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Medicine Feb 2019To investigate the relationship between cervical and thoracic sagittal alignment parameters measured by magnetic resonance imaging (MRI) and x-ray in patients with... (Observational Study)
Observational Study
To investigate the relationship between cervical and thoracic sagittal alignment parameters measured by magnetic resonance imaging (MRI) and x-ray in patients with cervical spondylosisData from 120 symptomatic patients who presented with cervical spondylosis between April 2015 and January 2016 were retrospectively analyzed. Patients received both a cervical MRI and a cervical radiograph during a single visit. The thoracic inlet angle (TIA), T1 slope (T1S), neck tilt (NT), C2-C7 angle (C2-C7), and C2-C7 sagittal vertical axis (C2-7 SVA) were assessed. Pearson correlation coefficient, paired t test, and linear regression models were used to analyze parameters obtained by cervical MRI and radiography.The difference in mean thoracic inlet angle x-ray (TIAX) and thoracic inlet angle MRI (TIAM) (TIAM-TIAX) (0.72 ± 5.82°) was not significant (P > .05). There were significant differences in mean T1 slope x-ray (T1SX) and T1 slope MRI (T1SM) (T1SM-T1SX) (-2.55 ± 6.14°), mean neck tilt x-ray (NTX) and neck tilt MRI (NTM) (NTM-NTX) (3.26 ± 6.01°), mean C2-C7 angle x-ray (C2-7X) and C2-C7 angle MRI (C2-7 M) (C2-7M-C2-7X) (-3.57 ± 10.00°), and mean C2-C7 sagittal vertical axis X ray (C2-7 SVAX) and C2-C7 sagittal vertical axis MRI (C2-7 SVAM) (C2-7 SVAM-C2-7 SVAX) (-4.50 ± 1.26 mm) (all P ≤ .001). There were positive correlations between TIAM and TIAX (r = 0.807), T1SM and T1SX (r = 0.581), NTM and NTX (r = 0.759), cervical loidosis MRI and cervical loidosis x-ray (r = 0.666), and SVAM and SVAX (r = 0.226).MRI may be useful to evaluate thoracic inlet and sagittal alignment parameters in patients with cervical spondylosis. Patients with cervical spondylosis may have a relatively low capacity for compensation in the cervical region.
Topics: Cervical Vertebrae; Female; Humans; Magnetic Resonance Imaging; Male; Retrospective Studies; Spondylosis; Thoracic Vertebrae
PubMed: 30762740
DOI: 10.1097/MD.0000000000014393 -
Clinical Orthopaedics and Related... May 2011Early-onset scoliosis, when left untreated, leads to severe deformity. Until the last decade, treatment of progressive curves in young children often consisted of... (Review)
Review
BACKGROUND
Early-onset scoliosis, when left untreated, leads to severe deformity. Until the last decade, treatment of progressive curves in young children often consisted of definitive spinal fusion. The recognition of thoracic insufficiency syndrome associated with definitive early fusion has led to the development of new surgical techniques developed to preserve spinal and thoracic growth in young patients with progressive scoliosis.
QUESTIONS/PURPOSES
We asked: (1) Does early definitive fusion arrest progression of spinal deformity? To what extent does early definitive spinal fusion influence (2) pulmonary function and (3) thoracic growth?
METHODS
A Medline search of the published literature on early-onset scoliosis, congenital scoliosis, and infantile scoliosis between 2008 and 2010 was performed on spinal fusion for early-onset scoliosis, focusing on studies reporting pulmonary function at followup.
RESULTS
Spinal deformity is apparently not well controlled by early fusion since revision surgery has been required in 24% to 39% of patients who underwent presumed definitive fusion in early childhood. Restrictive pulmonary disease, defined as forced vital capacity less than 50% of normal, occurs in 43% to 64% of patients who undergo early fusion surgery with those children who have extensive thoracic fusions and whose fusions involve the proximal thoracic spine at highest risk. Thoracic growth after early surgery is an average of 50% of that seen in children with scoliosis who do not have early surgery. Diminished thoracic spinal height correlates with decreased forced vital capacity.
CONCLUSIONS
The literature does not support routine definitive fusion of thoracic spinal deformity at an early age in children with scoliosis.
Topics: Adolescent; Age Factors; Age of Onset; Child; Child, Preschool; Female; Humans; Lung; Male; Patient Selection; Reoperation; Respiratory Insufficiency; Risk Assessment; Scoliosis; Spinal Fusion; Thoracic Vertebrae; Thorax; Treatment Outcome; Vital Capacity
PubMed: 20957466
DOI: 10.1007/s11999-010-1622-z -
European Spine Journal : Official... Mar 2013The diagnostic assessment and prognostic value of the posterior ligamentous complex (PLC) remains a controversial topic in the management of patients with thoracolumbar... (Review)
Review
PURPOSE
The diagnostic assessment and prognostic value of the posterior ligamentous complex (PLC) remains a controversial topic in the management of patients with thoracolumbar spinal injury. The purpose of this review was to critically appraise the literature and present an overview of the: (1) precision, (2) accuracy, and (3) validity of detecting PLC injuries in patients with thoracic and lumbar spine trauma.
METHODS
Studies evaluating the precision, accuracy and/or validity of detecting and managing PLC injuries in patients with thoracic and/or lumbar spine injuries were searched through the Medline database (1966 to September 2011). References were retrieved and evaluated individually and independently by two authors.
RESULTS
Twenty-one eligible studies were identified. Few studies reported the use of countermeasures for sampling and measurement bias. In nine agreement studies, the PLC was assessed in various ways, ranging from use of booklets to a complete set of diagnostic imaging. Inter-rater and intra-rater kappa values ranged from 0.188 to 0.915 and 0.455 to 0.840, respectively. In nine accuracy studies, magnetic resonance (MR) imaging was most often (n = 6) compared with intra-operative findings. In general, MR imaging tended to demonstrate relatively high negative predictive values and relatively low positive predictive values for PLC injuries.
CONCLUSIONS
A wide variety of methods have been applied in the evaluation of precision and accuracy of PLC injury detection, leaving spinal surgeons with a multitude of variable results. There is scant clinical evidence demonstrating the true prognostic value of detected PLC injuries in patients with thoracic and lumbar spine injuries. We recommend the conduct of longitudinal clinical follow-up studies on those cases assessed for precision and/or accuracy of PLC injuries.
Topics: Humans; Ligaments, Articular; Lumbar Vertebrae; Spinal Injuries; Thoracic Vertebrae
PubMed: 23208081
DOI: 10.1007/s00586-012-2602-7 -
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 -
Orthopaedics & Traumatology, Surgery &... Apr 2020Many authors have demonstrated the necessity of reconstruction of the anterior column in spinal trauma with vertebral body collapse or nonunion. There is no publication... (Comparative Study)
Comparative Study
AND BACKGROUND DATA
Many authors have demonstrated the necessity of reconstruction of the anterior column in spinal trauma with vertebral body collapse or nonunion. There is no publication comparing the result depending on the time between trauma and anterior reconstruction of the vertebral body.
OBJECTIVE
To compare long-term clinical and radiological results between early and late anterior vertebral body reconstruction with expandable cages in patients with thoracic and lumbar spine trauma.
HYPOTHESIS
An early anterior reconstruction of thoracolumbar fractures provides better clinical and radiological outcomes than a delayed one.
MATERIALS AND METHODS
A retrospective clinical study was carried out with 44 consecutive patients with injuries of the thoracic and lumbar spine treated operatively with combined posterior stabilization and anterior reconstruction with an expandable implant for vertebral body replacement. All patients were evaluated with EOS full-spine radiograph and CT-scan. The mean follow-up was 5.1 years. Clinical result was evaluated with ODI, SF12, VAS back pain, return to work and sport. Radiological result was evaluated with regional kyphosis angle (RKA) evolution, fusion rate and sagittal alignment. In Group A, twenty-nine patients underwent an early anterior reconstruction within 3 weeks after trauma. The indication of vertebral body reconstruction was placed after post-operative CT-scan for a Mc Cormack score≥7. In Group B, fifteen patients underwent a late anterior reconstruction after diagnosis of nonunion by the combination of pain and CT-scan after 1 year.
RESULTS
Clinical scores and scales were significantly better for patients operated early in Group A. Return to work and activities were significantly more important in Group A too. The mean RKA correction with posterior reduction was 9.3°. The secondary anterior approach permit to reduce 2.9° more. At last follow-up, the loss of reduction was 4.3°. There was no significant difference between groups for those results. No difference in fusion rate was observed between groups. There was no significant difference between groups in the sagittal alignment excepted for SVA that was higher for Group B while remaining under a normal value of 50mm.
CONCLUSION
Early anterior vertebral body reconstruction for fractures gives better clinical results than delayed reconstruction for patients with diagnosis of nonunion in patients with thoracic and lumbar spine trauma. Moreover, the shorter the time from trauma to operation, the better the sagittal reduction of kyphosis. The use of expandable titanium cage is a good way to perform and maintain this reduction.
LEVEL OF EVIDENCE
IV, retrospective study.
Topics: Early Medical Intervention; Humans; Kyphosis; Lumbar Vertebrae; Radiography; Retrospective Studies; Spinal Fractures; Spinal Fusion; Thoracic Vertebrae; Time-to-Treatment; Treatment Outcome
PubMed: 30765308
DOI: 10.1016/j.otsr.2018.11.019 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... May 2021To describe gender-related differences in the length of the left chord and pedicle at the level of 12th thoracic vertebrae and appropriate length of the screw to be...
BACKGROUND
To describe gender-related differences in the length of the left chord and pedicle at the level of 12th thoracic vertebrae and appropriate length of the screw to be applied so as to decrease the perforation risk of anterior cortex of the corpus and preventable injury of major vascular vessels.
METHODS
Axial bone window computed tomography images of T12 vertebral pedicles of 60 patients (30 males and 30 females, age >25 years) without any sign of spinal trauma were obtained and morphometric data were analyzed.
RESULTS
Mean ages of the female (n=30) and male (n=30) patients were 32.17±4.24 and 31.70±3.60 years, respectively. The left chord lengths of T12 of the male (38.17±2.54 mm) and female (36.62±2.27 mm) patients were compared and a statistically significant difference was found between these two measurements (p=0.016). A statistically significant difference between the length of the left chord (37.40±2.51) (range, 32-44 mm) and age (31.93±3.91) (range, 25-40 years) and also a moderate degree of correlation were observed (p=0.002), (r=0.401). A statistically significant difference and a moderate degree of correlation were found between the lengths of the left chords (37.40±2.51; range, 32-44 mm) and the left pedicles (12.12±1.34; range, 10.0-15.80 mm) (p=0.001), (r=0.577).
CONCLUSION
Significant differences and correlations exist between the left pedicle and the left chord in male and female patients and patients with different ages. The data obtained can be used as a guide to determine the implant size and intraoperative management of T12 vertebral pedicle.
Topics: Adult; Aorta, Thoracic; Female; Humans; Male; Sex Characteristics; Thoracic Vertebrae; Tomography, X-Ray Computed
PubMed: 33884593
DOI: 10.14744/tjtes.2020.16794 -
Journal of Orthopaedic Surgery (Hong... 2019The cervical spine has the largest sagittal motion in the whole spine, and cervical alignment affects the thoracic sagittal alignment. However, the effects of cervical...
INTRODUCTION
The cervical spine has the largest sagittal motion in the whole spine, and cervical alignment affects the thoracic sagittal alignment. However, the effects of cervical flexion and extension on thoracic sagittal alignment have not been investigated in detail. The purpose of this study was to analyze the change of thoracic sagittal alignment following cervical flexion and extension.
SUBJECTS AND METHODS
A total of 55 consecutive patients (42 men and 13 women; average age 49.1 years) who presented to our department with spinal degenerative disease between January 2016 and September 2017 were enrolled in our study. Subjects with a history of trauma, infection, tumor, inflammatory disease, ossification, or cervical deformities, and those who had undergone spinal surgery were excluded. The following parameters were analyzed: occipito-axial angle (O-C2), C2 slope (C2S), C2-C7 angle, T1 slope (T1S), thoracic kyphosis, T1-T4 angle, T5-T8 angle, T9-T12 angle, lumbar lordosis, sacral slope, pelvic tilt in cervical flexion, neutral, and extension.
RESULTS
Cervical flexion significantly decreased O-C2, C2-C7 angles and T1S, and increased C2S. Cervical extension conversely changed these parameters. At cervical flexion, the correlation of C2-C7 angle with thoracic parameters was maintained, except for the T1-T4 angle. At cervical extension, the correlation was observed with T1S and T1-T4 angle.
CONCLUSION
Cervical flexion affects the T1S and T5-T8 angle, but there is no significant change in T1-T4 and T9 and lower spino-pelvic columns. This study suggests that T2-T4 can be considered as a stable distal end when cervical long fixation for corrective surgery is performed.
Topics: Cervical Vertebrae; Female; Humans; Kyphosis; Lordosis; Male; Middle Aged; Posture; Radiography; Range of Motion, Articular; Thoracic Vertebrae
PubMed: 31597519
DOI: 10.1177/2309499019876999 -
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 -
International Orthopaedics Nov 2017A posterior-anterior vertebral vector is proposed to facilitate visualization and understanding of scoliosis. The aim of this study was to highlight the interest of... (Review)
Review
PURPOSE
A posterior-anterior vertebral vector is proposed to facilitate visualization and understanding of scoliosis. The aim of this study was to highlight the interest of using vertebral vectors, especially in the horizontal plane, in clinical practice.
METHODS
We used an EOS two-/three-dimensional (2D/3D) system and its sterEOS 3D software for 3D reconstruction of 139 normal and 814 scoliotic spines-of which 95 cases were analyzed pre-operatively and post-operatively, as well. Vertebral vectors were generated for each case. Vertebral vectors have starting points in the middle of the interpedicular segment, while they are parallel to the upper plate, ending in the middle of the segment joining the anterior end plates points, thus defining the posterior-anterior axis of vertebrae. To illustrate what information could be obtained from vertebral vector-based top-view images, representative cases of a normal spine and a thoracic scoliosis are presented.
RESULTS
For a normal spine, vector projections in the transverse plane are aligned with the posterior-anterior anatomical axis. For a scoliotic spine, vector projections in the horizontal plane provide information on the lateral decompensation of the spine and the lateral displacement of vertebrae. In the horizontal plane view, vertebral rotation and projections of the sagittal curves can also be analyzed simultaneously.
CONCLUSIONS
The use of posterior-anterior vertebral vector facilitates the understanding of the 3D nature of scoliosis. The approach used is simple. These results are sufficient for a first visual analysis furnishing significant clinical information in all three anatomical planes. This visualization represents a reasonable compromise between mathematical purity and practical use.
Topics: Adolescent; Female; Humans; Imaging, Three-Dimensional; Scoliosis; Thoracic Vertebrae
PubMed: 28801800
DOI: 10.1007/s00264-017-3548-5 -
European Journal of Trauma and... Oct 2021The aim of this review is to systematically screen the literature for clinical and biomechanical studies dealing with posterior stabilization of acute traumatic... (Review)
Review
PURPOSE
The aim of this review is to systematically screen the literature for clinical and biomechanical studies dealing with posterior stabilization of acute traumatic mid-thoracic vertebral fractures in patients with normal bone quality.
METHODS
This review is based on articles retrieved by a systematic search in the PubMed and Web of Science database for publications up to December 2018 dealing with the posterior stabilization of fractures of the mid-thoracic spine.
RESULTS
Altogether, 1012 articles were retrieved from the literature search. A total of 960 articles were excluded. A total of 16 articles were dealing with the timing of surgery in polytraumatized patients, patients suffering of neurologic deficits after midthoracic fractures, and the impact of concomitant thoracic injuries and were excluded. Thus, 36 remaining original articles were included in this systematic review depicting the topics biomechanics, screw insertion, and outcome after posterior stabilization. The overall level of evidence of the vast majority of studies is low.
CONCLUSION
High quality studies are lacking. Long-segmental stabilization is indicated in unstable midthoracic fractures with concomitant sternal fractures. Generally, long-segmental constructs seem to be the safer treatment strategy considering the relative high penetration rate of pedicle screws in this region. Thereby, navigated insertion techniques and intraoperative 3D-imaging help to improve pedicle screw placement accuracy.
Topics: Biomechanical Phenomena; Humans; Lumbar Vertebrae; Pedicle Screws; Spinal Fractures; Spinal Fusion; Thoracic Injuries; Thoracic Vertebrae; Treatment Outcome; Vertebral Body
PubMed: 33263816
DOI: 10.1007/s00068-020-01560-5