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Objective To study the anatomical structure of normal and scoliotic thoracic vertebrae in adolescents aged 12-15 years in Northern Shanxi Province, to provide detailed information for pedicle screw placement, and to provide data references for screw size design. Methods Totally 120 cases of normal thoracolumbar CT of 120 adolescents aged 12 to 15 years and 30 cases of adolescent idiopathic scoliosis were collected in Northern Shaanxi Province. The raw data of thoracolumbar tomographic images scanned continuously were imported into Mimics16. 0 software for analysis and measurement in DICOM format. Measurement indicators: pedicle width, pedicle height, pedicle length, transverse diameter of spinal canal, longitudinal diameter of spinal canal, transverse pedicle angle,maximum transverse pedicle angle, sagittal pedicle angle and pedicle area. Results Pedicle width:12-13 years old, T
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BACKGROUND: With the increasing number of osteoporosis vertebrae compression fracture patients, it is difficult to reach a consensus on how much bone cement is given in percutaneous kyphoplasty surgery. OBJECTIVE: To investigate the relationship of different doses of bone cement with clinical efficacy and bone cement leakage using Mimics software, and to explore the safe and effective bone cement injection threshold in percutaneous kyphoplasty for cases with osteoporosis vertebrae compression fracture. METHODS: Forty-three patients with osteoporosis vertebrae compression fracture undergoing percutaneous kyphoplasty were included and randomly divided into two groups. The amount of bone cement injected into the vertebral body and the volume of vertebral body were designed by Mimics software. The volume ratio of bone cement was calculated according to the average volume of upper and lower vertebrae. In groups A and B, 24% and 15% of bone cement were injected according to the bone cement volume ratio (bone cement volume/vertebral volume ratio) recognized by most documents. The differences of pain, leakage rate, Cobb’s angle and refracture rate between the two groups were evaluated by follow-up. RESULTS AND CONCLUSION: (1) All patients were followed up for 6-24 months. (2) There were significant differences in visual analogue scale score between the two groups between preoperation and at each time point after operation, the first day after operation and the fifth day (before discharge), three months and 12 months after operation (P 0.05). (3) There were 5 cases (24%) with leakage in group A and 2 cases (10%) in group B; there was no significant difference in the leakage rate of bone cement between the two groups (P > 0.05). (4) There were significant differences in Cobb’s angle between the two groups between different time points after operation and preoperation (P 0.05). (5) There were 3 cases of refracture in group A (14%) and 2 cases in group B (10%). There was no significant difference between the two groups (P > 0.05). (6) Above results confirm that it was accurate for us to evaluate bone cement volume according to the fracture vertebral body volume by 15% and 24% injection of bone cement using Mimics software, which showed less complications and short-term satisfactory clinical efficacy.
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We reported two cases of jockeys who sustained fracture/dislocation of the mid-thoracic spine due to traumatic falls during horse racing. We examined the injury mechanism based upon the patients' diagnostic images and video footage of races, in which the accidents occurred. Admission imaging of patient 1 (a 42 years old male) revealed T5 burst fracture with bony retropulsion of 7 mm causing complete paralysis below T5/6. There existed 22° focal kyphosis at T5/6, anterolisthesis of T5 relative to T6, T5/6 disc herniation, cord edema and epidural hemorrhage from T4 through T6, and cord injury from C3 through C6. Admission imaging of patient 2 (a 23 years old male) revealed T4/5 fracture/dislocation causing incomplete paralysis below spinal level. There existed compression fractures at T5, T6, and T7; 4 mm anterior subluxation of T4 on T5; diffuse cord swelling from T3 through T5; comminuted fracture of the C1 right lateral mass; right frontal traumatic subarachnoid hemorrhage; and extensive diffuse axonal injury. The injuries were caused by high energy flexion-compression of the mid-thoracic spine with a flexed posture upon impact. Our results suggest that substantially greater cord compression occurred transiently during trauma as compared to that documented from admission imaging. Video footage of the accidents indicated that the spine buckled and failed due to abrupt pocketing and deceleration of the head, neck and shoulders upon impact with the ground combined with continued forward and downward momentum of the torso and lower extremities. While a similar mechanism is well known to cause fracture/dislocation of the cervical spine, it is less common and less understood for mid-thoracic spine injuries. Our study provides insight into the etiology of fracture/dislocation patterns of the mid-thoracic spine due to falls during horse racing.
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Animals , Humans , Male , Accidental Falls , Horses , Joint Dislocations , Spinal Cord Injuries/etiology , Spinal Fractures/etiology , Spinal Injuries , Thoracic Vertebrae/injuriesABSTRACT
Resumen La fractura de "clay shoveler" es una fractura poco frecuente de la apófisis espinosa de las vértebras cervicales o torácicas superiores, más comúnmente entre C6 y T6 producida de manera aguda o crónica por fuerzas rotacionales ejercidas a nivel cervical en la labor de "palear", aunque también se han reportado casos asociados a la práctica de algunos deportes. Se presenta el caso de un péon agrícola de 43 años de edad que consulta por cervicalgia y sensación de inmovilidad luego de un movimiento brusco durante un levantamiento de tierra con pala, siendo que el ente asegurador no establece relación de causalidad, por lo que demanda a nivel judicial para valoración médico legal, documentándose fractura de "clay shoveler" en C7 y T1 según estudios radiológicos. La valoración médico legal del caso, que se sustentó en la documentación médica y estudios radiológicos, permitió determinar que la lesión evidenciada era consecuencia del accidente laboral reportado, estableciéndose la relación causal.
Abstract Clay shoveler's fracture is an infrequent lesion of the spinous process of the cervical or upper thoracic vertebrae, mainly between C6 and T6, produced acutely or chronically because of rotational forces exerted at the cervical level during shoveling, but some cases have been reported as a result of the practice of sports. We present the case of a 43-year old manual laborer who consulted because of cervical pain and range of motion limitation after a sudden move performed during shoveling, diagnosed with a clay shoveler's fracture in C7 and T1, treated conservatively. The patient was discharged after finishing treatment, since the insurance company dismissed causality. The medico legal assessment of the case, based on medical documentation, radiological findings and an Orthopedics consult, helped stablish causality since it was determined that the fracture was a result of the accident reported.
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Humans , Male , Adult , Cervical Vertebrae/diagnostic imaging , Spinal Fractures , Costa RicaABSTRACT
@#The incidence of neurenteric cyst (NC) is rare amongst spine tumors. It is most often asymptomatic but may present with sensory and motor symptoms. When associated with thoracic vertebra fusion it is not reported before, this complicates the placement of pedicle screw during posterior instrumentation. Herein, we report a case of thoracic spinal neurenteric cyst in a 40-year-old man that presents with chronic back pain, left lower limb weakness and numbness. Elective excision of NC over T6-T7 with laminectomy and multilevel posterior instrumentation was successfully performed with significant improvement of the symptoms. Neurenteric cyst is a rare spinal cord lesion which may cause permanent neurological sequalae. Complete surgical excision with spine fixation in this case provides good long-term outcome.
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Objective To compare biomechanical properties of cortical bone trajectory (CBT) screw and traditional trajectory screw for fixing upper-middle thoracic spine. Methods The tomography images were obtained by CT scanning of normal T7 and T8 segments, and the three-dimensional (3D) model of T7-8 was reconstructed by Mimics software. The finite element model of upper-middle thoracic spine was established by optimizing FreeForm model and pre-processing function of ANSYS software. On this basis, the CBT screw and pedicle screw fixation models after discectomy were established, and 5 N·m flexion, extension, lateral bending and rotation loads were applied to the two model groups, respectively. The displacement and peak stress of vertebrae and implants under different working conditions were compared and analyzed. Results Under different loading conditions, the maximum displacement of CBT screw group was lower than that of pedicle screw group, and the range of motion of CBT screw group was lower than that of pedicle screw group. The stress level of both models was close, and the stress of CBT screw group was slightly lower than that of pedicle screw group. Under the load of flexion, extension and rotation, the maximum vertebral stress of pedicle screw group decreased by 31%, 17% and 18% compared with that of CBT screw group, and under lateral bending load, the vertebral stress of CBT screw group was 20% lower than that of pedicle screw group. Under the load of flexion and rotation, the maximum stress of pedicle screw group decreased by 2% and 11%; however, the maximum stress of CBT screw group was 11% and 1% lower than that of pedicle screw group. Conclusions The stability of CBT screw was better than that of pedicle screw, and the overall stress distribution was similar to that of pedicle screw. However, the vertebral stress distribution of CBT group was slightly inferior. The research findings provide a theoretical basis for the clinical application of cortical screw fixation after the failure in pedicle screw fixation for the upper-middle thoracic vertebrae.
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@#Introduction: Posterior percutaneous instrumentation may represent a challenge when multiple levels need to be instrumentated, especially when including the upper thoracic spine. The aim of the present study was to evaluate the technical feasibility and the long-term outcome of such long constructs in different surgical conditions. Materials and Methods: This investigation was a retrospective cohort study which included patients who underwent thoraco-lumbar percutaneous fixations. We collected clinical, surgical and radiological data, with a minimum follow-up of 24 months. Health-related quality-oflife, residual pain, instrumentation placement, and complications were studied. Results: A total of 18 procedures were enrolled, in which 182 screws were implanted, (170 positioned in thoracic and 12 in lumbar pedicles, respectively). No surgical complications or hardware failure occurred in our series, 6 out of 182 (3,2%) screws had a partial pedicle breach, without neurological impairment or need for surgical revision. Conclusion: According to our results, a fully posterior percutaneous approach for long thoraco-lumbar spine instrumentation can be considered safe and reproducible, although an adequate training is strictly required.
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Objective To compare the rigidity at upper thoracic spine among the anterior transpedicular screw-plate system (ATPSPS),posterior transpedicle screw-rod system (PTPSRS) and anterior vertebral body screw-plate system (AVBSPS).Methods Twelve embalmed cadaver specimens were divided into three groups.The specimens in each group were randomly allocated to use the above 3 different internal fixation devices for conducting fixation.The stiffness of each specimen on the directions of axial compression,flexion and extension,and left and right lateral bending was detected under original status.All specimens conducted the simulated corpectomy of T2 (damage status).Then the rigidity on various directions was re-detected on the damage status.The corresponding internal fixation system was selected for conducting the install and fixation according to the grouping results.The intra-group and inter-group rigiditieson different directions were compared amongoriginal status,damage status and after internal fixation.Results The rigidities on different directions under original and damage statushad no statistical difference among various groups (P＜0.05).After conducting fixation in each group,the rigidity after fixation on different directions had statistically significant difference among groups(P＜0.05).The stiffness of anterior flexion in the ATPSPS group was greater than that in the other two groups (P＜0.05).The rigidity of axial compression and extension in the PTPSRS group was greater than that in the other two groups,the difference among groups was statistically significant (P＜0.05).The stiffness of lateral bending in the AVBSPS group was smaller than that in the other two groups,the difference was significant (P＜0.05),but the difference between the other two groups had no statistical significance (P＞0.05).Conclusion The rigidity of ATPSPS in all directions is higher than that of AVBSPS.The anterior flexion rigidity is greater than PTPSRS,and the axial compression and extension rigidity are less than PTPSRS,but the lateral bending rigidity is equivalent to PTPSRS.
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Resumen El carcinoma de células acinares es una neoplasia poco frecuente que se presenta principalmente en las glándulas salivales. Presentamos el caso de un paciente femenino de 48 años con dolor, paresia palpebral derecha y aumento de volumen. Biopsia que confirma diagnóstico, manejada con exenteración orbitaria derecha más RT. Durante seguimiento seis años después se presenta dolor columna dorsal, RMN con lesión osteoblástica en T2 biopsia con metástasis de carcinoma de células acinares. Debido a su baja incidencia el comportamiento del carcinoma de células acinares de la glán dula lacrimal es incierto, no hay reportes en la literatura de lesiones metastásicas únicas en columna.
Abstract Acinar cell carcinoma is a rare neoplasm occurs primarily in the salivary glands. We report the case of a female patient of 48 years with pain, right palpebral paresis, and increased volume. Biopsy confirmed diagnosis, handled right exenteration more RT. During follow-up six years after dorsal spine pain, MRI with T2 lesion biopsy osteoblastic metastatic carcinoma of acinar cells. Because of its low incidence behavior acinar cell carcinoma of the lacrimal gland is uncertain, there are no reports in the literature of metastatic lesions unique column.
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Humans , Female , Middle Aged , Spine , Carcinoma, Acinar Cell , Acinar Cells , Neoplasm MetastasisABSTRACT
Ossification of the ligamentum flavum (OLF) is a rare condition in which the ligamentum flavum, due to mechanical, biological and genetic factors, becomes ossified. Due to its nature and anatomic location, OLF produces symptoms characteristic of spinal cord compression. The diagnostic confirmation is based primarily on imaging tests such as computed tomography (CT) and magnetic resonance imaging (MRI). Ossification of the ligamentum flavum most often affects Asian populations, rarely occurring in black people. The authors report a case of a 61-year-old black man with progressive paraparesis due to OLF, and review the literature regarding the pathology's prevalence, pathogenesis, clinical features, diagnosis, treatment and prognosis.
A ossificação do ligamento flavo (OLF) é uma doença rara na qual o ligamento flavo se torna ossificado devido a fatores mecânicos, biológicos e genéticos. Devido à sua natureza e localização anatômica, a OLF produz sintomas característicos de compressão da medula espinhal. A confirmação diagnóstica baseia-se principalmente em exames de imagem, como tomografia computadorizada (TC) e ressonância magnética (RM). A OLF afeta mais comumente populações asiáticas, raramente sendo observada em pacientes negros. Os autores relatam o caso de um homem negro de 61 anos com paraparesia progressiva decorrente de OLF com uma revisão da literatura a respeito da prevalência, patogênese, aspectos clínicos, diagnóstico, tratamento e prognóstico desta patologia.
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Humans , Male , Middle Aged , Osteogenesis , Spinal Cord Compression , Ligamentum Flavum , Ossification of Posterior Longitudinal LigamentABSTRACT
Abstract Introduction: Biomedical studies involve complex anatomical structures, which require specific methodology to generate their geometric models. The middle segment of the thoracic spine (T5-T10) is the site of the highest incidence of vertebral deformity in adolescents. Traditionally, its geometries are derived from computed tomography or magnetic resonance imaging data. However, this approach may restrict certain studies. The study aimed to generate two 3D geometric model of the T5-T10 thoracic spine segment, obtained from graphical images, and to create mesh for finite element studies. Methods A 3D geometric model of T5-T10 was generated using two anatomical images of T6 vertebra (side and top). The geometric model was created in Autodesk® Maya® 3D 2013, and the mesh process in HiperMesh and MeshMixer (v11.0.544 Autodesk). Results The T5-T10 thoracic segment model is presented with its passive components, bones, intervertebral discs and flavum, intertransverse and supraspinous ligaments, in different views, as well as the volumetric mesh. Conclusion The 3D geometric model generated from graphical images is suitable for application in non-patient-specific finite element model studies or, with restrictions, in the use of computed tomography or magnetic resonance imaging. This model may be useful for biomechanical studies related to the middle thoracic spine, the most vulnerable site for vertebral deformations.
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STUDY DESIGN: Retrospective case series. PURPOSE: To describe a novel single incision that combines anterior and posterior approaches for decompression and instrumented fusion to treat tuberculosis of the thoracic spine and study the neurological and radiological outcomes. OVERVIEW OF LITERATURE: Tuberculosis of the spine remains a major health issue in many developing countries. The options for treating tuberculosis of the thoracic spine include the anterior, posterior, and combined approaches, each with its advantages and disadvantages. METHODS: Totally, 143 patients with tuberculosis of the thoracic spine were surgically treated using the “Versatile approach”. Posterior fixation was performed using sublaminar wires and a Hartshill rectangle in all patients. Anterior reconstruction was accomplished using bone graft harvested from autologous rib, iliac crest, or fibula. RESULTS: The study included 45 males and 98 females, with a mean age of 33.18±18.65 years (range, 3–82 years) and a mean follow-up of 60.23±24.56 months (range, 18–156 months). Kyphosis improved from a mean value of 24.02 preoperatively to 10.25 postoperatively. A preoperative neurological deficit was observed in 131 patients, with 130 patients regaining ambulatory power. No patient had deterioration of neurological status following surgery. Fusion was achieved in all cases. The visual analogscale score improved from an average score of 7.02 preoperatively to 1.51 at final follow-up. Eight patients had superficial macerations, which healed spontaneously. One patient had buckling of the anterior graft, and one patient had implant breakage following road traffic accident. CONCLUSIONS: The “Versatile approach” is an effective, single-stage, single-incision method that combines anterior and posterior approaches for the surgically treating tuberculosis of the thoracic spine. It offers the advantage of direct visualization for decompression and reconstruction of the anterior and posterior vertebral columns, thus providing an excellent, long-lasting clinical outcome.
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Female , Humans , Male , Accidents, Traffic , Decompression , Developing Countries , Fibula , Follow-Up Studies , Kyphosis , Methods , Retrospective Studies , Ribs , Spine , Transplants , TuberculosisABSTRACT
Ganglioneuroma (GN) is a rare benign tumor of neural crest origin usually found in the abdomen, but may occasionally present at uncommon sites including the cervical, lumbar, or sacral spine. However, GNs of thoracic spine are extremely rare. In this report, we describe a 12-year-old girl with giant GN in the thoracic spine, who underwent successful resection (T1–4 level) of the tumor. Histopathological examination confirmed the diagnosis. GN should be considered in the differential diagnosis of any paraspinal mass. A high index of suspicion and correlation of clinico-radiological findings is necessary in differentiating a large benign tumor from a malignant growth. Complete surgical excision is the treatment of choice; however tumor size and location need to be considered for the surgical approach (one-step or multiple surgeries). Close follow-up after surgery is mandatory.
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Child , Female , Humans , Abdomen , Diagnosis , Diagnosis, Differential , Follow-Up Studies , Ganglioneuroma , Neural Crest , SpineABSTRACT
Capillary hemangiomas are common benign vascular tumors on skin and soft tissues, but developing as an intradural and extramedullary (IDEM) tumor in spine is extremely rare. In this report, we present IDEM tumor compressing thoracic cord in T2–3 level with extensive arachnoiditis below the tumor level in a 60-year-old man. The lesion was removed and histological diagnosis was capillary hemangioma. Prompt diagnosis and resection are important to avoid neurological deterioration from acute hemorrhagic condition. Simultaneous arachnoiditis may be originated from old subarachnoid hemorrhage associated tumor before diagnosis, and we suggest it as a helpful diagnostic feature to suspect vascular tumors such as capillary hemangioma.
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Humans , Middle Aged , Arachnoid , Arachnoiditis , Capillaries , Diagnosis , Hemangioma, Capillary , Skin , Spinal Cord , Spine , Subarachnoid HemorrhageABSTRACT
We report a case of a 45-year-old man with a complaint of both leg weakness and hypoesthesia. Radiological evaluation revealed an osteolytic lesion of the ninth thoracic vertebra. The patient underwent posterior corpectomy with total excision of the tumor, mesh cage insertion with posterior screw fixation and subsequent radiotherapy. Histology confirmed the diagnosis of Langerhans cell histiocytosis (LCH). This case report presents the diagnostic work-up, histopathological evaluation, and the treatment procedures of rare LCH in the thoracic spine.
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Adult , Humans , Middle Aged , Diagnosis , Histiocytosis, Langerhans-Cell , Hypesthesia , Leg , Radiotherapy , SpineABSTRACT
BACKGROUND: The role of ultrasound in the thoracic spine has been underappreciated, partly because of the relative efficacy of the landmark-guided technique and the limitation of imaging through the narrow acoustic windows produced by the bony framework of thoracic spine. The aim of this study was to make a comparison between the 12th rib and the spinous process of C7 as a landmark for effective ultrasound-guided target segment identification in the thoracic spine. METHODS: Ultrasonography of 44 thoracic spines was performed and the same procedure was carried out 1 week later again. The target segments (T3–4, T7–8, and T10–11) were identified using the 12th rib (group 1) or the spinous process of C7 (group 2) as a starting landmark. Ultrasound scanning was done proximally (group 1) or distally (group 2) toward the target transverse process and further medially and slightly superior to the target thoracic facet. Then, a metal marker was placed on the T3–4, T7–8, and T10–11 and the location of each marker was confirmed by fluoroscopy. RESULTS: In the total 132 segments, sonographic identification was confirmed to be successful with fluoroscopy in 84.1% in group 1 and 56.8% in group 2. Group 1 had a greater success rate in ultrasound-guided target segment identification than group 2 (p = 0.001), especially in T10–11 (group 1, 93.2%; group 2, 43.2%; p = 0.001) and T7–8 (group 1, 86.4%; group 2, 56.8%; p = 0.002). The intrarater reliability of ultrasound-guided target segment identification was good (group 1, r = 0.76; group 2, r = 0.82), showing no difference between right and left sides. Ultrasound-guided target segment identification was more effective in the non-obese subjects (p = 0.001), especially in group 1. CONCLUSIONS: Ultrasound-guided detection using the 12th rib as a starting landmark for scanning could be a promising technique for successful target segment identification in the thoracic spine.
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Acoustics , Fluoroscopy , Nerve Block , Ribs , Spine , UltrasonographyABSTRACT
Glomangiopericytoma, also referred to as a hemangiopericytoma-like tumor or sinonasal type hemangiopericytoma, is a rare tumor of the nasal cavity and paranasal sinus that has never been reported in the spinal cord. Here, we report a case of a 47-year-old man who developed glomangiopericytoma in the thoracic spine. This lesion showed a heterogeneous high signal intensity compared to the spinal cord on a T2-weighted image and an easily enhanced isointense signal on a T1-weighted image.
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Humans , Middle Aged , Hemangiopericytoma , Nasal Cavity , Spinal Cord , SpineABSTRACT
<p><b>OBJECTIVE</b>To investigate the clincial effects and feasibility of anterior thoracoscopically assisted surgery (TAS) with posterior one-stage total en block spondylectomy(TES) for thoracic spinal tumour.</p><p><b>METHODS</b>From October 2014 to January 2016, 4 patients with thoracic spinal tumour were treated by anterior thoracoscopically assisted surgery with posterior one-stage total en block spondylectomy. There were 2 males and 2 females, aged 16, 35, 46, 60 years. Courses of disease were 1, 4, 6, 9 months. The tumor occurred at T₄, T₆, T₁₃₀ segment in 1 case respectively, at double T7/T8 segments in 1 case. Preoperative visual analogue scores(VAS) were 4, 5, 6, 8 points. Frankel grade of neurologic function was grade B in 2, D in 1, and E in 1. SF-36 quality of life scores were 38, 65, 35, 29 points, including 2 cases of primary spinal tumors, 2 cases of metastatic spinal tumors. According to the classification of Tomita, 1 case was type III, 2 cases were type IV, 1 case was type VI. And according to the WBB staging, 4-9/ABCD was in 2 cases, 5-8/ABC compliated with 1-3 was in 1 case, 6-7/ABC was in 1 case. Surgical procedure: With lateral position, the thoracoscope channel was inserted. The involved intervertebral vessels and corresponding intercostal vessels were ligated, while the prevertebral large vessels were completely separated and protected. The front halves of superior and inferior involved vertebral discs were removed. Then the patients were changed to prone position, posterior one-stage total en block spondylectomy, titanium cage bone graft (allograft bone), pedicle screw fixation were performed.</p><p><b>RESULTS</b>All of the operations were successful and the patients were followed up for 34, 10, 11, 12 months. Pleural effusion occurred in 1 case after operation, and pleural closed drainage was done. All incisions got primary healing; and all patients showed significant pain relief (<0.005), with the VAS score decreasing to 2(2 cases) and 3(2 cases) scores, 2 months after surgery. No nerve functional injury aggravated. SF-36 quality of life score obviously improved with postoperative scores for 88, 92, 71, 80 at 3 months after operation. No recurrent vertebral tumor, internal fixation lossening or breakage was found at follow-up points of 3, 6, 12 months. One patient with lung cancer died of multiple organ failure at 11 months after operation.</p><p><b>CONCLUSIONS</b>With anterior TAS, vertebral anterior vessels, intervertebral blood vessels, intercostal vessels were successfully separated or ligated, intraoperative bleeding was effectively controlled, lung and esophagus were effectively protected, and the tumor received wide excision. Anterior TAS and one-stage posterior TES could significantly reduce the surgical trauma and the risk of surgery.</p>
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Background: Thoracic hyper-kyphosis is a postural deviation that is associated with morbidity and mortality. There is limited evidence for the non-surgical reduction treatment for this condition. Objective: To describe the successful case of conservative reduction in thoracic hyper-kyphosis utilizing thoracic extension traction methods as performed in Chiropractic BioPhysics (CBP®) Technique. Clinical Features: On May 8, 2009 a 24-year old female music teacher reported to a spine clinic in Las Vegas seeking treatment while suffering from neck, mid, and low back pain as well as headaches. The major postural condition was determined to be a hyper-kyphotic thoracic spine with concomitant posterior thoracic translation. Intervention and Outcome: This patient was treated with full CBP® protocol with the unique application of thoracic extension traction. Although the treatment was interrupted by her involvement in a motor vehicle collision, a clinically significant reduction in her kyphosis occurred bringing her spine to within normal limits. She had simultaneous improvements in her clinical symptoms, neurologic and orthopedic tests. Discussion: Traditional conservative treatment options for thoracic hyper-kyphosis have included exercise, manual therapy, spinal orthosis, ‘practiced normal posture,’ and more recently, taping. All of these procedures, however, have been criticized because despite these methods as showing promise for improving health outcomes in patients with hyper-kyphosis, the trials used to evaluate them have been “small in scale, and most short in duration.” Since this deformity is associated with osteoporosis and worsening of kyphosis it is well advised to treat this condition earlier rather than later. Conclusion: Although traditional approaches to non-surgical treatment for thoracic hyper-kyphosis has weak supportive evidence, we propose extension traction for this condition will prove to be an effective treatment option.
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OBJECTIVE: To analyze the pressure change and distribution of the intervertebral disc of upper thoracic spine in vertical pressure and 5° flexion, extension, or lateral bending.