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Aldakheel DA. Classification of thoracic spine fractures: the four-column theory. INTERNATIONAL ORTHOPAEDICS 2023; 47:2907-2915. [PMID: 36943457 PMCID: PMC10673741 DOI: 10.1007/s00264-023-05778-x] [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: 01/31/2023] [Accepted: 03/11/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE The purpose of this study is to present a classification of thoracic spine fractures based on anatomical and biomechanical characteristics. METHODS This is a narrative review of the literature. RESULTS The classification is based on the relationship between movement and common forces acting on the spine. A mechanistic concept is incorporated into the classification, which considers both movements and the application of forces, leading to pathomorphological characteristics. A hierarchical ranking determines the severity of fractures within the thoracic spine, and treatment recommendations are presented in each category. The fourth column of the spine is incorporated into the classification through direct and indirect mechanisms. CONCLUSIONS The proposed classification accommodates several advantages, such as simplicity and practicality, that make this classification helpful in daily practice. The dynamic relationship between movement and force provides a better understanding of the fracture mechanism. Finally, incorporating the fourth column will strengthen the indication for surgical management. To the best of our knowledge, this classification is the first classification developed uniquely for the thoracic spine fractures and will help to address a critical gap in the literature.
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Affiliation(s)
- Dakheel A Aldakheel
- Colleg of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
- Department of Orthopaedic Surgery, King Fahd Hospital of the University, Khobar, Saudi Arabia.
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Nishida N, Tripathi S, Mumtaz M, Kelkar A, Kumaran Y, Sakai T, Goel VK. The Effect of Anterior-Only, Posterior-Only, and Combined Anterior Posterior Fixation for Cervical Spine Injury with Soft Tissue Injury: A Finite Element Analysis. World Neurosurg 2023; 171:e777-e786. [PMID: 36584897 DOI: 10.1016/j.wneu.2022.12.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/24/2022] [Accepted: 12/25/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE This finite element analysis aimed to investigate the effects of surgical procedures for cervical spine injury. METHODS A three-dimensional finite element model of the cervical spine (C2-C7) was created from computed tomography. This model contained vertebrae, intervertebral discs, anterior longitudinal ligament, and posterior ligament complex. To create the cervical spine injury model, posterior ligament complex and anterior longitudinal ligament at C3-C4 were resected and the center of the intervertebral disc was resected. We created posterior-only fixation (PF), anterior-only fixation (AF), and combined anterior-posterior fixation (APF) models. A pure moment with a compressive follower load was applied, and range of motion, annular/nucleus stress, instrument stress, and facet forces were analyzed. RESULTS In all motion except for flexion, range of motion of PF, AF, and APF models decreased by 80%-95%, 85%-93%, and 97%-99% compared with the intact model. C3-C4 annulus stress of PF, AF, and APF models decreased by 28%-72%, 96%-100%, and 99%-100% compared with the intact model. Facet contact forces of PF, AF, and APF models decreased by 77%-79%, 97%-99%, and 77%-86% at C3-C4 compared with the intact model. Screw stress in the PF model was higher than in the APF model, and plate stress in the AF model was lower than in the APF model, but bone graft stress in the AF model was higher than in the APF model. CONCLUSIONS Cervical stabilization was preserved by the APF model. Regarding range of motion, the PF model had an advantage compared with the AF model except for flexion. An understanding of biomechanics provides useful information for the clinician.
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Affiliation(s)
- Norihiro Nishida
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.
| | - Sudharshan Tripathi
- Engineering Center for Orthopaedic Research Excellence, Departments of Bioengineering and Orthopaedics, University of Toledo, Toledo, Ohio, USA
| | - Muzammil Mumtaz
- Engineering Center for Orthopaedic Research Excellence, Departments of Bioengineering and Orthopaedics, University of Toledo, Toledo, Ohio, USA
| | - Amey Kelkar
- Engineering Center for Orthopaedic Research Excellence, Departments of Bioengineering and Orthopaedics, University of Toledo, Toledo, Ohio, USA
| | - Yogesh Kumaran
- Engineering Center for Orthopaedic Research Excellence, Departments of Bioengineering and Orthopaedics, University of Toledo, Toledo, Ohio, USA
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Vijay K Goel
- Engineering Center for Orthopaedic Research Excellence, Departments of Bioengineering and Orthopaedics, University of Toledo, Toledo, Ohio, USA
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Güvercin Y, Yaylacı M, Dizdar A, Kanat A, Uzun Yaylacı E, Ay S, Abdioğlu AA, Şen A. Biomechanical analysis of odontoid and transverse atlantal ligament in humans with ponticulus posticus variation under different loading conditions: Finite element study. Injury 2022; 53:3879-3886. [PMID: 36229242 DOI: 10.1016/j.injury.2022.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 09/22/2022] [Accepted: 10/05/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Ponticulus posticus (PP) is a variation of the bone bridge that appears in the first cervical vertebra and through which the vertebral artery passes. Odontoid fractures are common spinal bone fractures in older people. This study aims to investigate the effect of neck movements on the odontoid and transverse atlantal ligament (TAL) of people with PP variation from a biomechanical view. METHOD C1, C2, and C3 vertebrae of the occipital bone were analyzed using the finite element method (FEM). In this study, solid models were created with the help of normal (N), incomplete (IC), and asymmetric complete (AC) PP tomography images. The necessary elements for the models were assigned, and the material properties were defined for the elements. As boundary conditions, models were fixed from the C3 vertebra, and 74 N loading was applied from the occipital bone. Stress and deformation values in the odontoid and transverse atlantal ligament were obtained by applying 1.8 Nm moment in flexion, extension, bending, and axial rotation directions. RESULTS The stress and deformation values of all three models in odontoid and TAL were obtained, and numerical results were evaluated. In all models, stress and deformation values were obtained in decreasing order in rotation, bending, extension, and flexion movements. The highest stress and strain values were obtained in AC and the lowest values were obtained in N. In all movements of the three models, the stress and deformation values obtained in the TAL were lower than in the odontoid. CONCLUSION The greatest stresses and deformations obtained in spines (AC) with PP were found in the odontoid. This may help explain the pathogenesis of odontoid fractures in older people. First, this study explains the mechanism of the formation of neck trauma in people with PP and the need for a more careful evaluation of the direction of impact. Secondly, the study reveals that the rotational motion of the neck independent of PP has more negative effects on the odontoid.
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Affiliation(s)
- Yılmaz Güvercin
- Trabzon Kanuni Training and Research Hospital, Department of Orthopaed & Traumatol, 61000 Trabzon, Turkey.
| | - Murat Yaylacı
- Recep Tayyip Erdogan University, Biomedical Engineering MSc Program, 53100 Rize, Turkey; Recep Tayyip Erdogan University, Department of Civil Engineering, 53100 Rize, Turkey.
| | - Ayberk Dizdar
- Kocaeli University, Department of Biomedical Engineering, 41380 Kocaeli, Turkey.
| | - Ayhan Kanat
- Recep Tayyip Erdogan University, Department of Neurosurgery, 53100 Rize, Turkey.
| | - Ecren Uzun Yaylacı
- Karadeniz Technical University, Surmene Faculty of Marine Science, 61530 Trabzon, Turkey.
| | - Sevil Ay
- Department of Civil Engineering, Artvin Coruh University, 08100 Artvin, Turkey.
| | | | - Ahmet Şen
- University of Health Sciences, Trabzon Kanuni Training and Research Hospital, Anesthesiaa and Reanimation Department, 61100 Trabzon, Turkey.
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Li J, Li Y, Liu H, Lin S, Xie H, Pan R, Chang X, Lu J, Li S, Zhou J. Preliminary Study of an Adjustable, Wearable, Noninvasive Vest Providing Chest Compression to Assist with Breathing. J Biomed Nanotechnol 2022; 18:1172-1179. [PMID: 35854446 DOI: 10.1166/jbn.2022.3323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Respiratory muscle paralysis caused by acute cervical spinal cord injury usually leads to pulmonary ventilation dysfunction and even death from respiratory failure. In addition to invasive treatments such as mechanical ventilation, the utilization of noninvasive respiratory support equipment plays an important role in long-term assisted breathing. In this study, we describes a wearable, noninvasive vest with adjustable pressure that enables assisted breathing and with an automatic alarm, and we aims to explore its safety and effectiveness on healthy adult participants. The vest monitors the human heart rate and the blood oxygen index data in real time, the alarm is automatically activated when the data is abnormal. Eight healthy participants had no obvious discomfort during the test while wearing the vest. Lung volumes, antero-posterior diameters, and left-right diameters at the second, fourth, and sixth ribs levels were acquired before and after inflation of the vest airbag, the data acquired by the imaging analysis using chest computed tomography showed significant differences before and after the inflation (p < 0.05). Thus, The vest designed for this study can achieve uniform and effective compression of the thorax, significantly changed the size of the thorax and lungs. It is expected to be applied as noninvasive support for patients with respiratory dysfunction.
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Affiliation(s)
- Jianwen Li
- Department of Spine Surgery, Thoracic and Cardiovascular Surgery and Anesthesiology, Dongguan People's Hospital/Affiliated Dongguan Hospital, Southern Medical University, Dongguan, Guangdong, 523069, China
| | - Yujiang Li
- Department of Spine Surgery, Thoracic and Cardiovascular Surgery and Anesthesiology, Dongguan People's Hospital/Affiliated Dongguan Hospital, Southern Medical University, Dongguan, Guangdong, 523069, China
| | - Huazhu Liu
- Dongguan University of Technology International Institute of Microelectronics, Dongguan, Guangdong, 523808, China
| | - Shengxin Lin
- Dongguan University of Technology International Institute of Microelectronics, Dongguan, Guangdong, 523808, China
| | - Haihui Xie
- Department of Spine Surgery, Thoracic and Cardiovascular Surgery and Anesthesiology, Dongguan People's Hospital/Affiliated Dongguan Hospital, Southern Medical University, Dongguan, Guangdong, 523069, China
| | - Ruilan Pan
- Department of Spine Surgery, Thoracic and Cardiovascular Surgery and Anesthesiology, Dongguan People's Hospital/Affiliated Dongguan Hospital, Southern Medical University, Dongguan, Guangdong, 523069, China
| | - Xueqin Chang
- Department of Spine Surgery, Thoracic and Cardiovascular Surgery and Anesthesiology, Dongguan People's Hospital/Affiliated Dongguan Hospital, Southern Medical University, Dongguan, Guangdong, 523069, China
| | - Jianfeng Lu
- Department of Spine Surgery, Thoracic and Cardiovascular Surgery and Anesthesiology, Dongguan People's Hospital/Affiliated Dongguan Hospital, Southern Medical University, Dongguan, Guangdong, 523069, China
| | - Songbo Li
- Department of Spine Surgery, Thoracic and Cardiovascular Surgery and Anesthesiology, Dongguan People's Hospital/Affiliated Dongguan Hospital, Southern Medical University, Dongguan, Guangdong, 523069, China
| | - Jianping Zhou
- Department of Spine Surgery, Thoracic and Cardiovascular Surgery and Anesthesiology, Dongguan People's Hospital/Affiliated Dongguan Hospital, Southern Medical University, Dongguan, Guangdong, 523069, China
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Tieppo Francio V, Gill B, Rupp A, Sack A, Sayed D. Interventional Procedures for Vertebral Diseases: Spinal Tumor Ablation, Vertebral Augmentation, and Basivertebral Nerve Ablation-A Scoping Review. Healthcare (Basel) 2021; 9:1554. [PMID: 34828599 PMCID: PMC8624649 DOI: 10.3390/healthcare9111554] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 12/13/2022] Open
Abstract
Low back pain is consistently documented as the most expensive and leading cause of disability. The majority of cases have non-specific etiologies. However, a subset of vertebral diseases has well-documented pain generators, including vertebral body tumors, vertebral body fractures, and vertebral endplate injury. Over the past two decades, specific interventional procedures targeting these anatomical pain generators have been widely studied, including spinal tumor ablation, vertebral augmentation, and basivertebral nerve ablation. This scoping review summarizes safety and clinical efficacy and discusses the impact on healthcare utilization of these interventions. Vertebral-related diseases remain a top concern with regard to prevalence and amount of health care spending worldwide. Our study shows that for a subset of disorders related to the vertebrae, spinal tumor ablation, vertebral augmentation, and basivertebral nerve ablation are safe and clinically effective interventions to decrease pain, improve function and quality of life, and potentially reduce mortality, improve survival, and overall offer cost-saving opportunities.
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Affiliation(s)
- Vincius Tieppo Francio
- Department of Rehabilitation Medicine, The University of Kansas Medical Center (KUMC), Kansas City, KS 66160, USA;
| | - Benjamin Gill
- Department of Physical Medicine and Rehabilitation, The University of Missouri, Columbia, MO 65212, USA;
| | - Adam Rupp
- Department of Rehabilitation Medicine, The University of Kansas Medical Center (KUMC), Kansas City, KS 66160, USA;
| | - Andrew Sack
- Department of Anesthesiology, The University of Kansas Medical Center (KUMC), Kansas City, KS 66160, USA; (A.S.); (D.S.)
| | - Dawood Sayed
- Department of Anesthesiology, The University of Kansas Medical Center (KUMC), Kansas City, KS 66160, USA; (A.S.); (D.S.)
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