Analysis of 150 cases from measuring sternal angle corresponded to thoracic plane by three-dimensional recon-struction of spiral CT / 局解手术学杂志

Objective To measure the sternal angle corresponded to thoracic plane by three-dimensional reconstruction of spiral CT , and to explore the accurate positioning methods and the preoperative assessment of cervicothoracic junction lesions .Methods Selected 42 cases of normal bone mass , 48 cases with bone loss , and 60 cases of osteoporosis who were diagnosed by dual-energy X-ray absorptiometry , and measured the location of thoracic sternal angle corresponded to the thoracic spine and thoracic kyphosis angle through the volume recon -struction data of the 16-slice spiral CT chest examinations .Results The range of sternal angle corresponded to thoracic plane was measure-ment units ⅢtoⅥ.The measure unit Ⅳwas the most, accounting for about 55%.There was no statistical significance between the position of sternal angle corresponded to thoracic plane and the relationship of bone mass , which required further study .The position of sternal angle corresponded to thoracic plane was associated with the thoracic kyphosis angle .The larger the thoracic kyphosis angle , the lower the corre-sponding position was .Conclusion The thoracic segment corresponded to the sternal angle is not a constant or accurate plane , which is not properly concerned as an accurate positioning mark to the thoracic segment .The measurement of the thoracic sternal angle was corresponded to the thoracic spine location , and its co-relationship evaluation between the thoracic kyphosis angle was vital for the accurately positioning of cervico-thoracic junction area lesions , the pre-assessment methods of surgical treatment , approach selection , and different methods for ster-num and other such contents .This research was of important clinical significance .

Finite element analysis on different spine reconstruction methods after total spondylectomy of cervicothoracic spine / 医用生物力学

Objective To establish 3D finite element of human cervicothoracic spine C5-T2 based on CT images, and explore effects on stability of the cervicothoracic spine after total spondylectomy (TS) by using various combinations of internal fixation devices (pedicle screw, titanium mesh, steel plate), including the stress distributions on these internal fixation devices. Methods The intact finite element model of cervicothoracic spine C5-T2 was established and validated by comparing the model’s range of motion (ROM) with that of other in vitro experiments. Then four reconstruction models after TS of cervical spine segment C7 were established: TM+AP+DPS model (titanium mesh + anterior plate + posterior double-segmental pedicle screw), TM+AP+SPS model (titanium mesh + anterior plate + posterior single-segmental pedicle screw), TM+DPS model (titanium mesh + posterior double-segmental pedicle screw), AP+DPS model (anterior plate + posterior double-segmental pedicle screw). ROM of each reconstruction model under flexion, extension, lateral bending and rotation and stress distributions on these internal fixation devices were then analyzed. Results ROM of the reconstruction segments was greatly reduced by over 93% as compare to that of the intact model. Stress concentration phenomenon appeared on the titanium mesh in the TM+AP+SPS model. Conclusions The fixation effects of four reconstruction models are similar. Stresses on 3 DPS fixed-models are more evenly distributed, indicating that the overall stability of DPS fixed-model is superior to that of SPS fixed-model.

Should We Recommend Ultrasonography for an Incidental Thyroid Nodule on Additional Cervicothoracic Sagittal T2-Weighted Image of Lumbar Spine MRI?

PURPOSE: To determine whether we should recommend ultrasonography (US) for an incidental thyroid nodule identified by additional cervicothoracic sagittal T2-weighted image (C-T sag T2WI) of lumbar spine magnetic resonance imaging (MRI). MATERIALS AND METHODS: A retrospective study of 61 patients who underwent both lumbar spine MRI and thyroid US between December 2011 and April 2015 was conducted. For all US-found thyroid nodules > 1 cm, investigators evaluated whether there was any correlation between thyroid nodule detectability by C-T sag T2WI and US features such as echogenicity, composition, or suspicion of malignancy. RESULTS: Solid hypoechoic (2/4; 50%) or mixed echoic nodules (4/8; 50%) appeared to be found relatively more easily by C-T sag T2WI than more benign-looking solid isoechoic (1/4; 25%) or spongiform nodules (0/6; 0%). Among six nodules with ultrasonographic suspicion for malignancy, only one nodule was detected by C-T sag T2WI. CONCLUSION: If an incidental thyroid nodule is seen by C-T sag T2WI, it would be better to recommend thyroid US for identifying malignancy.

The Value of Additional Cervicothoracic Spine Sagittal T2-weighted Images Included in Routine Lumbar Spine MR Imaging

PURPOSE: To evaluate the usefulness of cervicothoracic spine sagittal T2-weighted images (CT SAG T2WIs) included in routine lumbar spine MRI. MATERIALS AND METHODS: Institutional review board approval was obtained and informed consents were waived for this retrospective study. The study group comprised 2,113 patients who underwent lumbar spine MRI from January 2005 to December 2005. CT SAG T2WIs were added in the routine lumbar spine MRIs. Radiologic reports were reviewed retrospectively for pathologic lesions on CT SAG T2WIs by one radiologist. Information of additional cervical or thoracic spine MRI and/or CT for further evaluation of positive findings on CT SAG T2WIs and their treatment were collected by retrospectively reviewing medical records. RESULTS: The CT SAG T2WIs revealed 142 pathologic lesions in 139 (6.58%) of the 2,113 patients. They were easily obtained without positional change in a scan time of less than 2 minutes. Additional cervical or thoracic spine MRI and/or CT for positive findings on CT SAG T2WIs were performed in 13 patients. Seven patients underwent surgical treatment. CONCLUSION: CT SAG T2WIs included in routine lumbar spine MRI were useful in finding the pathologic lesions in cervicothoracic spine for the patients who assumed to have lesions in lumbar spine.

Late Occurrence of Cervicothoracic Ossification of Posterior Longitudinal Ligaments in a Surgically Treated Thoracic OPLL Patient

Ossification of the posterior longitudinal ligament (OPLL) in the thoracic spine is rare, even in the Far East. A 45-year-old female presented with a 4-month history of progressive motor weakness in the lower extremities, numbness below the midthoracic area, and spastic gait disturbance. Neuroradiological examinations revealed massive OPLLs at the T4-T6 levels with severe anterior compression of the spinal cord. Anterior decompressive corpectomies with bone grafts were performed from T4 to T6 using a trans-thoracic approach. After surgery, the patient made an uneventful recovery. However, eleven years after surgery, the patient developed recurrent lower extremity weakness and spastic gait disturbance. De novo OPLLs at the C6-T2 levels were responsible for the severe spinal cord compression on this occasion. After second surgery, paralysis in both legs was resolved. We present a rare case of late cervicothoracic OPLL in a patient surgically treated for thoracic OPLL.

Surgical Treatment of Spontaneous Cervicothoracic Spine Epidural Hematoma without Risk Factors: A Case Report / 대한척추외과학회지

Spinal epidural hematomas can often result from a spinal tap, trauma, pregnancy, bleeding diathesis, vascular malformations, hypertension, etc. However, a spontaneous spinal epidural hematomas (SSEH) without any risk factors are relatively rare clinical entities and the clinical suspicion is very difficult in an acute setting. The outcome for patients with SSEH usually is determined by the speed of the diagnosis and the initiation of the appropriate treatment. We present a good surgical outcome of a rare case of acute SSEH without any risk factors. The patient presented initially with paresis of both upper and lower extremities, upper thoracic and neck pain and mild headache. We report the diagnosis and treatment method of SSEH in this case with a review of the relevant literature.

Anterior approach operation for the treatment of cervicothoracic vertebral tumors / 第三军医大学学报

Objective To investigate the means of different anterior surgical approaches for cervicothoracic vertebral tumors, tumor excision procedure and reconstruction. Methods The clinical manifestation of tumors, different operative approaches, surgical procedures and prognosis of 7 cases admitted in our hospital from March, 1999 to May, 2002 were reported. Results After a follow up of 3 to 28 months, neurological function was improved significantly in all cases. One case with angiosarcoma and 2 cases with metastatic adenocarcinoma (C7, C6 7, T1) died of metastasis in other multiple locations and system failure in 3, 8 and 13 months after surgery respectively. No recurrent tumor focus was found at the operative sites during the follow up period. Conclusion The operative approach, surgical procedure and cervicothoracic spine anterior reconstruction should be selected according to the nature and location of tumors.