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Orthopaedics & Traumatology, Surgery &... Dec 2012Numerous improvements in minimally invasive spine surgery (MISS) have been made during the last decade. MISS in thoracolumbar spine trauma management must achieve the... (Review)
Review
Numerous improvements in minimally invasive spine surgery (MISS) have been made during the last decade. MISS in thoracolumbar spine trauma management must achieve the same results as conventional treatment but with less morbidity. The increased use of MISS technologies in spine trauma has been correlated to the availability of more versatile instrumentation, which makes the fixation of all thoracic and lumbar levels possible. Balloon-assisted techniques have been used to support the anterior column in a stand-alone manner or in combination with open or percutaneous pedicle screw fixation. Fluoroscopy-assisted pedicle screw insertion is associated with less pedicle wall violation when compared to open surgery, but with increased radiation exposure for the surgeon and patient. Surgeons must be aware of this issue and new technologies are available to decrease irradiation. The advantages of percutaneous pedicle screw fixation relative to open surgery are discussed: preservation of posterior musculature, less blood loss, shorter operative time, lower infection risk, less postoperative pain, shorter rehabilitation time as well as shorter hospital stay. Limitations of percutaneous fixation include the inability to achieve direct spinal canal decompression and not having the option to perform a fusion. Nevertheless, these limitations can be addressed by combining MISS with open techniques. Indications for percutaneous spine fixation alone or in combination with MISS or open techniques are discussed based on the AO classification. The benefits of percutaneous spinal fixation for unstable spine fractures in polytrauma patients are also discussed. Posterior instrumentation can be easily removed after bone union to allow young patients to regain their mobility. Large well-controlled prospective studies are needed to draw up guidelines for less invasive procedures in spine trauma. In the future, development of new technologies can expand the scope of indications and treatment possibilities using MISS techniques in spine trauma.
Topics: Fracture Fixation, Internal; Humans; Lumbar Vertebrae; Multiple Trauma; Spinal Fractures; Thoracic Vertebrae
PubMed: 23165222
DOI: 10.1016/j.otsr.2012.09.014 -
Journal of Orthopaedic Surgery (Hong... 2022To evaluate the vertebral bone mineral density and the value of stand-alone oblique lumbar interbody fusion (SA OLIF) for the management of single-level adjacent segment...
PURPOSE
To evaluate the vertebral bone mineral density and the value of stand-alone oblique lumbar interbody fusion (SA OLIF) for the management of single-level adjacent segment disease (ASD) and primary lumbar degenerative diseases.
PATIENTS AND METHODS
Seventy-eight patients undergoing single-level SA OLIF was divided into index surgery group ( = 36) or revision surgery group ( = 42) at single center. The vertebral body Hounsfield units (HU) value was measured to assess bone mineral density of operated level by the preoperative CT. The following data were retrospectively collected and compared between the two groups: demographic, surgical data, clinical results, and complications.
RESULTS
No differences were found between the two groups in surgical data. The fusion segment HU values in the revision group were significantly higher than that in the index group (147.4 ± 35.3 vs 129.2 ± 38.4 = .033). There were significant differences while comparing fusion segment HU values to L1-L4 horizontal plane (147.4 ± 35.3 vs 126.1 ± 28.4, = .000) and L1 (147.4 ± 35.3 vs 126.8 ± 26.2, = .000) in revision group, meanwhile, no statistically significant difference was observed in index group ( > .05). The cage subsidence was observed in the revision group ( = 2) and index group ( = 9) ( = .045). The patients with cage subsidence had significantly lower vertebral HU values.
CONCLUSION
SA OLIF is valid alternative to the traditional posterior approach in the management of ASD with good clinical outcomes at short-term follow-up. Increased HU values of fusion segment may play a role in the management of ASD by SA OLIF.
Topics: Bone Density; Humans; Lumbar Vertebrae; Reoperation; Retrospective Studies; Spinal Fusion
PubMed: 35410526
DOI: 10.1177/10225536221091846 -
European Spine Journal : Official... May 2007A systematic review of all available evidence on the timing of surgical fixation for thoracic and lumbar fractures with respect to clinical and neurological outcome was... (Review)
Review
A systematic review of all available evidence on the timing of surgical fixation for thoracic and lumbar fractures with respect to clinical and neurological outcome was designed. The purpose of this review is to clarify some of the controversy about the timing of surgical fracture fixation in spinal trauma. Better neurological outcome, shorter hospital stay and fewer complications have been reported after early fracture fixation. But there are also studies showing no difference in neurological outcome when compared to late treatment. Mortality is another controversial point since a recent report of higher mortality in early treated patients. A systematic review of the literature was preformed. Ten articles were included. Early fracture fixation is associated with less complications, shorter hospital and ICU stay. The effect of early treatment on the neurological outcome remains unclear due to the contradictory results of the included studies. Early thoracic and lumbar fracture fixation results in improvement of clinical outcome, but the effect on neurological outcome remains controversial.
Topics: Fracture Fixation, Internal; Humans; Lumbar Vertebrae; Spinal Fractures; Thoracic Vertebrae; Time Factors; Treatment Outcome
PubMed: 17109106
DOI: 10.1007/s00586-006-0224-7 -
Annals of Palliative Medicine May 2020Establishment of a three-dimensional (3D) finite element model of osteoporosis, the simulation fluid was used to enter the vertebral body to study the stiffness recovery...
BACKGROUND
Establishment of a three-dimensional (3D) finite element model of osteoporosis, the simulation fluid was used to enter the vertebral body to study the stiffness recovery of injured vertebral body under different perfusion and distribution conditions, and the stress analysis of adjacent vertebral body after percutaneous vertebroplasty (PVP) was carried out.
METHODS
A healthy male volunteer was selected. Computed tomography (CT) scanning was performed from T11 to L2. MIMICS 15.0 and ABAQUS 6.11 software was used to extract CT findings, and a vertebral model of osteoporotic fracture was established. The flow physical field and conduction and diffusion physical field were coupled to simulate the process and parts of the bone cement injection into the vertebral fracture model. The quantities of bone cement injected into the vertebral fracture model were 2, 4, and 6 mL, respectively. The diffusion range of bone cement was simulated on the simulated image, and the postinjection model of bone cement was obtained. For the simulation of vertebral movement, vertical downward, forward, and backward pressure of 300 N was applied on the model's surface. The stress changes in the upper and lower vertebrae and diseased vertebrae were calculated under different conditions.
RESULTS
It was revealed that the von Mises stress in the endplate under T12 was the highest in the three different states before and after fracture. The von Mises stress in the intervertebral discs and endplates was significantly higher after fracture than before fracture. When PVP was applied, the von Mises stress in adjacent endplates was increased with the increase of cement injection, while the von Mises stress was decreased in the adjacent endplates with cement injection compared with diseased vertebrae.
CONCLUSIONS
A reliable biomechanical model of lumbar vertebral fracture can be established through numerical simulation of CT scanning data. Vertebral fracture and vertebroplasty may cause biomechanical changes in adjacent vertebrae. The influence of biomechanical changes may notably increase along with the amount of bone cement injected. In this study, PVP revealed 4 mL to be the optimal amount for cement injection.
Topics: Bone Cements; Finite Element Analysis; Humans; Lumbar Vertebrae; Male; Spinal Fractures; Vertebroplasty
PubMed: 32434365
DOI: 10.21037/apm-20-955 -
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... Dec 2018The treatment of lumbar infectious spondylitis is controversial. In this study, we attempted to demonstrate that unilateral percutaneous endoscopic debridement with...
BACKGROUND
The treatment of lumbar infectious spondylitis is controversial. In this study, we attempted to demonstrate that unilateral percutaneous endoscopic debridement with physiologic saline and negative pressure drainage postoperatively may achieve a satisfactory result in lumbar infectious spondylitis.
METHODS
We retrospectively analyzed 17 patients with lumbar infectious spondylitis who underwent percutaneous endoscopic debridement and drainage (PEDD) through a posterolateral transforaminal approach. Each biopsy specimen was submitted without delay after surgery and examined for microorganisms and evaluated histopathologically. Patients were assessed by careful physical examination, MacNab criteria, Oswestry Disability Index (ODI), visual analog scale (VAS), regular serological tests, imaging studies for clinical function, and patient satisfaction.
RESULTS
Of the 17 patients, 14 (82.4%) had satisfactory relief of their back pain according to MacNab criteria at 1 week after PEDD. Three patients (17.6%) who had advanced infections with multilevel involvement and paraspinal abscesses underwent anterior debridement and autograft interbody fusion with instrumentation within 2 weeks. However, there were no other severe surgery-related complications. Causative bacteria were identified in most cases, and Staphylococcus aureus was the most prevalent strain.
CONCLUSIONS
Unilateral PEDD with physiological saline or empirical antibiotics did not disrupt lumbar stability and avoided the important intraspinal structures such as the dural sac and nerve roots. It not only had a high rate of identification of the causative pathogen, but also provided effective infection control and pain relief. PEDD may be a useful technique for treatment of lumbar infectious spondylodiscitis patients who have no severe deformities and are unable to undergo the conventional anterior surgery due to poor health or advanced age.
Topics: Adult; Aged; Aged, 80 and over; Debridement; Drainage; Endoscopy; Female; Gram-Positive Bacterial Infections; Humans; Lumbar Vertebrae; Male; Middle Aged; Retrospective Studies; Spondylitis
PubMed: 30509282
DOI: 10.1186/s13018-018-1009-5 -
IEEE Transactions on Bio-medical... Aug 2021Spinal fusion surgeries require accurate placement of pedicle screws in anatomic corridors without breaching bone boundaries. We are developing a combined ultrasound and...
OBJECTIVE
Spinal fusion surgeries require accurate placement of pedicle screws in anatomic corridors without breaching bone boundaries. We are developing a combined ultrasound and photoacoustic image guidance system to avoid pedicle screw misplacement and accidental bone breaches, which can lead to nerve damage.
METHODS
Pedicle cannulation was performed on a human cadaver, with co-registered photoacoustic and ultrasound images acquired at various time points during the procedure. Bony landmarks obtained from coherence-based ultrasound images of lumbar vertebrae were registered to post-operative CT images. Registration methods were additionally tested on an ex vivo caprine vertebra.
RESULTS
Locally weighted short-lag spatial coherence (LW-SLSC) ultrasound imaging enhanced the visualization of bony structures with generalized contrast-to-noise ratios (gCNRs) of 0.99 and 0.98-1.00 in the caprine and human vertebrae, respectively. Short-lag spatial coherence (SLSC) and amplitude-based delay-and-sum (DAS) ultrasound imaging generally produced lower gCNRs of 0.98 and 0.84, respectively, in the caprine vertebra and 0.84-0.93 and 0.34-0.99, respectively, in the human vertebrae. The mean ± standard deviation of the area of -6 dB contours created from DAS photoacoustic images acquired with an optical fiber inserted in prepared pedicle holes (i.e., fiber surrounded by cancellous bone) and holes created after intentional breaches (i.e., fiber exposed to cortical bone) was 10.06 ±5.22 mm and 2.47 ±0.96 mm , respectively (p 0.01).
CONCLUSIONS
Coherence-based LW-SLSC and SLSC beamforming improved visualization of bony anatomical landmarks for ultrasound-to-CT registration, while amplitude-based DAS beamforming successfully distinguished photoacoustic signals within the pedicle from less desirable signals characteristic of impending bone breaches.
SIGNIFICANCE
These results are promising to improve visual registration of ultrasound and photoacoustic images with CT images, as well as to assist surgeons with identifying and avoiding impending bone breaches during pedicle cannulation in spinal fusion surgeries.
Topics: Animals; Catheterization; Goats; Humans; Lumbar Vertebrae; Spinal Fusion; Surgery, Computer-Assisted; Ultrasonography
PubMed: 33347403
DOI: 10.1109/TBME.2020.3046370 -
Medicine Jul 2020Acupotomy has been widely used clinically to relieve low back pain. However, the efficacy of acupotomy for the third lumbar vertebrae transverse process syndrome is...
BACKGROUND
Acupotomy has been widely used clinically to relieve low back pain. However, the efficacy of acupotomy for the third lumbar vertebrae transverse process syndrome is still uncertain. The aim of this study is to determine the effectiveness and safety of acupotomy therapy for the third lumbar vertebrae transverse process syndrome.
METHODS
Relevant randomized controlled trials will be searched from the databases of PubMed, the Cochrane Library, Embase, the China National Knowledge Infrastructure, Wanfang Database, Chinese Science and Technology Periodical Database, and Chinese Biomedical Literature Database from their inception to May 2020. Two reviewers will independently select studies, collect data, and assess the methodology quality by the Cochrane risk of bias tool. The RevMan V.5.3 will be used for meta-analysis.
RESULTS
This study will provide an assessment of the current state of acupotomy for the third lumbar vertebrae transverse process syndrome, aiming to show the efficacy and safety of acupotomy treatment.
CONCLUSION
This study will provide evidence to judge whether acupotomy is an effective intervention for the third lumbar vertebrae transverse process syndrome.
PROSPERO REGISTRATION NUMBER
CRD42019134945.
Topics: Acupuncture Therapy; Clinical Protocols; Humans; Low Back Pain; Lumbar Vertebrae; Systematic Reviews as Topic; Treatment Outcome
PubMed: 32702850
DOI: 10.1097/MD.0000000000021072 -
Archives of Disease in Childhood Feb 2006
Topics: Discitis; Humans; Infant; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Radiography
PubMed: 16428364
DOI: 10.1136/adc.2005.080804 -
BMC Musculoskeletal Disorders Mar 2021The appropriate and optimal treatment for thoracic and lumbar (TL) burst fractures remains a topic of debate. Characterization of vertical laminar fractures (coronal...
INTRODUCTION
The appropriate and optimal treatment for thoracic and lumbar (TL) burst fractures remains a topic of debate. Characterization of vertical laminar fractures (coronal cross-sectional imaging) is presented in this study to determine the severity and treatment options in TL burst fractures.
METHODS
A retrospective evaluation of 341 consecutive patients with TL burst fractures was divided into Group I (whole), Group II (partial), and Group III (intact) based on the vertical laminar fracture morphology from coronal images on computed tomography (CT) scans. The presence of preoperative neurological status was reviewed, and several radiological parameters were measured. In addition, the incidence of dural tears was calculated in patients that underwent a decompression with posterior approach.
RESULTS
In total, 270 lumbar and 71 thoracic burst fractures were analyzed. Compared with the intact group, the two other groups had significantly shorter central canal distance, wider interpedicular distance, and smaller spinal canal area, in particular, Group III. The incidences of preoperative neurological deficits in Groups I to III were 63.0, 22.2, and 6.3%, respectively. The incidences of dural tears in Groups I to III were 25.6, 6.3, and 0%, respectively.
CONCLUSION
The morphology of vertical laminar fractures observed across the coronal plane was important. Patients with "whole", "partial" and "intact" laminar fractures indicated different severity of TL burst fractures. Due to the high probability of dural tears, decompression is recommended as a primary intervention for patients with "whole" laminar fractures. However, for patients without vertical laminar fractures, minimally invasive technique might be a better choice to avoid approach-related complications.
Topics: Fractures, Compression; Humans; Lumbar Vertebrae; Retrospective Studies; Spinal Fractures; Thoracic Vertebrae
PubMed: 33757488
DOI: 10.1186/s12891-021-04178-9