ABSTRACT
INTRODUCTION: Spontaneous regressions of calcified thoracic disc herniations (TDH) have been rarely described. Since now, no previous papers hypothesized that radiological factors could be able to predict the evolution of the herniation. This study shows that the radiodensity of the herniated material in herniations with spontaneous resolution might differ from that of operated herniations. METHODS: This is a retrospective study. A cohort of patients that underwent surgical removal of a calcified thoracic disc herniation has been compared to two cases conservatively treated and a case with spontaneous regression. CT scans were evaluated to compute the average radiodensity [in Hounsfield units (HU)] of the calcified components of the herniations. All the slices of the CT scans involving the calcification were evaluated in their axial images and in their coronal and sagittal reformations. Comparison of the slices radiodensity (spontaneously resolved versus surgically treated) was performed with the unpaired Student's t test. RESULTS: The mean density of calcification in the case with spontaneous regression was found to be 454 HU. In the control group of surgical cases observed, and the conservatively treated cases, the mean HU density showed higher values (respectively, 827 and 853 HU) (p < 0.01). CONCLUSION: Qualitative differences between calcified TDH that resolve spontaneously or need surgical treatment might be shown by differences of radiodensity. This comparative study, in spite of the limitations due to small numbers, provides a new insight in the interpretation of the phenomenon of spontaneous resolution of calcified TDH. These slides can be retrieved under Electronic Supplementary Material.
Subject(s)
Calcinosis , Intervertebral Disc Displacement , Thoracic Vertebrae , Adult , Aged , Calcinosis/diagnostic imaging , Calcinosis/physiopathology , Calcinosis/surgery , Female , Humans , Intervertebral Disc Displacement/diagnostic imaging , Intervertebral Disc Displacement/physiopathology , Intervertebral Disc Displacement/surgery , Male , Middle Aged , Predictive Value of Tests , Remission, Spontaneous , Retrospective Studies , Thoracic Vertebrae/diagnostic imaging , Thoracic Vertebrae/physiopathology , Thoracic Vertebrae/surgery , Tomography, X-Ray Computed , Treatment OutcomeSubject(s)
Back Pain/surgery , Intervertebral Disc Degeneration/surgery , Intervertebral Disc Displacement/surgery , Minimally Invasive Surgical Procedures/methods , Spinal Curvatures/surgery , Adult , Back Pain/diagnostic imaging , Female , Humans , Intervertebral Disc Degeneration/diagnostic imaging , Intervertebral Disc Displacement/diagnostic imaging , Male , Radiography , Spinal Curvatures/diagnostic imaging , Spinal Fusion/methodsABSTRACT
INTRODUCTION: Sagittal imbalance is a predictor of failure after surgery for lumbar degenerative pathology. For this reason, specialists advocate correction of sagittal deformity and systematically perform preoperative standing whole spine films. Such diagnostic investigations expose patients to significant doses of radiation. The authors propose an easier radiographic investigation helpful as a screening test to identify patients likely to have sagittal imbalance. METHODS: Fifteen whole spine lateral films were evaluated, classifying subjects into three categories: balanced, compensating imbalanced or imbalanced. A second specialist evaluated the reduced SLLP versions of the film (from L1 to proximal femora), measuring spinopelvic parameters. RESULTS: In the SLLP film, the combination of two parameters (femoral inclination >10°, pelvic tilt >1/3 pelvic incidence +5°) identified 94 % of patients with altered sagittal balance. CONCLUSIONS: This study preliminarily suggests that the SLLP film can be a useful screening test for sagittal balance abnormalities.
