The tibial nerve compression test for the diagnosis of lumbar spinal canal stenosis-A simple and reliable physical examination for use by primary care physicians.

OBJECTIVES: In the present study, we aimed to evaluate the diagnostic accuracy and suitability of the 'Tibial Nerve Compression Test (TNCT)' as a screening tool for lumbar spinal canal stenosis (LSS). METHODS: A total of 108 consecutive patients admitted to our hospital for surgical treatment or diagnosis of LSS were included in this study. Fifty healthy volunteers were examined as a control group. The severity of tenderness was scored (tenderness score) and measured on a visual analogue scale (P-VAS score). These scores were compared between the LSS and control groups. Moreover, they were compared before and after the operation among operated patients. RESULTS: The positive tenderness rate was significantly higher (92.6% [100/108]) in the LSS group than in the control group (30% [15/50]). The sensitivity and specificity of TNCT (95% confidence interval) were 0.93 (0.88-0.96) and 0.70 (0.61-0.77), respectively. Positive tenderness rates and P-VAS scores were significantly higher in the LSS group (p < 0.0001). Scores on all measures significantly improved post-operatively in operated patients (p < 0.0001). CONCLUSION: The Tibial Nerve Compression Test is a useful screening tool for LSS diagnosis in a primary care setting. LEVEL OF EVIDENCE: Level II, diagnostic study.

Adjacent vertebral body fracture following vertebroplasty with polymethylmethacrylate or calcium phosphate cement: biomechanical evaluation of the cadaveric spine.

STUDY DESIGN: A biomechanical study using human cadaveric thoracolumbar spinal columns. OBJECTIVE: To compare the effect of treatment by vertebroplasty (VP) with polymethylmethacrylate cement and VP with calcium phosphate cement on the creation of adjacent vertebral body fracture following VP. SUMMARY OF BACKGROUND DATA: Adjacent vertebral body fractures have been reported as a complication following VP. METHODS: Twenty-four spinal columns (T10-L2) from human cadavers were subjected to dual energy radiograph absorptiometry to assess bone mineral density. They were divided into the P group and C group, and experimental vertebral compression fractures were created at T12 vertebrae. T12 vertebrae were augmented with polymethylmethacrylate and calcium phosphate cement in the P group and C group, respectively. Each spinal column was compressed until a new fracture occurred at any vertebra, and the location of newly fractured vertebra and failure load was investigated. RESULTS: There was no significant difference in bone mineral density at each level within each group. In the P group, a new fracture occurred at T10 in 2 specimens, T11 in 8, and L1 in 2. In the C group, it occurred at T10 in 1 specimen, T11 in 2, L1 in 1, and T12 (treated vertebra) in 8. The failure loads of the spinal column were 1774.8+/-672.3 N and 1501.2+/-556.5 N in the P group and C group, respectively. There was no significant difference in the failure load of the spinal column between each group. CONCLUSION: New vertebral fractures occurred at the vertebra adjacent to augmented vertebrae in the P group and in the augmented vertebrae in the C group. The difference in the fractured site may be because of the difference in strength between the 2 bone filler materials. Therefore, the strength of bone filler materials is considered a risk factor in developing adjacent vertebral body fractures after VP.

Efficacy of novel-concept pedicle screw fixation augmented with calcium phosphate cement in the osteoporotic spine.

Pedicle screw instrumentation has become increasingly popular for rigid internal stabilization of the thoracolumbar spine. However, when pedicle screws are used in elderly osteoporotic patients, the screw-bone interface is stripped easily. Therefore, the risk of screw loosening and backing-out after surgery has increased. The purpose of this study was to evaluate the efficacy of the novel-concept pedicle screw fixation augmented with calcium phosphate cement (CPC) in the osteoporotic spine. The novel-concept screw has the same shape as the ordinary screw, but it is hollow and fabricated with 20 small holes (1.3 mm in diameter) leading to the hollow part on the bottom of the thread. Fifteen embalmed cadaveric lumbar vertebrae were instrumented with two types of pedicle screw (the ordinary screw and the novel-concept screw) in each pedicle. Only the novel-concept screws were augmented with CPC after insertion. Seven days later, axial pull-out testing was performed at a crosshead speed of 10 mm/min. The mean maximal pull-out strength of the ordinary screws was 258 N, and that of the novel concept screws was 637 N. These results suggest that the novel-concept screw augmented with CPC can be useful for pedicle screw fixation of the osteoporotic spine.

Biomechanical evaluation of kyphoplasty and vertebroplasty with calcium phosphate cement in a simulated osteoporotic compression fracture.

Kyphoplasty and vertebroplasty with polymethylmethacrylate (PMMA) have been used for the treatment of osteoporotic vertebral compression fractures. We performed kyphoplasty and vertebroplasty with alpha-tricalcium phosphate cement (CPC) and PMMA to compare the biomechanical properties. Thirty osteoporotic vertebrae were harvested from nine embalmed cadavers. We randomized the vertebrae into four treatment groups: (1) kyphoplasty with CPC; (2) kyphoplasty with PMMA; (3) vertebroplasty with CPC; and (4) vertebroplasty with PMMA. Prior to injecting the cement, all vertebrae were compressed to determine their initial strength and stiffness. They were then recompressed to determine their augmented strength and stiffness. Although the augmented strength was greater than the initial strength in all groups, there was no significant difference between the two bone cements for either kyphoplasty or vertebroplasty. The augmented stiffness was significantly less than the initial stiffness in the kyphoplasty groups, but the difference between the two cements did not reach significance. In the vertebroplasty groups, the augmented stiffness was not significantly different from the initial stiffness. There was no significant difference between the two bone cements for either procedure when cement volume and restoration of anterior height were assessed. We concluded that kyphoplasty and vertebroplasty with CPC were viable treatment alternatives to PMMA for osteoporotic vertebral compression fractures.

Implication for melatonin and its receptor in the spinal deformities of hereditary Lordoscoliotic Rabbits.

STUDY DESIGN: The association between melatonin system and the spontaneous development of the spinal deformities in the Hereditary Lordoscoliotic Rabbit, the natural animal model for idiopathic scoliosis, was studied. OBJECTIVES: To examine the implication for melatonin and its receptor in the spinal deformities of the natural animal model, the Hereditary Lordoscoliotic Rabbit. SUMMARY OF BACKGROUND DATA: We previously reported radiologic and histologic studies investigating the etiology of spinal deformities in a breed of Japanese White Rabbit, the Hereditary Lordoscoliotic Rabbit. These animals develop thoracic lordoscoliosis during growth and as such can be used as a model for human idiopathic scoliosis. Although previous studies in chickens have established that pinealectomy produces scoliosis, the cause of the condition is yet to be fully elucidated. METHODS: Serum melatonin levels in Hereditary Lordoscoliotic Rabbits were measured by radioimmunoassay and compared with those of Japanese White Rabbits (controls). The expression of melatonin receptor in the rabbit was detected by homology cloning to access the number of the melatonin receptor mRNA in the rabbit spinal cord by quantitative reverse-transcribed polymerase chain reaction. RESULTS: Serum melatonin levels in Hereditary Lordoscoliotic Rabbits were significant higher than those of controls in each period until 20 weeks. We detected the expression of melatonin receptor mRNA in rabbit spinal cord. However, no significant quantitative differences were found in the level of expression of melatonin mRNA in the spinal cord between Hereditary Lordoscoliotic Rabbits and controls. CONCLUSIONS: In relation to the present study, we suggest that causes of spinal deformities in the Hereditary Lordoscoliotic Rabbit may be the result of the contribution of melatonin receptors as well as that of altered serum melatonin levels in the Hereditary Lordoscoliotic Rabbit. Further studies will be required to investigate the expression of melatonin receptor in other tissues of the Hereditary Lordoscoliotic Rabbit as well as to delineate the role of melatonin in the pathogenesis of idiopathic scoliosis.