Clinical study of modified suspension reduction method combined with percutaneous vertebroplasty in the treatment of thoracolumbar osteoporotic compression fracture / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of modified suspension reduction method combined with percutaneous vertebroplasty in the treatment of osteoporotic thoracolumbar compression fractures.@*METHODS@#From February 2020 to October 2021, 92 patients with thoracolumbar osteoporotic compression fracture were treated by percutaneous vertebroplasty. According to different treatment methods, they were divided into the observation group and the control group. The observation group was treated with modified suspension reduction and then percutaneous vertebroplasty, while the control group was treated with percutaneous vertebroplasty alone. The observation group (47 cases), including 20 males and 27 females, the age ranged from 59 to 76 years old with an average of (69.74±4.50) years old, fractured vertebral bodies:T10(2 cases), T11(7 cases), T12(19 cases), L1(14 cases), L2(5 cases);the control group(45 cases), including 21 males and 24 females, the age ranged from 61 to 78 years old with an average of (71.02±3.58) years old, fractured vertebral bodies:T10(3 cases), T11(8 cases), T12(17 cases), L1(12 cases), L2(5 cases);The leakage of bone cement were observed, the visual analogue scale (VAS), Oswestry lumbar dysfunction index (ODI), anterior vertebrae height (AVH), Cobb angle of kyphosis and the amount of bone cement injected before and after operation were recorded and compared between the two groups.@*RESULTS@#All patients were followed up, ranged from 6 to10 with an average of (8.45±1.73) months. Two patients ocurred bone cement leakage in observation group and 3 patients in control group. AVH of observation group increased (P<0.05) and Cobb angle of injured vertebrae decreased (P<0.05). Cobb angle of injured vertebrae and AVH of the control group were not significantly changed (P>0.05). Cobb angle of injured vertebrae of the observation group was lower than that of control group (P<0.05) and AVH was higher than that of the control group (P<0.05). In the observation group, VAS before operation and 1 week, 3 and 6 months after operation respectively were(7.32±1.05) scores, (3.56±1.18) scores, (1.83±0.67) scores, (1.27±0.34) scores, and ODI were(40.12±14.69) scores, (23.76±10.19) scores, (20.15±6.39) scores, (13.45±3.46) scores. In the control group, VAS before operation and 1 week, 3 and 6 months after operation respectively were(7.11±5.26) scores, (3.82±0.68) scores, (1.94±0.88) scores, (1.36±0.52) scores, and ODI were(41.38±10.23) scores, (25.13±14.22) scores , (20.61±5.82) scores, (14.55±5.27) scores . The scores of VAS and ODI after operation were lower than those before operation (P<0.05), but there was no significant difference between the two groups (P<0.05).@*CONCLUSION@#Modified suspension reduction method combined with PVP surgery for osteoporotic thoracolumbar compression fractures has achieved good clinical results, which can effectively relieve lumbar back pain, restore vertebral height, correct kyphosis, improve lumbar function and patients' quality of life.

Investigation on the current situation and influencing factors of mood disorders in patients with thoracic and lumbar osteoporotic fractures / 中国实用护理杂志

Objective:To understand the current situation of mood disorders in patients with thoracic and lumbar osteoporotic fractures and to preliminarily explore its influencing factors.Methods:A cross-sectional survey method was used to select 212 patients with thoracic and lumbar osteoporotic fractures from Department of Orthopedics, West China Hospital, Sichuan University, from January 2018 to September 2020 as the research subjects. The general information questionnaire, Huaxi Emotional-distress Index, Pittsburgh Sleep Quality Index (PSQI) and pain Visual Analogue Scale (VAS) were used to investigate them.Results:The incidence of mood disorders in patients with thoracic and lumbar osteoporotic fractures was 10.38% (22/212). The results of multivariate regression analysis showed that age, days of injury, PSQI score and pain VAS score were the influencing factors of emotional disturbance in patients with thoracic and lumbar osteoporotic fractures ( t values were -3.72-7.66, all P<0.05). Conclusions:Patients with thoracic and lumbar osteoporotic fractures have mood disorders. Age, injury days, PSQI score and VAS score are related to the occurrence of mood disorders in patients with thoracic and lumbar osteoporotic fractures. More attention should be payed to the influencing factors of mood disorders in patients,and timely measures should be taken for individualized intervention.

Clinical and radiological results of thoracic and lumbar fracture and dislocation treated with posterior transforaminal decompression and interbody fusion / 中国骨伤

OBJECTIVE@#To evaluate the clinical and radiological results of patients with thoracic and lumbar fracture and dislocation treated by posterior transforaminal decompression and interbody fusion.@*METHODS@#From June 2010 to June 2017, posterior transforaminal decompression, interbody fusion combined with pedicle screw fixation were performed in 21 patients with thoracic and lumbar fracture and dislocation. Their clinical and radiological data were collected and retrospectively analyzed, including 15 males and 6 females, aged from 25 to 58 years with an average of 45 years old. According to the criterion of American Spinal Injury(ASIA), preoperative neurological function was graded A in 3 cases, B in 7 cases, C in 6 cases, D in 4 cases and E in 1 case. Operative time and intraoperative blood loss and correlative complications were recorded. And VAS score, ODI and Cobb angle were evaluated before and after surgery. The improvement of neurological function was also analyzed at the final follow-up. Intervertebral bony fusion was observed during the follow-up by CT three-dimensional reconstruction.@*RESULTS@#The operative time was 150 to 240 min with an average of (192±47) min. The intraoperative blood loss was 380 to 750 ml with an average of(603±120) ml. Dura sac tearing and cerebral fluid leakage occurred in 3 cases and were repaired during operation; superficial wound infection occurred in 1 case, and got healing after dressing change. The postoperative follow-up duration was 24 to 45 months with an average of(37.0±9.5) months. VAS score was improved from preoperative 8.9±0.4 to immediately postoperative 4.2±1.3(<0.05). At the final follow-up, VAS score decreased further to 3.6±0.8. ODI was decreased from preoperative (95.30±3.52)% to (32.51±6.30)% at the final follow-up (<0.05). Cobb angle was corrected from preoperative (21.2±8.8)° to immediately postoperative(2.3±3.1)° (<0.05). At the final follow-up, Cobb angle was (3.2±2.5)°, showing no significant difference with immediately postoperative value. The neurological function was grade A in 3 cases, B in 3 cases, C in 5 cases, D in 6 cases and E in 4 cases at the final follow-up. All the patients got solid intervertebral bone fusion in 8 to 13 months after operation, with an average fusion time of (10.3±2.5) months.@*CONCLUSIONS@#For the patients with thoracic and lumbar fracture and dislocation mainly involving intervertebral disc and endplate plane, posterior transforaminal decompression and interbody fusion not only is less invasive, but also can effectively reconstruct spinal three column and obtain good biomechanical stability. And, it is beneficial for the good recovery of neurological function.

Application of small incision approach in anterior surgery of thoracic and lumbar spinal tuberculosis / 中国修复重建外科杂志

Objective: To investigate the value of small incision approach in the anterior surgery of thoracic and lumbar spinal tuberculosis. Methods: A clinical data of 65 patients with thoracic or lumbar spinal tuberculosis treated with posterior-anterior surgery between January 2015 and January 2018 was retrospectively analyzed. The patients were divided into small incision group (group A, 29 patients) and traditional incision group (group B, 36 patients) according to the length of anterior incision. There was no significant difference in general data such as gender, age, disease duration, segment of lesion, American Spinal Cord Injury Association (ASIA) grading, preoperative pain visual analogue scale (VAS) score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and Cobb angle of spinal kyphosis between 2 groups ( P>0.05). The length of anterior incision, operation time, intraoperative blood loss, postoperative complications, postoperative hospitalization time, ESR, and CRP were recorded and compared. The VAS score was used to evaluate the pain after operation. The Cobb angles in patients with spinal kyphosis were measured and the loss of angle and correction rate of angle were calculated. The result of bone graft fusion was assessed according to the Bridwell standard. Results: The length of anterior incision, operation time, intraoperative blood loss, and hospitalization time of group A were all significantly less than those of group B ( P0.05). At last follow-up, the neurological function of patient with neurological symptoms was significantly better than that before operation, and there was no significant difference between 2 groups ( Z=0.167, P=0.868). The VAS scores of 2 groups at each time point after operation were significantly lower than those before operation ( P0.05). There was no significant difference in Cobb angle, loss of angle, and correction rate between 2 groups after operation ( P>0.05). The bone graft healed well at last follow-up in 2 groups. There was no significant difference in bone graft fusion rate between 2 groups at 6 months after operation, 1 year after operation, and last follow-up ( P>0.05). At last follow-up, all patients cured, and no recurrence occurred. Conclusion: In the anterior surgery of thoracic and lumbar tuberculosis, the application of small incision approach can achieve the similar effectiveness as traditional incision surgery with the advantages of minimally invasive, less complications, and quick recovery.

Observation and comparison of the efficacy of three kinds of operational method for treatment of thoraco- lumbar fractures / 实用医学杂志

Objective To compare treatment and efficacy of thoracolumbar fractures by using three different screw fixations:traditional approach,the vertebral side clearance into the road and percutaneous pedicle. Methods A total of 82 single segmental thoracic lumbar fractures cases hospitalized from March 2011 to March 2014 ,with male 67 cases ,female 15 cases ,and average age(33.7+/-12.5)years old. Patients were randomly divided into three groups:traditional approach group (n = 23),operation through paraspinal muscle gap group (n = 30),percutaneous group(n = 29). These following indicators will be compared in three groups:duration of operation ,intraoperative blood loss ,intraoperative fluoroscopy time ,postoperative flow ,VAS scores before and after operation and Oswestry disability index , difference of spinal sagittal position Cobb′s Angle. Results Compared with the traditional approach group ,operation through paraspinal muscle gap group and percu-taneous group have obvious advantages in duration of operation,intraoperative blood loss,postoperative flow,VAS scores before and after operation ,the Oswestry disability index. Additionally ,above mentioned three surgical methods could recover kyphosis deformity ,and there was no statistically significant difference among three groups (P > 0.05). Conclusion In the treatment of monosegmental thoracolumbar fractures ,compared with traditional approach ,operation through paraspinal muscle gap and percutaneous pedicle screw internal fixation have more advantages which includes fewer trauma,less bleeding,faster recovery and lower incidence of postoperative low back pain.

Finite element analysis of different motion states of vertebral pedicle screw fixation in thoracolumbar fractures / 医学研究生学报

Objective Construct the finite element model of vertebral pedicle screw fixation in thoracolumbar fractures can obtain the intuitive systematic mechanical effects under different motion conditions, it has a very important significance to the patients' rehabilitation, evaluation of system stability and prognosis.In this study, the biomechanical effects of different motion states of thoracic and lumbar spine fracture models were analyzed by the finite element analysis method.Methods We selected 1 orthopedic health volunteers from Nanjing General Hospital of Nanjing Military Region in June 2014, established the finite element model by the CT scan data of the healthy volunteer, used the geometric cutting method for fracture simulation and replacement, assembled posterior orthopedic internal fixation system of vertebral pedicle screw, simulated the different motion states and obtained the stress nephogram and displacement graph of the nail-stick system..Results For the six-nail and two-rod internal fixation system of posterior nail-stick system which set nails through injured vertebrae, we used the finite element operation method to simulate the biomechanical characteristics of different modes of motion in space, it combined by the movement of six directions(flexion, dorsiflexion, left side bend, right side bend, left twist, right twist).The maximum stress(94.99±1.72MPa) and the maximum displacement(0.1854±0.0052mm) and the of the dorsiflexion were significantly lower than that of flexion[(126.82±5.56)MPa、(0.2502±0.0050)mm]、left side bend[(152.18±9.13)Mpa、(0.3172±0.0048)mm]、right side bend[(159.58±13.54)Mpa、(0.3315±0.0051)mm](P<0.05).Conclusion The method of finite element analysis can obtain clear and intuitive biomechanical data, which provides effective evidence for the evaluation of surgical efficacy, the development of postoperative rehabilitation methods and the evaluation of the stability of thoracolumbar spinal system.

Influencing factors of recurrence of fracture after percutaneous vertebral augmentation / 中国综合临床

Objective To evaluate the influencing factors of recurrence of fracture after percutaneous vertebral augmentation.Methods From January 2007 to December 2013,256 cases patients with percutaneous vertebral augmentation in treatment of osteoporotic vertebral compression fractures in the Central Hospital of Chaoyang were retrospectively reviewed.After operation,the patients were divided into recurrent fracture group (59 cases) and no recurrence group (197 cases) according to whether postoperative recurrence of vertebral fracture.The age,sex,body mass index (BMI),bone mineral density,operation mode,bone cement injection volume,the existence of bone cement leakage and vertebral body height recovery rate were compared between the two groups respectively.Multi factor Logistic regression analysis was performed to analyze the correlation between the factors and the recurrence of vertebral body fractures.Results The age((75.9±4.6) years old vs.(69.9±5.0) years old),BMI((23.5±0.6) kg/m2 vs.(25.4±0.7) kg/m2),bone mineral density((-3.67±0.68)vs.(-2.75 ±0.98)),the existence of bone cement leakage rate(22.0％ vs.5.1％) and vertebral body height recovery rate ((24.1±2.9) ％ vs.(14.9±3.0)％) between recurrent fracture group and no recurrence group had statistically significant differences (P=0.046,0.047,0.046,0.026,0.023).Multi factor Logistic regression analysis showed that age,BMI were not related to postoperative recurrence of fracture(P=0.140,0.137),and bone density,bone cement leakage and vertebral body height recovery rate were related to recurrence of fracture (P=0.018,0.000,0.000).Conclusion Low bone mineral density,existence of bone cement leakage and high body height recovery rate are the risk factors of recurrence of fracture after percutaneous vertebral augmentation.

Effect of Short-segment Pedicle Screws System with or without Pedicle Screws on Fractured Level on Type A Thoracic and Lumbar Spine Fracture / 中国康复理论与实践

@#Objective To investigate the effects of short-segment pedicle screws system on type A thoracic and lumbar spine fracture with or without pedicle screws on the fractured level. Methods 23 patients with type A thoracic and lumbar spine fracture were included, in which 11 cases received traditional short-segment pedicle screws system without pedicle screws on the fractured level (group A), and other 12 cases with pedicle screws on the fractured level (group B). The anterior vertebral height, posterior vertebral height and local kyphosis an-gle were measured before and after operation. Results All pedicle screws were successfully implanted with good location and stability. The vertebral height and kyphosis angle significantly improved after operation in both groups (P<0.05), and the improvement of kyphosis angle was more in group B than in group A (P<0.05). Conclusion Short-segment pedicle screws system with pedicle screws on the fractured level may fine correct the kyphosis angle in short term.

Posterior Ligamentous Complex Injuries Are Related to Fracture Severity and Neurological Damage in Patients with Acute Thoracic and Lumbar Burst Fractures

PURPOSE: The proposed the thoracolumbar injury classification system (TLICS) for thoracolumbar injury cites the integrity of the posterior ligamentous complex (PLC). However, no report has elucidated the severity of damage in thoracic and lumbar injury with classification schemes by presence of the PLC injury. The purpose of this study was to accurately assess the severity of damage in thoracic and lumbar burst fractures with the PLC injuries. MATERIALS AND METHODS: One hundred consecutive patients treated surgically for thoracic and lumbar burst fractures were enrolled in this study. There were 71 men and 29 women whose mean age was 36 years. Clinical and radiologic data were investigated, and the thoracolumbar injury classification schemes were also evaluated. All patients were divided into two groups (the P group with PLC injuries and the C group without PLC injuries) for comparative examination. RESULTS: Fourth-one of 100 cases showed PLC injuries in MRI study. The load sharing classification score was significantly higher in the P group [7.8+/-0.2 points for the P group and 6.9+/-1.1 points for the C group (p<0.001)]. The TLICS (excluded PLC score) score was also significantly higher in the P group [6.2+/-1.1 points for the P group and 4.0+/-1.4 points for the C group (p<0.001)]. CONCLUSION: The presence of PLC injury significantly influenced the severity of damage. In management of thoracic lumbar burst fractures, evaluation of PLC injury is important to accurately assess the severity of damage.

Posterior Direct Decompression and Fusion of the Lower Thoracic and Lumbar Fractures with Neurological Deficit

STUDY DESIGN: A retrospective study. PURPOSE: To analyze the treatment outcome of patients with lower thoracic and lumbar fractures combined with neurological deficits. OVERVIEW OF LITERATURE: Although various methods of the surgical treatment for lower thoracic and lumbar fractures are used, there has been no surgical treatment established as a superior option than others. METHODS: Between March 2001 and August 2009, this study enrolled 13 patients with lower thoracic and lumbar fractures who underwent spinal canal decompression by removing posteriorly displaced bony fragments via the posterior approach and who followed up for more than a year. We analyzed the difference between the preoperative and postoperative extents of canal encroachment, degrees of neurologic deficits and changes in the local kyphotic angle. RESULTS: The average age of the patients was 37 years. There were 10 patients with unstable burst factures and 3 patients with translational injuries. Canal encroachment improved from preoperative average of 84% to 9% postoperatively. Local kyphosis also improved from 20.5degrees to 1.5degrees. In 92% (12/13) of the patients, neurologic deficit improved more than Frankel grade 1 and an average improvement of 1.7 grade was observed. Deterioration of neurologic symptoms was not observed. Although some loss of reduction of kyphotic deformity was observed at the final follow-up, serious complications were not observed. CONCLUSIONS: When posteriorly displaced bony fragments were removed by the posterior approach, neurological recovery could be facilitated by adequate decompression without serious complications. The posterior direct decompression could be used as one of treatments for lower thoracic and lumbar fractures combined with neurologic injuries.

Risk Factors of Deep Infection after Thoracic and Lumbar Spinal Arthrodesis / 대한척추외과학회지

STUDY DESIGN: This is a retrospective analysis OBJECTIVES: We wanted to analyze the risk factors related to deep infection and removing an implant after thoracic and lumbar spinal arthrodesis. SUMMARY OF LITERATURE REVIEWS: The relationship between deep infection and implant removal is controversial. MATERIALS AND METHODS: We retrospectively compared the infection group with the non-infection group for the rates of deep infection, the preoperative diagnosis, the number of fused segments, the operative methods, the graft materials, the operating time and the blood loss. Moreover, we classified the deep infection patients into two groups: those who underwent implant removal and those who did not, and we compared the microorganisms that were cultured out of the patients. We also compared the relationship of deep infection with the risk factors, the mean hospital stay and the mean number of operations. RESULTS: There were 18 cases (2.46%) of deep infection. The factors that did not show a significant difference were the preoperative diagnosis, the graft material, the increased number of fused segments, age, gender and BMI. The factors that were significant were the operating time (p=0.001), the amount of blood loss (p<0.000), DM (p=0.021), and PLF (p=0.054). The incidence of implant removal was higher for the cases with deep infection caused by MRSA. We were able to see a significant difference of between the group that had undergone implant removal and the group that had not undergone implant removal. CONCLUSIONS: The incidence of deep infection after thoracic and lumbar spinal athrodesis increased as the operating time and blood loss increased, and it was also higher when either PLF or DM were present. Implant removal causes bad clinical results, so physicians should be very cautious when operating on a case of implant removal.

Selective of different surgical procedure in treatment of thoracic and lumbar spine tuberculosis with severe kyphosis and paraplegia / 中国矫形外科杂志

[Objective]To evaluate the clinical results of the patients with severe kyphosis and paraplegia in differnt spine segment due to tuberculosis of thoracic and lumbar which had been treated by different surgical procedure. [Methods]There were a total of 23 patients, 16 male and 7 female in this stuady. The average age were 25 years, ranging from 12~56 years old. Tuberculosis lesion were located in different spine segment(T1~4)four cases, (T5~10)four cases, (T11~L2) nine cases,(L3~5) six cases, two vertebral bodies were involved in 8 patients and three vertebralbodies involved in 12 patients. Surgical procedure:four patients treated through modified anterior cervico-thoracic approach.Five patients treated through one stageposterior total vertebral osteotomy, other patients combined with anterior-posterior approach, according to the patient's surgical situation, twelve patients accepted anterior and posterior combined operation, two patients were treated by two stages.The period of bone grafting fusion, kyphosis deformity correction degree ,and neurological function recovery record were investigated postoperatively.[Results]All patients got solid fusion in a average of seven months. The kyphosis deformity was corrected 49? in average, which was maintained well within follow-up period. Patients neurological function deficiency achieved completely recovery, the longest time being within 10 months. All patients were cured thoroughly and there was no seroius complication.[Conclusion]Different surgical procedure should be selected, according to different spine segments due to tuberculosis of thoracic and lumbar vertebrae with the extent of severe kyphosis and paraplegia, it can achieve thoroughly debridement of tubereulosis, solid interbody fusion, good correction of deformity and forever stability of spine with anterior or posterior internal fixation.It could get successful rehablitation for patient’s neurological function and improve the patient’s life quality.

Radiographic study and clinical significance about sagittal plane curves in the adjacent segments of the thoracic and lumbar spine / 中国矫形外科杂志

[Objective]To study the anatomy about the sagittal plane curves of the adjacent segments of the thoracic and lumbar spine on the radiographs of standing position,in order to provide anatomical evidence for clinical operation. [Methods]Seventy-five standing posture radiographs about normal adult were obtained,the sagittal plane curves of the adjacent segments of the thoracic and lumbar spine were obtained by measuring the angles between perpendicular of adjacent superior end plate.The normal value and rule about sagiital plane curves were determined by statistical method.Fifty patients received operation according to these measures.The Cobb's angle of sagittal plane(T12-S1) at 0,3,12 months postoperatively,Denis scores at 12 months postoperatively and the cases in which breaking or loosening internal fixation occurred at 12 months postoperatively were recorded.[Results]The 95% confidence interval of about sagittal plane curves was obtained.There was no statistical significance for sex and age.It would improve function postoperatively and decrease the broken or loosened internal fixation.[Conclusion]It's important to recover the Cobb's angle in the short segmental internal fixation with pedicle screws through posterior approach.

CT Scanning for Traumatic Thoracolumbar Vertebral Compression Fracture / 医疗卫生装备

Objective To study CT scanning for traumatic thoracolumbar vertebral compression fracture. Methods After routine examination, 16 cases with unsatisfying results were performed CT scanning. Results Wolter classification scheme was involved in and the positions of spinal stenosis and injury were signed with different numbers. The results by CT were consistent with those by operation examination. Conclusion For the diagnosis of traumatic thoracolumbar vertebral compression fracture, CT is more effective than X-ray.

Vertebral Actinomycosis: Two Case Report / 대한정형외과학회잡지

The lack of familiarity with vertebral actinomycosis by both clinicians and radiologists, may contribute to its frequent omission from the differential diagnosis of suspicious lesions, therefore the condition can be difficult to diagnose. We now present the first report of two cases of thoracic and lumbar vertebral actinomycosis resulting in a paraparesis due to epidural abscess which necessifated surgery.

Comparison of Short and Long-Segment Fusion in Thoracic and Lumbar Fractures / 대한척추외과학회지

STUDY DESIGN: A retrospective study was designed to evaluate the clinical result and difference between short segment and long segment fixation, which was undertaken by posterior approach for thoracic and lumbar spine fractures. OBJECTIVE: To determine and compare the mechanical maintenance and ability of correction, and clinical and neurologic recov-ery between short segment and long segment fusion group. SUMMARY OF BACKGROUND DATA: The long segment instrumentation is a cause of decrease of motion segment in thoracic and lumbar spine. In short segment fusion, screw failures were reported. MATERIALS AND METHODS: From 1989 thorough 1997, 54 patients who had been operated on by the posterior approach with transpedicular screw fixation for spine injuries were divided into two groups. The authors applied the short segment transpedic-ular instrumentation including fractured vertebra. Short segment group included 35 cases, and long segment group, 19 cases. The mean follow-up period was one year and eight months for short segment group, two years and seven months for long segment one. The results were evaluated by comparing the anterior vertebral height, sagittal index in simple roentgenogram and neurologic recovery. RESULTS: The average of anterior vertebral height which was 50.7% at preoperation, became 78.7% after the operation and measured 74.9% at final follow-up in long segment fusion group, while in short segment fusion group it was 59.7%, 79.3% and 77.7%, respectively. The average of sagittal index of 17.5degreeat preoperation became 6.7degreeafter the operation, and measured 8degreeat final follow-up in long segment fusion group, while in short segment fusion group it was 19.9degree, 10.4degree, and 12.1degree, respectively. Overall clinical results had no statistical significant difference between two groups. Of the thirty-six patients with neurologic deficits, twenty-two improved by over the one Frankel grade. CONCLUSIONS: The authors conclude that the short segment transpedicular instrumentation including fractured vertebra is a successful method of thoracolumbar and lumbar burst fractures.

Evaluation by MRI of Disc Injury in Fractures of the Thoracic and Lumbar Spine

Injury to a lumbar disc is rare, and is seldom mentioned in the literature describing spinal fracture; even in patients with such fractures, disc herniation is infrequent and is often considered to be a sequella of trauma. Using magnetic resonance imaging(MRI) we investigated the incidence and pattern of disc injuries by an in 37 patients with fractures of the lumbar and thoracic spines. Discs adjacent to the fracture site were found to be normal in 19 patients(51.4%), but in ten(27.0%), the end plate was disrupted. The disc was ruptured in six patients(16.2%), and had degenerated in two patients(5.4%). Injured discs were found in the three patients with fracture-dislocation and three of the seven(42.9%) with burst fracture, but in none of the 27 with compression fracture. The three lower lumbar discs(L3-4, L4-5, and L5-S1) were found to be normal in 26 patients(70.3%), but had degenerated in seven(18.9%). Incidental asymptomatic disc herniation was found in four patients(10.8%), including one with degenerative spondylolisthesis. There was no traumatic disc herniation in the lower lumbar region. These results suggest that traumatic lumbar disc herniation is quite uncommon, even in the unstable thoracolumbar spinal injuries.

Differentiation Between Acute and Old Fractures in The Thoracic and Lumbar Spine: Observer Agreement

Differentiation between acute and old fractures in the thoracic and lumbar spine is often difficult. We have evaluated the intraobserver agreement and interobserver variability of interpretations. We have prepared 50 cases from 40 patients with thoracic or lumbar spine fracture for evaluation. At first, two radiologist interpreted each of the 50 cases, Only by using plain roentgenograms. Then, they interpreted the cases again using also spine CT, MRI, bone scintigrams and follow-up roentgenograms. Intraobserver agreement was found to be 78% in Doctor A, and 76% in Doctor B. Interobserver agreement was only 62% at first. It was 88%, when they used CT, MRI, bone scintigrams and follow-up roentgenograms. It was not easy to differentiate the old fractures from acute one only by plain roentgenograms. Differentiation was more difficult, when the patient was female or over 55 years old. Plain roentgenography in hyperextension posture seems to be a simple but useful method for the diagnosis of the acute fracture. MRI was more valuable than CT or bone scintigraphy to differentiate the old fractures from the acute ones.

Surgical Experience of transpediculr Screw Fixation of the Spine

Vertebral transpedicular screws provide secure attachment for posterior spinal fixation device, the authors had experienced 29 cases of transpedicular screw fixation to obtain fixations of the thorcolumbar and lumbar spine instability, the patients were operated between February, 1992, and May, 1995. Spinal Fusion was attempted at one to four levels of thoracic and lumbar spine. Follow-up period was from 6 to 33 months, averaging 16 months. The result was summerized as follows: 1) Of the 29 cases, 20 were spondylolisthesis and 9 were fracture and dislocation. 10 patients(34.5%) were 30 years old, and 20 cases(69%) were female. Mean age was 42 years. 2) The symptom included low back pain, sciatica and intemittant claudificaton in the order of incidence. 3) The sites of spondylolisthesis were L4-5 in 12 cases(60%) and L5-S1 in 8 cases(40%). The average degree of slippage in spondylolisthesis was Meyerding's grade I(85%). The sites of fracture were T12 in 5 cases(55.6%), L1 in 2 cases(22.2%), L2 with L3 in 1case(11.1%) and L1 in 1 case(11.1%). 4) There was no patient with significant neurologic injury or functional root loss. A screw malposition was observed in one case. 5) The results of operations were considered exellent in 16 cases(55%), good in 10 cases(35%) and fair in 3 cases(10%), and satisfactory bony fusion was obtained.

Treatment of Unstable thoracic and Lumbar Spine Fracture with Harrington Segmental Spinal Instrumentation (SSI) / 대한정형외과학회잡지

This is a retrospective clinical and roentgenographic study to measure the correction of deformity and rigidity of Harrington SSI in the stabilization of unstable thoracic and lumbar spine fractures. 35 patients with unstable thoracic and lumbar spine fracture were treated with Harrington SSI from Feb. 1985 to Mar. 1987 in SNUH and 29 patients were followed up for more than 1 year, average 15.6 months. At final follow up of these 29 patients, 73.1% of patients gained neurologic improvement. Measurement of correction of anterior, middle and posterior column height, local kyphosis and anteroposterior offset were 29.7%, 5.2%, 31.2%, 12.8°and 5.3mm and loss of correction of these were 6.5%, 0.1%, 5.8%, 3.1°and 1.1 mm.