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Current Osteoporosis Reports Dec 2020We aimed to synthesize the recent work on the intra-vertebral heterogeneity in density, trabecular architecture and mechanical properties, its implications for fracture... (Review)
Review
PURPOSE OF REVIEW
We aimed to synthesize the recent work on the intra-vertebral heterogeneity in density, trabecular architecture and mechanical properties, its implications for fracture risk, its association with degeneration of the intervertebral discs, and its implications for implant design.
RECENT FINDINGS
As compared to the peripheral regions of the centrum, the central region of the vertebral body exhibits lower density and more sparse microstructure. As compared to the anterior region, the posterior region shows higher density. These variations are more pronounced in vertebrae from older persons and in those adjacent to degenerated discs. Mixed results have been reported in regard to variation along the superior-inferior axis and to relationships between the heterogeneity in density and vertebral strength and fracture risk. These discrepancies highlight that, first, despite the large amount of study of the intra-vertebral heterogeneity in microstructure, direct study of that in mechanical properties has lagged, and second, more measurements of vertebral loading are needed to understand how the heterogeneity affects distributions of stress and strain in the vertebra. These future areas of study are relevant not only to the question of spine fractures but also to the design and selection of implants for spine fusion and disc replacement. The intra-vertebral heterogeneity in microstructure and mechanical properties may be a product of mechanical adaptation as well as a key determinant of the ability of the vertebral body to withstand a given type of loading.
Topics: Adaptation, Physiological; Biomechanical Phenomena; Bone Density; Humans; Porosity; Spinal Fractures; Stress, Mechanical; Vertebral Body; Weight-Bearing
PubMed: 33215364
DOI: 10.1007/s11914-020-00640-0 -
Ugeskrift For Laeger Feb 2020This review summarises the present, limited, knowledge of os odontoideum (OO). The prevalence is unknown, and the aetiology is widely debated, though irrelevant to... (Review)
Review
This review summarises the present, limited, knowledge of os odontoideum (OO). The prevalence is unknown, and the aetiology is widely debated, though irrelevant to management of the disease. Surgery of symptomatic patients is advocated, as there is more uncertainty about the treatment of asymptomatic patients. Diagnosis is obtained with plain X-ray. However, nowadays MRI and CT scanning are recommended for further clarification and judgement of the severity. Knowledge of OO is important to minimise misjudgement and consequently inappropriate treatment. It is recommended, that patients are examined by highly specialised spine doctors before further cervical manipulation due to the high risk of instability with potentially severe consequences.
Topics: Axis, Cervical Vertebra; Humans; Magnetic Resonance Imaging; Odontoid Process; Quadriplegia; Tomography, X-Ray Computed
PubMed: 32138818
DOI: No ID Found -
Biomimetics (Basel, Switzerland) Oct 2022The goose's neck is an excellent stabilizing organ with its graceful neck curves and flexible movements. However, the stabilizing mechanism of the goose's neck remains...
The goose's neck is an excellent stabilizing organ with its graceful neck curves and flexible movements. However, the stabilizing mechanism of the goose's neck remains unclear. This study adopts a dynamic in vivo experimental method to obtain continuous and accurate stable motion characteristics of the goose's cervical vertebra. Firstly, the results showed that when the body of a goose was separately moved back and forth along the Y direction (front and back) and Z direction (up and down), the goose's neck can significantly stabilize the head. Then, because of the limitation of the X-ray imaging area, the three-dimensional intervertebral rotational displacements for vertebrae C4-C8 were obtained, and the role that these five segments play in the stabilization of the bird's neck was analyzed. This study reveals that the largest range of the adjacent vertebral rotational movement is around the -axis, the second is around the -axis, and the smallest is around the -axis. This kinematic feature is accord with the kinematic feature of the saddle joint, which allows the flexion/around -axis and lateral bending/around -axis, and prevents axial rotation/around -axis.
PubMed: 36278717
DOI: 10.3390/biomimetics7040160 -
International Journal of Spine Surgery Aug 2022The practice of cement augmentation in pedicle screw fixation is well established. However, there is a lack of consensus regarding the optimal screw design or cement...
BACKGROUND
The practice of cement augmentation in pedicle screw fixation is well established. However, there is a lack of consensus regarding the optimal screw design or cement type. This remains a clinically important question given the incidence of cement augmentation-associated complications. While fenestrated screws have become widely used in clinical practice, the relationship between fenestration placement along the screw axis and cement plume geometry and pullout strength have yet to be clarified. This study was designed to evaluate the mechanical and geometric properties of different fenestrated screw designs and cement viscosities in pedicle screw fixation.
METHODS
Three different screw fenestration configurations and 2 different cement viscosities were examined in this study. Axial pullout tests were conducted in both foam blocks and cadaveric vertebrae. All vertebral specimens underwent tests of bone mineral density. In the foam blocks, 6 tests were conducted for each augmentation combination and also for nonaugmented controls. In the cadaveric testing, 36 lumbar vertebrae were instrumented with a cemented and uncemented control screw to compare features of fixation. Computed tomography (CT) images were taken to assess the geometric profile of the cement plumes in both the foam blocks and the cadaveric vertebrae.
RESULTS
In both foam blocks and vertebral specimens, cementation was shown to confer a significant increase in pullout strength. Significant correlations existed between the anterior-posterior and lateral cement plume diameters and pullout strength in cadaveric vertebra and foam blocks, respectively. Within instrumented vertebra, variables such as the width of the vertebral body and screw insertion were found to significantly correlate with enhanced fixation. CT analysis of the instrumented vertebra demonstrated that a centrally distributed pattern of fenestrations was found to result in a cement plume with consistently predictable distribution within the vertebral body, without evidence of leak.
CONCLUSION
Cementation of fenestrated pedicle screws increases overall pullout forces; however, there is an unclear relationship between the geometric properties of the cement plume and the overall strength of the screw-bone interface. This study demonstrates that the plume diameter, vertebral body width, and angle of screw insertion are correlated with enhanced pullout strength. Furthermore, varying the fenestration design of injectable screws resulted in a set of predictable plume patterns, which may be associated with fewer complications. Further investigation is required to clarify the optimal geometric and biomechanical properties of injectable pedicle screws and their role in establishing the cement-bone interface.
CLINICAL RELEVANCE
This study is relevant to currently practicing spinal surgeons and biomechanical engineers.
PubMed: 36007955
DOI: 10.14444/8350 -
Turkish Journal of Medical Sciences Aug 2022Cervical instability can be caused by a variety of factors, including trauma, tumors, or infection. The cervical transpedicular screw (CPS) is one of the most modern...
BACKGROUND
Cervical instability can be caused by a variety of factors, including trauma, tumors, or infection. The cervical transpedicular screw (CPS) is one of the most modern procedures for treating cervical instability. Despite the fact that numerous innovative techniques for CPS have been proposed, the appropriate screw entry points and screw directions have yet to be thoroughly established. The aim of this study is to determine the screw insertion angles and screw entry point distances based on reference points, pedicle axis lengths, and pedicle axis intersections for each vertebra from cervical (C) C2 to C7 in both right and left by gender and age groups.
METHODS
In this study, computed tomography (CT) images of patients who underwent cervical examination for any reason were evaluated retrospectively. A total of 100 patients (59 men and 41 females), ranging in age from 18 to 79 years (mean 43 years), were randomly selected for the study. Patients with a history of cervical pathology or surgery were excluded. CT images turned into 3D reconstructed images and density settings were made so that bone tissue could be best observed using OsiriX software. Pedicle axis length (PAL), pedicle transverse angle (PTA), pedicle sagittal angle (PSA), distance of screw entry point to lateral notch (DLN), distance of screw entry point to inferior articular process (DIAP), and pedicle axis intersections were measured.
RESULTS
According to our findings, the optimal entry point should be 2-4 mm medial to the lateral notch and 8-12 mm superior to inferior articular process. PTA ranges between 30 to 45°, while PSA ranges between 11 to 15°. Except for the C2 pedicles, which were slightly shorter, the pedicle axis lengths (PAL) were similar from C3 to C7 in the total group. The intersection of the right and left pedicle axes was determined to be the most in C4 (51.21% in females and 72.88% in males).
DISCUSSION
This study has shown that intersections of the pedicle axis must be considered in both genders, especially in C4. Standardizing optimal entry points and trajectories is crucial for improving the CPS technique's safety and effectiveness.
Topics: Humans; Female; Male; Adolescent; Young Adult; Adult; Middle Aged; Aged; Cervical Vertebrae; Retrospective Studies; Bone Screws; Spinal Diseases; Tomography, X-Ray Computed
PubMed: 36326362
DOI: 10.55730/1300-0144.5415 -
Sensors (Basel, Switzerland) Jun 2022The intense footwork required in flamenco dance may result in pain and injury. This study aimed to quantify the external load of the flamenco Zapateado-3 (Zap-3)...
The intense footwork required in flamenco dance may result in pain and injury. This study aimed to quantify the external load of the flamenco Zapateado-3 (Zap-3) footwork via triaxial accelerometry in the form of PlayerLoad (PL), comparing the difference in external loads at the fifth lumbar vertebra (L5), the seventh cervical vertebra (C7) and the dominant ankle (DA), and to explore whether the speed, position, axis and proficiency level of the flamenco dancer affected the external load. Twelve flamenco dancers, divided into professional and amateur groups, completed a 15-s Zap-3 footwork routine at different speeds. Triaxial accelerometry sensors were positioned at the DA, L5 and C7 and were utilized to calculate the total PlayerLoad (PLTOTAL), uniaxial PlayerLoad (PLUNI) and uniaxial contributions (PL%). For both PLTOTAL and PLUNI, this study identified significant effects of speed and position (p < 0.001), as well as the interaction between speed and position (p ≤ 0.001), and at the DA, values were significantly higher (p < 0.001) than those at C7 and L5. Significant single axis and group effects (p < 0.001) and effects of the interactions between the position and a single axis and the group and speed (p ≤ 0.001) were also identified for PLUNI. Medial-lateral PL% represented a larger contribution compared with anterior-posterior PL% and vertical PL% (p < 0.001). A significant interaction effect of position and PL% (p < 0.001) also existed. In conclusion, the Zap-3 footwork produced a significant external load at different positions, and it was affected by speed, axis and the proficiency level of the flamenco dancer. Although the ankle bears the most external load when dancing the flamenco, some external load caused by significant vibrations is also borne by the lumbar and cervical vertebrae.
Topics: Accelerometry; Dancing; Vibration
PubMed: 35808344
DOI: 10.3390/s22134847 -
Beijing Da Xue Xue Bao. Yi Xue Ban =... Jun 2021To explore the minimally invasive surgical method for cervical epidural neurilemmoma.
OBJECTIVE
To explore the minimally invasive surgical method for cervical epidural neurilemmoma.
METHODS
The clinical features, imaging characteristics and surgical methods of 63 cases of cervical epidural neurilemmoma from July 2010 to December 2018 were reviewed and analyzed. Pain and numbness in occipitocervical region were the common clinical symptoms. There were 58 cases with pain, 30 cases with numbness, 3 cases with limb weakness and 2 cases with asymptomatic mass. Magnetic resonance imaging (MRI) showed that the tumors located in the cervical epidural space with diameter of 1-3 cm. The equal or slightly lower T and equal or slightly higher T signals were found on MRI. The tumors had obvious enhancement. Individualized laminotomy was performed according to the location and size of the tumors, and axis spinous processes were preserved as far as possible. Resection of tumor was performed strictly within the capsule.
RESULTS
Total and subtotal resection of tumor were achieved in 60 and 3 cases respectively, and no vertebral artery injury was found. The operation time ranged from 60 to 180 minutes, with an average of 92.83 minutes. The hospitalization time ranged from 3 to 9 days, with an average of 5.97 days. All tumors were confirmed as neurilemmoma by pathology. There was no postoperative infection or cerebrospinal fluid leakage. There was no new-onset dysfunction except 9 cases of numbness in the nerve innervation area. The period of follow-up ranged from 6 months to 8 years (median: 3 years). All the new-onset dysfunction recovered completely. Pain disappeared in all of the 58 patients with pain. Numbness recovered completely in 27 patients while slight numbness remained in another 3 patients. Three patients with muscle weakness recovered completely. The spinal function of all the patients restored to McCormick grade Ⅰ. No recurrence was found on MRI. No cervical spine instability or deformity was found on X-rays.
CONCLUSION
It is feasible to resect cervical epidural neurilemmoma by full use of the anatomical space between atlas and axis and individual laminotomy. It is helpful to prevent cervical instability or deformity by minimizing the destruction of cervical bone and preserving normal muscle attachment to cervical spinous process. Strict intracapsular resection can effectively prevent vertebral artery injury.
Topics: Epidural Space; Humans; Laminectomy; Magnetic Resonance Imaging; Neoplasm Recurrence, Local; Neurilemmoma; Retrospective Studies; Treatment Outcome
PubMed: 34145865
DOI: 10.19723/j.issn.1671-167X.2021.03.024 -
Surgical Anatomy of Vertebral Artery in Relation to Atlantoaxial Instrumentation: A Cadaveric Study.Cureus Mar 2023With the advent of pedicle screws and advanced instrumentation techniques, internal fixation and stabilization of upper cervical vertebrae are possible in fractures of...
BACKGROUND
With the advent of pedicle screws and advanced instrumentation techniques, internal fixation and stabilization of upper cervical vertebrae are possible in fractures of an axis. However, the proximity of vertebral arteries (VAs) poses a unique challenge to surgeons during these procedures and can result in profound physical impairment to patients. Cadaveric studies contributing to fine anatomical details necessitate conducting such studies.
METHODS
After receiving due ethical permission, this descriptive cross-sectional study was carried out on 10 cadavers in the department of Anatomy, All India Institute of Medical Science (AIIMS) Rishikesh. Twenty VAs were dissected along their course, and measurements of parameters related to the axis and atlas vertebra were noted.
RESULTS
The length of the pre-osseous segment related to the axis (VAX-1) on the right and left sides were from 3.8 to 14.5 mm (7.48±3.88 mm) and 4.46 to 10.5mm (6.94±2.01mm) respectively. The length of the osseous segment related to the axis (VAX-2) on the right side and left sides were from 6.82 to 31 mm (17.9±7.84mm) and 7.35 to 20 mm (15.6±4.53). The osseous segment of the VA related to the axis (VAX-2) shows genu (bend), which extends to a variable distance towards the midline. The mean distance of VA genu from the midline of the axis vertebral body on the right and left sides was 15.6mm and 17.5 mm, respectively. The percentage of superior articular facet (SAF) surface area of the axis occupied by the VA was 25-50% in nine and 50-75% in 11 cadavers, reflecting incomplete occupancy.
CONCLUSION
The study suggests that for instrumentation of the axis vertebra in the midline, the minimum distance between the genu of both sides of VA segments, related to an osseous segment of the axis (VAX-2) and medial extent of the VA groove of the atlas, should be considered as a safe zone to minimize inadvertent VA injury. During atlantoaxial fixation through a posterior approach in interarticular, pars, and pedicle screws, the surgical anatomy of the VA in relation to the osseous segment of the VA within the transverse process of the axis should be kept in mind to avoid inadvertent VA injury.
PubMed: 37050984
DOI: 10.7759/cureus.35949 -
Global Spine Journal May 2022Retrospective case series.
STUDY DESIGN
Retrospective case series.
OBJECTIVE
The purpose of this study is to evaluate the clinical and radiographic outcomes following revision surgery following Harrington rod instrumentation.
METHODS
Patients who underwent revision surgery with a minimum of 1-year follow-up for flatback syndrome following Harrington rod instrumentation for adolescent idiopathic scoliosis were identified from a multicenter dataset. Baseline demographics and intraoperative information were obtained. Preoperative, initial postoperative, and most recent spinopelvic parameters were compared. Postoperative complications and reoperations were subsequently evaluated.
RESULTS
A total of 41 patients met the inclusion criteria with an average follow-up of 27.7 months. Overall, 14 patients (34.1%) underwent a combined anterior-posterior fusion, and 27 (65.9%) underwent an osteotomy for correction. Preoperatively, the most common lower instrumented vertebra (LIV) was at L3 and L4 (61%), whereas 85% had a LIV to the pelvis after revision. The mean preoperative pelvic incidence-lumbar lordosis mismatch and C7 sagittal vertical axis were 23.7° and 89.6 mm. This was corrected to 8.1° and 28.9 mm and maintained to 9.04° and 34.4 mm at latest follow-up. Complications included deep wound infection (12.2%), durotomy (14.6%), implant related failures (14.6%), and temporary neurologic deficits (22.0%). Eight patients underwent further revision surgery at an average of 7.4 months after initial revision.
CONCLUSIONS
There are multiple surgical techniques to address symptomatic flatback syndrome in patients with previous Harrington rod instrumentation for adolescent idiopathic scoliosis. At an average of 27.7 months follow-up, pelvic incidence-lumbar lordosis mismatch and C7 sagittal vertical axis can be successfully corrected and maintained. However, complication and reoperation rates remain high.
PubMed: 33000651
DOI: 10.1177/2192568220960759 -
Frontiers in Endocrinology 2022To evaluate the association between the growth hormone (GH)/insulin-like growth factor-1 (IGF-1) axis and muscle density in children and adolescents of short stature.
OBJECTIVE
To evaluate the association between the growth hormone (GH)/insulin-like growth factor-1 (IGF-1) axis and muscle density in children and adolescents of short stature.
METHODS
Participants were children and adolescents of short stature hospitalized in the Affiliated Hospital of Jining Medical University between January 2020 and June 2021. All participants had CT scan images available. We performed an analysis of the images to calculate the muscle density or skeletal muscle attenuation (SMA), skeletal muscle index (SMI), and fat mass index (FMI). Bioelectrical impedance analysis (BIA) was used to ensure that chest CT is a credible way of evaluating body composition.
RESULTS
A total of 297 subjects were included with the mean age of 10.00 ± 3.42 years, mean height standard deviation score (SDS) of -2.51 ± 0.53, and mean IGF-1 SDS of -0.60 ± 1.07. The areas of muscle and fat tissues at the fourth thoracic vertebra level in the CT images showed strong correlation with the total weights of the participants ( = 0.884 and 0.897, respectively). The peak of GH was negatively associated with FMI (r = - 0.323, P <.01) and IGF-1 SDS was positively associated with SMI (r = 0.303, P <.01). Both the peak GH and IGF-1 SDS were positively associated with SMA (r = 0.244, P <.01 and r = 0.165, P <.05, respectively). Multiple stepwise linear regression analysis demonstrated that the GH peak was the predictor of FMI (β = - 0.210, P < .01), the IGF-1 SDS was the predictor of SMI (β = 0.224, P < .01), and both the peak GH and IGF-1 SDS were predictors of SMA (β = 0.180, P < .01 and β = 0.222, P < .01).
CONCLUSIONS
A chest CT scan is a credible method of evaluating body composition in children and adolescents of short stature. In these patients, peak GH and IGF-1 SDS are independent predictors of muscle density and the GF/IGF-1 axis may regulate body composition through complex mechanisms.
Topics: Adolescent; Child; Growth Disorders; Growth Hormone; Human Growth Hormone; Humans; Insulin-Like Growth Factor I; Muscle, Skeletal
PubMed: 35774144
DOI: 10.3389/fendo.2022.920200