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The Journal of Spinal Cord Medicine Jul 2019Current treatment of TLST should consider injury morphology, neurological status, clinical status (pain and disability) and also multimodal radiological evaluation... (Review)
Review
CONTEXT
Current treatment of TLST should consider injury morphology, neurological status, clinical status (pain and disability) and also multimodal radiological evaluation (MMRE) with CT, MRI and dynamic/ standing plain radiographs.
METHODS
A narrative literature review was performed to propose a treatment algorithm to guide the management of thoracolumbar spinal trauma (TLST). In order to classify injuries and surgical indications, we utilized the two most recent classification systems (TLICS and new AO spine classification) and related recent literature.
RESULTS
Injuries were categorized into three groups according to stability: 1) Stable injuries, 2) Potentially unstable injuries/ delayed instability or 3) Clearly unstable injuries. Stable injuries included most of AO type A fractures without neurological deficit, mild clinical symptoms and without risk factors for late deformity. Potentially unstable injuries generally included patients without neurological deficits but with some risk factors for late deformity or with severe clinical symptoms. Surgery may be recommended in this group. Finally, clearly unstable injuries are those with spinal dislocations and/ or with neurological deficits, especially in the setting of persistent neural tissue compression, requiring early surgical treatment.
CONCLUSIONS
The proposed treatment algorithm is intended to help surgeons select the best treatment modality for their patients, categorizing injuries according to their main characteristics into one of these three groups. Further studies addressing the reliability and safety of this algorithm are necessary.
Topics: Algorithms; Humans; Lumbar Vertebrae; Spinal Cord Injuries; Thoracic Vertebrae; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 29412065
DOI: 10.1080/10790268.2018.1433267 -
European Journal of Trauma and... Jun 2022The aim of this systematically review is to detect differences between fractures located at the mid-thoracic spine compared to fractures of the thoracolumbar junction... (Review)
Review
PURPOSE
The aim of this systematically review is to detect differences between fractures located at the mid-thoracic spine compared to fractures of the thoracolumbar junction (TLJ) and the lumbar spine in osteoporotic vertebral body fractures.
METHODS
This review is based on articles retrieved by a systematic search in the PubMed and Web of Science database for publications regarding osteoporotic fractures of the thoracolumbar spine with respect to the fracture location. Differences in prevalence, cause of fracture, fracture healing, and outcomes between the mid-thoracic spine and the TLJ and the lumbar spine were considered.
RESULTS
Altogether, 238 articles could be retrieved from the literature search. A total of 222 articles were excluded. Thus, 16 remaining original articles were included in this systematic review comprising the topics prevalence, bone mineral density and regional blood flow, biomechanics, subsequent fractures, and outcome, respectively. The overall level of evidence of the vast majority of studies was moderate to low.
CONCLUSION
Several differences between osteoporotic fractures of the mid-thoracic spine compared to the TLJ and the lumbar spine could be identified. Thereby, osteoporotic mid-thoracic fractures seem to be particularly more related to frailty without a history of traumatic injury compared to osteoporotic fractures of the TLJ and the lumbar spine. Additionally, the presence of severe mid-thoracic fractures predicts subsequent fractures of the hip. In contrast, subsequent fractures of the spine are less likely.
Topics: Bone Density; Humans; Lumbar Vertebrae; Osteoporotic Fractures; Spinal Fractures; Thoracic Vertebrae; Vertebral Body
PubMed: 34590172
DOI: 10.1007/s00068-021-01792-z -
Acta Bio-medica : Atenei Parmensis Apr 2021Since 1974, when Wortzman et al were the first to describe a case of idiopathic spinal cord herniation (ISCH), the number of reported cases has increased owing to... (Review)
Review
Since 1974, when Wortzman et al were the first to describe a case of idiopathic spinal cord herniation (ISCH), the number of reported cases has increased owing to magnetic resonance imaging (MRI) now is routinely available for patients with myelopathy and spinal surgeons are becoming more familiar with this clinical entity. This extremely rare herniation occurs exclusively in the thoracic spine, causing slowly progressive myelopathy. Diagnosis is based on ventral displacement of the spinal cord in the thoracic spine. MRI is the technique of choice to exclude a posterior arachnoid cyst, the most common mistaken diagnosis, and to recognize a spinal cord herniation when an anterior dural defect is present. A case of ISCH is reported and a Literature review of this clinical entity often mis-diagnosed has been obtained.
Topics: Hernia; Humans; Magnetic Resonance Imaging; Spinal Cord Diseases; Thoracic Vertebrae
PubMed: 33944828
DOI: 10.23750/abm.v92iS1.9947 -
Orthopaedic Surgery Feb 2022To investigate the prevalence of 11 thoracic vertebrae (TVs), four lumbar vertebrae (LVs) and six LVs among asymptomatic Chinese volunteers, and the influence of spine...
OBJECTIVE
To investigate the prevalence of 11 thoracic vertebrae (TVs), four lumbar vertebrae (LVs) and six LVs among asymptomatic Chinese volunteers, and the influence of spine variations on the global spinal sagittal parameters.
METHODS
A total of 389 asymptomatic Chinese volunteers were recruited. Each subject underwent a full-spine X-ray examination with measurement of global spinal sagittal parameters. The radiographs were examined by a spine surgeon and a radiologist to determine the variation in the number of vertebrae. These parameters were used to compare individuals with five LVs to those with 11 TVs, four LVs, and six LVs.
RESULTS
The study population included 12 individuals (3.1%) with seven cervical vertebrae (C) + 11 thoracic vertebrae (T) + five lumbar vertebrae (L), 8 (2.1%) with 7C + 11T + 6L, 8 (2.1%) with 7C + 12T + 4L, and 15 (3.9%) with 7C + 12T + 6L. Compared to the 7C + 12T + 5L individuals, those with 7C + 11T + 5L had significantly lower C -T Cobb values (P < 0.05); 7C + 12T + 4L individuals had significantly greater thoracic inlet angles (P < 0.05) and significantly lower pelvic tilt (P < 0.05); individuals with 7C + 12T + 6L had significantly greater sacral slope, pelvic tilt, pelvic incidence, and L1-5 Cobb values (all P < 0.05), but significantly lower thoracic inlet angle (P < 0.05). There were no significant differences in any of the parameters examined between the 7C + 11T + 6L group and the 7C + 12T + 5L group.
CONCLUSIONS
Asymptomatic adults with 7C + 12T + 6L, 7C + 12T + 4L, and 7C + 11T + 5L presented with different spinal sagittal alignment compared to those with 7C + 12T + 5L. Compared to variation in the number of LVs, the variation in the number of TVs had less effect on global spinal sagittal parameters. Spinal surgeons and researchers should be aware of the effects of variation in numbers of TVs and LVs on global spinal parameters and sagittal balance.
Topics: Adult; Cervical Vertebrae; Humans; Kyphosis; Lordosis; Lumbar Vertebrae; Sacrum; Spinal Diseases; Spine; Thoracic Vertebrae
PubMed: 34935276
DOI: 10.1111/os.13185 -
Acta Orthopaedica Et Traumatologica... May 2021This study aimed to investigate the possible relationship between Scheuermann disease (SD) and the pathophysiological factors of thoracic spinal stenosis (TSS),...
OBJECTIVE
This study aimed to investigate the possible relationship between Scheuermann disease (SD) and the pathophysiological factors of thoracic spinal stenosis (TSS), including ossification of the ligamentum flavum (OLF), ossification of the posterior longitudinal ligament (OPLL), and thoracic disc herniation (TDH) in patients with symptomatic TSS.
METHODS
Demographic and radiological data from 66 consecutive patients diagnosed with symptomatic TSS from 2013 to 2018 were retrospectively collected and divided into 3 groups depending on the underlying pathomechanism of TSS: TDH group (18 patients; 6 women; mean age ± standard deviation [Sd] = 59.89 ± 11.34), OPLL group (12 patients; 8 women; mean age ± Sd = 56.08 ± 14.74), and OLF group (36 patients; 20 women; mean age ± Sd = 58.69 ± 9.77). A total of 41 age-matched healthy individuals (19 women; mean age ± Sd = 54.88 ± 13.63) were designated as the control group. In each group, both typical and atypical SD criteria were radiologically examined. The demographic data and presence of SD between the control group and 3 subgroups of TSS pathomechanisms were evaluated.
RESULTS
SD characteristics were identified in 83.33% (15/18) of patients in the TDH group, 44.44% (16/36) in the OLF group, 25% (3/12) in the OPLL group, and 17.07% (7/41) of the control individuals. When analyzed by the chi-squared test and logistic regression analysis, the presence of SD was significantly associated with TDH (P < 0.01) and OLF (P < 0.05) but not OPLL (P > 0.05). Patients with TDH and OLF showed peak involvement of T10/11, and patients with OPLL did not. Furthermore, we determined that age, sex, body-mass index, and smoking status were not the risk factors for TDH, OPLL, and OLF (P > 0.05). SD was found to be a risk factor for TDH (P < 0.01) and OLF (P < 0.05) but not for OPLL (P > 0.05).
CONCLUSION
Evidence from this study indicated that SD might be a risk factor for OLF and TDH but not for OPLL.
Topics: Female; Humans; Male; Middle Aged; Ossification of Posterior Longitudinal Ligament; Radiography; Retrospective Studies; Risk Assessment; Risk Factors; Scheuermann Disease; Spinal Stenosis; Thoracic Vertebrae
PubMed: 34100367
DOI: 10.5152/j.aott.2021.20022 -
Acta Cirurgica Brasileira 2023To create three-dimensional anatomical models of the thoracic and lumbar portions of the canine spine that reproduce the vertebral surgical approaches of dorsal...
PURPOSE
To create three-dimensional anatomical models of the thoracic and lumbar portions of the canine spine that reproduce the vertebral surgical approaches of dorsal laminectomy and hemilaminectomy, and to perform the respective radiographic evaluations of each approach.
METHODS
In a digital archive of the canine spine, digitally replicate the dorsal laminectomy and hemilaminectomy in the thoracic and lumbar portions and, then, make tridimensional prints of the vertebral models and obtain radiographs in three dorsoventral, ventrodorsal and laterolateral projections.
RESULTS
The anatomical models of the surgical spinal canal accesses of the thoracic and lumbar portions showed great fidelity to the natural bones. The created accesses have the proper shape, location and size, and their radiographic images showed similar radiodensities.
CONCLUSIONS
The replicas of the dorsal laminectomy and hemilaminectomy developed in the anatomical models in the thoracic and lumbar portions are able to represent the technical recommendations of the specialized literature, as well as their respective radiographic images, which have certain radiological properties that allow to make a deep radiological study. Therefore, the models are useful for neurosurgical training.
Topics: Dogs; Animals; Laminectomy; Thoracic Vertebrae; Lumbar Vertebrae; Dog Diseases; Radiography
PubMed: 37556719
DOI: 10.1590/acb382623 -
Clinical Orthopaedics and Related... Feb 2020
Review
Topics: Consensus; Humans; Lumbar Vertebrae; Observer Variation; Predictive Value of Tests; Reproducibility of Results; Spinal Fractures; Terminology as Topic; Thoracic Vertebrae; Tomography, X-Ray Computed
PubMed: 32022766
DOI: 10.1097/CORR.0000000000001086 -
Journal of Orthopaedic Surgery and... Mar 2023To explore the characteristics and clinical management of thoracic spinal stenosis with diffuse idiopathic skeletal hyperostosis (DISH).
BACKGROUND
To explore the characteristics and clinical management of thoracic spinal stenosis with diffuse idiopathic skeletal hyperostosis (DISH).
METHODS
The patients diagnosed with thoracic spondylotic myelopathy who underwent spinal decompression and fusion surgery in a single center between 2012 and 2020 were retrospectively analyzed. All the patients were followed up for at least 2 years. Patients were classified into DISH and non-DISH groups. Demographic, radiographic and clinical parameters were compared between the two groups.
RESULTS
A total of 100 thoracic spondylotic myelopathy patients were included in the study. 22 patients were diagnosed with DISH. The proportion of male patients in the DISH group was higher, and the average BMI was larger. The incidence of upper thoracic vertebrae with ossification of posterior longitudinal ligament (OPLL) (P < 0.05) and lumbar spine with ossification of ligamentum flavum (OLF) was higher (P < 0.05) in DISH the group. The proportion of patients received staged surgery is higher in the DISH group (P < 0.1). There were no significant differences between the two groups in the amount of surgical bleeding, the ratio of cerebrospinal fluid leakage, the time duration of drainage tube placement and the JOA scores.
CONCLUSION
Thoracic spinal stenosis with DISH occurred more in male patients with larger BMI. The posterior decompression and fusion surgery could achieve comparable satisfying clinical outcomes between DISH and non-DISH patients. More proportion of patients received staged surgery in the DISH group; the underline mechanism may be DISH caused more OPLL in the upper thoracic spine and more OLF in the lumbar spine because of mechanical stress.
Topics: Humans; Male; Female; Hyperostosis, Diffuse Idiopathic Skeletal; Spinal Stenosis; Retrospective Studies; Spinal Cord Diseases; Thoracic Vertebrae; Ossification of Posterior Longitudinal Ligament; Spondylosis; Decompression, Surgical; Treatment Outcome
PubMed: 36966324
DOI: 10.1186/s13018-023-03723-7 -
Pain Physician Mar 2021Conventional open laminectomy is considered to be the standard procedure for the treatment of thoracic ossified ligamentum flavum, but multi-segment thoracic laminectomy...
BACKGROUND
Conventional open laminectomy is considered to be the standard procedure for the treatment of thoracic ossified ligamentum flavum, but multi-segment thoracic laminectomy extensively removes the facet joints and ligamentous tissue, destroying the thoracic spine biomechanics and stability, may lead to delayed thoracic spine kyphosis deformities, which in turn can lead to potential neurological deterioration and local intractable pain.
OBJECTIVE
To introduce the technical notes and clinical outcome of ultrasonic osteotome assisted full-endoscopic en block resection of thoracic ossified ligamentum flavum.
STUDY DESIGN
A prospective cohort study.
SETTING
Hospital and outpatient surgery center.
METHODS
From January 2017 to March 2018, 15 patients with 1 - 2 segment thoracic ossified ligamentum flavum were treated with ultrasonic osteotome assisted full-endoscopic en block resection of thoracic ossified ligamentum flavum under local anesthesia. The magnetic resonance imaging and computed tomography of the thoracic spine was reexamined after the operation to evaluate the completeness of ossified ligamentum flavum resection and spinal cord decompression. The patients were followed up on the visual analog scale of back pain and radicular pain, Nurick score and mJOA score of neurological function, and Oswestry Disability Index at 1 week, 3 months, 6 months, one year, and 2 years after operation.
RESULTS
All operations of 17 segments thoracic ossified ligamentum flavum in 15 patients were successfully completed without intraoperative conversion to open surgery. There were no intraoperative spinal cord injuries, dura tears, postoperative cerebrospinal fluid leakage, postoperative infections, and postoperative spinal cord injury aggravated symptoms. Postoperative thoracic spine magnetic resonance imaging and computed tomography examinations of all patients showed that the spinal cord was fully decompressed without any residual pressure. Back pain and radicular pain were relieved significantly, and spinal cord function (Nurick, mJOA, and Oswestry Disability Index scores) was obviously restored. The mJOA recovery rate at the 2-year follow-up was 78.3% in average.
LIMITATIONS
This is an observational cohort study with relative small sample and short-term follow-up.
CONCLUSIONS
Ultrasonic assisted full-endoscopic en block resection of ossified ligamentum flavum is a safe and effective minimally invasive spine surgery for thoracic myelography caused by thoracic ossified ligamentum flavum.
Topics: Adult; Aged; Cohort Studies; Endoscopy; Female; Follow-Up Studies; Humans; Ligamentum Flavum; Male; Middle Aged; Ossification, Heterotopic; Prospective Studies; Thoracic Vertebrae; Treatment Outcome; Ultrasonography, Interventional
PubMed: 33740361
DOI: No ID Found -
Neurology India 2022Complete subluxation of >100% of one vertebral body with respect to the adjacent vertebra is defined as spondyloptosis. It is the severest form of injury caused by...
BACKGROUND
Complete subluxation of >100% of one vertebral body with respect to the adjacent vertebra is defined as spondyloptosis. It is the severest form of injury caused by high-energy trauma. Pediatric patients with a traumatic spine injury, particularly spondyloptosis are surgically demanding as reduction and achieving realignment of the spinal column requires diligent planning and execution.
OBJECTIVE
To enlighten readers about this rare but severest form of thoracolumbar spine injury and its management.
METHODS
Retrospective analysis of patients treated here with spondyloptosis between 2008 and 2016 was done.
RESULTS
Seven children, ranging from 9 to 18 years (mean years) age were included in the study. Five patients had spondyloptosis at thoracolumbar junction and one each in the lumbar and thoracic spine. All patients underwent single-stage posterior surgical reduction and fixation except one patient who refused surgery. Intraoperatively, cord transection was seen in five patients while dura was intact in one patient. The mean follow-up period was 17 months (1-36 months) during which one patient expired due to complications arising from bedsores. All patients remained American Spinal Injury Association (ASIA) A neurologically.
CONCLUSIONS
Traumatic spondyloptosis is a challenging proposition to treat and the aim of surgery is to stabilize the spine. Rehabilitation remains the most crucial but the neglected part and dearth of proper rehabilitation centers inflict high mortality and morbidity in developing countries.
Topics: Humans; Adolescent; Child; Thoracic Vertebrae; Retrospective Studies; Lumbar Vertebrae; Spondylolisthesis; Spinal Injuries
PubMed: 36412366
DOI: 10.4103/0028-3886.360921