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Objective:To evaluate the feasibility of using cortical bone trajectory (CBT) screws in the osteoporotic thoracolumbar fixation by comparing the bone CT values at the bone-screw interface between traditional trajectory (TT) screws and CBT screws in patients with different bone densities.Methods:The high-resolution CT imaging data of thoracolumbar segments following thoracic or lumbar spine fractures from April 2020 to October 2022 were collected at The Second Hospital Affiliated to Wenzhou Medical University for retrospective analysis. They were divided into 3 groups: a normal bone mass group, an osteopenia group and an osteoporosis group. From each group 30 cases were chosen (90 cases in total, 36 males and 54 females). All the data were imported into Mimics 18.0 for three-dimensional bone reconstruction in which placement of TT and CBT screws was simulated on the vertebrae from T10 to L2 (non-fractured vertebrae). Regions of interest (ROI) where each simulated screw intersected the bone were segmented to measure their CT bone values. For each vertebra in each group, the relative difference percentage in average CT value of ROI between TT and CBT screws was calculated. The CT values of ROI were compared in the same group between TT and CBT screws from T10 to L2; the CT values of ROI were compared in the same screws among the 3 groups from T10 to L2; the CT values of ROI were compared between the CBT screws in the osteopenia and osteoporosis groups and the TT screws in the normal bone mass group; the relative difference percentages in average CT value of ROI between CBT and TT screws were compared between the 3 groups from T10 to L2.Results:The average CT value of ROI for CBT screws was significantly higher than that for TT screws from T10 to L2 in every group ( P< 0.001); as for the CT values of ROI for CBT and TT screws from T10 to L2, the osteoporosis group<the osteopenia group<the normal bone mass group ( P<0.001); from T10 to L2, the CT value of ROI for CBT screws in the osteopenia group was significantly higher than that for TT screws in the normal bone mass group ( P<0.001); the CT value of ROI for CBT screws in the osteoporosis group was not significantly different from that for TT screws in the normal bone mass group ( P>0.05). At T10, T12, and L1, the relative difference percentage in average CT value of ROI between CBT and TT screws was significantly higher in the osteopenia and osteoporosis groups than that in the normal bone mass group ( P<0.05), but there was no such a difference between the osteopenia and the osteoporosis groups ( P>0.05). At T11 and L2, there was no significant difference between the 3 groups in the relative difference percentage in average CT value of ROI between CBT and TT screws ( P>0.05). Conclusions:As bone mass decreases, both CBT and TT screws lead to a significant decrease in the bone density at the bone-screw interface. In patients with osteoporosis, CBT screws can still lead to a higher bone density at the bone-screw interface than TT screws, thus providing a higher strength at the bone-screw interface.
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Objective:To introduce a novel technique note about anterior decompression through transoral axis slide and rotation osteotomy (ASRO) and identify its imaging parameters related to osteotomy, and to explore its clinical application value.Methods:CT data of cervical spine of 90 subjects were collected, including 54 males and 36 females. The age ranged from 26 to 72 years, with an average age of 48.7 years. The Mimics software was used to reconstruct the atlantoaxial three-dimensional model. We plan to perform osteotomy on both sides of the axis of the vertebral body in the anteroposterior direction and the ASRO related anatomical parameters were measured, including the minimum osteotomy angle, the maximum osteotomy angle, the minimum and maximumdistance between the osteotomy trajectory and the inner side of the articular surface, the length of the upper articular surface of the axis side mass, the depth of osteotomy at the highest point and lowest point of the axial osteotomy surface and the minimum osteotomy depth. A 56-year-old female patient was admitted to the hospital due to atlantoaxial dislocation with failure of occipital-cervical fusion, difficulty walking, weakness and hypoaesthesia in four limbs. Imaging revealed that narrow space between the transversal walking wire and upper-posterior of the odontoid process, compressing the spinal cord from the front and the back respectively. The ASRO technique was performed on the patient under neuro-electrophysiological monitoring, and the osteotomy angle, osteotomy depth, narrowest width of the upper cervical spinal canal, the medullary, spinal cord angle were measured and Japanese Orthopaedic Association Scores (JOA) cervical myelopathy evaluation were performed after the operation to evaluate the surgical treatment effect.Results:The minimum osteotomy angle and the maximum osteotomy angle was 14.7°± 4.36° and 33.0°± 8.67°. The minimum and maximumdistance between the osteotomy trajectory and the inner side of the articular surface, and the length of the upper articular surface of the axis side mass was 6.0±1.80 mm, 12.2±3.17 mm, and 17.2±1.90 mm, the ratio of the former two to the latter was 34%±8.7% and 70%± 15.0%. The depth of osteotomy at the upper edge, lower edge and narrowest place of the axial osteotomy surface were 6.0±1.80 mm, 12.2±3.17 mm and 17.2±1.90 mm. The postoperative imaging of the patient showed that the osteotomy angle was 17.1° on left side and 16.5° on right side, and the depth of osteotomy at the upper edge, lower edge and narrowest place of the axial osteotomy surface were 17.1 mm, 13.2 mm, and 9.1 mm on left side, and 17.4 mm, 11.8 mm, 8.46 mm on right side. All measured values met the ranges which were shown in the imaging anatomical study. The narrowest width of the upper cervical spinal canal increased from 6.58 mm to 15.28 mm, the medullary spinal cord angle increased from 131.7° to 153.8°postoperatively, and the cervical spine JOA score recovered from 6 points to 14 points, suggesting that the postoperative spinal canal space is obvious increased, the compression on the front of the spinal cord was significantly reduced. The patient's symptoms improved significantly.Conclusion:ASRO technique is a good choice for salvage of failed posterior occipitocervical fusion and some irreducible atlantoaxial dislocation because of the anterior bony fusion. It could direct decompress the spinal cord anteriorly, avoid the odontoid resection, which is a safe and feasible new technique.
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The morbidity of scoliosis in adolescents in China is about 3%-5%, 80%-85% of the patients are adolescent idiopathic scoliosis (AIS), whose etiology is unknown. Scoliosis is a structural spine disease occurring during puberty or before skeletal maturation. Scoliosis has a greatly negative impacton not only the growth and development of adolescent spine, but also the mental health of adolescents. Ocular disease is a common clinical disease in which the eye ball and its accessory structures have structural abnormalitiesordys function. Ocular disease snotonly bring in convenience to patients's life, but also may induce diseases in other organs. Recent studies have shown that various ocular diseases may have a potential impact on scoliosis, and quite a fewof patients with certain ocular diseases have higher incidence rate of scoliosis. Therefore, in this article, the etiological relationship between eye diseases and scoliosis will be summarized, which provides guidance and direction for the etiological research of scoliosis and eye diseases. After sorting out, we found that the relationship between ophthalmic diseases and scoliosis mainly concentrated in the following four aspects: choroidal thickness and scoliosis, Goldenhar syndrome, gene level and strabismus. Among them, the genetic relationship is the most complex, about 40 kinds of gene or chromosome abnormalities have been found to cause ocular diseases and scoliosis; Goldenhar syndrome, also known as oculo-auriculo-vertebral spectrum, first revealed the relationship between ocular diseases and scoliosis, but the current statistical relationship is still very vague. There are few studies on choroidal thickness and strabismus at home and abroad, which are statistical studies, only revealing the relationship between choroidal thickness and scoliosis, and there are many defects in the study of choroidal thickness, which need further research.
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Objective To measure anatomic data related to the thyroid cartilage and cricoid cartilage and to analyze their implications for anterior spine surgery.Methods From January 2015 to February 2017,Cervical spine CT image data of 309 normal adults (195 males,114 females) in our department were retrospectively analyzed.The transverse diameters of the thyroid cartilage and the cricoid cartilage was measured at three different levels as follows:the superior border of the thyroid cartilage(SBTC),the inferior border of the thyroid cartilage(IBTC),and the inferior border of the cricoid cartilage(IBCC).At those levels,the corresponding level and transverse diameter of the cervical vertebra or intervertebral disc were also determined.Differences of anatomic parameters for each gender and level,and the relationship between the transverse diameter and height and weight were analyzed.Results The transverse diameters of the thyroid cartilage or cricoid cartilage and the corresponding cervical vertebra or intervertebral disc were associated significantly with height and weight.The transverse diameters of the thyroid cartilage or cricoid cartilage gradually decreased from the level of SBTC (44.30±4.97 mm) to the level of IBTC (41.39±4.62 mm),and the latter to the level of IBCC (26.36±3.79 mm),but increased from the level of SBTC (27.47±2.66 mm) to the level of IBTC (29.00±3.15 mm),and the latter to the level of IBCC (31.48±3.49 mm) for the cervical vertebra or intervertebral disc.Differences of the transverse diameters of the thyroid cartilage or cricoid cartilage and the cervical vertebra or intervertebral disc on three levels had statistical significance.The transverse diameters of each level had individual differences,while men were greater than those for women.The thyroid cartilage was routinely located above the C5 (56.9％ for male,86.0％ for female).Differences of the frequency between men and women on three levels had statistical significance.Conclusion The Individual and sex differences in the location of the thyroid cartilage and the size of the thyroid cartilage and the cricoid cartilage provided anatomical basis for predicting the difficulty of intraoperative exposure,incidence of esophageal injuries and early postoperative dysphagia.
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Objective To analyze the incidence and risk factors of contralateral radiculopathy in patients after unilateral transforaminal lumbar interbody fusion (TLIF) surgery.Methods A retrospective study was conducted within 587 patients (average age 57.1 years,range 19-71 years) who underwent unilateral TILF from January 2010 to January 2014 in our hospital,including 334 males and 253 females.Patients were divided into a symptomatic group and an asymptomatic group.The causes of contralateral neurological symptom were evaluated according to the radiological data.The difference of pre-and post-operative contralateral foramen area (CFA),segmental angle (SA) and the clinical treatment outcomes (VAS,JOA score) were compared between two groups.Results Patients were followed up for 9-21 months,average 15.1 months.Post-operative contralateral radiculopathy occurred in 28 (4.8％) of the patients who underwent unilateral TLIF,including contralateral foraminal stenosis in 16 (57.1％,16/28),screw malposition in 5 (17.9％,5/28),contralateral lateral recess stenosis and/or newly developed disc herniation in 3 (10.7％,3/28),hematoma in 1 (3.6％,1/28),cement compression in 1 (3.6％,1/28),and unknown origin in 2 patients (7.1％,2/28).Nineteen (3.2％,19/587) of the 28 patients received revision surgery because of ineffective conservative treatment.Compared with the asymptomatic group,the difference of pre-and post-operative CFA was significantly smaller (-13.8±13.2 mm2) in symptomatic group,while the SA was significantly greater (7.0°±9.8°) in symptomatic group.The JOA score at 3 months after the surgery was significantly improved in asymptomatic group (63.0％±18.1％,P＜0.05).Conclusion The incidence rate of contralateral neurological symptom was 4.8％ in the present study.The potential risk factors associated with contralateral radiculopathy were predominantly contralateral foraminal stenosis and screw malposition.The excessive restoration of SA might have an effect on contralateral nerve compression,which should arouse the attention of the surgeon.
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Sagittal spinal deformity is one of the common reasons of sagittal disequilibrium which can cause torso forward,cardiopulmonary dysfunction,fiat back syndrome,intractable low back pain and a series of cases,affecting the patients' life quality and increasing huge economic burden on society.The treatment of sagittal spinal deformity has been a hot spot in the field of clinical spinal surgery and its main purpose is to reconstruct the overall balance of the body,which would relieve pain and improve life quality.Pedicle subtraction osteotomy is considered to be one of the most effective and safe method for correcting spinal deformity with excellent reconstruction of sagittal plane balance.However,the calculation of the angle required during surgery is still a problem,because insufficient or excessive correction will lead to the secondary sagittal disequilibrium.Therefore,an accurate calculation of the angle required during pedicle subtraction osteotomy is particularly important.In recent years,scholars believe that the sagittal equilibrium depends on a fragile balance among spinal curvature,pelvic shape and position of the lower limbs.Scholars have developed a standard of sagittal equilibrium based on their own research,and proposed a variety of quantitative analysis methods to calculate the angle required during pedicle subtraction osteotomy:trigonometric method,exact angle calculation method,overall balance method,spine femoral angle measurement method,digital virtual method,graphic method,acoustic meati to hip axis method and hilus pulmonis to hip axis method,which provide important theoretical bases for the treatment of sagittal spinal deformity.
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Objective To study the protection of vanillin derivative VND3207 on the cytogenetic damage of mouse bone marrow cell induced by ionizing radiation.Methods BALB/c mice were randomly divided into five groups:normal control group,2 Gy dose irradiation group,and three groups of 2 Gy irradiaiton with VND3207 protection at doses of 10,50 and 100 mg/kg,respectively.VND3207 was given by intragastric administration once a day for five days.Two hours after the last drug administration,the mice were irradiated with 2 Gy γ-rays.The changes of polychromatophilic erythroblasts micronuclei (MN),chromosome aberration (CA) and mitosis index (MI) of mouse bone marrow cells were observed at 24 and 48 h after irradiation.Results Under the protection of VND3207 at the dosages 10,50,100 mg/kg,the yields of poly-chromatophilic erythroblasts MN and CA of bone marrow cells were significantly decreased(t = 2.36-4.26,P ＜ 0.05),and the marrow cells MI remained much higher level compared with the irradiated mice without drug protection (t = 2.58,2.01,P ＜ 0.05).The radiological protection effect was drug dose-dependent,and the administration of VND3207 at the dosage of 100 mg/kg resulted in reduction by 50% and 65% in the yields of MN and CA,respectively.Conclusions VND3207 had a good protection effect of on γ-ray induced cytogentic damage of mouse bone marrow cells.