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World Neurosurgery Jun 2022Thoracolumbar burst fracture without neurological deficit is a common spinal injury. The ideal classification for the diagnosis and the optimal management strategies,... (Review)
Review
Thoracolumbar burst fracture without neurological deficit is a common spinal injury. The ideal classification for the diagnosis and the optimal management strategies, including conservative management, surgical approach, implant constructs, need for spinal fusion, and implant removal, are controversial and currently being investigated. This article reviews the current literature to provide updated evidence on these topics. Posterior ligamentous complex integrity plays an important role in the classification and decision-making process of treatment. A brace is not necessarily required in conservatively treated patients. Regarding surgical management, current evidence advocates posterior-only short segment instrumentation with intermediate screw. Cementoplasty is another option for vertebral augmentation at the fractured level. Spinal fusion is not necessary for this type of injury. Minimally invasive surgery techniques provide equivalent outcomes and can safely replace open approaches. Implant removal after stabilization may provide some benefits, especially in younger patients.
Topics: Fracture Fixation, Internal; Fractures, Comminuted; Fractures, Compression; Humans; Lumbar Vertebrae; Spinal Fractures; Thoracic Vertebrae; Treatment Outcome
PubMed: 35318156
DOI: 10.1016/j.wneu.2022.03.061 -
The Bone & Joint Journal Apr 2020Significant correction of an adolescent idiopathic scoliosis in the coronal plane through a posterior approach is associated with hypokyphosis. Factors such as the...
AIMS
Significant correction of an adolescent idiopathic scoliosis in the coronal plane through a posterior approach is associated with hypokyphosis. Factors such as the magnitude of the preoperative coronal curve, the use of hooks, number of levels fused, preoperative kyphosis, screw density, and rod type have all been implicated. Maintaining the normal thoracic kyphosis is important as hypokyphosis is associated with proximal junctional failure (PJF) and early onset degeneration of the spine. The aim of this study was to determine if coronal correction per se was the most relevant factor in generating hypokyphosis.
METHODS
A total of 95 patients (87% female) with a median age of 14 years were included in our study. Pre- and postoperative radiographs were measured and the operative data including upper instrumented vertebra (UIV), lower instrumented vertebra (LIV), metal density, and thoracic flexibility noted. Further analysis of the post-surgical coronal outcome (group 1 < 60% correction and group 2 ≥ 60%) were studied for their association with the postoperative kyphosis in the sagittal plane using univariate and multivariate logistic regression.
RESULTS
Of the 95 patients, 71.6% (68) had a thoracic correction of > 60%. Most (97.8%) had metal density < 80%, while thoracic flexibility > 50% was found in 30.5% (29). Preoperative hypokyphosis (< 20°) was present in 25.3%. A postoperative thoracic hypokyphosis was four times more likely to occur in patients with thoracic correction ≥ 60% (odds ratio (OR) 4.08; p = 0.005), after adjusting for confounding variables. This association was not affected by metal density, thoracic flexibility, LIV, UIV, age, or sex.
CONCLUSION
Our study supports the 'essential lordosis' hypothesis of Roaf and Dickson, i.e. with a greater ability to translate the apical vertebra towards the midline, there is a commensurate lengthening of the anterior column due to the vertebral wedging. Cite this article: 2020;102-B(4):513-518.
Topics: Adolescent; Child; Female; Humans; Male; Pedicle Screws; Postoperative Complications; Radiography; Range of Motion, Articular; Retrospective Studies; Scoliosis; Spinal Curvatures; Thoracic Vertebrae; Young Adult
PubMed: 32228067
DOI: 10.1302/0301-620X.102B4.BJJ-2019-1069.R1 -
Clinical Radiology Oct 2020Idiopathic spinal cord herniation is a rare but important and increasingly recognised cause of myelopathy seen in the thoracic spine. The factors that contribute to the... (Review)
Review
Idiopathic spinal cord herniation is a rare but important and increasingly recognised cause of myelopathy seen in the thoracic spine. The factors that contribute to the aetiology of the condition and of the dural defect through which the cord herniates remain under debate. We discuss the clinical features and proposed pathophysiology of the condition, and illustrate key imaging findings on MRI, fluoroscopy and computed tomography (CT) myelography to establish the diagnosis, and discuss relevant differential diagnoses. Awareness and recognition of the condition is key as surgical intervention can improve outcomes for patients.
Topics: Diagnosis, Differential; Disease Progression; Hernia; Herniorrhaphy; Humans; Spinal Cord Diseases; Thoracic Vertebrae
PubMed: 32499121
DOI: 10.1016/j.crad.2020.04.013 -
Anatomical Record (Hoboken, N.J. : 2007) Sep 2022The notarium is a rigid bony structure, which resulted from the fusion of thoracic vertebrae of some pterosaurs and birds. It is high variable, ranging from two to six... (Review)
Review
The notarium is a rigid bony structure, which resulted from the fusion of thoracic vertebrae of some pterosaurs and birds. It is high variable, ranging from two to six fused thoracic vertebrae. In this study, we reviewed and analyzed approximately 270 specimens of neornithine birds (representing 80% of the living orders) and some fossils in order to identify the number of fused vertebrae, degree and sites of vertebral fusion, occurrence of sutures, and other structures of potential phylogenetic and functional significance. These data were analyzed using a recent time-calibrated molecular phylogenetic tree and principal component analyses analysis evaluating the relationship with long bones in order to reconstruct macroevolutionary trends related to the evolution of the notarium. The occurrence of this structure shows a mosaic distribution over neornithine phylogeny, originating several times independently, especially during the Paleogene, in predominantly ground-dwelling forms. The notarium of these groups is characterized by: neural spines fused into single structure, intervertebral openings small to absent, large ventral keels forming ventral plates, and fused transverse processes. Derived neornithines, such as aquatic forms and long-legged birds, have a tendency to display a decreased degree of fusion between the vertebrae, which may indicate a reduction or disappearance of the notarium.
Topics: Animals; Biological Evolution; Birds; Fossils; Phylogeny; Thoracic Vertebrae
PubMed: 34910372
DOI: 10.1002/ar.24852 -
Zeitschrift Fur Orthopadie Und... Aug 2021The majority of traumatic vertebral fractures occur at the thoracolumbar junction and the lumbar spine and less commonly at the mid-thoracic and upper thoracic spine. In... (Review)
Review
The majority of traumatic vertebral fractures occur at the thoracolumbar junction and the lumbar spine and less commonly at the mid-thoracic and upper thoracic spine. In accordance, a high number of articles are dealing with thoracolumbar fractures focusing on the thoracolumbar junction. Nonetheless, the biomechanics of the thoracic spine differ from the thoracolumbar junction and the lumbar vertebral spine. The aim of this review is to screen the literature dealing with acute traumatic thoracic vertebral fractures in patients with normal bone quality. Thereby, the diagnostic of thoracic vertebral body fractures should include a CT examination. Ideally, the CT should include the whole thoracic cage particularly in patients suffering high energy accidents or in those with clinical suspicion of concomitant thoracic injuries. Generally, concomitant thoracic injuries are frequently seen in patients with thoracic spine fractures. Particularly sternal fractures cause an increase in fracture instability. In case of doubt, long segment stabilization is recommended in patients with unstable mid- und upper thoracic fractures, particularly in those patients with a high grade of instability.
Topics: Biomechanical Phenomena; Humans; Lumbar Vertebrae; Spinal Fractures; Thoracic Vertebrae
PubMed: 32392598
DOI: 10.1055/a-1144-3846 -
The Orthopedic Clinics of North America Oct 2021Thoracolumbar spine trauma can result in potentially life-threatening consequences and requires careful management to ensure good outcomes. The purpose of this chapter... (Review)
Review
Thoracolumbar spine trauma can result in potentially life-threatening consequences and requires careful management to ensure good outcomes. The purpose of this chapter is to discuss the anatomy, diagnostic tools, non-operative, and operative treatments important when addressing thoracolumbar trauma.
Topics: Humans; Lumbar Vertebrae; Osteoporotic Fractures; Spinal Fractures; Spinal Injuries; Thoracic Vertebrae; Trauma Severity Indices; Trauma, Nervous System
PubMed: 34538355
DOI: 10.1016/j.ocl.2021.05.014 -
World Neurosurgery Nov 2023In endoscopic thoracic spine surgery, adaptations of thoracic surgical techniques such as full endoscopic uniportal and biportal surgical techniques have been developed.... (Review)
Review
In endoscopic thoracic spine surgery, adaptations of thoracic surgical techniques such as full endoscopic uniportal and biportal surgical techniques have been developed. Full endoscopic uniportal surgery for thoracic disc herniation or thoracic ossified ligamentum flavum (OLF) has been performed via transforaminal and interlaminar approaches. In the case of thoracic OLF or thoracic spinal stenosis, the uniportal interlaminar approach is appropriate. The uniportal interlaminar approach has been used to treat thoracic OLF and has shown good surgical results. Thoracic OLF removal via a biportal endoscopic technique has been developed recently and is described in a few studies. Although endoscopic thoracic spine surgery has significant advantages, complications often occur with this approach. We reviewed the literature to date on the complications associated with endoscopic spine surgery in thoracic pathology. This review emphasizes how to avoid and manage complications. Based on the results of several previous studies, endoscopic thoracic spine surgery could be associated with fewer potential complications than conventional surgery. Endoscopic spine surgery has remarkable advantages; however, endoscopic thoracic surgery is technically challenging and is potentially associated with serious complications. To minimize the risk of avoidable complications, surgeons should be familiar with prevention methods and pitfalls.
Topics: Humans; Decompression, Surgical; Treatment Outcome; Retrospective Studies; Endoscopy; Thoracic Vertebrae; Ligamentum Flavum
PubMed: 37619844
DOI: 10.1016/j.wneu.2023.08.067 -
Veterinary Medicine and Science Sep 2022Computed tomography currently has a prominent role in diagnosis and evaluation of vertebral column. On the other hand, a thorough knowledge about vertebral column...
BACKGROUND
Computed tomography currently has a prominent role in diagnosis and evaluation of vertebral column. On the other hand, a thorough knowledge about vertebral column property in normal state is prerequisite an accurate diagnosis of different abnormalities in this region.
OBJECTIVE
The purpose of this study was to present a complete and exact descriptive and morphometric evaluation of thoracic vertebrae in rabbits with computed tomography. In images which were constructed by CT, several structures and different parts of the thoracic vertebrae have been named.
METHODS
Ten healthy, mature, White New Zealand rabbits were evaluated. The morphologic and morphometric parameters of the thoracic vertebrae were studied. In this study, several parameters of thoracic vertebrae, such as vertebral body height, spinous process height, transverse process length, transverse process width, etc., were measured by computed tomography.
RESULTS
Some parameters, such as spinal canal height, spinal canal width, pedicle length, pedicle width, end plate width, and endplate height, had no significant difference through thoracic vertebrae but other parameters, such as vertebral body height, transverse process length, transverse process width, spinous process angle, transverse process angle, and vertebral body length, had a significant difference.
CONCLUSIONS
In this study, a comprehensive anatomic atlas of CT anatomy of the thoracic vertebrae was produced for use by veterinary radiologists, clinicians, and surgeons. Finally, we must mention these two important points: (1) Many of the differences observed between rabbits and humans are based on the way the trunks of these two creatures are located on the ground and the differences in the way their bodies move. (2) In studies that are done by modelling humans on animals, it should be noted that the terms used in animal anatomy are different and the names are used using the principles of veterinary anatomy.
Topics: Animals; Humans; Rabbits; Thoracic Vertebrae; Tomography, X-Ray Computed
PubMed: 35763843
DOI: 10.1002/vms3.847 -
World Neurosurgery Oct 2022Ossification of the posterior longitudinal ligament (OPLL) is a rare condition that can lead to progressive spinal cord compression. Currently, surgical decompression... (Review)
Review
Ossification of the posterior longitudinal ligament (OPLL) is a rare condition that can lead to progressive spinal cord compression. Currently, surgical decompression remains the optimal treatment in symptomatic patients. In cases with significant thoracic stenosis and concern for ventral erosion of the dura, an anterior approach may be necessary for direct decompression. In Video 1, we demonstrate the successful application of a multidisciplinary approach for surgical resection of a large OPLL lesion located at the T2-3 disk space. A 37-year-old female with medical history significant for rickets presented a year after a fall with bilateral lower extremity paraparesis and saddle anesthesia. Exposure consisted of a manubrial window, followed by thoracic diskectomy and fusion with drilling of the calcified posterior longitudinal ligament. Major steps within this video include 1) a summary of the patient presentation and preoperative imaging, 2) exposure of thoracic vertebrae via a manubrial window approach, 3) thoracic diskectomy and fusion with take-down of calcified posterior longitudinal ligament, and 4) a review of the postoperative imaging. The patient tolerated the procedure well with immediate relief of symptoms and was subsequently discharged on postoperative day 1 with no complications. This operative video illustrates the technical steps and capabilities of an anterior approach, achieving near-complete gross total resection of an OPLL lesion using a multidisciplinary approach. The patient consented to this procedure.
Topics: Adult; Decompression, Surgical; Diskectomy; Female; Humans; Ossification of Posterior Longitudinal Ligament; Spinal Fusion; Thoracic Vertebrae; Treatment Outcome
PubMed: 35872134
DOI: 10.1016/j.wneu.2022.07.052 -
Korean Journal of Anesthesiology Oct 2020Paravertebral block, especially thoracic paravertebral block, is an effective regional anesthetic technique that can provide significant analgesia for numerous surgical... (Review)
Review
Paravertebral block, especially thoracic paravertebral block, is an effective regional anesthetic technique that can provide significant analgesia for numerous surgical procedures, including breast surgery, pulmonary surgery, and herniorrhaphy. The technique, although straightforward, is not devoid of potential adverse effects. Proper anatomic knowledge and adequate technique may help decrease the risk of these effects. In this brief discourse, we discuss the anatomy and technical aspects of paravertebral blocks and emphasize the importance of appropriate needle manipulation in order to minimize the risk of complications. We propose that, when using a landmark-based approach, limiting medial and lateral needle orientation and implementing caudal (rather than cephalad) needle redirection may provide an extra margin of safety when performing this technique. Likewise, recognizing a target that is not in close proximity to the neurovascular bundle when using ultrasound guidance may be beneficial.
Topics: Anesthetics, Local; Humans; Nerve Block; Pneumothorax; Punctures; Thoracic Vertebrae
PubMed: 32172551
DOI: 10.4097/kja.20065