severe AS kyphotic deformities.
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Affiliation(s)
- Zhijun Xin
- Department of Orthopaedics, General Hospital of Chinese People's Liberation Army (301 Hospital), 28 Fuxing Rd, Beijing, 100853, China
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China
| | - Guoquan Zheng
- Department of Orthopaedics, General Hospital of Chinese People's Liberation Army (301 Hospital), 28 Fuxing Rd, Beijing, 100853, China
| | - Peng Huang
- Department of Orthopaedics, General Hospital of Chinese People's Liberation Army (301 Hospital), 28 Fuxing Rd, Beijing, 100853, China
| | - Xuesong Zhang
- Department of Orthopaedics, General Hospital of Chinese People's Liberation Army (301 Hospital), 28 Fuxing Rd, Beijing, 100853, China
| | - Yan Wang
- Department of Orthopaedics, General Hospital of Chinese People's Liberation Army (301 Hospital), 28 Fuxing Rd, Beijing, 100853, China.
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Rava A, Fusini F, Cinnella P, Massè A, Girardo M. Is cast an option in the treatment of thoracolumbar vertebral fractures? JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2019; 10:51-56. [PMID: 31000982 PMCID: PMC6469317 DOI: 10.4103/jcvjs.jcvjs_8_19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background: Thoracolumbar vertebral fractures are common in high-energy trauma and often are associated to other concomitant injuries. Currently, brace and Closed Reduction and Casting (CRC) are the two conservative treatments proposed by literature. Despite CRC was widely used in the past, today brace is preferred. The aim of our study is to evaluate clinical and radiographic outcomes of thoracolumbar type A fractures, not associated with other injuries, treated with CRC. Materials and Methods: We retrospectively evaluated all patients treated from 2008 to 2015, with a mean age of 26.69 years (range 15–45). All patients were affected by AO type A fracture: 26 type A1, 17 type A2, and 21 type A3. All patients were evaluated by X-ray, computed tomography, and magnetic resonance imaging. Radiological evaluations included vertebral kyphosis (VK), segmental kyphosis (SK), regional kyphosis (RK) angle, and vertebral ratio (VR) measures. Patients were clinically assessed through visual analog scale, Oswestry Disability Index, Roland–Morris Disability Questionnaire, and Short Form 36 Health Survey. Results: Seventy-four patients (41 males and 33 females) were included in the study. At follow-up (mean 28.48 months ± 5.16), we found significant improvements in VK (P = 0.000013), SK (P = 0.000455), and RK (P = 0.000016). No significant differences were observed in VR (P = 0.26). Good clinical results were reported in patients in all scores and 90.7% of patients returned to work. Conclusions: Closed reduction and casting is still a reliable treatment option in selected thoracolumbar fractures without spinal cord involvement. A correct fracture evaluation, patient compliance, and motivation are essentials. Level of evidence: IV.
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Affiliation(s)
- Alessandro Rava
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Federico Fusini
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Pasquale Cinnella
- Orthopaedic and Trauma Centre, Spine Surgery Unit, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Alessandro Massè
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Massimo Girardo
- Orthopaedic and Trauma Centre, Spine Surgery Unit, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
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Delgado-López PD, Rodríguez-Salazar A, Martín-Velasco V, Martín-Alonso J, Castilla-Díez JM, Galacho-Harriero A, Araús-Galdós E. [Rationale and complications of the anterior-lateral extrapleural retroperitoneal approach for unstable thoracolumbar fractures: Experience in 86 consecutive patients]. Neurocirugia (Astur) 2017; 28:218-234. [PMID: 28342638 DOI: 10.1016/j.neucir.2017.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 01/16/2017] [Accepted: 01/17/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To describe the rationale, pros and cons, and complications of the anterior-lateral extrapleural retroperitoneal approach for unstable (TLICS>4) thoracolumbar fractures. PATIENTS AND METHODS Clinical and radiological data and outcomes from a cohort treated surgically via said approach were retrospectively reviewed. All patients were operated on exclusively by 5 neurosurgeons trained in spine surgery. RESULTS Between June 1999 and December 2015, 86 patients underwent surgery (median age 42years, most common level: L1). Approximately 32.5% presented with a preoperative neurological defect. After surgery (mean duration: 275minutes), 75.6% presented with no neurological sequelae and only one-third required blood transfusion. Median postoperative stay was 7days. Correction of kyphosis was considered adequate and suboptimal but acceptable in 91% and 9% of the patients, respectively. Complications occurred in 36 patients, the majority being transient. We observed failure of the construct in 2 cases (collapse of an expandable cage and extrusion of a locking screw). No infections, vascular or visceral lesions, permanent neurological worsening or mortality occurred during hospitalisation. One patient ultimately needed additional posterior fixation due to persistence of pain. Median follow-up was 252days (27.9% was lost to follow-up). CONCLUSIONS The extrapleural extraperitoneal approach provides solid anterior reconstruction, allows wide decompression of the spinal canal, and permits adequate and long-lasting correction of kyphosis. The rates of infection, construct failure, need for reoperation and vascular or visceral lesions are minimal.
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Affiliation(s)
| | | | | | | | | | | | - Elena Araús-Galdós
- Servicio de Neurofisiología Clínica, Hospital Universitario de Burgos, Burgos, España
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10
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Does the Traversing Length of the Aorta Change After Closing Wedge Osteotomy for Ankylosing Spondylitis Patients With Thoracolumbar Kyphosis?: A Magnetic Resonance Imaging Investigation. Spine (Phila Pa 1976) 2017; 42:106-112. [PMID: 27398895 DOI: 10.1097/brs.0000000000001781] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective magnetic resonance imaging (MRI) study. OBJECTIVE To investigate the change in aortic traversing length in patients with thoracolumbar kyphosis secondary to ankylosing spondylitis (AS) after closing wedge osteotomy (CWO). SUMMARY OF BACKGROUND DATA The CWO has been widely adopted for the correction of thoracolumbar kyphosis caused by AS. During this procedure, the aorta may be elongated in the instrumented area, which implies a potential risk of the aortic injury. To date, no reports have been specifically published using MRI to investigate the alteration in aortic traversing length in patients with AS undergoing CWO. METHODS From June 2013 to July 2015, 24 patients with AS with thoracolumbar kyphosis with a mean age of 38.1 years were recruited in the present study. All patients underwent single-level CWO. MRI examinations were performed before and 2 weeks after surgery. For each subject, the aortic diameter and length were measured on the MRI. Radiographic measurements included the global kyphosis, thoracic kyphosis, lumbar lordosis, local kyhosis, angle of fusion levels, and anterior height of the osteotomized vertebra. The height of these patients was also recorded. RESULTS The aortic traversing length significantly increased by an average of 2.0 cm after surgery. Significant changes in height, global kyphosis, lumbar lordosis, local kyphosis, and angle of fusion levels were observed (P < 0.01), whereas the anterior height of the osteotomized vertebra was comparable before and after surgery (P > 0.05). In addition, the correlation analysis revealed a significant correlation between the aortic traversing length and changes in global kyphosis, lumbar lordosis, local kyphosis, angle of fusion levels, and height (P < 0.01). CONCLUSION The stretch of the aorta after CWO for the correction of thoracolumbar kyphosis was quantitatively verified by MRI investigation in the present study. Spine surgeons should be aware of the potential vulnerability of aortic injury in patients with AS undergoing CWO. LEVEL OF EVIDENCE 4.
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Wei D, Jung J, Yang H, Stout DA, Yang L. Nanotechnology Treatment Options for Osteoporosis and Its Corresponding Consequences. Curr Osteoporos Rep 2016; 14:239-47. [PMID: 27542011 DOI: 10.1007/s11914-016-0324-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Unfortunately, osteoporosis, as a worldwide disease, is challenging human health with treatment only available for the symptoms of osteoporosis without managing the disease itself. Osteoporosis can be linked as the common cause of fractures and increased mortality among post-menopausal women, men, and the elderly. Regrettably, due to osteoporosis, incidents of fractures are more frequent among the presented populations and can be afflictive for carrying out everyday life activities. Current treatments of osteoporosis encompass changing lifestyles, taking orthopedic drugs, and invasive surgeries. However, these treatment options are not long lasting and can lead to complications after post-surgical life. Therefore, to solve this impairment, researchers have turned to nanotechnologies and nanomaterials to create innovative and alternative treatments associated with the consequences of osteoporosis. This review article provides an introduction to osteoporotic compression vertebral fractures (OVCFs) and current clinical treatments, along with the rationale and efficacy of utilizing nanomaterials to modify and improve biomaterials or instruments. The methods of applying bioactive agents (bone morphogenetic protein-2 (BMP-2), parathyroid hormone 1-34 (PTH 1-34)), as well as 3D printing will be presented from an osteoporosis treatment perspective. Additionally, the application of nanoparticles and nanotube arrays onto the current surgical treatments and orthopedic drug administration methods addressed will show that these systems reinforce a better mechanical performance and provide precise and slow-releasing drug delivery for better osseointegration, bone regeneration, and bone strength. In summary, nanomaterials can be seen as an alternative and more effective treatment for individuals with osteoporosis.
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Affiliation(s)
- Donglei Wei
- Orthopaedic Institute, Department of Orthopaedics, The First Affiliated Hospital, Soochow University, Suzhou, 215006, Jiangsu, People's Republic of China
- International Research Center for Translational Orthopaedics (IRCTO), Soochow University, Suzhou, 215006, Jiangsu, People's Republic of China
| | - Jinsuh Jung
- International Research Center for Translational Orthopaedics (IRCTO), Soochow University, Suzhou, 215006, Jiangsu, People's Republic of China
- Department of Biology, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Huilin Yang
- Orthopaedic Institute, Department of Orthopaedics, The First Affiliated Hospital, Soochow University, Suzhou, 215006, Jiangsu, People's Republic of China
- International Research Center for Translational Orthopaedics (IRCTO), Soochow University, Suzhou, 215006, Jiangsu, People's Republic of China
| | - David A Stout
- International Research Center for Translational Orthopaedics (IRCTO), Soochow University, Suzhou, 215006, Jiangsu, People's Republic of China.
- Department of Mechanical and Aerospace Engineering, California State University, Long Beach, 1250 Bellflower Blvd. ECS-632, Long Beach, CA, 90802, USA.
| | - Lei Yang
- Orthopaedic Institute, Department of Orthopaedics, The First Affiliated Hospital, Soochow University, Suzhou, 215006, Jiangsu, People's Republic of China.
- International Research Center for Translational Orthopaedics (IRCTO), Soochow University, Suzhou, 215006, Jiangsu, People's Republic of China.
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Abstract
OBJECTIVES To propose a simple method for measurement of femoral anteversion (AV) with a conventional fluoroscope, to evaluate the interobserver and intraobserver reliability of this method on the basis of human cadaver femurs, and to validate such method on the basis of computed tomography (CT). METHODS Fourteen human cadavers with 28 intact femurs were included in the study. Three blinded observers measured femoral AV of the specimen with a fluoroscope. The session was repeated 8 weeks later and CT of the femurs were performed. Mean AV values and the difference between single and mean AV values were calculated. Interobserver/intraobserver reliability of the proposed method was assessed. Correlation between AV values measured with fluoroscope and CT was calculated. RESULTS Mean AV was 18.1° when measured with fluoroscope and 19.2° when measured with CT. Mean differences between single AV values were 2.2° with fluoroscope and 2.5° with CT. The mean maximum observer variation per specimen was 8.8°. Interobserver reliability was excellent (intraclass correlation coefficient: 0.853) and intraobserver reliability was good (intraclass correlation coefficient: 0.682). A high correlation was found between AV values measured with fluoroscope and CT (rho = 0.739, P < 0.01). CONCLUSION The presented technique allows reliable and simple measurement of femoral AV with a conventional fluoroscope. The mean interobserver variation is comparable to what has been reported for CT. Maximum interobserver variation was <15° in all specimens. A clinical study will be necessary to prove the value of this technique for intraoperative adjustment of femoral AV according to the intact contralateral side.
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Dionyssiotis Y, Trovas G, Thoma S, Lyritis G, Papaioannou N. Prospective study of spinal orthoses in women. Prosthet Orthot Int 2015; 39:487-95. [PMID: 25138115 DOI: 10.1177/0309364614545416] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 07/01/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND There are not many clinical trials investigating the efficiency and compliance of using spinal orthoses in the management of osteoporosis. OBJECTIVES The purpose of this study was to investigate the effect of long-term use and the compliance of spinal orthoses in postmenopausal women with vertebral fractures. STUDY DESIGN Clinical trial of spinal orthoses in postmenopausal women. METHODS Women were separated into groups wearing different types of orthoses (Spinomed, Osteomed, Spinomed active, and Spine-X). Isometric maximum strength of trunk muscles (F/Wabdominals-extensors) was calculated and back pain was assessed in all women. In addition, women completed a compliance questionnaire about the use of the orthoses. RESULTS Spinomed decreased pain (p = 0.001) and increased trunk muscle strength (F/Wabdominals, p = 0.005 and F/Wextensors, p = 0.003, respectively). The compliance of wearing an orthosis for 6 months was 66%. CONCLUSION The results suggest that orthoses could be an effective intervention for back pain and muscle strengthening in osteoporotic women. CLINICAL RELEVANCE In women with established osteoporosis, wearing Spinomed orthosis for at least 2 h/day for 6 months decreased back pain significantly and increased personal isometric trunk muscle strength. All spinal orthoses could be valuable instruments to help all requested rehabilitation programs like spine muscles' strengthening and postural correct behavior, but only when used properly.
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Abstract
Osteoporosis is a serious public health problem affecting hundreds of millions of aged people worldwide, with severe consequences including vertebral fractures that are associated with significant morbidity and mortality. To augment or treat osteoporotic vertebral fractures, a number of surgical approaches including minimally invasive vertebroplasty and kyphoplasty have been developed. However, these approaches face problems and difficulties with efficacy and long-term stability. Recent advances and progress in nanotechnology are opening up new opportunities to improve the surgical procedures for treating osteoporotic vertebral fractures. This article reviews the improvements enabled by new nanomaterials and focuses on new injectable biomaterials like bone cements and surgical instruments for treating vertebral fractures. This article also provides an introduction to osteoporotic vertebral fractures and current clinical treatments, along with the rationale and efficacy of utilizing nanomaterials to modify and improve biomaterials or instruments. In addition, perspectives on future trends with injectable bone cements and surgical instruments enhanced by nanotechnology are provided.
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Affiliation(s)
- Chunxia Gao
- Department of Orthopaedic Surgery and Orthopaedic Institute, First Affiliated Hospital, Soochow University, Suzhou, People’s Republic of China
| | - Donglei Wei
- Department of Orthopaedic Surgery and Orthopaedic Institute, First Affiliated Hospital, Soochow University, Suzhou, People’s Republic of China
| | - Huilin Yang
- Department of Orthopaedic Surgery and Orthopaedic Institute, First Affiliated Hospital, Soochow University, Suzhou, People’s Republic of China
| | - Tao Chen
- Robotics and Microsystems Center, Collaborative Innovation Center of Suzhou Nano Science and Technology, Soochow University, Suzhou, People’s Republic of China
| | - Lei Yang
- Department of Orthopaedic Surgery and Orthopaedic Institute, First Affiliated Hospital, Soochow University, Suzhou, People’s Republic of China
- Laboratory of Nonlinear Mechanics, Institute of Mechanics, Chinese Academy of Sciences, Beijing, People’s Republic of China
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De Brito MBS, Bergamaschi JPM, Pellegrino LAN, Umeta RSG, Caffaro MFS, Meves R, Avanzi O. Kyphosis in fractures: evaluation of digital measuring. COLUNA/COLUMNA 2014. [DOI: 10.1590/s1808-18512014130200322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: This study evaluates the manual and digital reliability and reproducibility of five methods of measuring deformity (kyphosis) in thoracolumbar burst fractures. Method: Ninety (90) tomographic images were evaluated and, in each case, kyphotic deformity was measured, both manually and digitally, through the five most relevant methods described in the literature. For the assessment of intraobserver error, 20 cases were measured again. Results: The results show that all five methods are highly reliable and digitally reproducible, with estimated error near or lower than that indicated in the intraobserver error analysis. Cobb's method had the highest concordance (96%) while the sagittal index had the lowest concordance (75%). It is also suggested that digital assessment is more reliable then the manual method. Conclusion: All tested methods are highly reliable and digitally reproducible.
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Affiliation(s)
| | | | | | | | | | | | - Osmar Avanzi
- Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), Brazil
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Change of aortic length after closing-opening wedge osteotomy for patients with ankylosing spondylitis with thoracolumbar kyphosis: a computed tomographic study. Spine (Phila Pa 1976) 2013; 38:E1361-7. [PMID: 23873229 DOI: 10.1097/brs.0b013e3182a3d046] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A computed tomographic study. OBJECTIVE To investigate the change in aortic length in patients with ankylosing spondylitis (AS) with thoracolumbar kyphosis after closing-opening wedge osteotomy (COWO). SUMMARY OF BACKGROUND DATA Several previous studies reported that COWO can effectively correct severe thoracolumbar kyphosis caused by AS. However, one disadvantage of COWO is elongation of the aorta, which increases the risk of aortic injury. To date, no studies have analyzed the alteration in aortic length in patients with AS undergoing COWO for thoracolumbar kyphosis. METHODS A total of 21 consecutive patients with AS with a mean age of 38.9 years undergoing COWO for the correction of thoracolumbar kyphosis were retrospectively studied. Radiographical measurements included global kyphosis, thoracic kyphosis, lumbar lordosis, angle of fusion levels, local kyphosis, and anterior height of the osteotomized vertebra. The computed tomographic scans of the spine were used to measure the aortic diameter (at the site of the osteotomy) and length (the length between the superior endplate of the upper instrumented vertebra and the inferior endplate of L4). RESULTS The aortic length increased by an average of 2.2 cm postoperatively. Significant changes in global kyphosis, local kyphosis, angle of fusion levels, lumbar lordosis, anterior height of the osteotomized vertebra, and aortic diameter at the site of the osteotomy were observed (P < 0.01). Significant correlation was noted between aortic length and changes in global kyphosis (r = 0.525, P = 0.015), local kyphosis (r = 0.654, P = 0.001), angle of fusion levels (r = 0.634, P = 0.002), and lumbar lordosis (r = 0.538, P = 0.012). CONCLUSION Aortic lengthening after COWO for correction of kyphosis was quantitatively confirmed by this study. Spine surgeons should be aware of the potential risk for the development of aortic injury in patients with AS undergoing COWO for the correction of thoracolumbar kyphosis. LEVEL OF EVIDENCE 4.
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Surgical procedure and initial radiographic results of a new augmentation technique for vertebral compression fractures. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 22:1608-16. [PMID: 23283284 DOI: 10.1007/s00586-012-2603-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Revised: 09/26/2012] [Accepted: 11/24/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Recently, a new minimally invasive technique called 'vertebral body stenting' (VBS) was introduced for the treatment of osteoporotic vertebral fractures. The technique was developed to prevent the loss of reduction after deflation of the balloon and to reduce the complication rate associated with cement leakage. METHODS The amount of kyphosis correction, improvement of vertebral body height and quantitative cement leakage rate by applying CT-based quantitative volumetry after VBS were measured in 27 patients (55 vertebra) and compared with a control group (29 patients, 61 vertebrae), which was treated with conventional vertebroplasty. RESULTS After VBS, a significant improvement was seen in vertebral height, compared to conventional vertebroplasty. The mean improvement in segmental kyphosis and vertebral kyphosis were 5.8° (p < 0.05) and 3.5° (p < 0.05), respectively. In the VBS group, the mean injected volume of cement per vertebral body was 7.33 cm(3) (3.34-10.19 cm(3)). The average amount of cement outside the vertebrae was 0.28 cm(3) (0.01-1.64 cm(3)), which was 1.36% of the applied total cement volume. In the vertebroplasty group, the applied mean volume of the cement per level was 2.7 cm(3) (1-5.8 cm(3)) and the average amount of cement outside the vertebrae was 0.15 cm(3) (0.01-1.8 cm(3)), which was 11.5% (0.2-60%) of the applied total volume of cement. CONCLUSION The frequency of cement leakage after VBS was 25.5% compared to 42.1% in the vertebroplasty group. VBS led to a significant decrease in the leakage rate compared with conventional vertebroplasty.
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Comparison of the amounts of canal encroachment between semisitting and supine position of computed tomography-myelography for vertebral fractures of the elderly involving the posterior vertebral wall. Spine (Phila Pa 1976) 2012; 37:E1203-8. [PMID: 22614797 DOI: 10.1097/brs.0b013e31825e71a4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective radiographical trial. OBJECTIVE To elucidate effects of loading associated with spinal canal encroachment (SCE) in patients with insufficient bone union after vertebral fractures in the elderly, using computed tomography-myelography in 2 different positions. SUMMARY OF BACKGROUND DATA In elderly patients with vertebral fractures, influence of loading would be involved in SCE, but the details are not well understood. METHODS Seventeen patients (mean age, 77.4 ± 8 yr; range, 62-91 yr) with various degrees of neurological deficit due to insufficient bone union at both vertebral body and posterior vertebral wall were included in this study. Computed tomography-myelography was performed in both semisitting and supine positions. Kyphotic angle, rate of dural compression, ratio of occupation by bony fragments, and posterior vertebral body height ratio were measured and compared between positions. RESULTS Mean ratio of occupation by bony fragments was significantly higher in the semisitting position (47.9 ± 9.2%) than in the supine position (33.9 ± 10.0%, P, 0.001). Similarly, mean posterior vertebral body height ratio was significantly lower in the semisitting position (67.8 ± 10.8%) than in the supine position (76.3 ± 13.3%), indicating a significant loss of vertebral height in the semisitting position (P, 0.001). Mean rate of dural compression was likewise significantly higher in the semisitting position (48.6 ± 13.3%) than in the supine position (33.3 ± 16.5%; P, 0.001). Mean change in ratio of occupation by bony fragments, change in posterior vertebral body height ratio, and angular instability between positions were 13.9 ± 8.6%, 8.5 ± 6.7%, and 13° ± 5.7°, respectively. A significant correlation was identified between change in ratio of occupation by bony fragments and change in posterior vertebral body height ratio (P = 0.001). CONCLUSION Our study demonstrated that collapse of the nonunited posterior vertebral wall and intracanal protrusion of vertebral fragments would occur simultaneously with axial loading, causing SCE. Computed tomographic scan obtained in semisitting position seems quite useful to evaluate the amount of SCE by an unstable posterior wall.
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Jacquot F, Charpentier A, Khelifi S, Gastambide D, Rigal R, Sautet A. Measuring the Cobb angle with the iPhone in kyphoses: a reliability study. INTERNATIONAL ORTHOPAEDICS 2012; 36:1655-60. [PMID: 22653103 DOI: 10.1007/s00264-012-1579-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Accepted: 05/09/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Smartphones have gained widespread use in the healthcare field to fulfill a variety of tasks. We developed a small iPhone application to take advantage of the built-in position sensor to measure angles in a variety of spinal deformities. We present a reliability study of this tool in measuring kyphotic angles. METHODS Radiographs taken from 20 different patients' charts were presented to a panel of six operators at two different times. Radiographs were measured with the protractor and the iPhone application and statistical analysis was applied to measure intraclass correlation coefficients between both measurement methods, and to measure intra- and interobserver reliability RESULTS The intraclass correlation coefficient calculated between methods (i.e. CobbMeter application on the iPhone versus standard method with the protractor) was 0.963 for all measures, indicating excellent correlation was obtained between the CobbMeter application and the standard method. The interobserver correlation coefficient was 0.965. The intraobserver ICC was 0.977, indicating excellent reproductibility of measurements at different times for all operators. The interobserver ICC between fellowship trained senior surgeons and general orthopaedic residents was 0.989. Consistently, the ICC for intraobserver and interobserver correlations was higher with the CobbMeter application than with the regular protractor method. This difference was not statistically significant. CONCLUSION Measuring kyphotic angles with the iPhone application appears to be a valid procedure and is in no way inferior to the standard way of measuring the Cobb angle in kyphotic deformities.
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