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Neurologia Medico-chirurgica 2011A 69-year-old male presented with a rare spinal angiolipoma manifesting as history of back pain, and numbness in both lower limbs, which progressed over a period of 5...
A 69-year-old male presented with a rare spinal angiolipoma manifesting as history of back pain, and numbness in both lower limbs, which progressed over a period of 5 years. Total T10-T12 laminectomy was performed and the tumor was removed en bloc. The symptoms gradually improved postoperatively. Spinal angiolipoma is an uncommon benign extradural tumor of spine, which accounts for 0.14-1.2% of all spinal tumors and is a rare cause of spinal cord compression. Recognition of this entity is crucial as a benign and curable cause of paraplegia and back pain.
Topics: Aged; Angiolipoma; Decompression, Surgical; Humans; Male; Radiography; Spinal Neoplasms; Thoracic Vertebrae; Treatment Outcome
PubMed: 21785253
DOI: 10.2176/nmc.51.539 -
Medicine May 2021The thoracic spine is stabilized in the anteroposterior direction by the rib cage and the facet joints, thus thoracic degenerative spondylolisthesis is very uncommon....
RATIONALE
The thoracic spine is stabilized in the anteroposterior direction by the rib cage and the facet joints, thus thoracic degenerative spondylolisthesis is very uncommon. Here, we report a rare case of thoracic degenerative spondylolisthesis in which the lower thoracic region was the only region involved.
PATIENT CONCERNS
We present the case of a 56-year-old Chinese female who suffered from thoracic degenerative spondylolisthesis. She had a 2-year history of gait disturbance and bilateral lower-extremity numbness. The initial imaging examinations revealed Grade I anterior spondylolisthesis and severe cord compression, as well as bilateral facet joint osteoarthritis at T11/12.
DIAGNOSIS
The patient was diagnosed with thoracic degenerative spondylolisthesis-associated myelopathy.
INTERVENTIONS
She underwent a posterior decompression with transforaminal thoracic interbody fusion (TTIF) at T11/12.
OUTCOMES
The patient recovered well after the operation, and MRI at 12-month follow-up revealed that spinal cord compression was relieved and high signal intensity in T2-weighted image was improved.
LESSONS
To the best of our knowledge, this is the first reported case of thoracic degenerative spondylolisthesis in which the lower thoracic region was the only region involved. Disruption of joint capsule, instability with micromotion, and degenerative disc may contribute to this rare disease. Posterior decompression with posterolateral fusion or TTIF were the main treatment modalities, however, TTIF has its unique advantages because of sufficient decompression, immediate stability and high fusion rate.
Topics: Decompression, Surgical; Female; Gait Disorders, Neurologic; Humans; Lower Extremity; Magnetic Resonance Imaging; Middle Aged; Osteoarthritis; Paresthesia; Spinal Cord Compression; Spinal Fusion; Spondylolisthesis; Thoracic Vertebrae; Tomography, X-Ray Computed
PubMed: 34032771
DOI: 10.1097/MD.0000000000026150 -
Orthopaedics & Traumatology, Surgery &... Nov 2021The aim of this retrospective study was to evaluate the effect of navigation on the positioning of the SpineJack implant in the treatment of thoracic and lumbar...
INTRODUCTION
The aim of this retrospective study was to evaluate the effect of navigation on the positioning of the SpineJack implant in the treatment of thoracic and lumbar compression fractures.
METHODS
Between January 2018 and December 2019, all patients operated on for thoracic or lumbar fracture using the SpineJack device in stand-alone were included in this single-center study. The positioning of the SpineJack implant was analyzed on axial CT views by measuring the angle between the axis of the pedicle and the axis of the final implant. The relationships between implant positioning and the use of navigation or fluoroscopy, pedicle dimensions and levels of injury were analyzed. Surgical time, radiation exposure, radiological findings and complications were assessed.
RESULTS
One hundred patients were included, for 103 fractured vertebrae and a total of 205 implants, 148 placed under standard fluoroscopy and 57 with the Surgivisio navigation system. For pedicle diameters≥5mm (165 implants), the positioning of the implant relative to the axis of the pedicle was significantly better in the navigation group: 2°±1.4° (range, 0-7°) in the fluoroscopy group versus 1.2°±1.1° (range, 0-5°) in the navigation group (p=0.04). There were no significant differences in reduction of vertebral kyphosis angle or mean operating time. Dose area product (DAP) was significantly higher with navigation: 4.43Gy.cm versus 0.47Gy.cm (p<0.001) and dose to the surgeon significantly lower: 0.5 versus 1.6μSv (p<0.001). No difference was found regarding complications. Subgroup analysis showed significantly greater operative time and patient irradiation in the fluoroscopy group when pedicle diameter was less than 5mm.
CONCLUSION
This study demonstrates the interest of navigation for positioning the SpineJack implant with respect to the pedicle axis in vertebrae with pedicle diameter≥5mm. This study also confirmed the reliability of navigation and lower radiation dose to the surgeon, regardless of the fracture level. Navigation reduced operating time and patient irradiation for vertebrae with pedicle diameter<5mm.
LEVEL OF EVIDENCE
IV; retrospective study.
Topics: Fractures, Compression; Humans; Lumbar Vertebrae; Pedicle Screws; Reproducibility of Results; Retrospective Studies; Spinal Fractures; Spine; Thoracic Vertebrae
PubMed: 34329760
DOI: 10.1016/j.otsr.2021.103028 -
Pain Physician Sep 2021The costal pain is common in thoracic osteoporotic fracture patients. It is unclear why vertebral fracture patients without any specific nerve impingement on magnetic...
BACKGROUND
The costal pain is common in thoracic osteoporotic fracture patients. It is unclear why vertebral fracture patients without any specific nerve impingement on magnetic resonance imaging (MRI) present with costal pain.
OBJECTIVES
The aim of this study was to investigate the potential causes of costal pain in patients with osteoporotic fracture of thoracic vertebra.
STUDY DESIGN
A retrospective study.
SETTING
Shandong province, China.
METHODS
In this retrospective study, 100 patients with thoracic osteoporotic fractures were collected and assigned into 2 groups on the basis of pain patterns noted during medical history and physical examination. Group A was comprised of 50 patients with costal pain. Group B was comprised of 50 patients without costal pain. The Visual Analog Scale and Oswestry Disability Index scores were recorded to assess the pattern and severity of pain. The gender, age, presence or absence of trauma, time of fracture, fracture segments, and analgesic application were recorded. Computed tomography data including changes in fracture vertebral body shape (height, width, and length), intervertebral foramen shape (height and width), wedge shape of fractured vertebral body, and local kyphosis angle were recorded. The fracture edema signal was determined by MRI. Multivariate analysis was performed for all the above parameters.
RESULTS
There was a statistically significant difference in the vertebral body width between the 2 groups.
LIMITATIONS
The number of patients enrolled is not large enough. We also have limitations in interpreting all pains resulting from osteoporotic vertebral compression fractures, because all pain mechanisms are not fully understood. Further work is needed to improve the accuracy of locating pain sources and distinguishing pain patterns which may result from other spinal structures.
CONCLUSION
The incidence of costal pain is significantly and positively associated with the width of the fractured vertebra in patients with osteoporotic thoracic vertebrae fracture.
Topics: Fractures, Compression; Humans; Lumbar Vertebrae; Musculoskeletal Pain; Osteoporotic Fractures; Retrospective Studies; Spinal Fractures; Thoracic Vertebrae; Treatment Outcome
PubMed: 34554699
DOI: No ID Found -
BioMed Research International 2019Retrolaminar block (RLB) and erector spinae plane block (ESPB) are alternative approaches to paravertebral block (PVB) and are advantageous in that they are easier and... (Review)
Review
Retrolaminar block (RLB) and erector spinae plane block (ESPB) are alternative approaches to paravertebral block (PVB) and are advantageous in that they are easier and safer techniques compared with the traditional PVB. Many clinical reports of these blocks have described their efficacy for ipsilateral thoracic analgesia. The local anesthetic injection points of RLB and ESPB are the lamina and transverse process, respectively. Despite the similarity of the puncture sites, there have been no clinical studies comparing RLB and ESPB. In addition, the underlying mechanism of these blocks has not been clarified. Recent anatomical investigations indicated that the injectate was distributed in the paravertebral space and spread laterally into the intercostal spaces. The limited distribution into the paravertebral space indicated that compared to PVB, RLB and ESPB exert their effects via a different mechanism. In this review, we describe the features of and differences between RLB and ESPB based on current clinical and anatomical reports. We also propose the clinical indication and discuss the differences, clinical outcomes, and anatomical mechanisms of the techniques.
Topics: Analgesia; Anesthetics, Local; Humans; Nerve Block; Pain, Postoperative; Paraspinal Muscles; Thoracic Vertebrae; Treatment Outcome
PubMed: 31032339
DOI: 10.1155/2019/2578396 -
Medical Science Monitor : International... Dec 2016BACKGROUND The key to its successful application is to determine the best entry point for the vertebral screw(s). This study aimed to provide a reference for clinical...
UNLABELLED
BACKGROUND The key to its successful application is to determine the best entry point for the vertebral screw(s). This study aimed to provide a reference for clinical anterolateral fixation through digital measurement of computed tomography (CT) data to identify relevant anatomical positions in the middle and lower thoracic vertebrae (T4-T12) of 30 adults. MATERIAL AND METHODS We performed digital measurement of anatomical positions in the middle and lower thoracic vertebrae (T4-T12) of 30 adults.
ABBREVIATIONS
Left height of vertebral body, LHV; Right height of vertebral body, RHV; Anterior height of vertebral body, AHV; Middle height of vertebral body, MHV; Posterior height of vertebral body, PHV; Superior sagittal diameter of vertebral body, SSDV; Superior transverse diameter of vertebral body, STDV; inferior sagittal diameter of vertebral body, ISDV; Inferior transverse diameter of vertebral body, ITDV; (1) Left (right) height of vertebral body, [L(R)HV]; Anterior (middle, posterior) height of vertebral body [A(M,P)HV]; Superior (inferior) sagittal diameter of vertebral body, [S(I)SDV]; Superior (inferior) transverse diameter of vertebral body, [S(I)TDV]. RESULTS The transverse diameters of vertebral bodies were always larger than the sagittal diameter for 3~4 mm. The distance between 2 vertebrae (interval of 1 vertebra) range were (52-56) mm for T4-T7 and (44-48) mm for T8-T12, and the surgeons could collate these data to choose a suitable stick length. CONCLUSIONS Bone graft should prune into laterigrade cuboid, it can recover A-P and bilateral physiological functions load, and the height of the vertebral body increased from T4 to T12.
Topics: Adult; Bone Screws; China; Female; Humans; Male; Surgery, Computer-Assisted; Thoracic Vertebrae; Tomography, X-Ray Computed
PubMed: 27997524
DOI: 10.12659/msm.899062 -
Neurology India 2017
Topics: Female; Humans; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Spinal Fractures; Thoracic Vertebrae
PubMed: 28488607
DOI: 10.4103/neuroindia.NI_320_17 -
Journal of Radiology Case Reports Nov 2015Rosai-Dorfman disease is a rare benign histiocytic disease that infrequently presents in the spine. We report a case of Rosai-Dorfman disease isolated to the epidural... (Review)
Review
Rosai-Dorfman disease is a rare benign histiocytic disease that infrequently presents in the spine. We report a case of Rosai-Dorfman disease isolated to the epidural thoracic spine in a 26-year-old male. To our knowledge, this is the 15th reported case of isolated spinal disease and only the fourth case of isolated thoracic epidural disease. Given its rarity as well as non-specific symptoms and imaging findings, Rosai-Dorfman disease is often not considered and misdiagnosed on imaging studies. To help improve awareness of Rosai-Dorfman spinal disease, we review the literature and discuss the epidemiology, clinical presentation, imaging features, and treatment considerations for this condition.
Topics: Adult; Diagnosis, Differential; Histiocytosis, Sinus; Humans; Magnetic Resonance Imaging; Male; Spinal Diseases; Thoracic Vertebrae; Tomography, X-Ray Computed
PubMed: 27252790
DOI: 10.3941/jrcr.v9i11.2629 -
BMC Musculoskeletal Disorders Sep 2022This study aimed to investigate the laterality of the pedicle morphology at the apical vertebra (AV) level and identify the radiographic factors associated with the...
BACKGROUND
This study aimed to investigate the laterality of the pedicle morphology at the apical vertebra (AV) level and identify the radiographic factors associated with the laterality ratio of the pedicle morphology at the AV level in patients with adolescent idiopathic scoliosis (AIS).
METHODS
Overall, 684 pedicles in 57 AIS patients aged 10-20 years, who underwent preoperative computed tomography (CT) and had Lenke type 1 or 2 with right convex main thoracic curves (MTC), were evaluated. Pedicle diameters of the MTC were assessed. We defined and compared the region containing two vertebrae adjacent to the AV (APEX±1) and the region containing two vertebrae adjacent to the neutral vertebra. We analyzed the pedicle diameter and laterality ratio of APEX±1 and performed multiple linear regression analysis to identify the radiographic factors associated with the laterality of the pedicle diameter.
RESULTS
On the concave side of APEX±1, the pedicles of 15 patients (26.3%) did not accept a 4-mm-diameter pedicle screw (PS), even with 25% cortical bone width expansion. Laterality ratio differences in the pedicle diameters of the cortical bone width in APEX±1 were large in patients with more proximal AV level (p < 0.001) and smaller apical vertebral rotation (AVR) (p = 0.029).
CONCLUSIONS
Preoperative planning to accurately select and insert the PS in AIS should be based on the anatomical limitations in APEX±1, AV level, and AVR degree. In APEX±1, the correlation between AVR and the laterality ratio of the pedicle diameter may be useful for pathoetiological interpretation of the AIS deformity.
Topics: Adolescent; Humans; Kyphosis; Pedicle Screws; Retrospective Studies; Scoliosis; Spinal Fusion; Spine; Thoracic Vertebrae; Tomography, X-Ray Computed
PubMed: 36068555
DOI: 10.1186/s12891-022-05799-4 -
BMC Musculoskeletal Disorders Mar 2022It is common practice to use a combination approach of computed tomography (CT) scan followed by upright radiographs when assessing traumatic thoracolumbar (TL)...
BACKGROUND
It is common practice to use a combination approach of computed tomography (CT) scan followed by upright radiographs when assessing traumatic thoracolumbar (TL) vertebral fractures. The purpose of this study was to determine the clinical utility of upright spine radiographs in the setting of traumatic TL fracture management. Our null hypothesis is that upright TL radiographs rarely change management of acute vertebral fractures.
METHODS
A retrospective study was performed on patients with an initial plan of non-operative management for a TL fracture between January 2014 and June 2020 at a single Level 1 trauma center. Patients were followed from time of initial consult to either conversion to surgery (operative) or last available outpatient follow up imaging (non-operative). Lateral kyphotic angle of the fractured vertebra and anterior vertebral body height% loss on initial CT, first upright radiograph, and endpoint upright radiograph imaging were measured. Measurements were compared between and within operative and non-operative groups using t-tests and Mann-Whitney U tests when appropriate. P-values ≤ 0.05 were considered statistically significant.
RESULTS
The study included 70 patients with an average age of 54 years and 37 (52.9%) were women. Six (8.6%) of 70 patients had a change from non-operative to operative management based on upright radiographs. The mean (standard deviation) change in degrees of kyphosis from CT scan to first X-ray was 4.6 (7.0) in the non-operative group and 11.5 (8.1) in the operative group (P = 0.03). Delta degrees of kyphosis from CT scan to endpoint X-ray was 6.4 (9.0) and 16.2 (6.2) in the non-operative and operative groups, respectively (P = 0.01). In the operative group, mean degrees of kyphosis increased from 1.6 (7.6) in initial CT to 13.1 (8.9) in first X-ray (P = 0.02). First X-ray mean anterior body height% loss was 37.5 (17.6) and 53.2 (16.1) in the non-operative and operative groups, respectively (P = 0.04).
CONCLUSIONS
Upright radiographs are useful in guiding traumatic vertebral fracture management decisions. Larger studies are needed to determine the degree of change in kyphosis between CT and first standing radiograph that is suggestive of operative management.
TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION
Not applicable.
Topics: Female; Fractures, Bone; Humans; Lumbar Vertebrae; Middle Aged; Retrospective Studies; Spinal Fractures; Thoracic Vertebrae
PubMed: 35351077
DOI: 10.1186/s12891-022-05243-7