Mri morphometry of lumbar discs and vertebral bodies in correlation with serum vitamin d level / Morfometria de rm de discos lombares e corpos vertebrais em correlação com o nível sérico de vitamina d / Morfometría de rm de discos lumbares y cuerpos vertebrales en correlación con el nivel sérico de vitamina d

ABSTRACT: Introduction: The knowledge of the intervertebral disc morphology and its relation with the vertebrae is vital for managing degenerative spine disease. It is imperative to study the role of preventable and treatable causes, such as Vitamin D deficiency, so that standard guidelines can be framed for apt management. Objective: To evaluate the correlation between serum vitamin D levels and MRI morphometry of lumbar intervertebral discs. Methods: A total of 100 subjects (20-40 years) underwent an MRI of the lumbosacral spine. Intervertebral disc and vertebral body heights were measured, and disc degenerative changes were noted. Serum vitamin D levels were correlated with disc changes using the Pearson/Spearman rank correlation coefficient. A p-value of <0.05 was considered significant. Results: Vitamin D deficiency showed a high prevalence in patients with disc degenerative diseases, even in young adults and females with more severe vitamin D deficiency than males (p-value < 0.001). However, a significant relationship between vitamin D levels and disc or vertebral body heights could not be established. Conclusion: Vitamin D deficiency is more prevalent in patients with disc degenerative changes; however, its effect on disc and vertebral body heights needs to be extrapolated further in larger studies. Level of Evidence I; Cross-Sectional, Observational Study.

RESUMO: Introdução: O conhecimento da morfologia do disco intervertebral e sua relação com as vértebras é vital para o manejo da doença degenerativa da coluna. É imperativo estudar o papel das causas evitáveis e tratáveis, como a deficiência de vitamina D, para que possam ser elaboradas diretrizes padrão para um manejo adequado. Objetivo: Avaliar a morfometria da ressonância magnética dos discos intervertebrais lombares em correlação com os níveis séricos de vitamina D. Métodos: Um total de 100 indivíduos (20-40 anos) foram submetidos a ressonância magnética da coluna lombossacra. As alturas do disco intervertebral e do corpo vertebral foram medidas e alterações degenerativas do disco foram anotadas. Os níveis séricos de vitamina D foram correlacionados com alterações discais usando o coeficiente de correlação de Pearson/Spearman. Um valor de p <0,05 foi considerado significativo. Resultados: A deficiência de vitamina D apresentou alta prevalência em pacientes com doenças degenerativas do disco, mesmo em adultos jovens e mulheres que apresentavam deficiência de vitamina D mais grave que os homens (valor p < 0,001). No entanto, não foi possível estabelecer uma relação significativa entre os níveis de vitamina D e a altura do disco ou do corpo vertebral. Conclusão: A deficiência de vitamina D é mais prevalente em pacientes com alterações degenerativas do disco, no entanto, seu efeito na altura do disco e do corpo vertebral precisa ser extrapolado em estudos maiores. Nível de Evidência I; Estudio Observacional Transversal.

RESUMEN: Introducción: El conocimiento de la morfología del disco intervertebral y su relación con las vértebras es vital para el tratamiento de las enfermedades degenerativas de la columna vertebral. Es imprescindible estudiar el papel de las causas prevenibles y tratables, como la deficiencia de vitamina D, para poder elaborar directrices estándar para un tratamiento adecuado. Objetivo: Evaluar la morfometría por resonancia magnética de los discos intervertebrales lumbares en correlación con los niveles séricos de vitamina D. Métodos: Un total de 100 individuos (20-40 años) se sometieron a una resonancia magnética de la columna lumbosacra. Se midieron las alturas del disco intervertebral y del cuerpo vertebral y se observaron cambios degenerativos en el disco. Los niveles séricos de vitamina D se correlacionaron con los cambios discales mediante el coeficiente de correlación Pearson/Spearman. Se consideró significativo un valor p <0,05. Resultados: La deficiencia de vitamina D mostró una elevada prevalencia en pacientes con enfermedad degenerativa discal, incluso en adultos jóvenes y mujeres que presentaban una deficiencia de vitamina D más grave que los hombres (valor p < 0,001). Sin embargo, no fue posible establecer una relación significativa entre los niveles de vitamina D y la altura del disco o del cuerpo vertebral. Conclusión: La deficiencia de vitamina D es más prevalente en pacientes con cambios degenerativos del disco; sin embargo, su efecto sobre la altura del disco y del cuerpo vertebral debe extrapolarse en estudios mayores. Nivel de Evidencia I; Estudio Observacional Transversal.

3D-printed vertebral body in anterior spinal reconstruction after total spondylectomy for patients with cervical chordoma / 北京大学学报(医学版)

OBJECTIVE@#To investigate whether 3D-printed artificial vertebral body can reduce prosthesis subsidence rate for patients with cervical chordomas, through comparing the rates of prosthesis subsidence between 3D printing artificial vertebral body and titanium mesh for anterior spinal reconstruction after total spondylectomy.@*METHODS@#This was a retrospective analysis of patients who underwent surgical treatment for cervical chordoma at our hospital from March 2005 to September 2019. There were nine patients in the group of 3D artificial vertebral body (3D group), and 15 patients in the group of titanium mesh cage (Mesh group). The patients' characteristics and treatment data were extracted from the medical records, including age, gender, CT hounsfield unit of cervical vertebra and surgical information, such as the surgical segments, time and blood loss of surgery, frequency and degree of prosthesis subsidence after surgery. Radiographic observations of prosthesis subsidence during the follow-up, including X-rays, CT, and magnetic resonance imaging were also collected. SPSS 22.0 was used to analysis the data.@*RESULTS@#There was no significant difference between the two groups in gender, age, CT hounsfield unit, surgical segments, time of surgery, blood loss of posterior surgery and total blood loss. Blood loss of anterior surgery was 700 (300, 825) mL in 3D group and 1 500 (750, 2 800) mL in Mesh group (P < 0.05). The prosthesis subsidence during the follow-up, 3 months after surgery, there was significant difference between the two groups in mild prosthesis subsidence (P < 0.05). The vertebral height of the 3D group decreased less than 1 mm in eight cases (no prosthesis subsidence) and more than 1 mm in one case (mild prosthesis subsidence). The vertebral height of the Mesh group decreased less than 1 mm in five cases (no prosthesis subsidence), and more than 1 mm in eight cases (mild prosthesis subsidence). Two patients did not have X-rays in 3 months after surgery. There was a statistically significant difference between the two groups in the prosthesis subsidence rate at the end of 12 months (P < 0.01). The vertebral height of eight cases in the 3D group decreased less than 1 mm (no prosthesis subsidence) and one case more than 3 mm (severe prosthesis subsidence). Four of the 15 cases in the Mesh group decreased less than 1 mm (no prosthesis subsidence), two cases more than 1 mm (mild prosthesis subsidence), and nine cases more than 3 mm (severe prosthesis subsidence). There was a statistically significant difference between the two groups in the prosthesis subsidence rate at the end of 24 months (P < 0.01). The vertebral height of seven cases in the 3D group decreased less than 1 mm (no prosthesis subsidence), one case more than 3 mm (severe prosthesis subsidence), and one case died with tumor. One case in the Mesh group decreased less than 1 mm (no prosthesis subsidence), one case more than 1 mm (mild prosthesis subsidence), 11 case more than 3 mm (severe prosthesis subsidence), one case died with tumor and one lost the follow-up. Moreover, at the end of 12 months and 24 months, there was significant difference between the two groups in severe prosthesis subsidence rate (P < 0.01).@*CONCLUSION@#3D-printed artificial vertebral body for anterior spinal reconstruction after total spondylectomy for patients with cervical chordoma can provide reliable spinal stability, and reduce the incidence of prosthesis subsidence after 2-year follow-up.

Graded surgical strategy for osteoporotic vertebral compression fractures with kyphosis: application of balanced load concept / 中华骨科杂志

Objective:To explore the application value of graded surgical strategy and balanced load concept for thoracolumbar osteoporotic compression fractures (OVCFs) with kyphosis.Methods:All of 56 patients of thoracolumbar OVCFs with kyphosis were studied, including 11 males and 45 females, with an average of 75.6±9.3 years old. All patients had back pain, and 32 patients had nerve compression, including 5 patients with aggravation of vertebral collapse after conservative treatment, and 1 patient with cement loosening after percutaneous kyphoplasty (PKP) in another hospital. A graded surgical strategy was developed according to the concept of balanced load, including whether there existed nerve compression, kyphosis, sagittal index (SI), vertebral collapse, load capacity of anterior and middle columns, and fracture reducibility. All patients were treated with anti osteoporosis therapy. 24 patients without nerve compression underwent posture reduction and PKP; 32 patients with nerve compression underwent open surgery: 5 patients with arcuate ky-phosis and SI≤15° underwent Ponte osteotomy; 15 patients with angular kyphosis or SI>15° underwent posterior pedicle subtraction osteotomy (PSO) or/and modified PSO including intervertebral space; 11 patients with SI>15° and severe vertebral collapse (the height of anterior and middle vertebral bodies <1/3 of the average height of adjacent vertebral bodies) or cement loosen after PKP underwent vertebrectomy and reconstruction, of which 4 patients underwent posterior vertebral column resection (PVCR), and 8 patients underwent combined surgery including anterior subtotal vertebrectomy with support and posterior pedicle fixation. The clinical efficacy was evaluated by pain visual analog score (VAS) and Oswestry dysfunction index (ODI).Results:All patients were followed up for 12-60 months, with an average of 24.2 months. For the 24 patients with PKP, the symptoms improved significantly, and 1 case had adjacent vertebral fracture that was improved after PKP again. For the 32 patients with open surgery, the intraoperative blood loss was 400-1 800 ml, with an average of 960 ml (PVCR > PSO and combined surgery > Ponte); the operation time was 2-7 h, with an average of 4.3±1.9 h. The neurological symptoms improved after the operation. During follow-up, the artificial vertebral body and titanium mesh collapsed in 3 cases, but did not continue to deteriorate, no vertebral fracture, internal fixation displacement or loosening failure occurred on X-ray films. At the last follow-up, the VAS score and ODI score of 56 patients decreased from 7.0±2.6 and 60.4±16.2 pre-operation to 1.4±1.1 and 9.5+5.8 respectively, and local kyphosis angle improved from 18.1±4.3 pre-operation to 5.6±4.3. According to the overall satisfaction of patients, the effect was fair in 12 cases, good in 30 cases, excellent in 14 cases, and the excellent and good rate was 78.6%.Conclusion:The graded surgical strategy for thoracolumbar OVCFs with kyphosis based on the concept of balanced load can restore the balanced load of the anterior and middle columns of the spine, reduce the fixation and fusion segments, and reduce the risk of internal fixation displacement and loosening failure.

The incidence and risk factors of lumbodorsal fasciitis in osteoporotic vertebral compression fractures / 中华骨科杂志

Objective:To identify the incidence and risk factors related to lumbodorsal fasciitis in acute osteoporotic vertebral compression fractures (OVCF).Methods:The clinical data of 1182 acute OVCF hospitalized in Zhongda Hospital Southeast University between June 2016 and October 2020 were retrospectively analyzed, including 219 males and 963 females, aged 72.19±9.39 years (range, 45-98 years). The demographics, comorbidity profile, spine trauma, back pain duration, and vertebral fracture number of the OVCF with or without lumbodorsal fasciitis were summarized and compared. The independent risk factors of lumbodorsal fasciitis were identified by binary logistic regression analysis.Results:There were 532 cases of OVCF complicated with lumbodorsal fasciitis among 1,182 patients, and the incidence was 45.01%. The OVCF with fasciitis had higher ratio of males (23.5%, 125/532) than the OVCF without (14.5%, 94/650) fasciitis (χ 2=15.82, P<0.001). The OVCF with fasciitis were aged 74.57±9.21 years and significantly older than the OVCF (aged 70.24±9.60 years) without fasciitis ( t=7.85, P<0.001). The highest proportion of patients with OVCF combined with fasciitis was ≥80 years old (36.1%, 192/532), while most (34.6%, 225/650) of the OVCF without fasciitis were aged 60-70 years (χ 2=56.27, P<0.001). The OVCF with fasciitis had higher ratio of no evident spine trauma (37.0%, 197/532) and multiple vertebral fractures involving ≥3 vertebra (10.5%, 56/532) than the OVCF without fasciitis [26.3% (171/650), 3.2% (21/650); χ 2=17.67, P<0.001; χ 2=40.63, P<0.001]. The ratio of pre-hospital back pain >4 weeks was higher in the OVCF with (20.7%, 110/532) than without (7.4%, 48/650) fasciitis (χ 2=62.46, P<0.001). The OVCF with fasciitis had higher comorbidity of hypertension (52.8%, 281/532), coronary heart disease (14.7%, 78/532), and cerebral infarction (24.8%, 132/532) than the OVCF without fasciitis [42.8% (278/650), 9.9% (64/650), 17.9% (116/650); χ 2=11.85, P<0.001; χ 2=6.42, P=0.011; χ 2=8.56, P=0.003]. The OVCF with fasciitis had higher ratio of two comorbidities (23.7%, 126/532) than the OVCF without fasciitis (16.1%, 105/650) (χ 2=21.15, P<0.001). Binary logistic regression analysis showed significantly higher risk of lumbodorsal fasciitis in males than in females ( OR=1.69, P=0.001), in age group 60-<70、70-<80 and ≥80 years than in <60 years ( OR=2.28, P=0.002; OR=2.64, P<0.001; OR=4.90, P<0.001), in back pain for 2-<4 weeks and >4 weeks than in ≤1 week ( OR=1.70, P=0.005; OR=3.81, P<0.001), and in multiple fractures involving 2 and ≥3 vertebra than in single vertebrae ( OR=1.75, P=0.003; OR=3.36, P<0.001). Conclusion:Up to 45% of acute OVCF have concurrent lumbodorsal fasciitis. Male, aged ≥60 years, pre-hospital back pain ≥2 weeks, and fractures in ≥2 vertebra are independent risk factors of lumbodorsal fasciitis in OVCF.

Kummel's disease

Kummel's disease is a crush fracture of a vertebral body caused by a minor trauma, with the most accepted etiology being avascular necrosis. It is more frequent in individuals with risk factors such as osteoporosis or prolonged treatment with corticosteroids. Initially, it usually has normal radiological tests and an asymptomatic period, followed by a progressive onset of pain along with probable kyphosis and a sign of void or fluid abscess on radiological tests, which may create nerve/spinal involvement. The case is presented of a 76-year-old man, who was admitted to this center for the differential diagnosis of a single vertebral lesion. After imaging tests and biopsy, the definitive diagnosis of Kummel's disease was reached. The confirmatory diagnosis was reached by vertebral biopsy, but given its invasive nature, imaging techniques can play a significant role. As regards metabolic imaging tests, bone scintigraphy has shown to be one of the most sensitive tools to detect ischemia in earlier stages or to determine if it affects other locations. The whole body scan with diphosphonates shows an increase in activity in relation to bone remodeling activity in this condition. The 3-phase study makes it possible to differentiate whether it is an acute/subacute or chronic process, and can influence the therapeutic decision. Knowledge of this disease is important to make a differential diagnosis with tumour or infectious pathology, with emphasis on performing imaging tests in the event of persistent pain with a normal initial plaque.

La enfermedad de Kummel es una fractura-aplastamiento de un cuerpo vertebral precedida por un traumatismo menor, cuya etiología más aceptada es la necrosis avascular. Es más frecuente en individuos con factores de riesgo como osteoporosis o tratamiento prolongado con corticoides. Inicialmente, suele presentar pruebas radiológicas normales y un periodo asintomático, con aparición progresiva del dolor junto a probable cifosis y signo del vacío o absceso líquido en las pruebas radiológicas, pudiendo llegar a crear compromiso nervioso/medular. Presentamos el caso de un varón de 76 arios que ingresa en nuestro centro para el diagnóstico diferencial de una lesión única vertebral; tras la realización de las pruebas de imagen y biopsia se llega al diagnóstico definitivo de enfermedad de Kummel. El diagnóstico de confirmación de esta enfermedad se alcanza mediante la biopsia vertebral, pero dada su naturaleza invasiva, las técnicas de imagen toman un papel relevante. En relación con las pruebas de imagen metabólicas, la gammagrafía ósea ha demostrado ser una de las herramientas más sensibles para detectar isquemia en fases más tempranas o para conocer si afecta a otras localizaciones. El rastreo corporal de cuerpo completo con difosfonatos muestra un aumento de actividad en relación con la actividad ósea remodelativa en este cuadro. El estudio de tres fases permite diferenciar si se trata de un proceso agudo/subagudo o crónico, lo que influye en la decisión terapéutica. Es importante el conocimiento de esta enfermedad para realizar diagnóstico diferencial con patología tumoral o infecciosa e insistir en la realización de pruebas de imagen ante la persistencia del dolor con una placa inicial normal.

Magnetic resonance imaging at 3.0-T in postmenopausal osteoporosis: a prospective study and review of the literature / Ressonância magnética de 3.0-T na osteoporose pós-menopausa: estudo prospectivo e revisão da literatura

Abstract Objective: To promote advanced research using magnetic resonance imaging (MRI) in the diagnosis of and screening for osteoporosis by looking for correlations among the T-scores measured by dual-energy X-ray absorptiometry (DEXA), the apparent diffusion coefficient (ADC) values on diffusion-weighted imaging (DWI), and the T1-weighted signal intensity values. Materials and Methods: This was a prospective study of postmenopausal women with no contraindications to MRI and no history of cancer who underwent DEXA within 30 days before or after the MRI examination. A 3.0-T scanner was used in order to acquire sagittal sequences targeting the lumbar spine. Results: Thirteen women underwent DEXA and MRI. In two cases, the MRI was discontinued early. Therefore, the final sample comprised 11 patients. The ADC values and T1-weighted signal intensity were found to be higher in patients with osteoporosis. However, among the patients > 60 years of age with osteoporosis, ADC values were lower and T1-weighted signal intensity was even higher. Conclusion: It is unlikely that MRI will soon replace DEXA for the diagnostic workup of osteoporosis. Although DWI and ADC mapping are useful for understanding the pathophysiology of osteoporosis, we believe that T1-weighted sequences are more sensitive than is DWI as a means of performing a qualitative analysis of vertebral alterations.

Resumo Objetivo: Promover pesquisas avançadas usando ressonância magnética (RM) no diagnóstico e rastreamento de osteoporose, procurando correlações entre os escores T medidos por absorciometria de raios-X de dupla energia (DEXA), valores de coeficiente de difusão aparente (ADC) na difusão e valores de intensidade de sinal ponderado em T1. Materiais e Métodos: Estudo prospectivo de mulheres na pós-menopausa sem contraindicações para RM e sem histórico de câncer que foram submetidas a DEXA 30 dias antes ou após o exame de RM. Um scanner 3.0-T foi utilizado para adquirir sequências sagitais direcionadas à coluna lombar. Resultados: Treze mulheres foram submetidas a DEXA e RM. Em dois casos, a RM foi interrompida precocemente. Portanto, a amostra final foi composta por 11 pacientes. Os valores de ADC e intensidade de sinal ponderado em T1 foram mais elevados nas pacientes com osteoporose. No entanto, no subgrupo de pacientes > 60 anos de idade com osteoporose, os valores de ADC foram menores e a intensidade do sinal ponderado em T1 foi ainda maior. Conclusão: É improvável que a RM substitua DEXA para a investigação diagnóstica da osteoporose no futuro próximo. Embora a difusão e o mapeamento ADC sejam úteis para a compreensão da fisiopatologia da osteoporose, acreditamos que as sequências ponderadas em T1 são mais sensíveis do que a difusão como meio de realizar uma análise qualitativa das alterações vertebrais.

Application of percutaneous curved kyphoplasty in treatment of old osteoporotic vertebral body with endplate fractures / 中华骨科杂志

Objective:To investigate the clinical effect of percutaneous curved kyphoplasty in the treatment of old osteoporotic vertebral body with endplate fracture.Methods:Clinical data of 58 patients suffering from old osteoporotic vertebral bodies with endplate fractures from January 2018 to January 2020 were analyzed retrospectively. All patients had a single vertebral body fracture and were treated with bilateral injection of bone cement with percutaneous kyphoplasty (PKP). According to the shape of the puncture device, the patients were divided into a curved needle group and a ordinary group. There were 28 cases in the curved needle group, including 7 males and 21 females, aged 60-84 years old, with an average age of 71.8±7.8 years. The distribution of vertebral bodies with fractures: T 11 3 cases, T 12 5 cases, L 1 6 cases, L 2 5 cases, L 3 3 cases, L 4 4 cases, and L 5 2 cases. In the ordinary group, there were 30 cases, 8 males and 22 females, with an average age of 73.2±8.4 years (range, 61-88 years). The vertebral body distribution of fracture: T 11 3 cases, T 12 5 cases, L 1 7 cases, L 2 4 cases, L 3 4 cases, L 4 5 cases, and L 5 2 cases. The surgery time, amount of bone cement injection, and bone cement leakage rate were compared between the two groups, as well as the visual analogue scale (VAS) and Oswestry disability index (ODI) at 1 week, 6 months, and 1 year after surgery. Preoperative and postoperative vertebral midpoint height and kyphosis Cobb angle were measured. Results:All patients were followed up for 12-24 months, with an average of 14.7±2.9 months. The bone cement leakage rate in curved needle group (18%, 5/28) was lower than that in ordinary group (23%, 7/30), but there was no significant statistical difference (χ 2=0.27, P=0.607). The amount of bone cement injection and surgery time in curved needle group (5.0±0.5 ml, 55.2±6.9 min) were significantly higher than those in ordinary group (3.4±0.6 ml, 42.9±3.6 min, P<0.05) . The scores of VAS (2.3±1.0, 2.6±1.5) and ODI (27.5%±9.7%, 28.7%±11.3%) in curved needle group were lower than those in ordinary group (2.7±1.0, 4.5±1.1 and 31.8%±10.5%, 43.1%±13.4%) at 6 months after surgery and at the last follow-up after surgery. In the curved needle group, the Cobb angle was 25.5°±3.5° preoperatively, 18.4°±1.6° postoperatively, and 20.5°±4.9°at the last follow-up. The height of the vertebral body was 14.2±1.9 mm before surgery, 21.5±2.2 mm after surgery, and 20.1±3.6 mm at the last follow-up. Compared with the preoperative results, the kyphosis Cobb angle decreased and the height of the fractured vertebral body increased at the last follow-up, and the differences were statistically significant ( P<0.05). In the ordinary group, the Cobb angle was 24.4°±3.6° preoperatively, 23.1°±4.0° postoperatively, and 27.8°±2.9° at the last follow-up. The height of the vertebral body was 14.5±1.8 mm before surgery, 15.4±2.0 mm after surgery, and 12.7±1.0 mm at the last follow-up. At the last follow-up, the kyphosis Cobb angle increased and the height of the fractured vertebral body decreased compared with preoperative and postoperative 1 week, and the differences were statistically significant ( P<0.05). At 1 week after surgery, 6 months after surgery and the last follow-up, the Cobb angle of curved needle group was lower than that of ordinary group ( P<0.05), the height of vertebral body was higher than that of ordinary group ( P<0.05). Conclusion:Flexible application of percutaneous curved kyphoplasty in the treatment of old osteoporotic vertebral body with endplate fractures can effectively increase the riveting force of bone cement in the vertebral body, restore the height of endplate, and reduce the occurrence of kyphosis and chronic low back pain.

Establishment of finite element model of anterior cervical transpedicular system for reconstruction of cervical stability after subtotal resection of two segments of lower cervical spine / 中国骨伤

OBJECTIVE@#To establish the fixation model of anterior cervical transpedicular system (ACTPS) after subtotal resection of two segments of lower cervical spine(C3-C7) in order to provide a finite element modeling method for anterior cervical reconstruction.@*METHODS@#The CT data of the cervical segment (C1-T1) of a 30-year-old adult healthy male volunteer was collected. Used Mimics 10.0, Rapidform XOR3, HyperMesh 10.0, CATIA5V19 and ANSYS 14.0 to establish the three-dimensional nonlinear complete model of lower cervical spine(C3-C7) as the intact group. The number of units and nodes of the complete model were recorded. After the effectiveness of the complete model was verified, the C5 and C6 vertebral subtotal resection was performed, and the ACTPS model was established as the ACTPS group. The axial force of 75 N and moment couple of 1N·m was loaded on the upper surface of C3 in intact group and ACTPS group, the range of motion(ROM)and stress distribution in states of flexion extension, lateral flexion, rotation was compared between two groups.@*RESULTS@#There were 85 832 elements and 23 612 nodes in the complete model of lower cervical spine(C3-C7) which was established in this experiment. The stress distribution of ACTPS internal fixation model was relatively uniform. Comparing with the intact group, the overall range of motion in ACTPS group was decreased in flexion extension, lateral flexion and rotation directions, and the corresponding compensation of adjacent C3,4 segment was increased slightly.@*CONCLUSION@#The stress distribution of ACTPS fixation system is uniform, there is no stress concentration area at the joint of screw and titanium plate, and the fracture risk of internal fixation is low. It is suitable for stability reconstruction after anterior decompression of two or more cervical segments.

Study Of Radiological Evaluation Of Cervical Spine In Marathwada Region

Background:Cervical vertebraeare the most crucially located and play a dynamic role in the mobility and protection of the vital parts of the central nervous system, they are prone to undergo degenerative diseases like spinal stenosis, cervical spondylosis etc.Hence it is important to know the exact dimensions of cervical vertebralbody and spinal canal in the diagnosis, prognosis and treatment of diseasesrelated tocervical spine and spinal cord.Material And Methods:Normal plain radiographs of cervical spine of two hundred adult subjects of known sex (one hundred males and one hundred females) and of known age group (between 18 to 50 years) studied for Antero-posterior diameter of vertebral body (AP-VB), Height of vertebral body (HT-VB)and Canal body ratio (CBR) in C3 to C7 cervical vertebrae. Data tabulated and analysed by using software statistical Package for Social Sciences(SPSS).Result:Higher mean AP –VB diameter andmean Ht -VB valuesare recorded in males as compared to females.Highermean Canal body ratio (CBR) was recorded in femalesascompared to males.Conclusion:Present study showed,higher mean value of(AP-VB),(HT-VB) in males as compared to females and found to be statistically significant indicating sexual dimorphism. Canal body ratio(CBR) showed slightly higher values in females as compared to malesand found statistically significant at C6 and C7 Levels.

Therapeutic effects of percutaneous vertebroplasty and kyphoplasty on osteoporotic vertebral compression fracture / 中国组织工程研究

BACKGROUND: Percutaneous vertebral body stenting system (VBS) can alleviate patient's pain, recover the height of vertebral body, and correct local kyphosis, but there is no definite clinical study to show that It has obvious advantages over percutaneous kyphoplasty (PKP). OBJECTIVE: To compare the short-term effect of VBS versus PKP in the treatment of osteoporotic vertebral compression fracture. METHODS: Forty patients with osteoporotic vertebral compression fracture who received VBS or PKP between January 2017 and December 2018 In the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine were included in this study. They were divided into a VBS group (n=15) and a PKP group (n=25) according to surgery method. According to whether fluoroscopic operation was performed in retroextension position, two subgroups were designated: VBS retroextension group (n=7) and PKP retroextension group (n=14). RESULTS AND CONCLUSION: Compared with the PKP group, the amount of bone cement injected Into the vertebra was greater in the VBS group (P 0.05). Compared with preoperative situations, Visual Analogue Scale score was significantly decreased after surgery In both VBS and PKP groups, and further decreased at the last follow-up (P 0.05). These results suggest that VBS and PKP are effective in the treatment of osteoporotic vertebral compression fractures. VBS can better correct compression kyphosis deformity when more bone cement Is injected. The difference of therapeutic efficacy between two surgical approaches can be reduced with proper surgical position, keeping the surgical segment In the retroextension position.

Safety dose of bone cement in vertebroplasty assessed by mimics software / 中国组织工程研究

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.

Is there effect of intervertebral disc herniation on the lumbar spine in early period? A morphometric and stereological study / ¿Existe algún efecto de la hernia de disco intervertebral en la columna lumbar en el período temprano? Un estudio morfométrico y estereológico

The degeneration of the Lumbar Intervertebral Disc (LIVD) and the other elements of the spine are an inevitable result of aging. However, it is observed that the same degree of degenerative change does not occur in each individual. In the present study, the purpose was to compare the morphometric changes on the lumbar spine with or without intervertebral disc herniation in early period. Group 1 (the Patient Group) consisted of the patients who were diagnosed with lumbar intervertebral disc hernia and who were not operated at least one month clinical duration. Group 2 (the Control Group) consisted of individuals who were selected randomly, had only back pain, underwent magnetic resonance imaging (MRI), and were determined to have intact intervertebral disc. The sagittal and axial MRI sections of lumbar spine was used for measurements and statistical evaluation. There were no statistically significant differences between the intervertebral disc volumes, vertebral body volumes and intervertebral disc anterior and posterior heights of Group 1 and 2 (p>0.05). In terms of anterior-posterior length, the length of the L5 vertebral body was determined to be more in the Patient Group (p<0.05). A correlation was determined in terms of the increase in L2, L4 and L5 volumes with increasing age; however, there were no statistically significant correlations between age increase and a decrease in the intervertebral disc volumes. There were no correlations between the increase in age and the decrease in intervertebral disc heights (p>0.05). There were no apparent relations between the change on the lumbar vertebra corpus and intervertebral disc in early period. It was concluded that the intact intervertebral disc could protect the lower lumbar vertebra corpus from degenerative changes. Although the herniation of the intervertebral disc is newly formed, it is understood that the physiological process or morphometric changes started earlier.

La degeneración del disco intervertebral lumbar y de otros elementos de la columna vertebral son un resultado inevitable del envejecimiento. Sin embargo, no se observa el mismo grado de degeneración en cada individuo. En el presente estudio, el objetivo era comparar los cambios morfométricos en la columna lumbar con o sin hernia de disco intervertebral en el período temprano. El grupo 1 (grupo de pacientes) estaba formado por los pacientes diagnosticados con hernia de disco intervertebral lumbar y que no fueron operados durante al menos un mes. El Grupo 2 (Grupo de Control) consistió en sujetos que fueron seleccionados al azar, reportaban solamente dolor de espalda, fueron sometidos a una resonancia magnética (MRI) y se determinó un disco intervertebral intacto. Las secciones de resonancia magnética sagital y axial de la columna lumbar se utilizaron para las mediciones y la evaluación estadística. No hubo diferencias estadísticamente significativas entre los volúmenes del disco intervertebral, los volúmenes del cuerpo vertebral y las alturas anterior y posterior del disco intervertebral de los Grupos 1 y 2 (p> 0,05). En términos de longitud anterior-posterior, se determinó que la longitud del cuerpo vertebral L5 era mayor en el grupo de pacientes (p <0,05). Se determinó una correlación en términos del aumento en los volúmenes L2, L4 y L5 con el aumento de la edad; sin embargo, no hubo correlaciones estadísticamente significativas entre el aumento de la edad y una disminución en los volúmenes del disco intervertebral. No hubo correlaciones entre el aumento de la edad y la disminución de las alturas de los discos intervertebrales (p> 0,05). No hubo relaciones aparentes entre el cambio en el cuerpo de la vértebra lumbar y el disco intervertebral en el período temprano. Se concluyó que el disco intervertebral intacto podría proteger el cuerpo de la vértebra lumbar inferior de los cambios degenerativos. Aun cuando la formación de la hernia del disco fue reciente, se entiende que el proceso fisiológico o los cambios morfométricos habían comenzado antes.

Types and advantages of spinal implants in percutaneous kyphoplasty / 中国组织工程研究

BACKGROUND: Percutaneous kyphoplasty is of breakthrough significance in minimally invasive treatment of vertebral compression fractures, but it also has shortcomings, such as bone cement leakage, limited height recovery of the vertebral body, and increased risk of fracture of adjacent vertebral bodies. In recent years, a variety of spinal implants have been developed, and the application of these implants in the treatment of vertebral compression fractures in percutaneous kyphoplasty has achieved good clinical efficacy, and is beneficial to reduce the complications of traditional percutaneous kyphoplasty. OBJECTIVE: To describe the types and characteristics of various spinal implants and explore their clinical applications in percutaneous kyphoplasty. METHODS: CNKI, PubMed and Elsevier were retrieved for relevant literature. The key words were "percutaneous kyphoplasty, spinal implants, vertebral stents, vertebral compression fractures". Relevant articles published from January 2000 to June 2019 were reviewed, including review, basic research and clinical research. Preliminary screening was conducted by reading the article title and abstract, and the literatures with low relevance to the article topic were excluded. According to the inclusion and exclusion criteria, 62 articles were finally included for analysis. RESULTS AND CONCLUSION: (1) Spinal implants used in percutaneous kyphoplasty include VBS stent, Jack vertebra expander, SKY bone expander system, Osseofix system, SpineJack, KIVA system and memory alloy vertebral stent. (2) They are modified and developed on the basis of classic percutaneous kyphoplasty to achieve the same clinical efficacy while minimizing complications such as cement leakage, loss of vertebral height, and increased risk of adjacent vertebral body fracture.

Mechanical stability of the fracture at the junction of lumbar vertebral body and pedicle after implantation with different diameters of pedicle screws / 中国组织工程研究

BACKGROUND: Most scholars believe that the fracture of the lumbar spine and pedicle is stable, and transvertebral pedicle screw implantation can improve the stability of fractures. However, the diameter of the transvertebral pedicle screw, mechanical stability and safety of the vertebrae still remain controversial. OBJECTIVE: To analyze the effect of pedicle screws of different diameters and pedicle cortex on the mechanical stability of the fractured vertebrae and pedicle by three-dimensional finite element method. METHODS: Based on normal adult L2-L3 CT DICOM data, a mimics software was used to establish a model of the fracture at L2 vertebral body and the pedicle. At the same time, a three-dimensional model of L3 vertebra was created. The L2-L3 model was imported into 3-matic in stl format, and a model of pedicle screws with different diameters (diameter of 6.5 and 6.0 mm, and length of 45 mm) was established. The model was imported into ansys after the material attributes were assigned in the mimics software. A vertical load of 500 N was applied to the upper surface of the L2 vertebral body to simulate the biomechanical performance of a adult with standard body mass after implantation with transvertebral pedicle screw with different diameters under upright condition. RESULTS AND CONCLUSION: (1) After implantation with 6.0 mm screw, the equivalent load on the lower, upper, inner, and outer walls of the pedicle at the junction of the lumbar vertebra and the pedicle was (1.28±0.62), (0.95±0.18), (0.62±0.37), and (0.36±0.16) MPa, respectively. The difference was significant among groups (F=4.298, P < 0.05). (2) After implantation with 6.5 mm screw, the equivalent load on the lower, upper, inner, and outer walls of the pedicle at the junction of the lumbar vertebra and the pedicle was (1.82±0.76), (1.11±0.18), (0.93±0.38), and (0.43±0.14) MPa, respectively. The difference was significant among groups (F=7.034, P < 0.05). (3) The equivalent load on the lower, upper, inner, and outer walls of the 6.5 mm pedicle screw model was significantly higher than that on the 6.0 mm pedicle screw model (P < 0.05). (4) These results imply that the larger the pedicle screw is, the greater the load on the cortical bone at the junction of the lumbar vertebra and the pedicle is, and the stronger the holding force is. The load on the upper, lower, inner and outer walls of the pedicle is positively related to its cortical thickness. The cortical bone of the inferior wall is thickest, the equivalent load it bears is largest, and the cortical bone of the outer wall is thinnest, and it has the smallest equivalent load. The closer the pedicle screw is to the lower medial wall within the pedicle, the stronger the holding force and the better the stability. The closer it is to the upper and outer side walls, the smaller the gripping force and the worse the stability. However, the placement of nails on the upper and outer walls is safer than the placement of nails on the lower inner wall, and the pros and cons need to be weighed in accordance with the experience of the surgeon during placement.

Three-dimensional finite element analysis of the influence of bone cement dispersion type on the stress of adjacent vertebrae after vertebroplasty / 中国组织工程研究

BACKGROUND: The fracture of adjacent vertebrae after vertebroplasty has been widely concerned. The finite element study of the influence of three cement diffusion types on the stress change of adjacent vertebrae after vertebroplasty has not been reported at home and abroad. OBJECTIVE: To analyze the stress changes of the adjacent vertebrae of the affected vertebrae under different loads using the finite element method. METHODS: Based on the original CT data of one L1 vertebral compression fracture patient and three L1 vertebral consolidation patients with bone cement distributed in the form of dispersion, mixture and agglomeration, the finite elements of T11-L1 vertebral functional unit compression fracture and three types of bone cement dispersion were established by dividing grids, defining material attributes and assembling models, using software such as Mimics 19. 0, Geomagic Studio 2013 and SolidWorks 2017. The models underwent three levels of pressure 0. 3 MPa (low pressure), 1. 0 MPa (medium pressure) and 4. 0 MPa (high pressure) and four load directions of forward bending, backward extension, lateral bending and rotation, respectively. The stress distribution of T12 and L2 vertebrae under different pressures and loads was observed. RESULTS AND CONCLUSION: (1) The increase of the stress of the adjacent vertebrae was positively correlated with the increase of the axial stress after the injection of bone cement. (2) The maximum stress of the adjacent vertebrae was significantly higher than that of the diffusion type and the mixed type under the four loading directions of the agglomerate type of bone cement, and the stress of the mixed type of the adjacent vertebrae was lower than that of the agglomerate type and the diffusion type under the forward bending and lateral bending loads. (3) The results showed that the agglomerate type of bone cement is an important factor leading to the increase of the stress of the adjacent vertebrae. The mixed cement distribution may reduce the risk of adjacent vertebral fractures.

Treatment of severely osteoporotic vertebral compression fractures with the vertebral body stent system and percutanous kyphoplasty combined with zoledronic acid / 中国骨伤

OBJECTIVE@#To investigate the clinical efficacy of vertebral body stent (VBS) system and percutanous kyphoplasty (PKP) combined with zoledronic acid for the treatment of severely osteoporotic compression vertebral fractures (OVCFs).@*METHODS@#The clinical data of 48 patients with osteoporotic thoracolumbar fractures treated from December 2017 to December 2018 were retrospectively analyzed, including 13 males and 35 females, aged 55 to 92 years old with an average (71.2±10.5) years. All patients were treated with VBS system PKP surgery, and zoledronic acid injection was used for anti-osteoporosis treatment after operation. The VAS scores ODI, the height of diseasedvertebral lost were compared before operation, 3 d and half a year after operation, and whether there was re-fracture of diseased or adjacent vertevrae after operation was observed.@*RESULTS@#Before operation, 3 d and half a year after operation, VAS scores were 7.60±0.12, 3.00±0.46, 1.20±0.23, ODI were(82.00±0.32)%, (30.00±1.50) %, (18.00±0.16) %, the height of diseased vertebral lost were (12.00±0.43) mm, (3.00± 0.15) mm, (3.60±0.51) mm respectively. Postoperative VAS score, ODI, the height of diseased vertebral lost were obviously improved (0.05). All the 48 patients were followed up with an average time of (6.6±0.5) months. All the incisions healed at grade A after operation, and no re-fracture of diseased vertebrae or adjacent vertebrae was found at the final follow-up.@*CONCLUSION@#VBS system and PKP combined with zoledronic acid in the treatment of OVCFs not only may effectively relieve the pain in the thoracolumbar back, improve the mobility of the thoracolumbar, but also can restore the height of the vertebral body to the maximum extent, and prevent the re-fracture of the affected vertebrae and adjacent vertebrae, which is worthy to spread in clinic.

Three-dimensional finite element analysis of the influence of bone cement dispersion type on the stress of adjacent vertebrae after vertebroplasty / 中国组织工程研究

BACKGROUND: The fracture of adjacent vertebrae after vertebroplasty has been widely concerned. The finite element study of the influence of three cement diffusion types on the stress change of adjacent vertebrae after vertebroplasty has not been reported at home and abroad. OBJECTIVE: To analyze the stress changes of the adjacent vertebrae of the affected vertebrae under different loads using the finite element method. METHODS: Based on the original CT data of one L, vertebral compression fracture patient and three L, vertebral consolidation patients with bone cement distributed in the form of dispersion, mixture and agglomeration, the finite elements of T11-L2 vertebral functional unit compression fracture and three types of bone cement dispersion were established by dividing grids, defining material attributes and assembling models, using software such as Mimics 19.0, Geomagic Studio 2013 and SolidWorks 2017. The models underwent three levels of pressure 0.3 MPa (low pressure), 1.0 MPa (medium pressure) and 4.0 MPa (high pressure) and four load directions of forward bending, backward extension, lateral bending and rotation, respectively. The stress distribution of T12 and L2 vertebrae under different pressures and loads was observed. RESULTS AND CONCLUSION: (1) The increase of the stress of the adjacent vertebrae was positively correlated with the increase of the axial stress after the injection of bone cement. (2) The maximum stress of the adjacent vertebrae was significantly higher than that of the diffusion type and the mixed type under the four loading directions of the agglomerate type of bone cement, and the stress of the mixed type of the adjacent vertebrae was lower than that of the agglomerate type and the diffusion type under the forward bending and lateral bending loads (3) The results showed that the agglomerate type of bone cement is an important factor leading to the increase of the stress of the adjacent vertebrae. The mixed cement distribution may reduce the risk of adjacent vertebral fractures.

Modal Analysis of Thoracolumbar Osteoporotic Vertebral Bodies / 医用生物力学

Objective To explore the dynamic characteristics of the thoracolumbar osteoporotic vertebral bodies under free state. Methods Based on CT data from the thoracic and lumbar vertebral body of a healthy female volunteer, model materialization and intervertebral disc tissue reconstruction were realized by using the computerized processing software. The finite element models of normal thoracolumbar vertebral body and thoracolumbar osteoporotic vertebral body were established in ABAQUS 6.14 to perform modal analysis. Results Compared with the normal model, the osteoporosis model had a lower natural frequency and a lager amplitude. As the vibration frequency increased, the model vibration type changed from uniaxial and unidirectional motion to multiaxial and multidirectional motion, and the responsible vertebral body for the maximum amplitude moved down gradually. Conclusions Modal analysis can better analyze dynamic characteristics of the thoracolumbar osteoporotic vertebral body. Patients with osteoporosis should try to avoid the specific vibration environment, so as to decrease the risk of intervertebral disc tissue degeneration, strain of thoracolumbar soft tissues and lesion in posterior structures of the vertebral body.

Advances on the study of movable artificial vertebral body / 中国骨伤

At present, artificial vertebral implants have proven to be effective in the treatment of spinal tumors, infections, fractures and other diseases. However, the fusion artificial vertebral body can cause adjacent intervertebral joint degeneration and loss of original physiological curvature and activity. The movable artificial vertebral body can, to some extent, restore the normal physiological movement and reduce biomechanical changes of the spine, reducing the occurrence of complication. The design of movable artificial vertebral body is to equip movable device when the basis of reliable stability is obtained. According to its principle it can be divided into ball socket joint or elastic deformation. However the overall design of movable artificial vertebral body needs further improvement. Traditional mechanical processing methods are difficult to process complex prostheses and the agreement rate between traditional produced prostheses and lesions was low. While the emerging 3D printing technology can achieve individualized improvement of prosthesis, its slow rate and high cost need to be improved. The materials of movable artificial vertebral body includes metal, ceramics, biomaterials, high polymer materials and so on. Titanium alloy is the main material in metal materials, which is widely used, but its modulus of elasticity is still far from that of human bone and it lacks ideal bone fusion. Ceramic materials are rich in variety but fragile and poor in wear resistance. Biomaterials include autogenous bone, allogeneic bone, etc., with limited source and complicated operation. There are many kinds of polymer and biodegradable materials which obtain excellent and ideal properties. But their properties and applications need to be further studied. The movable artificial vertebral body still needs to be promoted and developed. The clinical experimental data is still insufficient, and long-term curative effect needs to be further observed and studied. This paper reviews the development, advantages, design, processing and materials of movable artificial vertebral bodies and provides useful reference for optimization design, processing and clinical application of movable artificial vertebral bodies.

Nursing care of lower cervical spine fracture treated with 3D print microporous titanium artificial vertebral body / 中国实用护理杂志

Objective@#To summarize the perioperative nursing measures and effects of 3D printed artificial cervical vertebrae for lower cervical spine fractures.@*Methods@#Treatment of 15 cases of lower cervical spine fracture with 3D printed artificial cervical vertebrae. Preoperative cervical spine fixation to prevent spinal cord injury, strict observation of clinical symptoms, assist the doctor to perform CT three-dimensional reconstruction of the cervical spine, and calculate the physiological height of the injured vertebrae; maintain the surgical position fixed during surgery, carefully prepare the supporting equipment, familiar with the surgical related steps, accurate delivery of all types of surgical instruments to assist with intraoperative fluoroscopy. Postoperative focus on the neck to see if there is swelling, effectively maintain the airway patency, observe changes in spinal nerve function, develop a personalized functional exercise program to promote rehabilitation, and actively prevent complications.@*Results@#The JOA score increased from (9.23±1.62) points before surgery to (14.09±1.35) points after surgery, and the improvement rate was 62.55%. There were no complications such as difficulty swallowing, hoarseness, and difficulty breathing.@*Conclusions@#Through targeted perioperative care, surgical complications can be reduced and the quality of life of patients improved.