Efficacy of Opportunistic Screening with Chest CT in Identifying Osteoporosis and Osteopenia in Patients with T2DM.

Purpose: To explore the validity of the thoracic spine Hounsfield Unit (HU) measured by chest computed tomography (CT) for opportunistic screening of diabetic osteoporosis. The current study attempted to establish a diagnostic threshold for thoracic spine HU in a type 2 diabetes mellitus (T2DM) population with osteoporosis. Patients and Methods: The current study retrospectively included 334 patients with T2DM. They underwent chest CT and Dual-energy X-ray (DXA) between August 2021 and January 2022 in our hospital. HU values were measured on the resulting chest CT images at thoracic spine 11 and 12 to construct regions of interest. All patients were grouped according to the lowest T-value of DXA examination: osteoporosis, osteopenia and normal bone density. HU values were compared with T-values in each group of patients, and receiver operating characteristics curves were plotted to calculate diagnostic thresholds as well as sensitivity and specificity. Results: There was a strong correlation between the HU values of chest CT and the T-values of DXA (p < 0.01). The sensitivity for osteoporosis was 88.7% for T11 attenuation≤ 98 HU and the specificity for osteoporosis was 87.5% for T12 attenuation ≤ 117HU; the specificity for normal BMD was 85.4% for T11 attenuation ≥ 147 HU and 82% for T12 attenuation ≥ 146 HU. Conclusion: Chest CT can be used to screen patients with T2DM for opportunistic osteoporosis and help determine if they need DXA screening. The current study suggests that when the HU threshold of T11 ≤ 98/T12 ≤ 117, patients may need further osteoporosis screening.

Sexual dimorphism of the twelfth thoracic vertebra for sex determination in the Central Thai population.

Analyzing skeletal remains is crucial for identifying individuals, and forensic anthropologists use this analysis to determine biological characteristics, particularly sex, aiding criminal investigations. Among thoracic vertebrae, the twelfth thoracic vertebra (T12) is highly sexually dimorphic in various populations. This study aims to establish a discriminant function equation (DFE) for sex determination based on T12 in the Central Thai population. A total of 15 parameters of T12 were examined in 69 bone samples (43 males and 26 females). Among the 15 parameters, 14 were significantly different between males and females. The discriminant function equation (DFE) was generated as DFE = -19.578 + 0.376(i) BDsm + 0.254(l) PW + 0.081TDm, with a cutoff value of -0.296 for males and females, showing 92.8 % accuracy. The evaluation of the DFE using 10 blind samples showed 90 % accuracy. These findings may offer an additional method for sex determination through T12, complementing the examination of other skeletal elements.

Advantages of unilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures-a systematic review and meta-analysis.

Data from English randomized controlled trials comparing unilateral versus bilateral PKP for the treatment of OVCFs were retrieved and analyzed, and the results showed that unilateral PKP is a better choice for the treatment of patients with OVCFs, which will provide a reliable clinical rationale for the treatment of OVCFs. PURPOSE: To investigate the advantages of unilateral percutaneous kyphoplasty (PKP) for the treatment of osteoporotic vertebral compression fractures(OVCFs). METHODS: The systematic evaluation program met all program requirements (CRD 42023422383) by successfully passing the PROSPERO International Prospective Systematic Evaluation Registry. Researchers searched the references of English-language randomized controlled trials comparing unilateral and bilateral PKP for the treatment of osteoporotic vertebral compression fractures published between 2010 and 2023 and manually searched for known primary and review articles. The study statistically analyzed data from all the included literature, which primarily included time to surgery, visual pain score(VAS) and Oswestry disability index(ODI) at postoperative follow-up time points, polymethylmethacrylate (PMMA, bone cement) injection dose, cement leakage, radiation dose, and improvement in kyphotic angle. RESULTS: This meta-analysis searched 416 articles published from 2010 to 2023 based on keywords, and 18 articles were finally included in this study. The results of the forest plot showed that unilateral PKP operative time, amount of bone cement used, and radiation dose to the patient were significantly reduced (p < 0.01, p < 0.01, and p < 0.01, respectively), and unilateral and bilateral PKP had comparable cement leakage (p = 0.49, 95% CI = 0.58-1.30), and there was no significant difference in the kyphotic angle between unilateral and bilateral PKP (p = 0.42, 95% CI = - 2.29-0.96). During follow-up, there was no significant difference in pain relief between unilateral and bilateral PKP (p = 0.70, 95% CI = - 0.09-0.06), nor was there a significant difference in ODI (p = 0.27, 95% CI = - 0.35-1.24). CONCLUSIONS: There is no difference in clinical efficacy between unilateral PKP and bilateral PKP, but unilateral PKP has a shorter operative time, a lower incidence of cement leakage, a lower amount of cement, and a lower radiation dose to the patient and operator. Unilateral PKP is a better option for patients with OVCFs.

Opportunistic prediction of osteoporosis in patients with degenerative lumbar diseases: a simplified T12 vertebral bone quality approach.

BACKGROUND: Osteoporosis is one of the risk factors for screw loosening after lumbar fusion. However, the probability of preoperative osteoporosis screening in patients with lumbar degenerative disease is low. Therefore, the aim of this study was to investigate whether a simplified vertebral bone quality (VBQ) score based on T12 T1-MRI could opportunistically predict osteoporosis in patients with degenerative lumbar spine diseases. METHODS: We retrospectively analyzed cases treated for lumbar degenerative diseases at a single institution between August 2021 and June 2022. The patients were divided into three groups by the lowest T-score: osteoporosis group, osteopenia group, and normal bone mineral density (BMD) group. The signal intensity based on the T12 vertebral body divided by the signal intensity of the cerebrospinal fluid was calculated to obtain the simplified VBQ score, as well as the CT-based T12HU value and the traditional L1-4VBQ score. Various statistical analyses were used to compare VBQ, HU and DEXA, and the optimal T12VBQ threshold for predicting osteoporosis was obtained by plotting the receiver operating curve (ROC) analysis. RESULTS: Total of 166 patients were included in this study. There was a statistically significant difference in T12VBQ scores between the three groups (p < 0.001). Pearson correlation showed that there was a moderate correlation between T12VBQ and T-score (r=-0.406, p < 0.001). The AUC value of T12VBQ, which distinguishes between normal and low BMD, was 0.756, and the optimal diagnostic threshold was 2.94. The AUC value of T12VBQ, which distinguishes osteoporosis from non-osteoporosis, was 0.634, and the optimal diagnostic threshold was 3.18. CONCLUSION: T12VBQ can be used as an effective opportunistic screening method for osteoporosis in patients with lumbar degenerative diseases. It can be used as a supplement to the evaluation of DEXA and preoperative evaluation. TRIAL REGISTRATION: retrospectively registered number:1502-009-644; retrospectively registered number date:27 oct 2022.

Severe hemothorax due to traumatic fracture of thoracic vertebra.

BACKGROUND: Hemothorax occurs in approx. 0.4% of all chest injury patients, but hemothorax due to a thoracic vertebral fracture is rare. CASE PRESENTATION: A 76-year-old Japanese man was transported to our hospital for right hemothorax due to a car accident. We performed emergency hemostasis surgery and tried to stop the bleeding by several methods, but it was difficult to control the bleeding because the bleeding point was an artery branch that runs in front of the vertebral body. CONCLUSION: It is important to be aware that a fractured vertebra can damage the aorta's arterial branch and follow a severe course.

[Effectiveness of TiRobot-assisted and free-hand percutaneous kyphoplasty via pedicle of vertebra in treatment of osteoporotic vertebral compression fracture of thoracic vertebra].

Objective: To compare the effectiveness of TiRobot-assisted and C-arm X-ray fluoroscopy assisted percutaneous kyphoplasty (PKP) via pedicle of vertebra in the treatment of osteoporotic vertebral compression fracture (OVCF) of thoracic vertebrae. Methods: The clinical data of 85 patients with OVCF of thoracic vertebrae who were admitted between January 2020 and March 2023 and met the selection criteria was retrospectively analyzed including 40 patients (50 vertebrae) undergoing PKP assisted by TiRobot (group A) and 45 patients (50 vertebrae) undergoing PKP assisted by C-arm X-ray fluoroscopy (group B). There was no significant difference in the comparison of baseline data such as gender, age, body mass index, bone mineral density T-value, fracture segment, trauma history, and preoperative numerical rating scale (NRS) score, Oswestry disability index (ODI), and Cobb angle of injured vertebra between the two groups ( P>0.05). The effectiveness evaluation indexes of the two groups, including the operation time, the volume of injected cement, the times of fluoroscopies, the length of hospital stay, and the occurrence of postoperative complications were collected and compared. Anteroposterior and lateral X-ray films and CT of the injured vertebra were reviewed at 1 day after operation to observe whether there was cement leakage and to evaluate the distribution of cement in the injured vertebra. Before and after operation, pain was assessed using the NRS score, dysfunction was assessed using the ODI, and vertebral height recovery was assessed by measuring the Cobb angle of the injured vertebrae by X-ray films. Results: Both groups of patients successfully completed the operation, the operation time, the volume of injected cement, the times of fluoroscopies, and the length of hospital stay in group A were significantly less than those in group B ( P<0.05). The patients in two groups were followed up 4-12 months (mean, 9.6 months). Bone cement leakage occurred in 5 vertebrae in group A and 15 vertebrae in group B after operation, all of which leaked to the intervertebral space and around the vertebral body, and the patients had no obvious clinical symptoms. The difference of bone cement leakage between the two groups was significant ( P<0.05). No severe complication such as intraspinal leakage, infection, or vascular embolism was found in the two groups. At 1 day after operation, the distribution index of bone cement in group A was mostly grade Ⅴ, which was well dispersed; while in group B, it was mostly grade Ⅱ and grade Ⅴ; the difference of bone cement distribution index between the two groups was significant ( P<0.05). The NRS score, ODI, and Cobb angle of injured vertebra in both groups were significantly improved at 1 day after operation when compared with preoperative ones ( P<0.05). There was no significant difference in the difference of the above indexes between the two groups before and after operation ( P>0.05). Conclusion: TiRobot-assisted unilateral PKP in the treatment of OVCF of thoracic vertebrae is safe and effective, which can reduce the X-ray transmission times during operation, shorten the operation time, reduce the volume of bone cement injection, and thus decrease incidence of bone cement leakage.

[Robot-assisted PVP for the treatment of osteoporotic fractures of the upper thoracic vertebra].

OBJECTIVE: To investigate the clinical effect of "Tianji" orthopedic robot-assisted percutaneous vertebro plasty(PVP) surgery in the treatment of upper thoracic osteoporotic fracture. METHODS: A retrospective analysis was performed on 32 patients with upper thoracic osteoporotic fracture who underwent PVP surgery in Shenzhen Hospital of Traditional Chinese Medicine from August 2016 to June 2022. There were 8 males and 24 females, ranging in age from 58 to 90 years old, with a mean of (67.75±12.27) years old. Fifteen patients were treated with robot-assisted PVP surgery (robot group), including 3 males and 12 females, with an average age of (68.5±10.3) years. Fracture location:1 case of T2 fracture, 1 case of T3 fracture, 3 cases of T4 fracture, 3 cases of T5 fracture, and 7 cases of T6 fracture. The follow-up period ranged from 1.0 to 3.0 months, with a mean of (1.6±0.7) months. Seventeen patients underwent routine PVP surgery (conventional group), including 5 males and 12 females, with an average age of (66.8±11.6) years old. Fracture location:1 case of T1 fracture, 5 cases of T4 fracture, 2 cases of T5 fracture and 9 cases of T6 fracture. The follow-up period ranged from 0.5 to 4.0 months, with a mean of (1.5±0.6) months. Preoperative and postoperative visual analogue scale(VAS) and Oswestry disability index(ODI) scores were compared between the two groups, and the number of punctures, perspective times, operation time, intraoperative blood loss, bone cement distribution, bone cement leakage, and intraoperative radiation dose were compared between the two groups. RESULTS: Number of punctures times, perspective times, operation time, intraoperative blood loss, bone cement distribution, bone cement leakage and intraoperative radiation dose in the robot group were all significantly better than those in the conventional group(P<0.05). VAS of 2.03±0.05 and ODI of (22.16±4.03) % in the robot group were significantly better than those of the robot group before surgery, which were (8.67±0.25) score and (79.40±7.72)%(t=100.869, P<0.001;t=25.456, P<0.001). VAS of 2.17±0.13 and ODI of (23.88±6.15)% in the conventional group were significantly better than those before surgery, which were (8.73±0.18) score and (80.01±7.59)%(t=121.816, P<0.001;t=23.691, P<0.001). There was no significant difference in VAS and ODI between the two groups after operation (t=-3.917, P=0.476;t=-0.922, P=0.364). CONCLUSION: Robot-assisted PVP in the treatment of upper thoracic osteoporotic fractures can further improve surgical safety, reduce bone cement leakage, and achieve satisfactory clinical efficacy.

Examination and Scientific Analysis of Thoracic Vertebral Fractures.

Background Thoracic vertebral fractures are clinically important due to their association with the thoracic spinal cord and the potential to cause devastating neurological injury. Using the National Electronic Injury Surveillance System (NEISS) data, this study investigated fracture patterns to understand associated factors to improve prevention strategies. We explored different factors associated with thoracic vertebral fractures to improve our understanding of preventative strategies and patient care standards, focusing on spatial distribution, sex-age dynamics, and location of injury. Methodology This retrospective, cross-sectional study examines thoracic vertebral fractures across diverse age groups from 2013 to 2022, utilizing the NEISS database from the U.S. Consumer Product Safety Commission. Inclusion criteria based on specific terms related to thoracic fractures were employed. Descriptive statistics illustrated fracture distribution by age groups and associated products. Statistical analyses, including chi-square tests and multivariate logistic regressions, were conducted to explore associations between fracture occurrence, locations, products, age, and gender. Results The analysis of thoracic vertebral fractures by location and associated products yielded several statistically significant findings. Notably, the prevalence of fractures at home (39.67%) was significantly higher than in other locations, and these differences in fracture distribution were statistically significant (χ² = 7.34, p < 0.001). Among the associated products, ladders (10.46%) emerged as the most frequent product associated with fractures. Multivariate logistic regression analysis showed that the age groups of 41-50, 51-60, and 61-70 had increased odds of fractures with adjusted odds ratios (AORs) of 1.08 (95% confidence interval (CI) = 1.04-1.42, p < 0.05), 1.21 (95% CI = 1.13-1.56, p < 0.001), and 1.17 (95% CI = 1.08-1.39, p < 0.001), respectively. The likelihood of thoracic vertebral fractures did not significantly differ between males and females (AOR = 1.12, 95% CI = 0.87-1.53, p = 0.262). Fracture distribution by age groups and products indicated increasing ladder-related fractures within the 41-50 age group and 51-60 age group. Football-related fractures peaked within the 21-30 age group. Fracture distribution patterns for bicycles had increased prevalence within the 11-20 and 21-30 age groups, and football-related fractures in younger age groups. Conclusions This study analyzed factors associated with thoracic vertebral fractures, showing the significance of targeted preventative interventions, such as earlier screening, physical therapy, and nutritional status assessment, in the setting of significant location and age-related susceptibilities. The observed patterns of injury provide a foundation for future research to elucidate the underlying mechanisms between different environments and the likelihood of injury to improve preventive strategies.

Pure uniportal video-assisted thoracic surgery for treating thoracic tuberculous spondylitis: an initial case series of seven patients.

BACKGROUND: The development of thoracic surgical techniques has provided a new avenue for treating thoracic tuberculosis. Moreover, microscopic treatment of spinal tuberculosis has attracted increasing attention, as it affords good visual access and reduces trauma. Traditional thoracoscopic treatment of spinal tuberculosis usually requires 2-3 passages, accompanied by a corresponding number of incisions. With a large number of conventional thoracoscopic surgeries performed, improved resolution of the microscopic field of view, effective hemostasis of the peripheral vessels using the ultrasonic knife, and many reports in the literature, thoracic tuberculosis can now be treated microscopically by creating a single channel. The aim of this study was to explore the feasibility and surgical technique for thoracic tuberculous spondylitis treatment via debridement and bone graft fusion surgery employing pure uniportal video-assisted thoracic surgery (VATS), combined with posterior internal fixation. METHODS: Seven patients with relatively complete documentation were included in this study. All patients underwent lesion removal and bone graft reconstruction via uniportal VATS with posterior internal fixation. The mean patient age was 39.6 years. Surgical duration, blood loss volume, postoperative recovery time, and thoracic kyphosis angle were recorded. RESULTS: The surgeries were successful with no severe postoperative complications. All patients were followed-up, and no recurrence of tuberculosis was observed. Imaging data, including computed tomography scans, confirmed the complete removal of the lesions. Additionally, bone fusion at the graft site was successful, no loss of the thoracic kyphosis angle was noted postoperatively, and the thoracic kyphosis angle improved. CONCLUSIONS: Pure uniportal VATS yields satisfactory results and inflicts less trauma than previous surgical techniques. This technique also offers a reference value for treating thoracic tuberculous spondylitis.

Sparganosis of a thoracic vertebra misdiagnosed as bone metastasis from lung cancer.

Sparganosis is a rare parasitic infection caused by plerocercoid tapeworm larvae. We described a case of a 27-year-old man presenting with numbness in both legs and masses in the right lung and spine, initially thought to have spinal metastasis from lung cancer. However, after pathological and parasitological examinations, the patient was found to have spinal sparganosis, likely due to a history of consuming raw frogs. The patient was successfully treated with praziquantel, resulting in the recovery of muscle strength in his legs. This case highlights the importance of considering spinal sparganosis as a differential diagnosis in patients with spinal masses, especially those with a history of consuming raw or undercooked frogs. Accurate diagnosis and early treatment are crucial for managing this infection.

Percutaneous Kyphoplasty to Relieve the Rib Region Pain in Osteoporotic Thoracic Vertebral Fracture Patients Without Local Pain of Fractured Vertebra.

BACKGROUND: Osteoporotic vertebral compression fractures (OVCF) are common. A few patients with thoracic vertebral fracture show pain in the bilateral rib region but not at the fracture site. The point of specific tenderness in the rib region cannot be located. It is not clear whether percutaneous kyphoplasty (PKP) can relieve the pain in the bilateral rib region in these patients. OBJECTIVE: To check whether PKP can alleviate the rib region pain in thoracic vertebral fracture patients without local pain at the fractured vertebra. STUDY DESIGN: Retrospective study. SETTING: The study was carried out at a university hospital. METHODS: We performed a retrospective analysis of thoracic vertebral fracture patients admitted to our hospital for PKP surgery between January 2018 and June 2022. The main clinical manifestations of these patients were pain in the bilateral rib region but no local tenderness and percussion pain at the fractured vertebra. CT and MRI examinations of the thoracic vertebrae were performed after admission. PKP was performed under general anesthesia after no surgical contraindication. Visual analog scale (VAS) scores and heights of the anterior, middle, and posterior edges of the fractured vertebra before the surgery, one day after surgery, and one month after surgery were compared. Also, the Cobb angles formed by the upper and lower endplate of the fractured vertebra before the surgery, one day after surgery, and one month after surgery were compared. RESULTS: A total of 50 patients were included in this study (3 men and 47 women, with an average age of 72.46 ± 8.15 years), of which 7 patients had 2 segmental fractures, so a total of 57 vertebrae were included. The VAS scores on day one and one month after the surgery were significantly lower than that before the surgery. The heights of the anterior, middle, and posterior edges of the fractured vertebra on day one after the surgery were significantly higher than those before the surgery. The Cobb angle of the fractured vertebra on day one after the surgery was lower than that before the surgery. The vertebrae of 23 patients were examined using x-ray one month after the surgery. The heights of the anterior, middle, and posterior edges of the fractured vertebra one month after the surgery were also significantly higher than those before the surgery but significantly lower than those one day after the surgery. Also, the Cobb angle of the fractured vertebra one month after the surgery was significantly lower than that before the surgery. LIMITATIONS: This was a retrospective study, which may be prone to selection and recall bias. Single-center non-controlled studies may also introduce bias. CONCLUSION: The exact location of the pain in the rib region caused by thoracic fracture cannot be identified usually. PKP can alleviate the rib region pain caused by the thoracic fracture.

[Application of unilateral biportal endoscopy technique in single-segment thoracic ossification of ligamentum flavum].

Objective: To investigate the safety and effectiveness of unilateral biportal endoscopy (UBE) technique in the treatment of single-segment thoracic ossification of ligamentum flavum (TOLF). Methods: Between August 2020 and December 2021, 11 patients with single-segment TOLF were treated with UBE technique. There were 6 males and 5 females, with an average of 58.2 years (range, 49-72 years). The responsible segment was T 6, 7 in 1 case, T 7, 8 in 1 case, T 8, 9 in 2 cases, T 9, 10 in 2 cases, T 10, 11 in 2 cases, and T 11, 12 in 3 cases. Imaging examination showed that the ossification were located on the left side in 4 cases, on the right side in 3 cases, and on bilateral sides in 4 cases. The main clinical symptoms were chest and back pain or lower limb pain, all accompanied by lower limb numbness and fatigue. The disease duration ranged from 2 to 28 months (median, 17 months). The operation time, postoperative hospital stay, and complications were recorded. Visual analogue scale (VAS) score was used to evaluate the chest and back pain and low limb pain, and Oswestry disability index (ODI) and Japanese Orthopedic Association (JOA) score were used to evaluate functional recovery before operation and at 3 days, 1 month, 3 months after operation, and last follow-up. The anteroposterior diameter of the coronal spinal canal was measured by CT before and after operation to evaluate the effect of surgical decompression. Results: All operations were successfully completed. The operation time was 50-105 minutes, with an average of 80.0 minutes. No postoperative complication such as dural sac tear, cerebrospinal fluid leakage, spinal nerve injury, or infection occurred. The postoperative hospital stay was 2-5 days, with an average of 3.1 days. All incisions healed by first intention. All patients were followed up 6-22 months, with an average of 14.8 months. CT measurement at 3 days after operation showed that the anteroposterior diameter of the spinal canal was (8.63±1.61) mm, which was significantly larger than that before operation [(3.67±1.37) mm] ( t=-12.181, P<0.001). The VAS score of chest and back pain and lower limb pain and ODI at each time point after operation were significantly lower than those before operation ( P<0.05). The above indexes were further improved after operation, except that there was no significant difference between at 3 months after operation and at last follow-up ( P>0.05), the differences between other time points were significant ( P<0.05). There was no recurrence during the follow-up period. Conclusion: UBE technique is a safe and effective method to treat single-segment TOLF, but its long-term effectiveness needs to be further studied.

An anatomical study of the external bone graft axis from the pedicle to the endplate from T10 to L5 in compression healing fractures of the anterior vertebral column / 中华创伤骨科杂志

Objective:To anatomically study the external bone graft axis from the pedicle (canal) to the endplate designed for compression healing fractures of the anterior vertebral column in freshly dried vertebral specimens from T10 to L5.Methods:Eight groups of freshly dried vertebral specimens from T10 to L5 (128 vertebral bodies and 256 lateral pedicles and lateral vertebral bodies) were used to observe the vertebral axis of the pedicle (canal), the internal sagittal diameter of the pedicle (canal), and the sagittal diameter of the vertebral body, and the position of vertebral pedicle (canal) axis (f-angle) before design of the external bone graft axis from the pedicle (canal) to the endplate of the compression healing vertebral body. (1) The internal sagittal diameter of the pedicle (canal) was divided into 3 segments. The lateral segment of the vertebral plate was wide, the middle segment of the isthmus of the vertebral arch was narrow and the medial segment of the terminal segment of the vertebral arch was wide. The narrow isthmus of the middle arch (canal) was used as a transposition axis in the design of the axis of the bone graft from the vertebral arch (canal) to the endplate of the compression healing vertebral body. (2) The axis of the vertebral body of the pedicle (canal) was located medial to the transposition axis, parallel to the f-angle at 0° as described by Saillant G. (3) The compression degree of the vertebral body was measured at the outer edge of the lateral anterior column, with Ⅰ° for less than 1/4 compression of the anterior column of the vertebral body, Ⅱ° for 1/4 to 2/4, Ⅲ° for 2/4 to 3/4 and Ⅳ° for more than 3/4 of the compression. (4) The f-angle described by Salliant G at the entry end which was corresponding to the endplate of the compression healing vertebral body was used to design the pedicle (canal) to the outer implant axis of the endplate of the compression healing vertebral body.Results:At an f-angle of 8° to 10°, the bone graft axis was aligned with the Ⅱ° compression healing vertebral endplate on the superior endplate side of the vertebral body axis of the arch; at an f-angle of 16° to 18°, the bone graft axis corresponded to the superior endplate of the Ⅰ° compression healing vertebral body. At an f-angle of -10°~-8°, the bone graft axis corresponded to the Ⅲ° compression healing vertebral endplate on the inferior endplate side of the vertebral body axis of the arch; at an f-angle of -18°~-16°, the bone graft axis corresponded to the inferior endplate of the Ⅳ° compression healing vertebral body.Conclusions:The external axis from the pedicle (canal) to the endplate designed in the present anatomic study for compression healing fractures of the anterior vertebral column allows for safe and easy granular bone implantation due to the toughness of the cortical bone around the arch root (canal) in addition to the precise design of the bone graft axis from the pedicle to the endplate from T10 to L5.

Robot-assisted PVP for the treatment of osteoporotic fractures of the upper thoracic vertebra / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of "Tianji" orthopedic robot-assisted percutaneous vertebro plasty(PVP) surgery in the treatment of upper thoracic osteoporotic fracture.@*METHODS@#A retrospective analysis was performed on 32 patients with upper thoracic osteoporotic fracture who underwent PVP surgery in Shenzhen Hospital of Traditional Chinese Medicine from August 2016 to June 2022. There were 8 males and 24 females, ranging in age from 58 to 90 years old, with a mean of (67.75±12.27) years old. Fifteen patients were treated with robot-assisted PVP surgery (robot group), including 3 males and 12 females, with an average age of (68.5±10.3) years. Fracture location:1 case of T2 fracture, 1 case of T3 fracture, 3 cases of T4 fracture, 3 cases of T5 fracture, and 7 cases of T6 fracture. The follow-up period ranged from 1.0 to 3.0 months, with a mean of (1.6±0.7) months. Seventeen patients underwent routine PVP surgery (conventional group), including 5 males and 12 females, with an average age of (66.8±11.6) years old. Fracture location:1 case of T1 fracture, 5 cases of T4 fracture, 2 cases of T5 fracture and 9 cases of T6 fracture. The follow-up period ranged from 0.5 to 4.0 months, with a mean of (1.5±0.6) months. Preoperative and postoperative visual analogue scale(VAS) and Oswestry disability index(ODI) scores were compared between the two groups, and the number of punctures, perspective times, operation time, intraoperative blood loss, bone cement distribution, bone cement leakage, and intraoperative radiation dose were compared between the two groups.@*RESULTS@#Number of punctures times, perspective times, operation time, intraoperative blood loss, bone cement distribution, bone cement leakage and intraoperative radiation dose in the robot group were all significantly better than those in the conventional group(P<0.05). VAS of 2.03±0.05 and ODI of (22.16±4.03) % in the robot group were significantly better than those of the robot group before surgery, which were (8.67±0.25) score and (79.40±7.72)%(t=100.869, P<0.001;t=25.456, P<0.001). VAS of 2.17±0.13 and ODI of (23.88±6.15)% in the conventional group were significantly better than those before surgery, which were (8.73±0.18) score and (80.01±7.59)%(t=121.816, P<0.001;t=23.691, P<0.001). There was no significant difference in VAS and ODI between the two groups after operation (t=-3.917, P=0.476;t=-0.922, P=0.364).@*CONCLUSION@#Robot-assisted PVP in the treatment of upper thoracic osteoporotic fractures can further improve surgical safety, reduce bone cement leakage, and achieve satisfactory clinical efficacy.

Effectiveness of TiRobot-assisted and free-hand percutaneous kyphoplasty via pedicle of vertebra in treatment of osteoporotic vertebral compression fracture of thoracic vertebra / 中国修复重建外科杂志

OBJECTIVE@#To compare the effectiveness of TiRobot-assisted and C-arm X-ray fluoroscopy assisted percutaneous kyphoplasty (PKP) via pedicle of vertebra in the treatment of osteoporotic vertebral compression fracture (OVCF) of thoracic vertebrae.@*METHODS@#The clinical data of 85 patients with OVCF of thoracic vertebrae who were admitted between January 2020 and March 2023 and met the selection criteria was retrospectively analyzed including 40 patients (50 vertebrae) undergoing PKP assisted by TiRobot (group A) and 45 patients (50 vertebrae) undergoing PKP assisted by C-arm X-ray fluoroscopy (group B). There was no significant difference in the comparison of baseline data such as gender, age, body mass index, bone mineral density T-value, fracture segment, trauma history, and preoperative numerical rating scale (NRS) score, Oswestry disability index (ODI), and Cobb angle of injured vertebra between the two groups ( P>0.05). The effectiveness evaluation indexes of the two groups, including the operation time, the volume of injected cement, the times of fluoroscopies, the length of hospital stay, and the occurrence of postoperative complications were collected and compared. Anteroposterior and lateral X-ray films and CT of the injured vertebra were reviewed at 1 day after operation to observe whether there was cement leakage and to evaluate the distribution of cement in the injured vertebra. Before and after operation, pain was assessed using the NRS score, dysfunction was assessed using the ODI, and vertebral height recovery was assessed by measuring the Cobb angle of the injured vertebrae by X-ray films.@*RESULTS@#Both groups of patients successfully completed the operation, the operation time, the volume of injected cement, the times of fluoroscopies, and the length of hospital stay in group A were significantly less than those in group B ( P<0.05). The patients in two groups were followed up 4-12 months (mean, 9.6 months). Bone cement leakage occurred in 5 vertebrae in group A and 15 vertebrae in group B after operation, all of which leaked to the intervertebral space and around the vertebral body, and the patients had no obvious clinical symptoms. The difference of bone cement leakage between the two groups was significant ( P<0.05). No severe complication such as intraspinal leakage, infection, or vascular embolism was found in the two groups. At 1 day after operation, the distribution index of bone cement in group A was mostly grade Ⅴ, which was well dispersed; while in group B, it was mostly grade Ⅱ and grade Ⅴ; the difference of bone cement distribution index between the two groups was significant ( P<0.05). The NRS score, ODI, and Cobb angle of injured vertebra in both groups were significantly improved at 1 day after operation when compared with preoperative ones ( P<0.05). There was no significant difference in the difference of the above indexes between the two groups before and after operation ( P>0.05).@*CONCLUSION@#TiRobot-assisted unilateral PKP in the treatment of OVCF of thoracic vertebrae is safe and effective, which can reduce the X-ray transmission times during operation, shorten the operation time, reduce the volume of bone cement injection, and thus decrease incidence of bone cement leakage.

[Intraoperative ultrasound assisted circumferential decompression for multilevel ossification of the posterior longitudinal ligament in thoracic vertebrae].

OBJECTIVE: To analyze the effect of short-segment circumferential decompression and the nerve function improvement in 30 cases of multilevel thoracic OPLL assisted by intraoperative ultrasound. METHODS: A total of 30 patients with multilevel thoracic OPLL from January 2016 to January 2021 were enrolled, all of whom were located by intraoperative ultrasound and underwent circumferential decompression. There were 14 males and 16 females, with an average age of (49.3±11.4) years. The initial symptoms were mainly numbness and weakness of lower limbs (83.3%), and the mean duration of symptoms was (33.9±42.9) months (1-168 months). Neurological function was assessed by the Modified Japanese Orthopedic Association (mJOA) score (0-11) preoperative and at the last follow-up, in which the rate of neurological improvement was calculated by the Harabayashi method. The patients were divided into excellent improved group and poor improved group according to the improvement of neurological function. The age, body mass index (BMI), duration of symptoms, operation time, blood loss, mJOA score, surgical level, and cerebrospinal fluid leakage of the two groups were collected and analyzed for statistical differences. The factors influencing the improvement of neurological function were analyzed by univariate and multivariate Logisitic regression analysis. RESULTS: The mean operation time was 137.4±33.8 (56-190) min, and the mean blood loss was (653.7±534.2) mL (200－3 000 mL). The preoperative mJOA score was 6.0±2.1 (2－9), and the last follow-up mJOA score was 7.6±1.9 (4－11), which was significantly improved in all the patients (P < 0.001). The average improvement rate of neurological function was 38.1%±24.4% (14.3%－100%), including 75%－100% in 4 cases, 50%－74% in 3 cases, 25%－49% improved in 14 cases, and 0%－24% in 9 cases. There was significant difference in intraoperative blood loss between the excellent improved group and the poor improved group (P=0.047). Intraoperative blood loss was also an independent risk factor in regression analysis of neurological improvement. CONCLUSION: Thoracic circumferential decompression assisted with intraoperative ultrasound can significantly improve the neurological function of patients with multilevel OPLL and achieve good efficacy. The improvement rate of nerve function can be improved effectively by controlling intraoperative blood loss.

The impact of age on the morphology of the 12th thoracic vertebral endplates.

The current article explores the aging effects on the overall morphology of the endplates of the 12th thoracic vertebra (T12), while screening for sex differences. It further evaluates the suitability of T12 for estimating age-at-death in bioarcheaological contexts. We captured the morphology of the vertebral endplates, including the formation of osteophytes, in a novel continuous quantitative manner using digital photography. 168 Greek adults from the Athens Collection were used for modeling the aging effects and another 107 individuals from two Danish archaeological assemblages for evaluation. Regression analysis is based on generalized additive models for correlating age-at-death and morphological variation. Our proposed measurement method is highly reliable (R>0.98) and the main differences observed between sexes are size related. Aging has considerable effect on the endplate morphology of the T12 with the total area of the endplate, the area of the epiphyseal rim, and the shape irregularities of the endplate's external boundary being mostly affected. Multivariate regression shows that aging effects account up to 46% of the observed variation, although with differential expression between sexes. Correct age prediction on archaeological remains reached 33% with a prominent tendency for overestimation. The morphology of the T12 endplates is influenced by age and it can provide some insight with respect to the age-at-death of unidentified individuals, especially when other skeletal age markers are unavailable. Our proposed method provides an age-estimation framework for bioarchaeological settings, especially for estimating broader age ranges, such as discriminating between young and old adults.