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Qu N, Jin J, Wang X, Deng Y, Zhang B, Qi Q. Quantitatively assessing the effect of cervical sagittal alignment on dynamic intervertebral kinematics by video-fluoroscopy technique. Musculoskelet Sci Pract 2024; 72:102959. [PMID: 38626497 DOI: 10.1016/j.msksp.2024.102959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 04/07/2024] [Accepted: 04/10/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND Cervical sagittal alignment is crucial for distributing the head load to lower cervical segments and maintaining normal cervical spine function, but its biomechanical effect on the cervical spine was not fully elucidated. OBJECTIVE To investigate the effect of cervical sagittal alignment on dynamic intervertebral kinematics. DESIGN Cross-sectional study. METHODS Healthy participants without neck pain were recruited and divided into lordosis, straight and kyphosis groups according to the C2-C7 Cobb angle at the neutral position. The anti-directional and total joint motions were extracted across 10 epochs of dynamic cervical flexion and extension movements. RESULTS /findings: The overall anti-directional joint motion during flexion is larger in the kyphosis group when compared with the lordosis group (p = 0.021), while the range of flexion is smaller in the kyphosis group than that in the lordosis group (p = 0.017). The C2/C3 anti-directional joint motion during extension in the straight group is larger than that in the lordosis group (p = 0016). The range of extension in the kyphosis group (p < 0.001) and the straight group (p = 0.002) are larger than that in the lordosis group. The increased range of extension in the kyphosis and straight groups were mainly from the C3/C4, C4/C5, and C5/C6 joints(p < 0.05). CONCLUSION Changes in cervical sagittal alignment alter both the quality and quantity of the individual joint motions. More adjustments are required by the cervical joints to complete neck movements with the loss of lordosis. The lordotic curvature is a relatively effort-saving mode for the cervical spine from a biomechanical perspective.
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Affiliation(s)
- Ning Qu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - JiaHao Jin
- Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xu Wang
- Department of Orthopedic Surgery, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - YanQun Deng
- Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Bin Zhang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - QiHua Qi
- Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
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Tao H, Zhu P, Xia W, Chu M, Chen K, Wang Q, Gu Y, Lu X, Bai J, Geng D. The Emerging Role of the Mitochondrial Respiratory Chain in Skeletal Aging. Aging Dis 2024; 15:1784-1812. [PMID: 37815897 PMCID: PMC11272194 DOI: 10.14336/ad.2023.0924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/24/2023] [Indexed: 10/12/2023] Open
Abstract
Maintenance of mitochondrial homeostasis is crucial for ensuring healthy mitochondria and normal cellular function. This process is primarily responsible for regulating processes that include mitochondrial OXPHOS, which generates ATP, as well as mitochondrial oxidative stress, apoptosis, calcium homeostasis, and mitophagy. Bone mesenchymal stem cells express factors that aid in bone formation and vascular growth. Positive regulation of hematopoietic stem cells in the bone marrow affects the differentiation of osteoclasts. Furthermore, the metabolic regulation of cells that play fundamental roles in various regions of the bone, as well as interactions within the bone microenvironment, actively participates in regulating bone integrity and aging. The maintenance of cellular homeostasis is dependent on the regulation of intracellular organelles, thus understanding the impact of mitochondrial functional changes on overall bone metabolism is crucially important. Recent studies have revealed that mitochondrial homeostasis can lead to morphological and functional abnormalities in senescent cells, particularly in the context of bone diseases. Mitochondrial dysfunction in skeletal diseases results in abnormal metabolism of bone-associated cells and a secondary dysregulated microenvironment within bone tissue. This imbalance in the oxidative system and immune disruption in the bone microenvironment ultimately leads to bone dysplasia. In this review, we examine the latest developments in mitochondrial respiratory chain regulation and its impacts on maintenance of bone health. Specifically, we explored whether enhancing mitochondrial function can reduce the occurrence of bone cell deterioration and improve bone metabolism. These findings offer prospects for developing bone remodeling biology strategies to treat age-related degenerative diseases.
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Affiliation(s)
- Huaqiang Tao
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Jiangsu, China.
| | - Pengfei Zhu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Jiangsu, China.
| | - Wenyu Xia
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Jiangsu, China.
| | - Miao Chu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Jiangsu, China.
| | - Kai Chen
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Jiangsu, China.
| | - Qiufei Wang
- Department of Orthopedics, Changshu Hospital Affiliated to Soochow University, First People’s Hospital of Changshu City, Jiangsu, China.
| | - Ye Gu
- Department of Orthopedics, Changshu Hospital Affiliated to Soochow University, First People’s Hospital of Changshu City, Jiangsu, China.
| | - Xiaomin Lu
- Department of Oncology, Affiliated Haian Hospital of Nantong University, Jiangsu, China.
| | - Jiaxiang Bai
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Jiangsu, China.
- Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Anhui, China.
| | - Dechun Geng
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Jiangsu, China.
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Taverne M, Lalieve L, Persohn S, Khonsari RH, Paternoster G, James S, Blauwblomme T, Benichi S, Laporte S. Anatomy and mobility in the adult cadaveric craniocervical junction. J Morphol 2024; 285:e21748. [PMID: 38938002 DOI: 10.1002/jmor.21748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 06/12/2024] [Accepted: 06/14/2024] [Indexed: 06/29/2024]
Abstract
Genetic diseases with craniofacial malformations can be associated with anomalies of the craniocervical joint (CCJ). The functions of the CCJ are thus impaired, as mobility may be either limited by abnormal bone fusion causing headaches, or exaggerated in the case of hypermobility, which may cause irreparable damage to the spinal cord. Restoring the balance between mobility and stability requires surgical correction in children. The anatomy and biomechanics of the CCJ are quite unique, yet have been overlooked in the past decades. Pediatric evidence is so scarce, that investigating the adult CCJ is our best shot to disentangle the form-function relationships of this anatomical region. The motivation of the present study was to understand the morphological and functional basis of motion in the CCJ, in the hope to find morphological features accessible from medical imaging able to predict mobility. To do so, we have quantified the in-vitro kinematics of the CCJ in nine cadaveric asymptomatic adults, and estimated a wide range of mobility variables covering the complexity of spinal motion. We compared these variables with the shape of the occipital, the atlas and the axis, obtained using a dense geometric morphometric approach. Morphological joint congruence was also quantified. Our results suggest a strong relationship between bone shape and motion, with the overall geometry predicting best the primary movements, and the joint facets predicting best the secondary movements. We propose a functional hypothesis stating that the musculoligamental system determines movements of great amplitude, while the shape and congruence of joint facets determine the secondary and coupled movements, especially by varying the geometry of bone stops and the way ligaments are tensioned. We believe this work will provide valuable insights in understanding the biomechanics of the CCJ. Furthermore, it should help surgeons treating CCJ anomalies by enabling them to translate objectives of functional and clinical outcome into clear objectives of morphological outcome.
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Affiliation(s)
- Maxime Taverne
- Craniofacial Growth and Form Laboratory, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Laura Lalieve
- Craniofacial Growth and Form Laboratory, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Sylvain Persohn
- Arts et Métiers - Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, Paris, France
| | - Roman Hossein Khonsari
- Craniofacial Growth and Form Laboratory, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
- Department of Pediatric Maxillofacial Surgery and Plastic surgery, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
- UFR de Médecine, Université Paris Cité, Paris, France
| | - Giovanna Paternoster
- UFR de Médecine, Université Paris Cité, Paris, France
- Department of Pediatric Neurosurgery, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
- CRMR CRANIOST, Filière TeteCou, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Syril James
- UFR de Médecine, Université Paris Cité, Paris, France
- Department of Pediatric Neurosurgery, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Thomas Blauwblomme
- UFR de Médecine, Université Paris Cité, Paris, France
- Department of Pediatric Neurosurgery, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
- CRMR C-MAVEM, Filière NeuroSphinx, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Sandro Benichi
- UFR de Médecine, Université Paris Cité, Paris, France
- Department of Pediatric Neurosurgery, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
- CRMR C-MAVEM, Filière NeuroSphinx, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Sébastien Laporte
- Arts et Métiers - Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, Paris, France
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Liu F, Feng X, Deng G, Leung F, Wang C, Chen B. Biomechanical comparison of a new undercut thread design vs. the V-shape thread design for pedicle screws. Spine J 2024:S1529-9430(24)00263-8. [PMID: 38843954 DOI: 10.1016/j.spinee.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/19/2024] [Accepted: 05/20/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND CONTEXT Thread shape is regarded as an important factor influencing the fixation strength and osseointegration of bone screws. However, commercial pedicle screws with a V-shaped thread are prone to generating stress concentration at the bone-screw interface, thereby increasing the risk of screw loosening. Thus, modification of the pedicle-screw thread is imperative. PURPOSE This study aimed to investigate the fixation stability of pedicle screws with the new undercut thread design in comparison to pedicle screws with a V-shaped thread. STUDY DESIGN In vitro cadaveric biomechanical test and finite element analysis (FEA). METHODS Pedicle screws with the undercut thread (characterized by a flat crest feature and a tip-facing undercut feature) were custom-manufactured, whereas those with the V-shaped thread were procured from a commercial supplier. Fixation stability was assessed by the cyclic nonpullout compressive biomechanical testing on cadaveric female osteoporotic vertebrae. The vertical displacement and rotation angle of the 2 types of pedicle screws were calculated every 100 cycles to evaluate their resistance to migration and rotation. FEA was conducted to investigate the stress distribution and bone damage at the bone-screw interface for both types of pedicle screws. RESULTS Biomechanical testing revealed that the pedicle screws with the undercut thread exhibited significantly lower vertical displacement and rotation angles than the pedicle screws with the V-shape thread (P < 0.05). FEA results demonstrated a more uniform stress distribution in the bone surrounding the thread in the undercut design than in the V-shape design. Additionally, bone damage resulting from the pedicle screw was lower in the undercut design than in the V-shape design. CONCLUSIONS Pedicle screws with an undercut thread are less prone to migration and rotation and thus more stable in the bone than those with a V-shape thread. CLINICAL SIGNIFICANCE The undercut thread design may reduce the incidence of pedicle-screw loosening.
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Affiliation(s)
- Fei Liu
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoreng Feng
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China; Department of Orthopaedics and Traumatology, Yangjiang People's Hospital, Yangjiang, China
| | - Geyang Deng
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Frankie Leung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR, China
| | - Chengyong Wang
- Guangdong Provincial Key Laboratory of Minimally Invasive Surgical Instruments and Manufacturing Technology, Guangdong University of Technology, Guangzhou, China
| | - Bin Chen
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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Hipp J, Grieco T, Newman P, Patel V, Reitman C. Reference Data for Diagnosis of Spondylolisthesis and Disc Space Narrowing Based on NHANES-II X-rays. Bioengineering (Basel) 2024; 11:360. [PMID: 38671782 PMCID: PMC11048070 DOI: 10.3390/bioengineering11040360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 03/28/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
Robust reference data, representing a large and diverse population, are needed to objectively classify measurements of spondylolisthesis and disc space narrowing as normal or abnormal. The reference data should be open access to drive standardization across technology developers. The large collection of radiographs from the 2nd National Health and Nutrition Examination Survey was used to establish reference data. A pipeline of neural networks and coded logic was used to place landmarks on the corners of all vertebrae, and these landmarks were used to calculate multiple disc space metrics. Descriptive statistics for nine SPO and disc metrics were tabulated and used to identify normal discs, and data for only the normal discs were used to arrive at reference data. A spondylolisthesis index was developed that accounts for important variables. These reference data facilitate simplified and standardized reporting of multiple intervertebral disc metrics.
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Affiliation(s)
- John Hipp
- Medical Metrics, Houston, TX 77056, USA; (T.G.); (P.N.)
| | - Trevor Grieco
- Medical Metrics, Houston, TX 77056, USA; (T.G.); (P.N.)
| | | | - Vikas Patel
- Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA;
| | - Charles Reitman
- Medical University of South Carolina, Charleston, SC 29425, USA;
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Hamzeh Shalamzari M, Shamsoddini A, Ghanjal A, Shirvani H. Comparison of the effects of core stability and whole-body electromyostimulation exercises on kyphosis angle and core muscle endurance of inactive people with hyper kyphosis: A quasi-experimental pre-post study. J Bodyw Mov Ther 2024; 38:474-482. [PMID: 38763596 DOI: 10.1016/j.jbmt.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 08/11/2023] [Accepted: 11/06/2023] [Indexed: 05/21/2024]
Abstract
OBJECTIVE Restoring the degree of kyphosis to be consistent with good sagittal alignment of the spine is a key concern. This study aimed to compare the effect of core stability exercises (CSE) versus whole-body electromyostimulation (WB-EMS) and a combined program (PLUS) on kyphosis angle and core muscle endurance in sedentary individuals with hyperkyphosis. DESIGN A quasi-experimental single group pre-post study. SETTINGS Laboratory of corrective exercise. PARTICIPANTS seventy-five untrained men (28.9 ± 5.3 years) with thoracic hyperkyphosis. MAIN OUTCOME MEASURES A flexible ruler was used to measure the angle of kyphosis and McGill's test was used to evaluate core stability. RESULTS The results of the post hoc test demonstrated that the kyphosis angle was improved in the WB-EMS and PLUS groups compared to that in the CG (P < 0.05), but no significant difference was observed among the three groups(P > 0.05). In the post-test, core stability was significantly improved in CSE, WB-EMS and PLUS groups compared to that in the CG. CONCLUSIONS The WB-EMS and PLUS protocols as new training methods seem to be effective in changing posture parameters and correcting postural deformities, including kyphosis. Therefore, these protocols along with other rehabilitation programs can be used to correct kyphosis and improve core muscle endurance.
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Affiliation(s)
- Mohammad Hamzeh Shalamzari
- Department of Sports Injury and Biomechanics, Faculty of Sport Sciences and Health, University of Tehran, Tehran, Iran.
| | - Alireza Shamsoddini
- Exercise Physiology Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Ali Ghanjal
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Hossein Shirvani
- Exercise Physiology Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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Lambeaux C, Lapègue F, Fayolle H, Degboe Y, Chiavassa-Gandois H, Basselerie H, Goumarre C, Bilger R, Sans N, Faruch-Bilfeld M. Lumbar muscle involvement in the occurrence of osteoporotic vertebral fracture. RESEARCH IN DIAGNOSTIC AND INTERVENTIONAL IMAGING 2024; 9:100037. [PMID: 39076584 PMCID: PMC11265192 DOI: 10.1016/j.redii.2023.100037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/26/2023] [Indexed: 07/31/2024]
Abstract
Objective To determine if a lumbar musculature deficiency (paravertebral - PVM - and psoas - PM - muscles) is associated with a higher prevalence of vertebral fractures in osteoporotic patients. Methods To constitute the fracture group, data were collected retrospectively from patients with one or more recent osteoporotic vertebral fractures between T10 and L5 such as non-injected computerized tomography (CT), dual-energy X-ray absorptiometry (DXA). A control group was made by matching the patients on age, bone mineral density measured by DXA and gender. We analyzed PM and PVM atrophy based on cross-sectional area (CSA) adjusted to the body area as well as fatty infiltration on a 3-level scale and the average muscle density in Hounsfield units (HU). Results One hundred seventeen patients were included in each group. The fracture group had a lower PVM CSA than the control group (2197.92 ± 460.19 versus 2335.20 ± 394.42 mm2.m-2, respectively p = 0.015), but there was no significant difference in the PM (746.92 ± 197.89 versus 731.74 ± 215.53 mm2.m-2, respectively p = 0.575). The fracture group had a higher grade of fatty infiltration than the control group (PM: 1.3 ± 0.46 versus 1.07 ± 0.25, p < 0.001; PVM: 1.93 ± 0.5 versus 1.74 ± 0.5, p = 0.003) and a lower average muscle density (PM: 26.99 ± 12.83 versus 33.91 ± 8.12 HU, p < 0.001; PVM: 3.42 ± 21.06 versus 12.94 ± 18.88 HU, p < 0.001). Conclusion This study shows an association between a lack of axial musculature and the occurrence of osteoporotic vertebral fractures. Preventive strengthening exercises could be proposed to osteoporotic patients.
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Affiliation(s)
- Constance Lambeaux
- Radiology department, hôpital Pierre-Paul-Riquet, CHU Toulouse Purpan, avenue du Professeur-Jean-Dausset, 31300 Toulouse, France
| | - Franck Lapègue
- Radiology department, hôpital Pierre-Paul-Riquet, CHU Toulouse Purpan, avenue du Professeur-Jean-Dausset, 31300 Toulouse, France
| | - Hélio Fayolle
- Nuclear medicine department, hôpital Pierre-Paul-Riquet, CHU Toulouse Purpan, avenue du Professeur-Jean-Dausset, 31300 Toulouse, France
| | - Yannick Degboe
- Rheumatology department, hôpital Pierre-Paul-Riquet, CHU Toulouse Purpan, avenue du Professeur-Jean-Dausset, 31300 Toulouse, France
| | - Hélène Chiavassa-Gandois
- Radiology department, hôpital Pierre-Paul-Riquet, CHU Toulouse Purpan, avenue du Professeur-Jean-Dausset, 31300 Toulouse, France
| | - Hubert Basselerie
- Radiology department, hôpital Pierre-Paul-Riquet, CHU Toulouse Purpan, avenue du Professeur-Jean-Dausset, 31300 Toulouse, France
| | - Céline Goumarre
- Radiology department, hôpital Pierre-Paul-Riquet, CHU Toulouse Purpan, avenue du Professeur-Jean-Dausset, 31300 Toulouse, France
| | - Romain Bilger
- Radiology department, hôpital Pierre-Paul-Riquet, CHU Toulouse Purpan, avenue du Professeur-Jean-Dausset, 31300 Toulouse, France
| | - Nicolas Sans
- Radiology department, hôpital Pierre-Paul-Riquet, CHU Toulouse Purpan, avenue du Professeur-Jean-Dausset, 31300 Toulouse, France
| | - Marie Faruch-Bilfeld
- Radiology department, hôpital Pierre-Paul-Riquet, CHU Toulouse Purpan, avenue du Professeur-Jean-Dausset, 31300 Toulouse, France
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Xu H, Yu L, Xiao B, Zhao H, Gu X, Gao Z, Wang W. Comparison of Outcomes Between Endoscopic Transforaminal Lumbar Interbody Fusion and Minimally Invasive Transforaminal Lumbar Interbody Fusion in Patients With Single-Level Lumbar Degenerative Disease: A Retrospective Study. World Neurosurg 2024; 183:e98-e108. [PMID: 38008170 DOI: 10.1016/j.wneu.2023.11.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/17/2023] [Accepted: 11/18/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVE The objective of this study was to compare the clinical and radiological outcomes of endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). METHODS This retrospective study included 110 patients with single-level lumbar degenerative disease who underwent Endo-TLIF or MIS-TLIF between January 2019 and December 2021. Patients were divided into Endo-TLIF (n = 55) and MIS-TLIF groups (n = 55). Perioperative, clinical, and radiological outcomes were assessed. RESULTS The Endo-TLIF group had significantly lower blood loss and shorter hospital stay. However, the operation time was significantly longer and there was more x-ray exposure than in the MIS-TLIF group. There were no significant differences in complications between the groups. The Endo-TLIF group showed significantly lower creatine kinase levels than the MIS-TLIF group at 3 days postoperatively (P < 0.05), but not at 7 days postoperatively (P > 0.05). Oswestry Disability Index and visual analog scale scores were significantly reduced in both groups at different time points postoperation compared to preoperation. The visual analog scale score in the Endo-TLIF group was lower than that in the MIS-TLIF group at 3 days postoperatively. Moreover, no significant differences were found in fusion rates, lumbar lordosis, and lumbar segmental lordosis between the 2 groups (P > 0.05). CONCLUSIONS Endo-TLIF might be considered as an effective and reliable treatment option for single-level lumbar degeneration. It results in less trauma and faster postoperative recovery, but a longer operative time and more x-ray exposure than MIS-TLIF. Endo-TLIF has effects on clinical and radiological outcomes that are comparable to those of MIS-TLIF.
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Affiliation(s)
- Hongyao Xu
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Lei Yu
- Department of Orthopedic Surgery and Neurosurgery, No.906 Hospital of the People's Liberation Army, Ningbo, Zhejiang, China
| | - Bing Xiao
- Department of Orthopaedics, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Hong Zhao
- Department of Orthopedic Surgery and Neurosurgery, No.906 Hospital of the People's Liberation Army, Ningbo, Zhejiang, China
| | - Xin Gu
- Department of Orthopaedics, Tongren Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Zengxin Gao
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Weiheng Wang
- Department of Orthopaedics, Second Affiliated Hospital of Naval Medical University, Shanghai, China.
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Tan L, Du X, Tang R, Rong L, Zhang L. Preoperative Adjacent Facet Joint Osteoarthritis Is Associated with the Incidence of Adjacent Segment Degeneration and Low Back Pain after Lumbar Interbody Fusion. Asian Spine J 2024; 18:21-31. [PMID: 38379146 PMCID: PMC10910148 DOI: 10.31616/asj.2023.0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 02/22/2024] Open
Abstract
STUDY DESIGN A retrospective cohort study. PURPOSE To analyze the association between preoperative adjacent facet joint osteoarthritis (FJOA) and outcomes of lumbar interbody fusion (LIF). OVERVIEW OF LITERATURE Whether preoperative adjacent FJOA is associated with the incidence of radiological adjacent segment degeneration (RASD) and low back pain (LBP) relief after lumbar fusion remains unknown. METHODS The study included patients who underwent LIF. The demographic characteristics and radiographic and surgical data were collected and evaluated. The included patients were divided into control group and FJOA group based on the preoperative adjacent facet joint Pathria grade. Preoperative and last follow-up LBP Visual Analog Scale (VAS) score, leg pain (LP) VAS, Oswestry Disability Index (ODI) and RASD were evaluated and compared. The improvement rates in VAS and ODI were calculated and compared between the two groups. Logistic regression was used to analyze the risk factors of LBP relief and incidence of RASD. RESULTS In total, 197 patients (control group, 86; FJOA group, 111) were included, and the median follow-up was 46 months. The VAS and ODI in both groups significantly improved after surgery. At the last follow-up, the FJOA group had higher VAS and lower VAS improvement rates of LBP than the control group (p<0.05). However, no significant difference in the LP VAS and ODI was found between the two groups. The incidence of RASD in the FJOA group was significantly higher than that in the control group (48.6% vs. 30.2%, p=0.034). Multivariate logistic regression analysis showed that preoperative adjacent FJOA was significantly associated with LBP relief (odds ratio [OR], 0.691; 95% confidence interval [CI], 0.498-0.958) and the postoperative incidence of RASD (OR, 1.406; 95% CI, 1.020-1.939). CONCLUSIONS The preoperative FJOA in the adjacent segments was significantly associated with LBP following LIF. Patients with preoperative FJOA were more likely to have RASD following lumbar fusion surgery.
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Affiliation(s)
- Lixian Tan
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou,
China
| | - Xiaokang Du
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou,
China
| | - Runmin Tang
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou,
China
| | - Limin Rong
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou,
China
- Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou,
China
- Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou,
China
| | - Liangming Zhang
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou,
China
- Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou,
China
- Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou,
China
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Sun Q, Wang L, Chen X, Zhang Y, Tian Y, Yuan S, Liu X. How Sagittal Spinal Parameters Predict Anterolateral Spinal Ossification Severity: A Study Based on CT Classification. Spine (Phila Pa 1976) 2023; 48:1679-1687. [PMID: 36728011 DOI: 10.1097/brs.0000000000004582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/01/2022] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Retrospective observational study. OBJECTIVE The purpose of this study was to establish a CT classification system of anterolateral spinal ossification and analyze the effects of sagittal spinal parameters on ossification. SUMMARY OF BACKGROUND DATA Patients with diffuse idiopathic skeletal hyperostosis often present with anterolateral ossification of the spine. Few reports consider anterolateral spinal ossification at each spinal level or explore the influence of sagittal alignment. MATERIALS AND METHOD One hundred and twenty patients (79 males and 41 females) over 60 years old who underwent whole spinal CT scans from October 2018 to November 2021 were analyzed. Volume rendering technique images were used to assess the degree of anterolateral spinal ossification in each intervertebral space, and a classification system was established. Sagittal parameters, such as thoracic kyphosis, lumbar lordosis (LL), cervical lordosis, sacral slope, and thoracolumbar junction angle of the patients were measured. Multifactor stepwise linear regression analysis and ordered logistic regression analysis were used to study the effects of the sagittal parameters on ossification grades. RESULTS The median age of the study population was 67 years (63-72 IQR). The new classification system classifies the severity of anterolateral spinal ossification in each intervertebral space into grades 0 to 3 with an intra-observer intraclass correlation coefficient value of 0.909 and inter-observer intraclass correlation coefficient value of 0.900. Multivariate stepwise linear regression analysis showed that age (OR=1.30, P <0.001), weight (OR=1.23, P =0.013), and cervical lordosis (OR=1.19, P <0.001) were significantly correlated with total ossification grade. Multifactor ordered logistic regression analysis showed that there was a statistically significant correlation between cervical lordosis and the ossification grades of each intervertebral space of T1~T4 ( P ≤0.005), between thoracic kyphosis and each intervertebral space in T4~T12 ( P ≤0.019), and between thoracolumbar junction angle and each intervertebral space in T10~L3 ( P ≤0.025). LL was significantly and positively correlated with the ossification grades of each intervertebral space in T7~T11 ( P ≤0.041). LL and sacral slope were significantly negatively correlated with the ossification grades of each intervertebral space in L3~S1 ( P ≤0.047). CONCLUSION Our new classification scheme demonstrated good accuracy and reliability for the evaluation of the severity of anterolateral spinal ossification. The effect of sagittal parameters on anterolateral spinal ossification was position-specific. The greater the kyphosis or the smaller the lordosis of a spinal region, the more severe the degree of ossification in the corresponding region. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Qingyu Sun
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, P. R. China
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11
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Hebda PW, Majewski O. Minimally invasive fenestration for decompression of C2-C3 spinal stenosis. BMJ Case Rep 2023; 16:e254174. [PMID: 37963660 PMCID: PMC10649468 DOI: 10.1136/bcr-2022-254174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Abstract
Conventional techniques in neurosurgery such as laminectomy have been extensively displaced by minimally invasive types, owing to the character of complexity of cervical spinal region. Spinal canal stenosis at C2-C3 level is documented in the literature with the majority being caused by intervertebral disc herniations.This case reports a patient who presented with classical myelopathy symptoms and significant thickening of ligamentum flavum, while minimal spondylosis was detected at C2-C3 level. The decompression was performed from posterior approach and limited to the removal of ligamentum flavum with minimal resection of adjacent laminae, no fixation and no disc evacuation. After surgery, there was a significant improvement with preserved spinal stability.Although the anterior approach is more common for cervical spine, universal access site has not been defined in literature. We suggest that minimal decompression produces desirable effects with no need for fusion and preserving adequate stability of spinal complex.
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Affiliation(s)
- Patrycja Weronika Hebda
- Neurosurgery, Queen Elizabeth University Hospital, Glasgow, UK
- Neurosurgery, Szpital Specjalistyczny im Edmunda Biernackiego w Mielcu, Mielec, Poland
| | - Olaf Majewski
- Neurosurgery, Szpital Specjalistyczny im Edmunda Biernackiego w Mielcu, Mielec, Poland
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Muellner M, Haffer H, Chiapparelli E, Dodo Y, Shue J, Tan ET, Zhu J, Pumberger M, Sama AA, Cammisa FP, Girardi FP, Hughes AP. Fat infiltration of the posterior paraspinal muscles is inversely associated with the fat infiltration of the psoas muscle: a potential compensatory mechanism in the lumbar spine. BMC Musculoskelet Disord 2023; 24:846. [PMID: 37891498 PMCID: PMC10604445 DOI: 10.1186/s12891-023-06967-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 10/15/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The function of the paraspinal muscles and especially the psoas muscle in maintaining an upright posture is not fully understood. While usually considered solely as a hip flexor, the psoas muscle and its complex anatomy suggest that the muscle has other functions involved in stabilizing the lumbar spine. The aim of this study is to determine how the psoas muscle and the posterior paraspinal muscles (PPM; erector spinae and multifidus) interact with each other. METHODS A retrospective review including patients undergoing posterior lumbar fusion surgery between 2014 and 2021 at a tertiary care center was conducted. Patients with a preoperative lumbar magnetic resonance imaging (MRI) scan performed within 12 months prior to surgery were considered eligible. Exclusion criteria included previous spinal surgery at any level, lumbar scoliosis with a Cobb Angle > 20° and patients with incompatible MRIs. MRI-based quantitative assessments of the cross-sectional area (CSA), the functional cross-sectional area (fCSA) and the fat area (FAT) at L4 was conducted. The degree of fat infiltration (FI) was further calculated. FI thresholds for FIPPM were defined according to literature and patients were divided into two groups (< or ≥ 50% FIPPM). RESULTS One hundred ninetypatients (57.9% female) with a median age of 64.7 years and median BMI of 28.3 kg/m2 met the inclusion criteria and were analyzed. Patients with a FIPPM ≥ 50% had a significantly lower FI in the psoas muscle in both sexes. Furthermore, a significant inverse correlation was evident between FIPPM and FIPsoas for both sexes. A significant positive correlation between FATPPM and fCSAPsoas was also found for both sexes. No significant differences were found for both sexes in both FIPPM groups. CONCLUSION As the FIPPM increases, the FIPsoas decreases. Increased FI is a surrogate marker for a decrease in muscular strength. Since the psoas and the PPM both segmentally stabilize the lumbar spine, these results may be indicative of a potential compensatory mechanism. Due to the weakened PPM, the psoas may compensate for a loss in strength in order to stabilize the spine segmentally.
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Affiliation(s)
- Maximilian Muellner
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA.
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin, Germany.
| | - Henryk Haffer
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Erika Chiapparelli
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Yusuke Dodo
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Jiaqi Zhu
- Biostatistics Core, Hospital for Special Surgery, New York City, NY, USA
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Federico P Girardi
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, New York City, NY, USA
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13
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Aimar E, Iess G, Labiad I, Mezza F, Bona A, Ciuffi A, Grassia F, Isidori A, Zekaj E, Bonomo G. Degenerative L4-L5 spondylolisthesis and stenosis surgery: does over-level flavectomy technique influence clinical outcomes and rates of cranial adjacent segment disease? Acta Neurochir (Wien) 2023; 165:3107-3117. [PMID: 37632571 DOI: 10.1007/s00701-023-05761-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/10/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND One of the most dreaded long-term complications related to L4-L5 lumbar arthrodesis is the onset of adjacent segment disease, which most frequently occurs at the cranial level. Few studies have compared the rates of cranial adjacent segment disease (CASD) in patients undergoing lumbar fusion associated with total laminectomy at the same level with those undergoing partial laminectomy. No study has examined the role of selective over-level flavectomy (OLF; i.e., L3-L4). METHODS A total of 299 patients undergoing posterolateral arthrodesis (PLA) for L4-L5 degenerative spondylolisthesis were retrospectively analyzed with a 5-year follow-up. 148 patients underwent PLA + L4-L5 flavectomy + L4 partial laminectomy (control group), while 151 underwent PLA + L4-L5 flavectomy + total L4 laminectomy + L3-L4 flavectomy (OLF group). Rates of reoperations due to CASD were examined utilizing Cox proportional hazard models, while clinical improvement at follow-up (measured in ODI) was analyzed using generalized linear models (GLMs). Adjustments for potential confounders were made (grade of lumbar lordosis, age, sex, BMI, intervertebral disc degeneration, and presurgical cranial spinal stenosis). RESULTS At 5 years from the operation, 16 patients (10.8%) in the control group had undergone revision surgery for CASD compared to 5 patients (3.3%) in the OLF group (p = 0.013). Survival analysis and GLM demonstrated that the OLF group had a significantly lower incidence of CASD and presented more favorable clinical outcome. There were no differences in the rate of discal degeneration or the onset of Meyerding's grade I degenerative spondylolisthesis at the adjacent segment. BMI was the only other significant predictor of ODI improvement and of the incidence of CASD. CONCLUSIONS In patients with L4-L5 degenerative spondylolisthesis and stenosis, the OLF technique may lower rates of CASD and improve clinical outcomes by preventing cranial spinal stenosis without increasing iatrogenic instability or accelerating intervertebral disc degenerative changes.
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Affiliation(s)
- Enrico Aimar
- Department of Neurosurgery, IRCCS Istituto Ortopedico Galeazzi, Lumbardy, Milan, Italy
| | - Guglielmo Iess
- Department of Neurosurgery, IRCCS Istituto Ortopedico Galeazzi, Lumbardy, Milan, Italy.
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Lumbardy, Milan, Italy.
- Università degli Studi di Milano, Lumbardy, Milan, Italy.
| | - Ikrame Labiad
- Università degli Studi di Milano, Lumbardy, Milan, Italy
| | - Federica Mezza
- Department of Economics, Bocconi University, Lumbardy, Milan, Italy
| | - Alberto Bona
- Department of Neurosurgery, IRCCS Istituto Ortopedico Galeazzi, Lumbardy, Milan, Italy
| | - Andrea Ciuffi
- Department of Neurosurgery, IRCCS Istituto Ortopedico Galeazzi, Lumbardy, Milan, Italy
| | - Fabio Grassia
- Department of Neurosurgery, Anschutz medical campus, Aurora, CO, USA
| | - Alessandra Isidori
- Department of Neurosurgery, IRCCS Istituto Ortopedico Galeazzi, Lumbardy, Milan, Italy
| | - Edvin Zekaj
- Department of Neurosurgery, IRCCS Istituto Ortopedico Galeazzi, Lumbardy, Milan, Italy
| | - Giulio Bonomo
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Lumbardy, Milan, Italy
- Università degli Studi di Milano, Lumbardy, Milan, Italy
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Cho M, Han JS, Kang S, Ahn CH, Kim DH, Kim CH, Kim KT, Kim AR, Hwang JM. Biomechanical Effects of Different Sitting Postures and Physiologic Movements on the Lumbar Spine: A Finite Element Study. Bioengineering (Basel) 2023; 10:1051. [PMID: 37760153 PMCID: PMC10525568 DOI: 10.3390/bioengineering10091051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/30/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
This study used the finite element method(FEM) to investigate how pressure on the lumbar spine changes during dynamic movements in different postures: standing, erect sitting on a chair, slumped sitting on a chair, and sitting on the floor. Three load modes (flexion, lateral bending, and axial rotation) were applied to the FEM, simulating movements of the lumbar spine. Results showed no significant difference in pressure distribution on the annulus fiber and nucleus pulposus, representing intradiscal pressure, as well as on the cortical bone during movements between standing and erect sitting postures. However, both slumped sitting on a chair and sitting on the floor postures significantly increased pressure on the nucleus pulposus, annulus fibrosus, and cortical bone in all three movements when compared to standing or erect sitting on a chair. Notably, sitting on the floor resulted in even higher pressure on the nucleus pulposus and annulus fibers compared to slumped sitting on a chair. The decreased lumbar lordosis while sitting on the floor led to the highest increase in pressure on the annulus fiber and nucleus pulposus in the lumbar spine. In conclusion, maintaining an erect sitting position with increased lumbar lordosis during seated activities can effectively reduce intradiscal pressure and cortical bone stress associated with degenerative disc diseases and spinal deformities.
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Affiliation(s)
- Mingoo Cho
- Precision Mechanical Process and Control R&D Group, Korea Institute of Industrial Technology, Jinju-si 52845, Republic of Korea; (M.C.); (S.K.)
| | - Jun-Sang Han
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Republic of Korea; (J.-S.H.); (C.-H.A.); (C.-H.K.)
| | - Sungwook Kang
- Precision Mechanical Process and Control R&D Group, Korea Institute of Industrial Technology, Jinju-si 52845, Republic of Korea; (M.C.); (S.K.)
| | - Chang-Hwan Ahn
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Republic of Korea; (J.-S.H.); (C.-H.A.); (C.-H.K.)
| | - Dong-Hee Kim
- Department of Orthopaedic Surgery, Gyeongsang National University, College of Medicine, Jinju-si 52727, Republic of Korea;
| | - Chul-Hyun Kim
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Republic of Korea; (J.-S.H.); (C.-H.A.); (C.-H.K.)
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Kyoung-Tae Kim
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu 41944, Republic of Korea;
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Ae-Ryoung Kim
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Republic of Korea; (J.-S.H.); (C.-H.A.); (C.-H.K.)
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Jong-Moon Hwang
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Republic of Korea; (J.-S.H.); (C.-H.A.); (C.-H.K.)
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
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Mazurek M, Kulesza B, Gołębiowska N, Tyzo B, Kura K, Szczepanek D. Factors Predisposing to The Formation of Degenerative Spondylolisthesis-A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1430. [PMID: 37629720 PMCID: PMC10456558 DOI: 10.3390/medicina59081430] [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: 06/04/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023]
Abstract
The relationship between various factors predisposing to the formation of spondylolisthesis, including degenerative spondylolisthesis, has been analyzed by many authors. However, not all observations are consistent. In this review, we identified factors whose impact on the prevalence of spondylolisthesis was most often mentioned in the literature. These included gender, age, bone mineral density, ethnic origin, and oophorectomy. The results were inclusive in terms of physical activity, pregnancy status, and use of hormone replacement therapy. Associations between diabetes and smoking were very poorly marked. The literature so far has identified a number of factors significantly affecting the incidence of degenerative spondylolisthesis. These include age, gender, body weight, ethnic origin, bone mineral density, and hormonal balance. Radiological parameters, which include iliac crest, pelvic tilt, pelvic incidence, sacral slope, and lumbar lordosis, may also be of great importance for assessing changes in the occurrence and progression. However, the authors do not agree on the real significance of individual factors. The aim of this review was to identify the factors predisposing to the formation of degenerative spondylolisthesis, the importance of which has been suggested in the current literature. The systematization of knowledge in this field can allow a more accurate adjustment of the treatment plan for each patient affected by this condition.
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Affiliation(s)
- Marek Mazurek
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, 20-954 Lublin, Poland
| | - Bartłomiej Kulesza
- Department of Medical Chemistry, Medical University of Lublin, 20-093 Lublin, Poland
| | - Natalia Gołębiowska
- Department of Neurosurgery and Spine Surgery, Regional Hospital in Kielce, 25-736 Kielce, Poland
| | - Bartłomiej Tyzo
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, 20-954 Lublin, Poland
| | - Krzysztof Kura
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, 20-954 Lublin, Poland
| | - Dariusz Szczepanek
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, 20-954 Lublin, Poland
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Dewi DK, Gunawan CO. Type IIB urethral duplication in adult: A case report. Radiol Case Rep 2023; 18:2612-2614. [PMID: 37273733 PMCID: PMC10238602 DOI: 10.1016/j.radcr.2023.04.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 04/19/2023] [Accepted: 04/22/2023] [Indexed: 06/06/2023] Open
Abstract
Urethral duplication are rare anomalies of the lower urinary tract consisting of partial or complete development of an accessory urethra that common in males than female. The exact embryological mechanism for this condition remain unclear, it is thought to relate to a disruption of development of the lateral folds of Rathke during hindgut development. There are 3 types based on Effman's classification. Diagnosis of urethral duplication, a genital examination has to performed and confirmed by micturating cytourethrography and retrograde urethrography. The authors presented a case of 67-year-old man complaining of dysuria, who was diagnosed with urethral duplication Effman Classification type IIB accompanied by bulbar urethral stricture and diverticula and multiple bladder diverticula after performing retrograde urethrography and micturating cystourethrography. This is an extremely rare type of duplication of the urethra (type IIB) with late presentation. Further study may be required regarding the surgical management.
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Wang S, Aikeremu D, Kahaer A, Maimaiti A, Xiao Y, Tuoheti A, Zhang R, Maimaiti X, Guo H, Rexiti P. Anatomical and imaging measurements of the angle between the axis of the lumbar pedicle and lateral isthmus margin and its clinical significance. J Orthop Surg Res 2023; 18:509. [PMID: 37464385 DOI: 10.1186/s13018-023-03983-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/05/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND This study aims to explore the measurement of the angle between the axis of the pedicle and the lateral margin of the isthmus on the lumbar spine, and investigate its clinical significance. METHODS The angle was measured on 120 normal adults' X-ray and 25 dry anatomical specimens. 60 screws were placed by junior residents on 6 wet specimens through the freehand technique. 30 screws were placed on one side with their original experience. After learning the techniques mentioned in the study, 30 screws were placed on the other side. The specimens were examined by X-ray and CT, and the angles of the screw paths and the integrity of the pedicle were evaluated. RESULTS The angles of 120 subjects and 25 anatomical specimens show a gradually increasing trend. The differences among each segment were statistically significant (P < 0.05), but the difference in the same segment between the X-ray and the anatomical specimens was not statistically significant (P > 0.05). Furthermore, the differences in L1, L2, and L3 between the two genders were not statistically significant (P > 0.05). However, the angles were larger in female group than in male group in L4 and L5, and the differences were statistically significant (P < 0.05). The difference in the deviation rate of screw placement before and after the learning was statistically significant only in the L5 segment (P < 0.05). The difference in overall excellence rate was statistically significant (P < 0.05). CONCLUSIONS The measurement of the angle between the axis of the pedicle and the lateral margin of the isthmus on the lumbar can improve the accuracy of the lumbar sagittal screw angle.
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Affiliation(s)
- Shuiquan Wang
- Department of Anatomy, College of Basic Medicine, Xinjiang Medical University, Urumqi, China
| | - Dilimulati Aikeremu
- Department of 2nd Spine Surgery, People's Hospital of Xinjiang, Urumqi, China
| | - Alafate Kahaer
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Abulikemu Maimaiti
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yang Xiao
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Abudusalamu Tuoheti
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Rui Zhang
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xieraili Maimaiti
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Hailong Guo
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
| | - Paerhati Rexiti
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
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Wenjie L, Jiaming Z, Weiyu J. The difference and clinical application of modified thoracolumbar fracture classification scoring system in guiding clinical treatment. J Orthop Surg Res 2023; 18:493. [PMID: 37434179 DOI: 10.1186/s13018-023-03958-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/25/2023] [Indexed: 07/13/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the feasibility of the modified thoracolumbar injury classification and severity score system in guiding clinical treatment. METHODS A retrospective study was conducted on a cohort of 120 patients with thoracolumbar fractures who were admitted to the Department of Spinal Surgery at Ningbo Sixth Hospital between December 2019 and June 2021. The study population consisted of 68 males and 52 females, with an average age of 36.7 ± 5.7 years. The severity of the fractures was assessed based on comprehensive scores incorporating fracture morphology, neurological function, posterior ligament complex integrity, and disc injury status. The evaluation was performed using the total score T, which guided the formulation of the clinical treatment strategy. Furthermore, the study compared the treatment options, imaging data, and clinical efficacy between two classification systems. RESULTS The analysis of 120 patients revealed no statistically significant difference in the total score or treatment method between the TLICS system and the modified TLICS system. However, the operation rate for the modified TLICS system (73.3%) was slightly lower compared to the TLICS system (79.2%). All patients were followed up for a mean duration of 19.2 ± 4.6 months, ranging from 11 to 27 months. At the last follow-up, the visual analogue scale score was 1.94 ± 0.52, and the modified Japanese Orthopaedic Association score was 28.8 ± 4.5, indicating a significant improvement compared to the scores obtained prior to treatment. The neurological status exhibited varying degrees of improvement. Notably, the anterior vertebral height ratio was 87.10 ± 7.17%, the sagittal index was 90.35 ± 7.72%, and the Cobb angle was 3.05 ± 0.97 degrees at the last follow-up. All these measurements demonstrated statistically significant differences compared to the values observed prior to treatment (P < 0.05). Additionally, two cases of pedicle screw breakage and seven cases of pedicle screw wear and cutting in the vertebral body were observed at the last follow-up, resulting in varying degrees of low back pain. However, no instances of rod breakage were reported. CONCLUSION The modified TLICS system is a practical tool for the classification and assessment of thoracolumbar fractures. It has guiding significance for clinical treatment, and the operation rate was slightly lower than that of TLICS system.
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Affiliation(s)
- Lu Wenjie
- Ningbo Sixth Hospital, Ningbo, 315000, China
| | - Zhang Jiaming
- Zhejiang University of Traditional Chinese Medicine, Hangzhou, 310000, China
| | - Jiang Weiyu
- Ningbo Sixth Hospital, Ningbo, 315000, China.
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Dahdaleh NS, El-Tecle N, Cloney MB, Shlobin NA, Koski TR, Wolinsky JP. An Approach to Managing Disorders Affecting the Craniovertebral Junction. World Neurosurg 2023; 175:172-182. [PMID: 36990349 DOI: 10.1016/j.wneu.2023.03.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023]
Abstract
The craniovertebral junction (CVJ), or the "first junction," can be affected by a variety of pathological states. Some of these conditions could represent a gray area in that they can be treated by general neurosurgeons or such specialists as skull base or spinal surgeons. However, some conditions are best managed with a multidisciplinary approach. The importance of in-depth knowledge of the anatomy and biomechanics of this junction cannot be overemphasized. Identifying what represents clinical stability or instability is key to successful diagnosis and, hence, treatment. In this report, the second in a 3-article series, we describe our approach to managing CVJ pathologies in a case-based fashion to illustrate key concepts.
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Affiliation(s)
- Nader S Dahdaleh
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
| | - Najib El-Tecle
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael B Cloney
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tyler R Koski
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jean Paul Wolinsky
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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A biomimetic gradient porous cage with a micro-structure for enhancing mechanical properties and accelerating osseointegration in spinal fusion. Bioact Mater 2023; 23:234-246. [DOI: 10.1016/j.bioactmat.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/08/2022] [Accepted: 11/12/2022] [Indexed: 11/17/2022] Open
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Hamada Y, Okubo Y, Hattori H, Nazuka T, Kikuchi Y, Akasaka K. Relationship between Isokinetic Trunk Muscle Strength and Return to Sports Competition after Conservative Therapy in Fresh Cases of Lumbar Spondylolysis: A Retrospective Observational Study. Healthcare (Basel) 2023; 11:healthcare11040625. [PMID: 36833159 PMCID: PMC9957178 DOI: 10.3390/healthcare11040625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/11/2023] [Accepted: 02/18/2023] [Indexed: 02/22/2023] Open
Abstract
This study aimed to clarify the relationship between isokinetic trunk muscle strength and return to sporting activities in fresh cases of lumbar spondylolysis treated with conservative therapy. Patients included a total of ten men (age: 13.5 ± 1.7) who were instructed by their attending physicians to stop exercising and who met the eligibility criteria. Isokinetic trunk muscle strength was measured immediately after exercising for the first time (First) and one month (1M). Flexion and extension and maximum torque/body weight ratio were significantly lower First compared to 1M at all angular velocities (p < 0.05). Maximum torque generation time was significantly lower for First at 120°/s and 180°/s than at 1M (p < 0.05). Correlations with the number of days to return to sports competition were detected at 60°/s for maximum torque generation time (p < 0.05, r = 0.65). Following conservative treatment for lumbar spondylolysis, it was considered necessary to focus on trunk flexion and extension muscle strength and contraction speed of trunk flexors at the beginning of the exercise period. It was suggested that trunk extension muscle strength in the extension range might be one of the critical factors for returning to sports.
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Affiliation(s)
- Yuji Hamada
- Graduate School of Medicine, Saitama Medical University, 981 Kawakado, Moroyama 350-0495, Japan
- Department of Rehabilitation, Kawagoe Clinic, Saitama Medical University, 7-21 Wakitahontyo, Moroyama 350-0495, Japan
| | - Yu Okubo
- Graduate School of Medicine, Saitama Medical University, 981 Kawakado, Moroyama 350-0495, Japan
- School of Physical Therapy, Saitama Medical University, 981 Kawakado, Moroyama 350-0495, Japan
| | - Hiroshi Hattori
- Graduate School of Medicine, Saitama Medical University, 981 Kawakado, Moroyama 350-0495, Japan
- School of Physical Therapy, Saitama Medical University, 981 Kawakado, Moroyama 350-0495, Japan
| | - Takeshi Nazuka
- Department of Rehabilitation, Kawagoe Clinic, Saitama Medical University, 7-21 Wakitahontyo, Moroyama 350-0495, Japan
| | - Yuto Kikuchi
- Graduate School of Medicine, Saitama Medical University, 981 Kawakado, Moroyama 350-0495, Japan
- Department of Rehabilitation, Kawagoe Clinic, Saitama Medical University, 7-21 Wakitahontyo, Moroyama 350-0495, Japan
| | - Kiyokazu Akasaka
- Graduate School of Medicine, Saitama Medical University, 981 Kawakado, Moroyama 350-0495, Japan
- School of Physical Therapy, Saitama Medical University, 981 Kawakado, Moroyama 350-0495, Japan
- Correspondence: ; Tel.: +81-49-295-1001
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Hsu TL, Lee YH, Wang YH, Chang R, Wei JCC. Association of Hallux Valgus with Degenerative Spinal Diseases: A Population-Based Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1152. [PMID: 36673906 PMCID: PMC9858771 DOI: 10.3390/ijerph20021152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
Background: Although hallux valgus is known to cause lower-back pain, the association between hallux valgus and spinal degenerative disease remains unclear. Methods: A retrospective cohort study was conducted between 1 January 2000 and 31 December 2015 using data from the Longitudinal Health Insurance Database in Taiwan. After propensity score matching for age, sex, and some potential comorbidities, 1000 individuals newly diagnosed with hallux valgus were enrolled in the study group, while 1000 individuals never diagnosed with hallux valgus served as the control group. Both groups were followed up until 2015 to evaluate the incidence of hallux valgus. Kaplan-Meier analysis was used to determine the cumulative incidence of hallux valgus, while the Cox proportional hazard model was adopted to estimate the hazard ratio (HR) and adjusted hazard ratio (aHR) with 95% confidence intervals (CIs). Results: The incidence densities of spinal degeneration in the hallux valgus and non-hallux valgus groups were 73.10 and 42.63 per 1000 person-years, respectively. An increased risk of spinal degenerative changes was associated with hallux valgus (adjusted HR = 1.75, 95% CI = 1.50−2.05). Age- and sex-stratified analyses showed a significantly higher risk of spinal degeneration in the hallux valgus group. Moreover, sub-outcome evaluations revealed significantly higher risks of spondylosis (aHR = 2.01, 95% CI = 1.55−2.61), intervertebral disorder (aHR = 2.27, 95% CI = 1.62−3.17), and spinal stenosis (aHR = 1.24, 95% CI = 1.47−1.76). There was also an increased risk of spinal degenerative change in those with hallux valgus without surgical intervention (aHR = 1.95, 95% CI = 1.66−2.99, p < 0.001). Conclusions: Hallux valgus was associated with increased risk of degenerative spinal changes and other spinal disorders.
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Affiliation(s)
- Ta-Li Hsu
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
| | - Yung-Heng Lee
- Department of Senior Services Industry Management, Minghsin University of Science and Technology, Hsinchu 304, Taiwan
- Department of Recreation and Sport Management, Shu-Te University, Kaohsiung 824, Taiwan
- Department of Orthopedics, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung 842, Taiwan
| | - Yu-Hsun Wang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Renin Chang
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
- Department of Recreation Sports Management, Tajen University, Pingtung 907, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung 404, Taiwan
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Shang Q, Wang D, Wang D, Peng P, Wang H, Jia H, Mao J, Gao C, Du M, He X, Ma Y, Zheng C, Yang L, Luo Z, Hu X. Facet joint degeneration—An initial procedure of the cervical spine degeneration. JOR Spine 2023; 6:e1241. [PMID: 36994467 PMCID: PMC10041371 DOI: 10.1002/jsp2.1241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/11/2022] [Accepted: 12/19/2022] [Indexed: 01/04/2023] Open
Abstract
Objective This study aims to emphasize the initiating role of facet joint (FJ) degeneration in the process of cervical spine degeneration induced by tangential load, and we further validate it in a novel cervical spine degeneration animal model. Methods The characteristics of cervical degeneration in patients of different ages were summarized through case collection. In the rat models, Hematoxylin-Eosin, Safranin O staining, and micro-computed tomography were used to show the histopathological changes and bone fiber structure of FJ and the height of intervertebral disc (IVD) space. The ingrowth of nociceptive sensory nerve fibers was observed by immunofluorescence staining. Results FJ degeneration without IVDs degeneration was more common in people with cervical spondylosis in young patients. The obvious degeneration phenotypes of the FJs preceded the IVDs at the same cervical segment in our animal model. The SP+ and CGRP+ sensory nerve fibers were observed in the articular subchondral bone of degenerated FJs and porous endplates of degenerated IVDs. Conclusion The FJ degeneration may act as the major contributor to cervical spine degeneration in young people. The dysfunction of functional unit of spine, not a certain part of IVD tissue, results in the occurrence of cervical degeneration and neck pain.
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Affiliation(s)
- Qiliang Shang
- Institute of Orthopedic Surgery, Xijing Hospital Fourth Military Medical University Xi'an People's Republic of China
| | - Dong Wang
- Institute of Orthopedic Surgery, Xijing Hospital Fourth Military Medical University Xi'an People's Republic of China
| | - Di Wang
- Institute of Orthopedic Surgery, Xijing Hospital Fourth Military Medical University Xi'an People's Republic of China
| | - Pandi Peng
- Institute of Orthopedic Surgery, Xijing Hospital Fourth Military Medical University Xi'an People's Republic of China
- Medical Research Institute Northwestern Polytechnical University Xi'an People's Republic of China
| | - Han Wang
- Institute of Orthopedic Surgery, Xijing Hospital Fourth Military Medical University Xi'an People's Republic of China
| | - Haoruo Jia
- Institute of Orthopedic Surgery, Xijing Hospital Fourth Military Medical University Xi'an People's Republic of China
| | - Jianxin Mao
- Institute of Orthopedic Surgery, Xijing Hospital Fourth Military Medical University Xi'an People's Republic of China
| | - Chu Gao
- Institute of Orthopedic Surgery, Xijing Hospital Fourth Military Medical University Xi'an People's Republic of China
| | - Mu Du
- Institute of Orthopedic Surgery, Xijing Hospital Fourth Military Medical University Xi'an People's Republic of China
| | - Xin He
- Pharmacy Department Air Force Hospital of Eastern Theater Command Nanjing People's Republic of China
| | - Yachao Ma
- Institute of Orthopedic Surgery, Xijing Hospital Fourth Military Medical University Xi'an People's Republic of China
| | - Chao Zheng
- Institute of Orthopedic Surgery, Xijing Hospital Fourth Military Medical University Xi'an People's Republic of China
| | - Liu Yang
- Institute of Orthopedic Surgery, Xijing Hospital Fourth Military Medical University Xi'an People's Republic of China
| | - Zhuojing Luo
- Institute of Orthopedic Surgery, Xijing Hospital Fourth Military Medical University Xi'an People's Republic of China
| | - Xueyu Hu
- Institute of Orthopedic Surgery, Xijing Hospital Fourth Military Medical University Xi'an People's Republic of China
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Menachem S, Seex K. A biomechanical study shows the direction of compression influences the amount of lordosis gained in lumbar fusion. Clin Biomech (Bristol, Avon) 2023; 101:105862. [PMID: 36549049 DOI: 10.1016/j.clinbiomech.2022.105862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
STUDY DESIGN Biomechanical model study. BACKGROUND Lumbar lordosis is usually lost in the degenerative process, and when lumbar fusion is required, its restoration is one of the modern metrics of a successful operation. We sought to investigate the hypothesis that changing direction of compression during surgical fusion, would gain more lordosis. METHODS Using a biomechanical Sawbones™ model we inserted polyaxial pedicle screws from S1 to L4. A rod was placed in the screws without requiring reduction. Markers were attached to the spinous processes to allow photographic analysis of lordosis. Two methods were compared. Method A - caudal screws were locked first and compression proceeded in a cranial direction prior to locking. Method B - cranial screws were locked first and compression proceeded caudally. Increasing levels of surgical invasiveness were tested; intact, interbody cage, inferior facet resection, and Ponte resection and using different rods including: lordotic, hyperlordotic and straight. FINDINGS Method B demonstrated to be consistently superior to Method A, regardless of the type of rod used and for every level of surgical invasiveness performed. (P < 0.001). INTERPRETATION locking the top screws first was a consistently superior method of compression, gaining more lordosis. To explain this finding we suggest the following: During posterior compression of pedicle screws along a fixed rod, screw motion is limited by the conflict between the fixed lordotic rod position, and the need for the moving screw to move in a kyphotic arc which is determined by the cage which acts as a pivot point.
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Affiliation(s)
- Shay Menachem
- Macquarie University, Faculty of Medicine and Health Sciences, Sydney, Australia.
| | - Kevin Seex
- Macquarie University, Faculty of Medicine and Health Sciences, Sydney, Australia; Macquarie University Hospital, Department of Neurosurgery, Sydney, Australia
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Lacroix M, Nguyen C, Burns R, Laporte A, Rannou F, Feydy A. Degenerative Lumbar Spine Disease: Imaging and Biomechanics. Semin Musculoskelet Radiol 2022; 26:424-438. [PMID: 36103885 DOI: 10.1055/s-0042-1748912] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Chronic low back pain (CLBP) is one of the most common diagnoses encountered when considering years lived with disability. The degenerative changes of the lumbar spine include a wide spectrum of morphological modifications visible on imaging, some of them often asymptomatic or not consistent with symptoms. Phenotyping by considering both clinical and imaging biomarkers can improve the management of CLBP. Depending on the clinical presentation, imaging helps determine the most likely anatomical nociceptive source, thereby enhancing the therapeutic approach by targeting a specific lesion. Three pathologic conditions with an approach based on our experience can be described: (1) pure painful syndromes related to single nociceptive sources (e.g., disk pain, active disk pain, and facet joint osteoarthritis pain), (2) multifactorial painful syndromes, representing a combination of several nociceptive sources (such as lumbar spinal stenosis pain, foraminal stenosis pain, and instability pain), and (3) nonspecific CLBP, often explained by postural (muscular) syndromes.
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Affiliation(s)
- Maxime Lacroix
- Department of Musculoskeletal Radiology, Hôpital Cochin, Université de Paris, Paris, France.,Department of Radiology, Hôpital Européen Georges-Pompidou, Université de Paris, Paris, France
| | - Christelle Nguyen
- Department of Physical and Rehabilitation Medicine, Hôpital Cochin, Université de Paris, Paris, France
| | - Robert Burns
- Department of Musculoskeletal Radiology, Hôpital Cochin, Université de Paris, Paris, France
| | - Amandine Laporte
- Department of Musculoskeletal Radiology, Hôpital Cochin, Université de Paris, Paris, France
| | - François Rannou
- Department of Physical and Rehabilitation Medicine, Hôpital Cochin, Université de Paris, Paris, France
| | - Antoine Feydy
- Department of Musculoskeletal Radiology, Hôpital Cochin, Université de Paris, Paris, France
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Qu N, Tian H, De Martino E, Zhang B. Neck Pain: Do We Know Enough About the Sensorimotor Control System? Front Comput Neurosci 2022; 16:946514. [PMID: 35910451 PMCID: PMC9337601 DOI: 10.3389/fncom.2022.946514] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
Neck pain is a worldwide health problem. Clarifying the etiology and providing effective interventions are challenging for the multifactorial nature of neck pain. As an essential component of cervical spine function, the sensorimotor control system has been extensively studied in both healthy and pathological conditions. Proprioceptive signals generated from cervical structures are crucial to normal cervical functions, and abnormal proprioception caused by neck pain leads to alterations in neural plasticity, cervical muscle recruitment and cervical kinematics. The long-term sensorimotor disturbance and maladaptive neural plasticity are supposed to contribute to the recurrence and chronicity of neck pain. Therefore, multiple clinical evaluations and treatments aiming at restoring the sensorimotor control system and neural plasticity have been proposed. This paper provides a short review on neck pain from perspectives of proprioception, sensorimotor control system, neural plasticity and potential interventions. Future research may need to clarify the molecular mechanism underlying proprioception and pain. The existing assessment methods of cervical proprioceptive impairment and corresponding treatments may need to be systematically reevaluated and standardized. Additionally, new precise motor parameters reflecting sensorimotor deficit and more effective interventions targeting the sensorimotor control system or neural plasticity are encouraged to be proposed.
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Affiliation(s)
- Ning Qu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - HaoChun Tian
- Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Enrico De Martino
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Aerospace Medicine and Rehabilitation Laboratory, Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Bin Zhang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
- *Correspondence: Bin Zhang,
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Imaging of Thoracolumbar Spine Traumas. Eur J Radiol 2022; 154:110343. [DOI: 10.1016/j.ejrad.2022.110343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 11/15/2022]
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Aikawa T, Miyazaki Y, Kihara S, Saitoh Y, Nishimura M, Stephan SL, Dewey CW. Vertebral stabilisation for thoracolumbar vertebral instability associated with cranial and caudal articular process anomalies in pugs: Seven cases (2010-2019). J Small Anim Pract 2022; 63:699-706. [PMID: 35577348 DOI: 10.1111/jsap.13505] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To describe the diagnostic findings, surgical technique and outcomes in seven pugs with thoracolumbar vertebral instability due to articular process anomalies. MATERIALS AND METHODS Records (2010 to 2019) of pugs with thoracolumbar vertebral instability associated with articular process anomalies that underwent decompressive laminectomy and vertebral stabilisation were reviewed. Data on preoperative and postoperative neurologic status, diagnostic findings, surgical techniques and outcomes were retrieved. RESULTS Seven dogs were presented with ambulatory or non-ambulatory paraparesis. Caudal articular process anomalies (three dogs) and concomitant cranial and caudal articular process anomalies (four dogs) were noted. Myelography (six dogs) or magnetic resonance imaging (one dog) showed none to severe spinal cord compression. Dynamic myelography in six dogs demonstrated nine distinct sites of spinal cord dimension reduction positioned in extension and/or flexion (mean reduction: 16.0%, range: 8.5 to 24.0%). These dynamic compressions were located at sites with articular process anomalies (seven sites) and sites with no articular process anomalies (two sites). Vertebral instability was confirmed by intraoperative spinal manipulation in all dogs. All dogs remained ambulatory with improved (five dogs) or static (two dogs) neurological deficits at the last follow-up (median: 16 months; range: 1.5 to 66 months). CLINICAL SIGNIFICANCE Dynamic myelography and/or intraoperative spinal manipulation demonstrated vertebral instabilities at sites with or without articular process anomalies on imaging. Decompressive laminectomy with vertebral stabilisation resulted in long-term neurological improvement in most dogs.
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Affiliation(s)
- T Aikawa
- Department of Surgery, Aikawa Veterinary Medical Center, Tokyo, Japan
| | - Y Miyazaki
- Department of Surgery, Aikawa Veterinary Medical Center, Tokyo, Japan
| | - S Kihara
- Department of Surgery, Aikawa Veterinary Medical Center, Tokyo, Japan
| | - Y Saitoh
- Department of Surgery, Aikawa Veterinary Medical Center, Tokyo, Japan
| | - M Nishimura
- Department of Surgery, Aikawa Veterinary Medical Center, Tokyo, Japan
| | - S L Stephan
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, New York, USA
| | - C W Dewey
- Elemental Pet Vets, Freeville, New York, USA
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Wang Y, Wang J, Tu S, Li S, Yi J, Zhao H, Qiao H, Yan K, Liao B. Biomechanical Evaluation of an Oblique Lateral Locking Plate System for Oblique Lumbar Interbody Fusion: A Finite Element Analysis. World Neurosurg 2022; 160:e126-e141. [PMID: 35031519 DOI: 10.1016/j.wneu.2021.12.105] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/26/2021] [Accepted: 12/27/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The oblique lateral locking plate system (OLLPS) is a novel internal fixation with a locking and reverse pedicle track screw configuration designed for oblique lumbar interbody fusion (OLIF). The OLLPS is placed in a single position through the oblique lateral surgical corridor to reduce operative time and complications associated with prolonged anesthesia and prone positioning. The purpose of this study was to verify the biomechanical effect of the OLLPS. METHODS An intact finite element model of L1-S1 (intact) was established based on computed tomography images of a healthy male volunteer. The L4-L5 intervertebral space was selected as the surgical segment. The surgical models were established separately based on OLIF surgical procedures and different internal fixations: 1) stand-alone OLIF (SA); 2) OLIF with a 2-screw lateral plate; 3) OLIF with a 4-screw lateral plate; 4) OLIF with OLLPS; and 5) OLIF with bilateral pedicle screw fixation (BPS). After validation of the intact model, physiologic loads were applied to the superior surface of L1 to simulate motions such as flexion, extension, left bending, right bending, left rotation, and right rotation. The evaluation indices included the L4/5 range of motion, the L4 maximum displacement, and the maximum stresses of the superior and inferior end plates, the cage, and the supplemental fixation. RESULTS During OLIF surgery, the OLLPS provided multiplanar stability similar to that provided by BPS. Compared with 2-screw lateral plate and 4-screw lateral plate, OLLPS had better biomechanical properties in terms of enhancing the instant stability of the surgical segment, reducing the stress on the superior and inferior end plates of the surgical segment, and decreasing the risk of cage subsidence. CONCLUSIONS With a minimally invasive background, the OLLPS can be used as an alternative to BPS in OLIF and it has better prospects for clinical promotions and applications.
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Affiliation(s)
- Yinge Wang
- Department of Orthopedics, The Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi, China; Department of Orthopedics, The 922nd Hospital of Joint Logistics Support Force, Hengyang, Hunan, China
| | - Jiajia Wang
- Department of Orthopedics, The Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi, China
| | - Sha Tu
- Department of Nutrition, The 922nd Hospital of Joint Logistics Support Force, Hengyang, Hunan, China
| | - Shuang Li
- Department of Orthopedics, The Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi, China
| | - Jiangpu Yi
- 3D Printing Research Center, The Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi, China
| | - Haien Zhao
- Department of Orthopedics, The Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi, China
| | - Huanhuan Qiao
- Department of Orthopedics, The Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi, China
| | - Kang Yan
- Department of Orthopedics, The Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi, China.
| | - Bo Liao
- Department of Orthopedics, The Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi, China.
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Zhu HF, Fang XQ, Zhao FD, Zhang JF, Zhao X, Hu ZJ, Fan SW. Comparison of Oblique Lateral Interbody Fusion (OLIF) and Minimally Invasive Transforaminal Lumbar Interbody Fusion (MI-TLIF) for Treatment of Lumbar Degeneration Disease: A Prospective Cohort Study. Spine (Phila Pa 1976) 2022; 47:E233-E242. [PMID: 34855704 PMCID: PMC8865215 DOI: 10.1097/brs.0000000000004303] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/21/2021] [Accepted: 11/15/2021] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVE To assess the differences in the clinical and radiological outcomes between oblique lateral interbody fusion (OLIF) and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). SUMMARY OF BACKGROUND DATA Nowadays, there is still a controversy regarding whether OLIF is superior to MI-TLIF in the management of degenerative lumbar disease. METHODS Between August 3, 2019 and February 3, 2020, 137 patients were assigned to OLIF or MI-TLIF at their request and the surgeon's discretion: 71 in the OLIF group and 66 in the MI-TLIF group. The perioperative data, patient-reported outcomes, radiographic outcomes, and complications were compared between the two groups. RESULTS The OLIF group showed shorter operation time (110.5 vs.183.8 minutes, P < 0.001), lesser estimated blood loss (123.1 vs. 232.0 mL, P < 0.001), shorter length of hospital stay (5.5 vs. 6.7 days, P < 0.001), and lower serum creatine kinase (CK) (1 day postoperatively) (376.0 vs. 541.8 IU/L, P < 0.01) than that of MI-TLIF group. Both groups showed no significant differences in the visual analog scale (VAS) scores of lower back and leg pain and the Oswestry Disability Index (ODI) scores preoperatively and at 1, 3, and 12 months postoperatively, respectively (P > 0.05). Compared with the MI-TLIF group, the OLIF group showed better restoration of disc height (DH) (4.7/4.6/4.7 vs. 3.7/3.7/3.7 mm, P < 0.01) and lumbar lordosis angle (LLA) (10.5°/10.8°/11.1° vs. 5.8°/5.7°/5.3°, P < 0.001), but not the value of segmental lordosis angle (SLA) (P > 0.05) at 1 day, 1 month, and 1 year postoperatively, respectively. The complication rate of OLIF was higher than that of MI-TLIF (29.4% vs. 9.7%, P < 0.01). CONCLUSION Compared with MI-TLIF, OLIF showed similar results in terms of patient-reported outcomes, restoration of SLA and fusion rate, and superior results with respect to restoration of DH and LLA, operation time, estimated blood loss, length of hospital stay, and serum CK levels (1 day postoperatively). Even though the complication rate of OLIF is higher than that of MI-TLIF, it does not bring persistent and substantial damage to the patients.Level of Evidence: 3.
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Affiliation(s)
- Hai-Feng Zhu
- Department of Orthopedics, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China
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Computer-Aided Diagnosis for Determining Sagittal Spinal Curvatures Using Deep Learning and Radiography. J Digit Imaging 2022; 35:846-859. [PMID: 35277750 PMCID: PMC9485333 DOI: 10.1007/s10278-022-00592-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 11/26/2022] Open
Abstract
Analyzing spinal curvatures manually is time-consuming and tedious for clinicians, and intra-observer and inter-observer variability can affect manual measurements. In this study, we developed and evaluated the performance of an automated deep learning-based computer-aided diagnosis (CAD) tool for measuring the sagittal alignment of the spine from X-ray images. The CAD system proposed here performs two functions: deep learning-based lateral spine segmentation and automatic analysis of thoracic kyphosis and lumbar lordosis angles. We utilized 322 datasets with data augmentation for learning and fivefold cross-validation. The segmentation model was based on U-Net, which has multiple applications in medical image processing. Here, we utilized parameter equations and trigonometric functions to design spinal angle measurement algorithms. The kyphosis (T4-T12) and lordosis angle (L1-S1, L1-L5) were automatically measured to help diagnose kyphosis and lordosis. The segmentation model had precision, sensitivity, and dice similarity coefficient values of 90.53 ± 4.61%, 89.53 ± 1.8%, and 90.22 ± 0.62%, respectively. The performance of the CAD algorithm was also verified with the Pearson correlation, Bland-Altman, and intra-class correlation coefficient (ICC) analysis. The proposed angle measurement algorithm exhibited high similarity and reliability during verification. Therefore, CAD can help clinicians in reaching a diagnosis by analyzing the sagittal spinal curvatures while reducing observer-based variability and the required time or effort.
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Bo J, Zhao X, Hua Z, Li J, Qi X, Shen Y. Impact of sarcopenia and sagittal parameters on the residual back pain after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fracture. J Orthop Surg Res 2022; 17:111. [PMID: 35184761 PMCID: PMC8859872 DOI: 10.1186/s13018-022-03009-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/09/2022] [Indexed: 11/19/2022] Open
Abstract
Objective The objective of this study was to explore the impact of sarcopenia and sagittal parameters on the residual back pain (RBP) after percutaneous vertebroplasty (PVP) for treatment of osteoporotic vertebral compression fracture (OVCF). Methods This retrospective study included elderly patients (age range 60–90 years) with OVCF treated with PVP from January 2015 and December 2020 in our hospital. The skeletal muscle mass index (SMI) was calculated by dividing the T12 pedicle level muscle cross-sectional area by the square of body height from chest CT to diagnose sarcopenia. The radiological parameters for measuring the sagittal alignment were included: C7-sagittal vertical axis (SVA), T1 pelvic angle (TPA), lumbar lordosis (LL), thoracic kyphosis (TK), pelvic tilt (PT), sacral slope (SS), pelvic incidence (PI). Result According to whether the VAS score > 4, patients were divided into RBP group (56 patients) and Control group (100 patients). There was no difference in age, gender, body mass index, BMD, surgical segment, bone cement usage between the groups (P > 0.05). The SMI in RBP group (27.3 ± 5.1) was significantly lower compared to that in Control group (36.8 ± 3.2) (P < 0.05). Sarcopenia was present in 19 patients (20.3%) in RBP group, which was significantly more than that in Control group (P < 0.05). C7-SVA and TPA was significantly larger in the RBP group than in the Control group (P < 0.05). PI and LL was significantly smaller in the RBP group compared to the Control group (P < 0.05). However, no significant differences between the two groups with respect to TK, SS and PT (P > 0.05). Conclusion Poor sagittal parameters and sarcopenia in OVCF patients after PVP were more prone to residual back pain. Larger C7-SVA, TPA and PI-LL mismatch could increase the incidence of RBP in elderly patients with single-segment osteoporotic compression fractures.
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Jian Q, Liu Z, Duan W, Guan J, Jian F, Chen Z. Reconstruction of the cervical lateral mass using 3D-printed prostheses. Neurospine 2022; 19:202-211. [PMID: 35130422 PMCID: PMC8987545 DOI: 10.14245/ns.2143008.504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/28/2021] [Indexed: 11/20/2022] Open
Abstract
Objective This study aimed to investigate the outcome of using 3-dimensional (3D)-printed prostheses to reconstruct a cervical lateral mass to maintain cervical stability.
Methods We retrospectively analyzed data of 7 patients who underwent cervical lateral mass reconstruction using a 3D-printed prosthesis, comprising axial and subaxial lateral mass reconstruction in 2 and 5 patients, respectively. Bilateral mass was reconstructed in 1 patient and unilateral mass in the remaining 6 patients.
Results Using a 3D-printed lateral mass prosthesis, internal fixation was stable for all 7 patients postoperatively. No implant-related complications such as prosthesis loosening, displacement, and compression were observed at the last follow-up.
Conclusion Reconstruction of the lateral mass structure is beneficial in restoring load transfer in the cervical spine under physiological conditions. A 3D-printed prosthesis can be considered a good option for reconstruction of the lateral mass as fusion was achieved, with no subsequent complications observed.
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Affiliation(s)
- Qiang Jian
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhenlei Liu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wanru Duan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jian Guan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Fengzeng Jian
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zan Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Corresponding Author Zan Chen https://orcid.org/0000-0002-0104-115X Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China
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Laser Marking of Spine Rods Is Strongly Associated With Risk of Clinical Rod Failure. J Am Acad Orthop Surg 2022; 30:e252-e263. [PMID: 34715690 DOI: 10.5435/jaaos-d-20-00866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/02/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION What is overlooked in clinical studies are the possibilities of manufacturing and design aspects of the instrumentation that could initiate rod fracture. Although revision because of hardware fracture is a small fraction of the overall revision rates (12.1% to 13.7%), there are sufficient numbers of revision cases where hardware removed can undergo a thorough metallurgic analysis. This study is unique in that rod characteristics, such as alloy, surface markings, and fracture type, seen at fracture surfaces are considered in the analysis. METHODS This work was conducted under both a retrospective and prospective IRB. Patients considered for this study were between the ages of 18 and 85 years who underwent or were undergoing revision spine surgery with previous instrumentation in the cervical, thoracic, or lumbar region and evidence of at least one of the following: catastrophic hardware failure, pseudarthrosis, implant loosening, or nonfusion. Inclusion criteria were determined through radiographic and medical records review. RESULTS Fifty-six patients who had revision procedures because of different indications were included; 101 rods were removed, tested for fracture, and included in the analysis. Laser marking is significantly (P < 0.0001) associated with rod fracture. Detailed analysis showed notable surface and subsurface changes as the result of the marking, such as surface melting, cracking, and notching, creating locations to initiate a fracture. The three most informative variables to clinical rod fracture using multiple regression modeling were body mass index, presence or absence of laser mark (yes/no), and length of posterior fusion (≤2 spinal levels/>2 spinal levels). It was found that the relative risk of rod fracture is 23 times higher during 20 postoperative years than in cases with this index <0.4. DISCUSSION For a patient with a given body mass index, if they require a multilevel fixation greater than two levels and rods with laser marks are used, the risk of early rod fracture increases by 40%.
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Jian Q, Liu Z, Duan W, Jian F, Chen Z. Subaxial lateral mass prosthesis for posterior reconstruction of cervical spine. J Neurol Surg A Cent Eur Neurosurg 2022; 84:316-320. [PMID: 35026858 DOI: 10.1055/a-1739-2488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To obtain the relevant morphometry of the lateral mass of the subaxial cervical spine (C3-C7) and to design a series of lateral mass prostheses for the posterior reconstruction of the stability of cervical spine. METHODS The computed tomography (CT) scans of healthy volunteers were obtained. RadiAnt DICOM Viewer software (Version 2020.1, Medixant, Poland) was used to measure the parameters of lateral mass, such as height, anteroposterior dimension (APD), mediolateral dimension (MLD) and facet joint angle. According to the parameters, a series of cervical lateral mass prostheses were designed. Cadaver experiment was conducted to demonstrate its feasibility. RESULTS 23 volunteers with an average age of 30.1 ± 7.1 years were enrolled in this study. The height of lateral mass is 14.1 mm averagely. Facet joint angle, APD and MLD of lateral mass averaged 40.1 degrees, 11.2 mm and 12.18 mm, respectively. With these key data, a lateral mass prosthesis consists of a bone grafting column and a posterior fixation plate was designed. The column has a 4.0 mm radius, 41 degrees surface angle and adjustable height of 13, 15, or 17 mm. In the cadaver experiment, the grafting column could function as a supporting structure between adjacent facets, and it would not violate exiting nerve root (NR) or vertebral artery (VA). CONCLUSION This study provided detailed morphology of the lateral mass of subaxial cervical spine. A series of subaxial cervical lateral mass prostheses were designed awaiting further clinical application.
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Affiliation(s)
- Qiang Jian
- Neurosurgery, Xuanwu Hospital Department of Neurosurgery, Bei Jing, China
| | - Zhenlei Liu
- Neurosurgery, Xuanwu Hospital Department of Neurosurgery, Bei Jing, China
| | - Wanru Duan
- Neurosurgery, Xuanwu Hospital Department of Neurosurgery, Beijing, China
| | - Fengzeng Jian
- Neurosurgery, Xuanwu Hospital Department of Neurosurgery, Beijing, China
| | - Zan Chen
- Neurosurgery, Xuanwu Hospital Department of Neurosurgery, Beijing, China
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Hofstetter L, Häusler M, Schweinhardt P, Heggli U, Bron D, Swanenburg J. Influence of Axial Load and a 45-Degree Flexion Head Position on Cervical Spinal Stiffness in Healthy Young Adults. Front Physiol 2022; 12:786625. [PMID: 35002768 PMCID: PMC8733818 DOI: 10.3389/fphys.2021.786625] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Neck pain is a major cause of disability worldwide. Poor neck posture such as using a smartphone or work-related additional cervical axial load, such headgear of aviators, can cause neck pain. This study aimed at investigating the role of head posture or additional axial load on spinal stiffness, a proxy measure to assess cervical motor control. Methods: The posterior-to-anterior cervical spinal stiffness of 49 young healthy male military employees [mean (SD) age 20 ± 1 years] was measured in two head positions: neutral and 45-degree flexed head position and two loading conditions: with and without additional 3 kg axial load. Each test condition comprised three trials. Measurements were taken at three cervical locations, i.e., spinous processes C2 and C7 and mid-cervical (MC). Results: Cervical spinal stiffness measurements showed good reliability in all test conditions. There was a significant three-way interaction between location × head position × load [F(2, 576) = 9.305, p < 0.001]. Significant two-way interactions were found between measurement locations × loading [F(2, 576) = 15.688, p < 0.001] and measurement locations × head position [F(2, 576) = 9.263, p < 0.001]. There was no significant interaction between loading × head position [F(1, 576) = 0.692, p = 0.406]. Post hoc analysis showed reduction of stiffness in all three measurement locations in flexion position. There was a decrease in stiffness in C2 with loading, increase in stiffness in C7 and no change in MC. Discussion: A flexed head posture leading to decreased stiffness of the cervical spine might contribute to neck pain, especially if the posture is prolonged and static, such as is the case with smartphone users. Regarding the additional load, stiffness decreased high cervical and increased low cervical. There was no change mid cervical. The lower spinal stiffness at the high cervical spine might be caused by capsular ligament laxity due to the buckling effect. At the lower cervical spine, the buckling effect seems to be less dominant, because the proximity to the ribs and sternum provide additional stiffness.
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Affiliation(s)
- Léonie Hofstetter
- Integrative Spinal Research ISR, Department of Chiropractic Medicine, Balgrist University Hospital, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Melanie Häusler
- Integrative Spinal Research ISR, Department of Chiropractic Medicine, Balgrist University Hospital, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Petra Schweinhardt
- Integrative Spinal Research ISR, Department of Chiropractic Medicine, Balgrist University Hospital, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Ursula Heggli
- AeMC, Aeromedical Center, Swiss Air Forces, Dubendorf, Switzerland
| | - Denis Bron
- AeMC, Aeromedical Center, Swiss Air Forces, Dubendorf, Switzerland
| | - Jaap Swanenburg
- Integrative Spinal Research ISR, Department of Chiropractic Medicine, Balgrist University Hospital, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
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Bizdikian AJ, El Rachkidi R. Posterior Ligamentous Complex Injuries of the Thoracolumbar Spine: Importance and Surgical Implications. Cureus 2021; 13:e18774. [PMID: 34796064 PMCID: PMC8590454 DOI: 10.7759/cureus.18774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2021] [Indexed: 11/05/2022] Open
Abstract
The soft tissues surrounding the spine play a primordial role in its stability, the most important of which are located posteriorly and are deemed the posterior ligamentous complex (PLC). Injuries to the PLC in the setting of thoracolumbar trauma are often dreaded and little attention has been given to them in the management protocols of thoracolumbar trauma. This review aims to summarize and contextualize current concepts in PLC injuries of the thoracolumbar spine with the aim to provide a clear guide for clinical management. Injuries to the PLC may be suspected on the clinical exam but are often missed, leading to serious complications, including instability and neurological compromise. The diagnosis is often made indirectly by spinal radiographs and CT-scanning or by direct visualization of soft tissues via magnetic resonance imaging. The latter remains the standard imaging modality and is mandatory for patients with a high suspicion of PLC injury. PLC injuries are associated with vertebral fractures and follow a progressive pattern of severity, depending on the mechanism of injury and extent of trauma. Surgical management is warranted, as PLC damage renders the spine unstable. Although fusion was once the standard of care and remains applicable for certain patients, recent endeavors of temporary spinal fixation without fusion are increasingly gaining traction in patients with PLC injuries. In conclusion, PLC injuries are challenging as they are often missed, poorly understood, and are not easily managed. Proper diagnosis and management are crucial to avoid long-standing complications such as spinal instability. Considering the paucity of available data on such an important topic in thoracolumbar trauma, this review article aims to contextualize current concepts in PLC injuries in order to demystify this sparsely covered subject.
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Affiliation(s)
- Aren Joe Bizdikian
- Department of Orthopaedics and Traumatology, Hotel-Dieu de France Hospital, Beirut, LBN
| | - Rami El Rachkidi
- Department of Orthopaedics and Traumatology, Hotel-Dieu de France Hospital, Beirut, LBN
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Chaggar RS, McKinley WO. Dual lesion spinal cord injury in a polytrauma patient: a case report. Spinal Cord Ser Cases 2021; 7:91. [PMID: 34593763 DOI: 10.1038/s41394-021-00455-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/18/2021] [Accepted: 09/19/2021] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Dual lesion spinal cord injury (SCI) is the presence of two distinct regions of injury to the spinal cord, which can occur simultaneously or as a sequela of initial injury. Dual lesion SCI appears to be a rather rare occurrence with a paucity of cases described. As such, there is limited information available regarding presentation, evaluation, long-term rehabilitation management, and prognostication of these patients. CASE PRESENTATION Presented is a case of a 25-year-old woman with a gunshot wound injury to the T5 vertebra with associated cord damage, initially classified as T6 ASIA Impairment Scale (AIS) B. A subsequent cervical spinal stroke, in the setting of cord edema, resulted in a motor incomplete cervical SCI. As such, she underwent additional functional decline. DISCUSSION Patients with dual lesion SCI present with unique challenges in evaluation and management. This case highlights key factors for the acute care and rehabilitation teams to consider when addressing these challenges.
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Affiliation(s)
- Rajbir S Chaggar
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University Health System, Richmond, VA, USA.
| | - William O McKinley
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University Health System, Richmond, VA, USA
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Rafique D, Heggli U, Bron D, Colameo D, Schweinhardt P, Swanenburg J. Effects of increasing axial load on cervical motor control. Sci Rep 2021; 11:18627. [PMID: 34545145 PMCID: PMC8452641 DOI: 10.1038/s41598-021-97786-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/24/2021] [Indexed: 11/26/2022] Open
Abstract
To investigate the effects of increasing axial load on cervical motor control. Surrogates of cervical motor control were active cervical range of motion (C-ROM) and joint position error (JPE) assessed in flexion, extension, lateroflexion and rotation directions in 49 healthy young men (mean age: 20.2 years). All measurements were executed with 0-, 1-, 2-, and 3-kg axial loads. Linear mixed models were used to assess the effects of axial loading and cervical movement-direction on C-ROM and JPE. Post-hoc analysis was performed to compare load levels. Axial loading (p = 0.045) and movement direction (p < 0.001) showed significant main effects on C-ROM as well as an interaction (p < 0.001). C-ROM significantly changed with 3-kg axial load by decreaseing extension (− 13.6%) and increasing lateroflexion (+ 9.9%). No significant main effect was observed of axial loading on JPE (p = 0.139). Cervical motor control is influenced by axial loading, which results in decreased C-ROM in extension and increased C-ROM lateroflexion direction.
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Affiliation(s)
- David Rafique
- Department of Chiropractic Medicine, Balgrist University Hospital, Zürich, Switzerland.,University of Zurich, Zürich, Switzerland
| | - Ursula Heggli
- AeMC, Aeromedical Center, Swiss Air Forces, Dubendorf, Switzerland
| | - Denis Bron
- AeMC, Aeromedical Center, Swiss Air Forces, Dubendorf, Switzerland
| | - David Colameo
- Laboratory of Systems Neuroscience, Department of Health Science and Technology, Institute for Neuroscience, ETH, Zürich, Switzerland
| | - Petra Schweinhardt
- University of Zurich, Zürich, Switzerland.,Integrative Spinal Research ISR, Department of Chiropractic Medicine, Balgrist University Hospital, Balgrist Campus, Lengghalde 5, 8008, Zürich, Switzerland
| | - Jaap Swanenburg
- University of Zurich, Zürich, Switzerland. .,Integrative Spinal Research ISR, Department of Chiropractic Medicine, Balgrist University Hospital, Balgrist Campus, Lengghalde 5, 8008, Zürich, Switzerland.
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Tempel ZJ, Hlubek RJ, Kachmann MC, Body A, Okonkwo DO, Kanter AS, Buchholz AL, Krueger BM. Novel Distributed Loading Technique Using Multimaterial, Long-Segment Spinal Constructs to Prevent Proximal Junctional Pathology in Adult Spinal Deformity Correction-Operative Technique and Radiographic Findings. World Neurosurg 2021; 155:e264-e270. [PMID: 34418605 DOI: 10.1016/j.wneu.2021.08.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Proximal junctional kyphosis (PJK) and proximal junction failure are common and costly complications after long-segment adult spinal deformity (ASD) correction. Although much research has focused on the concept of "softening the landing" to prevent proximal junction pathologies, long-segment constructs largely deviate from the force-deformation curve of the physiologic spine. Our novel distributed loading technique for ASD correction is described using multimaterial, long-segment constructs to create a biomechanically sound, yet physiologic, decremental stiffness toward the rostral end. METHODS Operative steps detail the custom-designed constructs of dual-headed pedicle screws and varied rod diameters and materials (cobalt chromium or titanium) for an initial 20 patients (mean 66.6 ± 4.8 years). Standing scoliosis films were obtained preoperatively and at regular intervals postoperatively to assess for PJK. RESULTS No patient had evidence of PJK or proximal junction failure at latest radiographic follow-up (mean 17.9 months, range 13-25 months). Radiographic findings for sagittal vertical axis averaged 11.2 ± 5.6 cm preoperatively and 3.6 ± 2.3 cm postoperatively. Compared with preoperative parameters, postoperative reductions in pelvic incidence-lumbar lordosis mismatch averaged 28.7 ± 12.9 degrees, and sagittal vertical axis averaged 7.6 ± 5.2 cm while PJA was essentially unchanged. CONCLUSIONS Preliminary results suggest that the distributed loading technique is promising for prevention of PJK with stiffness gradients that mimic the force-deformation curve of the physiologic posterior tension band. Our technique may optimize the degree of stress at the proximal junction without overwhelming the anterior column bony while remodeling and mature arthrodesis takes place.
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Affiliation(s)
| | | | | | - Alaina Body
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Adam S Kanter
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Avery L Buchholz
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
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Remus R, Lipphaus A, Neumann M, Bender B. Calibration and validation of a novel hybrid model of the lumbosacral spine in ArtiSynth-The passive structures. PLoS One 2021; 16:e0250456. [PMID: 33901222 PMCID: PMC8075237 DOI: 10.1371/journal.pone.0250456] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 04/07/2021] [Indexed: 12/04/2022] Open
Abstract
In computational biomechanics, two separate types of models have been used predominantly to enhance the understanding of the mechanisms of action of the lumbosacral spine (LSS): Finite element (FE) and musculoskeletal multibody (MB) models. To combine advantages of both models, hybrid FE-MB models are an increasingly used alternative. The aim of this paper is to develop, calibrate, and validate a novel passive hybrid FE-MB open-access simulation model of a ligamentous LSS using ArtiSynth. Based on anatomical data from the Male Visible Human Project, the LSS model is constructed from the L1-S1 rigid vertebrae interconnected with hyperelastic fiber-reinforced FE intervertebral discs, ligaments, and facet joints. A mesh convergence study, sensitivity analyses, and systematic calibration were conducted with the hybrid functional spinal unit (FSU) L4/5. The predicted mechanical responses of the FSU L4/5, the lumbar spine (L1-L5), and the LSS were validated against literature data from in vivo and in vitro measurements and in silico models. Spinal mechanical responses considered when loaded with pure moments and combined loading modes were total and intervertebral range of motions, instantaneous axes and centers of rotation, facet joint contact forces, intradiscal pressures, disc bulges, and stiffnesses. Undesirable correlations with the FE mesh were minimized, the number of crisscrossed collagen fiber rings was reduced to five, and the individual influences of specific anatomical structures were adjusted to in vitro range of motions. Including intervertebral motion couplings for axial rotation and nonlinear stiffening under increasing axial compression, the predicted kinematic and structural mechanics responses were consistent with the comparative data. The results demonstrate that the hybrid simulation model is robust and efficient in reproducing valid mechanical responses to provide a starting point for upcoming optimizations and extensions, such as with active skeletal muscles.
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Affiliation(s)
- Robin Remus
- Chair of Product Development, Department of Mechanical Engineering, Ruhr-University Bochum, Bochum, Germany
- * E-mail:
| | - Andreas Lipphaus
- Biomechanics Research Group, Chair of Product Development, Department of Mechanical Engineering, Ruhr-University Bochum, Bochum, Germany
| | - Marc Neumann
- Chair of Product Development, Department of Mechanical Engineering, Ruhr-University Bochum, Bochum, Germany
| | - Beate Bender
- Chair of Product Development, Department of Mechanical Engineering, Ruhr-University Bochum, Bochum, Germany
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Ma YH, Tian ZS, Liu HC, Zhang BY, Zhu YH, Meng CY, Liu XJ, Zhu QS. Predictive risk factors for recollapse of cemented vertebrae after percutaneous vertebroplasty: A meta-analysis. World J Clin Cases 2021; 9:2778-2790. [PMID: 33969060 PMCID: PMC8058688 DOI: 10.12998/wjcc.v9.i12.2778] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/18/2021] [Accepted: 03/11/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND As one of the most common complications of osteoporosis, osteoporotic vertebral compression fracture (OVCF) increases the risk of disability and mortality in elderly patients. Percutaneous vertebroplasty (PVP) is considered to be an effective, safe, and minimally invasive treatment for OVCFs. The recollapse of cemented vertebrae is one of the serious complications of PVP. However, the risk factors associated with recollapse after PVP remain controversial.
AIM To identify risk factors for the recollapse of cemented vertebrae after PVP in patients with OVCFs.
METHODS A systematic search in EMBASE, MEDLINE, the Cochrane Library, and PubMed was conducted for relevant studies from inception until March 2020. Studies investigating risk factors for the recollapse of cemented vertebrae after PVP without additional trauma were selected for analysis. Odds ratios (ORs) or standardized mean differences with 95% confidence interval (CI) were calculated and heterogeneity was assessed by both the chi-squared test and the I-squared test. The methodological quality of the included studies was assessed according to the Newcastle-Ottawa Scale.
RESULTS A total of nine case-control studies were included in our meta-analysis comprising 300 cases and 2674 controls. The significant risk factors for the recollapse of cemented vertebrae after PVP in OVCF patients were fractures located at the thoracolumbar junction (OR = 2.09; 95%CI: 1.30 to 3.38; P = 0.002), preoperative intravertebral cleft (OR = 2.97; 95%CI: 1.93 to 4.57; P < 0.00001), and solid lump distribution pattern of the cement (OR = 3.11; 95%CI: 1.91 to 5.07; P < 0.00001). The analysis did not support that age, gender, lumbar bone mineral density, preoperative visual analogue scale score, injected cement volume, intradiscal cement leakage, or vertebral height restoration could increase the risk for cemented vertebra recollapse after PVP in OVCFs.
CONCLUSION This meta-analysis suggests that thoracolumbar junction fractures, preoperative intravertebral cleft, and solid lump cement distribution pattern are associated with the recollapse of cemented vertebrae after PVP in OVCF patients.
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Affiliation(s)
- Yi-Hang Ma
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Zhi-Sen Tian
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Hao-Chuan Liu
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Bo-Yin Zhang
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Yu-Hang Zhu
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Chun-Yang Meng
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Xiang-Ji Liu
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Qing-San Zhu
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
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Numerical Evaluation of Spinal Stability after Posterior Spinal Fusion with Various Fixation Segments and Screw Types in Patients with Osteoporotic Thoracolumbar Burst Fracture Using Finite Element Analysis. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11073243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The aim of this study was to analyze the spinal stability and safety after posterior spinal fusion with various fixation segments and screw types in patients with an osteoporotic thoracolumbar burst fracture based on finite element analysis (FEA). To realize various osteoporotic vertebral fracture conditions on T12, seven cases of Young’s modulus, namely 0%, 1%, 5%, 10%, 25%, 50%, and 100% of the Young’s modulus, for vertebral bones under intact conditions were considered. Four types of fixation for thoracolumbar fracture on T12 (fixed with T11-L1, T10-T11-L1, T11-L1-L2, and T10-T11-L1-L2) were applied to the thoracolumbar fusion model. The following screw types were considered: pedicle screw (PS) and cortical screw (CS). Using FEA, four motions were performed on the fixed spine, and the stress applied to the screw, peri-implant bone (PIB), and intervertebral disc (IVD) and the range of motion (ROM) were calculated. The lowest ROM calculated corresponded to the T10-T11-L1-L2 model, while the closest to the intact situation was achieved in the T11-L1-L2 fixation model using PS. The lowest stress in the screw and PB was detected in the T10-T11-L1-L2 fixation model.
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Shah NG, Keraliya A, Harris MB, Bono CM, Khurana B. Spinal trauma in DISH and AS: is MRI essential following the detection of vertebral fractures on CT? Spine J 2021; 21:618-626. [PMID: 33130303 DOI: 10.1016/j.spinee.2020.10.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/01/2020] [Accepted: 10/26/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Both ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH) cause a rigid spine, but through different pathophysiology. Recent data has shown that characteristic fracture patterns may also differ following trauma since the posterior osseous and soft tissue elements are often spared in DISH. CT and MRI are important in diagnosing spine injury, but given the differences between AS and DISH, the utility of obtaining both studies in all patients warrants scrutiny. PURPOSE To assess the prevalence of posterior element injury on CT and MRI in DISH and AS patients with known vertebral body injury detected on CT; to determine whether MRI demonstrates additional injuries in neurologically intact patients presumed to have isolated vertebral body injuries on CT. STUDY DESIGN Multicenter, retrospective, case-control study. PATIENT SAMPLE DISH and AS patients presenting after spine trauma between 2007 and 2017. OUTCOME MEASURES Review of CT and MRI findings at the time of presentation. METHODS One hundred sixty DISH and 85 AS patients presenting after spine trauma were identified from 2 affiliated academic hospitals serving as level 1 trauma and tertiary referral centers. A diagnosis of DISH or AS was verified by a board-certified emergency radiologist with 3 years of experience. Age, gender, mechanism of injury, fracture type, spine CT and MRI imaging findings, surgical intervention, and neurologic deficit were recorded. The CT and MRI studies were reviewed by the same radiologist for fracture location and type using the AO spine classification. No funding source or conflict of interest was present. RESULTS Median age was 72 and 79 years old for the AS and DISH groups, respectively. Both were predominantly male (81%) and most presented after a low energy mechanism of injury (74% and 73%). Type C AO spine injuries were seen in 52% of AS patients but only 4% of DISH patients. In patients with known vertebral body injury on CT, additional injury to the posterior elements on CT or MRI in DISH patients was 51% versus 92% in AS patients. However, in patients with an isolated vertebral body fracture on CT and no neurological deficit, MRI identified posterior element injury in only 4/22 (18%) DISH patients compared to 5 of 7 (71%) AS patients. None of the MRI findings in the DISH patients were considered clinically important while all 5 AS patients eventually underwent operative treatment despite having no neurological deficit. Epidural hematoma on MRI was seen in 43% of AS patients as opposed to 5% of DISH patients. CONCLUSION Based on our small sample size, CT alone may be adequate in DISH patients with isolated vertebral body fractures and no neurologic deficit, but an additional MRI should be considered in the presence of an unclear neurological exam or deficit. MRI should be strongly considered for any AS patient regardless of neurologic status.
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Affiliation(s)
- Nandish G Shah
- Brigham and Women's Hospital, Department of Radiology, Boston, MA, USA
| | - Abhishek Keraliya
- Brigham and Women's Hospital, Department of Radiology, Boston, MA, USA
| | - Mitchel B Harris
- Massachusetts General Hospital, Department of Orthopedic Surgery, Boston, MA, USA
| | - Christopher M Bono
- Massachusetts General Hospital, Department of Orthopedic Surgery, Boston, MA, USA
| | - Bharti Khurana
- Brigham and Women's Hospital, Department of Radiology, Boston, MA, USA.
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Scaturro D, Rizzo S, Sanfilippo V, Giustino V, Messina G, Martines F, Falco V, Cuntrera D, Moretti A, Iolascon G, Letizia Mauro G. Effectiveness of Rehabilitative Intervention on Pain, Postural Balance, and Quality of Life in Women with Multiple Vertebral Fragility Fractures: A Prospective Cohort Study. J Funct Morphol Kinesiol 2021; 6:jfmk6010024. [PMID: 33802536 PMCID: PMC7931028 DOI: 10.3390/jfmk6010024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 01/31/2021] [Accepted: 02/24/2021] [Indexed: 02/05/2023] Open
Abstract
Patients with vertebral fragility fractures often experience chronic pain, postural and balance disorders, and poor quality of life (QoL). Although several studies have investigated the role of rehabilitation in severe osteoporosis, the effectiveness of this intervention in patients with multiple vertebral fractures is poorly known. The aim of our longitudinal cohort study is to evaluate the effectiveness of rehabilitation, including postural training, resistance exercises, and visual stabilization exercises, for a 7-week period, on the pain, postural balance, and QoL of subjects with at least two vertebral fragility fractures receiving denosumab and vitamin D. We investigated, before (T0) and after (T1, at 7 weeks) rehabilitation, the following outcome measures on 28 patients: pain (Numerical Rating Scale (NRS)), self-perceived QoL (36-Item Short Form Survey (SF-36) and Mini-Osteoporosis Quality of Life Questionnaire (Mini-OQOL)), dizziness (Dizziness Handicap Inventory (DHI-I)), mobility (Timed-Up and Go (TUG) test), and instrumental posturographic assessment (FreeMed posturography system). At the end of the treatment, improvements of pain and QoL were recorded. Pain relief was highly obtained in patients with more than two vertebral fractures. Moreover, a significant functional improvement (TUG test) was found in those with two vertebral fractures, without any statistically significant change reported for other outcomes. Our findings suggest that combined intervention, including anti-osteoporotic drugs and postural rehabilitation, should be proposed to osteoporotic patients with multiple vertebral fractures.
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Affiliation(s)
- Dalila Scaturro
- Department of Oncology and Stomatological Surgical Disciplines, University of Palermo, 90100 Palermo, Italy; (D.S.); (S.R.); (V.S.); (G.L.M.)
| | - Serena Rizzo
- Department of Oncology and Stomatological Surgical Disciplines, University of Palermo, 90100 Palermo, Italy; (D.S.); (S.R.); (V.S.); (G.L.M.)
| | - Valeria Sanfilippo
- Department of Oncology and Stomatological Surgical Disciplines, University of Palermo, 90100 Palermo, Italy; (D.S.); (S.R.); (V.S.); (G.L.M.)
| | - Valerio Giustino
- Program in Health Promotion and Cognitive Sciences, Department of Psychology, Educational Science and Human Movement, University of Palermo, 90100 Palermo, Italy;
| | - Giuseppe Messina
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90100 Palermo, Italy;
- PosturaLab Italia Research Institute, 90100 Palermo, Italy
| | - Francesco Martines
- Istituto Euromediterraneo di Scienza e Tecnologia—IEMEST, 90100 Palermo, Italy;
- Bi.N.D. Department, Audiology Section, University of Palermo, 90100 Palermo, Italy
| | - Vincenzo Falco
- Department of Economics, Statistics University of Palermo, 90100 Palermo, Italy; (V.F.); (D.C.)
| | - Daniele Cuntrera
- Department of Economics, Statistics University of Palermo, 90100 Palermo, Italy; (V.F.); (D.C.)
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
- Correspondence: ; Tel.: +39-081-566-5537
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Giulia Letizia Mauro
- Department of Oncology and Stomatological Surgical Disciplines, University of Palermo, 90100 Palermo, Italy; (D.S.); (S.R.); (V.S.); (G.L.M.)
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Kao Y, Liu Z, Leng J, Qu Z, Song Q, Liu Y, Wang Z. A Preoperative Predictive Model of Lower Lumbar Spine Instability Based on Three-Dimensional Computed Tomography: A Retrospective Case-Control Pilot Study. Orthop Surg 2021; 13:484-492. [PMID: 33554427 PMCID: PMC7957420 DOI: 10.1111/os.12861] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 10/07/2020] [Accepted: 10/18/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This study aimed to build a predictive model of lower lumbar instability. METHODS This retrospective study included 199 patients. Patients were divided into the lower lumbar instability group (LLIG) (n = 98) and lower lumbar stability group (LLSG) (n = 101). All participants of LLIG were recruited over a 2-year period (2015-2017) from the patients who accept lumbar surgery at the First Hospital of Jilin University. The LLSG was selected from outpatients who had underwent lumbar spine computed tomography (CT) and Flexion and extension radiographs (FER) at the First Hospital of Jilin University from 2015 to 2017. Several lower lumbar parameters were measured, including Lordosis angle (LA), intervertebral height (IH), ratio of anterior height to posterior height (APR), angle between endplate and anterior edge of vertebral body (AEPVa), sagittal slip ratio (SSR), and angle between the upper endplate and z-axis on sagittal plane (AUEZS). These parameters were keyed into the SPSS software to create a predictive model for classification. Sensitivity, specificity, predictive accuracy, and Kappa value were used to evaluate the predictive model. RESULTS Compared with LLSG, the LA of LLIG decreased by 3.49° (126.54° vs 130.3°). Similarly, the IH of LLIG decreased by 1.23°mm, 1.66°mm, and 0.71°mm at L3-4, L4-5, and L5-S1. Compared with LLSG, the SSR of LLIG is higher at L3-4, L4-5, and L5-S1 (0.54 vs 0.51, 0.57 vs 0.46, and 0.59 vs 0. 47). Moreover, the APR of LLIG is higher than those of LLSG at L3-4, L4-5, and L5-S1 (1.97 vs 1.81, 2.40 vs 1.97, and 2.69 vs 2.26). The LLIG has bigger AEPVa than LLIG at L3-4, L4-5, and L5-S1. Compared with LLSG, the AUEZS of LLIG is bigger at L3-4 (91.75° vs 90.81°) and smaller at L4-5 and L5-S1(84.63° vs 85.85° and 73.27° vs 75.01°). The SSR (L4) show highest predictive accuracy (83%) when every parameter was fed to LDA classifier to generate a univariate model. All parameters represent a statistically significant difference (P < 0.05) between LLSG and LLIG. The model including LA, APR (L5-S1), IH (L4-5), SSR (L5), AUEZS (L5) has highest predictive accuracy of 88.2%. The sensitivity, specificity, and Kappa value are 88.7%, 93.1%, and 0.77. CONCLUSION The predictive model has good classification performance and can be an auxiliary tool for clinicians to evaluate lumbar instability in preoperative patients with severe pain aggravated by lumbar movement.
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Affiliation(s)
- Yanbing Kao
- Departments of Spine Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Zijing Liu
- Nursing Platform of Spinal Surgery Department, The First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Jiali Leng
- Department of Hospice, The First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Zhigang Qu
- Departments of Spine Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - QingXu Song
- Departments of Spine Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yi Liu
- Departments of Spine Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Zhenyu Wang
- Departments of Spine Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
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Braunstein J, Hipp JA, Browning R, Grieco TF, Reitman CA. Analysis of translation and angular motion in loaded and unloaded positions in the lumbar spine. NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2020; 4:100038. [PMID: 35141606 PMCID: PMC8819970 DOI: 10.1016/j.xnsj.2020.100038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 09/17/2020] [Accepted: 11/16/2020] [Indexed: 12/02/2022]
Abstract
Background Context Abnormalities in intervertebral rotation and translation are important to diagnosis and treatment planning for common spinal disorders. Tests that do not sufficiently load the spine can result in mis-diagnosed motion abnormalities. Upright flexion and extension x-rays are commonly used despite known limitations. Additional evidence is needed in support of preliminary studies suggesting that the change from standing to supine may sufficiently stress the spine to diagnose motion abnormalities. Purpose Compare intervertebral translation between flexion and extension to translation between upright and supine positions in a representative clinical population. Study Design/Setting Prospective analysis of images retrospectively collected from routine clinical practices. Methods After obtaining IRB approval for analysis of previously obtained images, patients were identified via chart reviews where a neutral-lateral x-ray and an MRI or CT exam were obtained for diagnosis of a spinal disorder and where flexion-extension x-rays had been obtained to help diagnose abnormal intervertebral motion. The mid-sagittal slice from the MRI or CT exam was paired with the neutral-lateral radiograph. Intervertebral translation at the L4-L5 and L5-S1 levels between supine and standing and between flexion and extension were measured from the images using previously validated methods. The translations were classified as normal or abnormal with reference to a previously obtained database of intervertebral motion in radiographically normal and asymptomatic volunteers. Results At the L5-S1 level in particular, there tended to be greater translation between the supine and standing than between upright flexion and extension. On average, translations were below that found in asymptomatic volunteers. No abnormal translations were detected from flexion-extension radiographs whereas approximately 7% of levels had abnormal translations between supine and upright positions. Conclusions Intervertebral translations between supine and standing, measured using the mid-sagittal slice from a MRI or CT exam and a lateral x-ray with the patient standing can help to identify abnormal motion. This would be particularly valuable for patients with limited flexion and extension. This study thereby adds to the evidence in support of measuring intervertebral motion between the supine and upright positions to detect abnormal intervertebral motion.
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Affiliation(s)
- Jacob Braunstein
- Medical University of South Carolina Department of Orthopaedics and Physical Medicine. Charleston, SC
| | - John A. Hipp
- Medical Metrics Diagnostics, Inc, Houston, TX USA
- Corresponding author.
| | - Robert Browning
- Rush University Department of Orthopedic Surgery. Chicago, IL USA
| | | | - Charles A. Reitman
- Medical University of South Carolina Department of Orthopaedics and Physical Medicine. Charleston, SC
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Cho JH, Lee KH, Lim ST. Aged Lumbar Extension Strength of Chronic Low Back Pain in Korean Population of 10-80 Years. IRANIAN JOURNAL OF PUBLIC HEALTH 2020; 49:1894-1901. [PMID: 33346210 PMCID: PMC7719641 DOI: 10.18502/ijph.v49i10.4692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background: The purpose of this study was to find the basic data of medical and exercise therapy by indexing lumbar extension muscle strength of low back pain (LBP) patients. Methods: In this cross-sectional study, 3078 chronic LBP participants from The J hospital, Seoul, Republic of Korea, from 2003 to 2010 were enrolled. Maximum muscle strength was measured at maximum flexion angle and maximum extension angle according to range of motion (ROM) results. For each isometric test, participants were seated and secured in the MEDX (medx lumbar extension machine, Ocala, FL, USA) machine. Results: The relative ROM (P=0.012) differed significantly among the aged groups in all participants. In addition, mean of strength (P<0.001), maximal of strength (P<0.001), mean of strength %BW (P<0.001) and maximal of strength %BW (P<0.001) are significant differences in all participants. The results of multiple regression analysis was the ‘model A’, maximal of strength for 32.1% of the variance in weigh, body mass index and range of motion. In addition, ‘model B’ was 30.4%, ‘model C’ was 28.8%, ‘model D’ was 28.5%, ‘model E’ was 21.7%, and ‘model F’ was 23.5% of the variance in weigh, body mass index and range of motion. Conclusion: We found the three predictor (weight, BMI, and ROM) variables accounted for 32.1% of the variance in maximal of strength %BW, the highest in < 29 yr groups. Our data indicate the basic data of medical and exercise therapy by indexing lumbar extension muscle strength of LBP patients.
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Affiliation(s)
- Ji-Hoon Cho
- Department of Sport and Leisure Studies, Shingyeong University, Hwaseong, Republic of Korea
| | - Ki-Hyuk Lee
- Department of Sport Culture, Dongguk University, Seoul, Republic of Korea
| | - Seung-Taek Lim
- Institute of Sport Science, Kangwon National University, Gangwon-do, Republic of Korea.,Nasaret International Hospital, Incheon, Republic of Korea.,Waseda Institute for Sport Sciences, Waseda University, Saitama, Japan
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Su QH, Li YC, Zhang Y, Tan J, Cheng B. Assessment of load-sharing thoracolumbar injury: A modified scoring system. World J Clin Cases 2020; 8:5128-5138. [PMID: 33269249 PMCID: PMC7674748 DOI: 10.12998/wjcc.v8.i21.5128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/14/2020] [Accepted: 09/22/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Many classification systems of thoracolumbar spinal fractures have been proposed to enhance treatment protocols, but none have achieved universal adoption.
AIM To develop a new patient scoring system for cases with thoracolumbar injury classification and severity score (TLICS) = 4, namely the load-sharing thoracolumbar injury score (LSTLIS).
METHODS Based on thoracolumbar injury classification and severity score, this study proposes the use of the established load-sharing classification (LSC) to develop an improved classification system (LSTLIS). To prove the reliability and reproducibility of LSTLIS, a retrospective analysis for patients with thoracolumbar vertebral fractures has been conducted.
RESULTS A total of 102 cases were enrolled in the study. The scoring trend of LSTLIS is roughly similar as the LSC scoring, however, the average deviation based on the former method is relatively smaller than that of the latter. Thus, the robustness of the LSTLIS scoring method is better than that of LSC. LSTLIS can further classify patients with TLICS = 4, so as to assess more accurately this particular circumstance, and the majority of LSTLIS recommendations are consistent with actual clinical decisions.
CONCLUSION LSTLIS is a scoring system that combines LSC and TLICS to compensate for the lack of appropriate inclusion of anterior and middle column compression fractures with TLICS. Following preliminary clinical verification, LSTLIS has greater feasibility and reliability value, is more practical in comprehensively assessing certain clinical circumstances, and has better accuracy with clinically significant guidelines.
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Affiliation(s)
- Qi-Hang Su
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
- Department of Orthopedics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Yong-Chao Li
- Department of Orthopedics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Yan Zhang
- Department of Orthopedics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Jun Tan
- Department of Orthopedics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Biao Cheng
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
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Schmitz TC, Salzer E, Crispim JF, Fabra GT, LeVisage C, Pandit A, Tryfonidou M, Maitre CL, Ito K. Characterization of biomaterials intended for use in the nucleus pulposus of degenerated intervertebral discs. Acta Biomater 2020; 114:1-15. [PMID: 32771592 DOI: 10.1016/j.actbio.2020.08.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/06/2020] [Accepted: 08/03/2020] [Indexed: 12/19/2022]
Abstract
Biomaterials for regeneration of the intervertebral disc must meet complex requirements conforming to biological, mechanical and clinical demands. Currently no consensus on their characterization exists. It is crucial to identify parameters and their method of characterization for accurate assessment of their potential efficacy, keeping in mind the translation towards clinical application. This review systematically analyses the characterization techniques of biomaterial systems that have been used for nucleus pulposus (NP) restoration and regeneration. Substantial differences in the approach towards assessment became evident, hindering comparisons between different materials with respect to their suitability for NP restoration and regeneration. We have analysed the current approaches and identified parameters necessary for adequate biomaterial characterization, with the clinical goal of functional restoration and biological regeneration of the NP in mind. Further, we provide guidelines and goals for their measurement. STATEMENT OF SIGNIFICANCE: Biomaterials intended for restoration of regeneration of the nucleus pulposus within the intervertebral disc must meet biological, biomechanical and clinical demands. Many materials have been investigated, but a lack of consensus on which parameters to evaluate leads to difficulties in comparing materials as well as mostly partial characterization of the materials in question. A gap between current methodology and clinically relevant and meaningful characterization is prevalent. In this article, we identify necessary methods and their implementation for complete biomaterial characterization in the context of clinical applicability. This will allow for a more unified approach to NP-biomaterials research within the field as a whole and enable comparative analysis of novel materials yet to be developed.
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Affiliation(s)
- Tara C Schmitz
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, Netherlands.
| | - Elias Salzer
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, Netherlands.
| | - João F Crispim
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, Netherlands.
| | - Georgina Targa Fabra
- Centre for Research in Medical Devices (CÚRAM), National University of Ireland Galway, 7WQJ+8F Galway, Ireland.
| | - Catherine LeVisage
- Université de Nantes, INSERM UMR 1229, Regenerative Medicine and Skeleton, RMeS School of Dental Surgery, University of Nantes, 1 Place Ricordeau, 44300 Nantes, France.
| | - Abhay Pandit
- Centre for Research in Medical Devices (CÚRAM), National University of Ireland Galway, 7WQJ+8F Galway, Ireland.
| | - Marianna Tryfonidou
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 1, 3584 CL Utrecht, Netherlands.
| | - Christine Le Maitre
- Biomolecular Sciences Research Centre Sheffield Hallam University, City Campus, Howard Street, S1 1WB Sheffield, United Kingdom.
| | - Keita Ito
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, Netherlands.
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