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Journal of Anatomy Jul 2018The epaxial muscles produce intervertebral rotation in the transverse, vertical and axial axes. These muscles also counteract the movements induced by gravitational and...
The epaxial muscles produce intervertebral rotation in the transverse, vertical and axial axes. These muscles also counteract the movements induced by gravitational and inertial forces and movements produced by antagonistic muscles and the intrinsic muscles of the pelvic limb. Their fascicles are innervated by the dorsal branch of the spinal nerve, which corresponds to the metamere of its cranial insertion in the spinous process. The structure allows the function of the muscles to be predicted: those with long and parallel fibres have a shortening function, whereas the muscles with short and oblique fibres have an antigravity action. In the horse, the multifidus muscle of the thoracolumbar region extends in multiple segments of two to eight vertebral motion segments (VMS). Functionally, the multifidus muscle is considered a spine stabiliser, maintaining VMS neutrality during spine rotations. However, there is evidence of the structural and functional heterogeneity of the equine thoracolumbar multifidus muscle, depending on the VMS considered, related to the complex control of the required neuromuscular activity. Osteoarticular lesions of the spine have been directly related to asymmetries of the multifidus muscle. The lateral (LDSM) and medial (MDSM) dorsal sacrocaudal muscles may be included in the multifidus complex, the function of which is also unclear in the lumbosacral region. The functional parameters of maximum force (F ), maximum velocity of contraction (V ) and joint moment (M) of the multifidus muscles inserted in the 4th, 9th, 12th and 17th thoracic and 3rd and 4th lumbar vertebrae of six horses were studied postmortem (for example: 4MT4 indicates the multifidus muscle that crosses four metameres with cranial insertion in the T4 vertebra). Furthermore, the structural and functional characteristics of LDSM and MDSM were determined. Data were analysed by analysis of variance (anova) in a randomised complete block design (P ≤ 0.05). For some muscles, the ordering of V values was almost opposite to that of F values, generally indicating antigravity or dynamic functions, depending on the muscle and VMS. The muscles 3MT12, 3ML3 and 4ML4 exhibited high F and low V values, indicating a stabilising action. The very long 7MT4 and 8MT4 multifidus had low F and high V values, suggesting a shortening action. However, some functional characteristics of interest did not fall within these general observations, also indicating a dual action. In summary, the results of the analysis of various structural and functional parameters confirm the structural and functional heterogeneity of the equine thoracolumbar multifidus complex, depending on the VMS, regardless of the number of metameres crossing each fascicle. To clarify the functions of the equine multifidus muscle complex, this study aimed to assess its functional parameters in thoracolumbar VMSs with different movement characteristics and in the MDSM and LDSM muscles, hypothesising that the functional parameters vary significantly when the VMS is considered.
Topics: Animals; Back Muscles; Horses; Lumbar Vertebrae; Sacrum; Thoracic Vertebrae
PubMed: 29708263
DOI: 10.1111/joa.12818 -
Orthopaedics & Traumatology, Surgery &... Nov 2021Fusion surgeries for scoliosis patients are believed to deteriorate sports performance; in particular, forward roll should deteriorate, but no literature is available to...
BACKGROUND
Fusion surgeries for scoliosis patients are believed to deteriorate sports performance; in particular, forward roll should deteriorate, but no literature is available to substantiate this claim.
HYPOTHESIS
The extent of postoperative deterioration can vary according to surgery type or curve type.
PATIENTS AND METHODS
Idiopathic scoliosis patients between 10 and 29 years of age who underwent correction and fusion surgeries at our hospital were included in this study. Forward roll was recorded on video preoperatively and 1-year postoperatively. Performances were evaluated twice on a 10-point scale by two blinded examiners. Preoperative and 1-year postoperative upright spinal radiographs were analyzed for the Lenke classification, number of fused vertebrae, upper and lower instrumented vertebrae, major curve Cobb angle, thoracic kyphosis, lumbar lordosis, and surgical procedures.
RESULTS
The average age was 16 years. Curve types according to the Lenke classification were: 15, type 1; 5, type 2; 14, type 5; 2, type 6. The mean number of fused vertebrae was 6.9 (3.2 for anterior surgeries and 9.3 for posterior surgeries). The mean preoperative assessment of forward roll was 9.6 points, and the 1-year postoperative assessment was lower at 8.8 points. Cluster analysis classified patients into 3 groups: long fusion with marked performance deterioration (C1), long fusion with minimal deterioration (C2), and short fusion with minimal deterioration (C3). The upper and lower instrumented vertebrae in C1 were more distal than those in C2.
CONCLUSION
Patients with thoracic curves were classified into two groups, and patients who underwent surgeries with more distal upper and lower instrumented vertebra levels exhibited lower postoperative performance. However, patients with Lenke 5 curves who underwent anterior surgery showed better preoperative performance than other patients who underwent posterior surgery, showing minimal postoperative deterioration.
LEVEL OF EVIDENCE
III;Therapeutic Study.
Topics: Adolescent; Humans; Lumbar Vertebrae; Retrospective Studies; Scoliosis; Spinal Fusion; Thoracic Vertebrae; Treatment Outcome
PubMed: 34364003
DOI: 10.1016/j.otsr.2021.103034 -
Medical Ultrasonography Sep 2010Thoracic paravertebral blockade is a simple and easy-to-learn technique with a low incidence of complications. It should be considered as a safe alternative to thoracic... (Review)
Review
Thoracic paravertebral blockade is a simple and easy-to-learn technique with a low incidence of complications. It should be considered as a safe alternative to thoracic epidural analgesia/anaesthesia. We reviewed the techniques of thoracic paravertebral blockade with special interest to ultrasound guidance.
Topics: Humans; Nerve Block; Thoracic Vertebrae; Thorax; Ultrasonography, Interventional
PubMed: 21203600
DOI: No ID Found -
Orthopaedic Surgery May 2012There is little consensus on treatment of thoracolumbar fractures, which are one of the most controversial areas in spine surgery. The great variations in clinical... (Review)
Review
There is little consensus on treatment of thoracolumbar fractures, which are one of the most controversial areas in spine surgery. The great variations in clinical decision making may come from differences in evaluation of spine stability with these fractures. Few high-quality studies concerning optimal treatment of thoracolumbar fractures have been conducted. This article reviews the conflicting results and recommendations for management of thoracolumbar fractures of currently published reports. Specifically, it addresses issues regarding evaluation of stability, indications for operative treatment, timing of surgery, surgical approach, and fusion length.
Topics: Humans; Lumbar Vertebrae; Orthopedic Procedures; Spinal Fractures; Thoracic Vertebrae; Time Factors; Treatment Outcome
PubMed: 22615149
DOI: 10.1111/j.1757-7861.2012.00174.x -
European Spine Journal : Official... Oct 2013To critically review and summarize the literature comparing the results of surgery via an anterior approach and that via a posterior approach for the treatment of... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To critically review and summarize the literature comparing the results of surgery via an anterior approach and that via a posterior approach for the treatment of thoracolumbar burst fractures to identify the better approach.
METHODS
In this meta-analysis, we conducted electronic searches of MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and other databases using the search terms "thoracolumbar fractures", "anterior", "posterior", "controlled clinical trials". Relevant journals or conference proceedings were also searched manually. Data extraction and quality assessment were in accordance with Cochrane Collaboration guidelines. The analysis was performed on individual patient data from all the trials that met the selection criteria. Sensitivity analysis was performed when there was significant heterogeneity. Results were expressed as risk difference for dichotomous outcomes and mean difference for continuous outcomes with 95 % confidence interval.
RESULTS
Four randomized clinical trials and three controlled clinical trials comparing the results of the anterior versus posterior approach in the treatment of thoracolumbar burst fractures were retrieved; these studies included 179 and 152 patients in the anterior and posterior approach groups, respectively. There were no differences in terms of neurological recovery, return to work, complications and Cobb angle between the two groups. The anterior approach was associated with longer operative time, greater blood loss and higher cost than the posterior approach.
CONCLUSIONS
The posterior approach may be more effective than the anterior approach. However, more high-quality, randomized controlled trials are required to compare these approaches and guide clinical decision-making. Level of Evidence Level II, therapeutic study. See the Guidelines for Authors for a complete description of level of evidence.
Topics: Fracture Fixation; Humans; Lumbar Vertebrae; Spinal Fractures; Thoracic Vertebrae
PubMed: 24013718
DOI: 10.1007/s00586-013-2987-y -
BMC Musculoskeletal Disorders Jul 2023To investigate the safety and accuracy of applying a new self-guided pedicle tap to assist pedicle screw placement.
PURPOSE
To investigate the safety and accuracy of applying a new self-guided pedicle tap to assist pedicle screw placement.
METHODS
A new self-guided pedicle tap was developed based on the anatomical and biomechanical characteristics of the pedicle. Eight adult spine specimens, four males and four females, were selected and tapped on the left and right sides of each pair of T1-L5 segments using conventional taps (control group) and new self-guided pedicle taps (experimental group), respectively, and pedicle screws were inserted. The screw placement time of the two groups were recorded and compared using a stopwatch. The safety and accuracy of screw placement were observed by CT scanning of the spine specimens and their imaging results were graded according to the Heary grading criteria.
RESULTS
Screw placement time of the experimental group were (5. 73 ± 1. 18) min in thoracic vertebrae and (5. 09 ± 1. 31) min in lumbar vertebrae respectively. Screw placement time of the control group were respectively (6. 02 ± 1. 54) min in thoracic vertebrae and (5.51 ± 1.42) min in lumbar vertebrae. The difference between the two groups was not statistically significant (P > 0. 05). The Heary grading of pedicle screws showed 112 (82.35%) Heary grade I screws and 126 (92.65%) Heary grade I + II screws in the experimental group, while 96 (70.59%) Heary grade I screws and 112 (82.35%) Heary grade I + II screws in the control group.The difference between the two groups was statistically significant (P < 0.05).
CONCLUSION
The new self-guided pedicle tap can safely and accurately place thoracic and lumbar pedicle screws with low-cost and convenient procedure,which indicates a good clinical application value.
Topics: Male; Adult; Female; Humans; Pedicle Screws; Surgery, Computer-Assisted; Feasibility Studies; Spinal Fusion; Lumbar Vertebrae; Thoracic Vertebrae; Retrospective Studies
PubMed: 37422653
DOI: 10.1186/s12891-023-06681-7 -
BMC Musculoskeletal Disorders Mar 2023This study represents the first finite element (FE) analysis of long-instrumented spinal fusion from the thoracic vertebrae to the pelvis in the context of adult spinal...
BACKGROUND
This study represents the first finite element (FE) analysis of long-instrumented spinal fusion from the thoracic vertebrae to the pelvis in the context of adult spinal deformity (ASD) with osteoporosis. We aimed to evaluate the von Mises stress in long spinal instrumentation for models that differ in terms of spinal balance, fusion length, and implant type.
METHODS
In this three-dimensional FE analysis, FE models were developed based on computed tomography images from a patient with osteoporosis. The von Mises stress was compared for three different sagittal vertical axes (SVAs) (0, 50, and 100 mm), two different fusion lengths (from the pelvis to the second [T2-S2AI] or 10th thoracic vertebra [T10-S2AI]), and two different types of implants (pedicle screw or transverse hook) in the upper instrumented vertebra (UIV). We created 12 models based on combinations of these conditions.
RESULTS
The overall von Mises stress was 3.1 times higher on the vertebrae and 3.9 times higher on implants for the 50-mm SVA models than that for the 0-mm SVA models. Similarly, the values were 5.0 times higher on the vertebrae and 6.9 times higher on implants for the 100-mm SVA models than that for the 0-mm SVA models. Higher SVA was associated with greater stress below the fourth lumbar vertebrae and implants. In the T2-S2AI models, the peaks of vertebral stress were observed at the UIV, at the apex of kyphosis, and below the lower lumbar spine. In the T10-S2AI models, the peaks of stress were observed at the UIV and below the lower lumbar region. The von Mises stress in the UIV was also higher for the screw models than for the hook models.
CONCLUSION
Higher SVA is associated with greater von Mises stress on the vertebrae and implants. The stress on the UIV is greater for the T10-S2AI models than for the T2-S2AI models. Using transverse hooks instead of screws at the UIV may reduce stress in patients with osteoporosis.
Topics: Adult; Humans; Finite Element Analysis; Spinal Fusion; Kyphosis; Lumbar Vertebrae; Thoracic Vertebrae; Pedicle Screws; Osteoporosis; Retrospective Studies
PubMed: 36890531
DOI: 10.1186/s12891-023-06290-4 -
Journal of Anatomy Mar 2021Birds and their ornithodiran ancestors are unique among vertebrates in exhibiting air-filled sinuses in their postcranial bones, a phenomenon called postcranial skeletal...
Birds and their ornithodiran ancestors are unique among vertebrates in exhibiting air-filled sinuses in their postcranial bones, a phenomenon called postcranial skeletal pneumaticity. The factors that account for serial and interspecific variation in postcranial skeletal pneumaticity are poorly understood, although body size, ecology, and bone biomechanics have all been implicated as influencing the extent to which pneumatizing epithelia invade the skeleton and induce bone resorption. Here, I use high-resolution computed-tomography to holistically quantify vertebral pneumaticity in members of the neognath family Ciconiidae (storks), with pneumaticity measured as the relative volume of internal air space. These data are used to describe serial variation in extent of pneumaticity and to assess whether and how pneumaticity varies with the size and shape of a vertebra. Pneumaticity increases dramatically from the middle of the neck onwards, contrary to previous predictions that cervical pneumaticity should decrease toward the thorax to maintain structural integrity as the mass and bending moments of the neck increase. Although the largest vertebrae sampled are also the most pneumatic, vertebral size cannot on its own account for serial or interspecific variation in extent of pneumaticity. Vertebral shape, as quantified by three-dimensional geometric morphometrics, is found to be significantly correlated with extent of pneumaticity, with elongate vertebrae being less pneumatic than craniocaudally short and dorsoventrally tall vertebrae. Considered together, the results of this study are consistent with the hypothesis that shape- and position-specific biomechanics influence the amount of bone loss that can be safely tolerated. These results have potentially important implications for the evolution of vertebral morphology in birds and their extinct relatives.
Topics: Animals; Birds; Cervical Vertebrae; Male; Thoracic Vertebrae; X-Ray Microtomography
PubMed: 32981054
DOI: 10.1111/joa.13322 -
The Journal of Spinal Cord Medicine Nov 2019Osseous epithelioid hemangioma is uncommon, and reports of epithelioid hemangiomas of the spine are especially rare. Case report. A 43-year-old male was referred to our... (Review)
Review
Osseous epithelioid hemangioma is uncommon, and reports of epithelioid hemangiomas of the spine are especially rare. Case report. A 43-year-old male was referred to our department with progressive gait disturbance. CT scans showed a lucent mass in the vertebral body at the T3 level. MRI of the thoracic spine showed a strongly enhanced mass compressing the spinal cord. The patient underwent laminectomy from T2 to T4, debulking of the tumor, and posterior fusion from T1 to T5. After the operation, the patient's neurological status improved significantly, and he was able walk without assistance. Histological examination determined that the tumor was an epithelioid hemangioma. The patient was treated with 40 Gy radiation for local control of the tumor. The patient could walk without difficulty 12 months after the surgery. This is a rare example of an epithelioid hemangioma that developed in the thoracic spine and compressed the spinal cord, and was treated successfully.
Topics: Adult; Hemangioendothelioma; Humans; Magnetic Resonance Imaging; Male; Spinal Cord Compression; Spinal Neoplasms; Thoracic Vertebrae
PubMed: 29065791
DOI: 10.1080/10790268.2017.1390032 -
Contrast Media & Molecular Imaging 2022To analyze the influence of minimally invasive arch root nailing internal fixation surgery on tissue traumatic stress response in patients with vertebral fractures and...
OBJECTIVE
To analyze the influence of minimally invasive arch root nailing internal fixation surgery on tissue traumatic stress response in patients with vertebral fractures and explore the advantages of this treatment.
METHODS
One hundred and thirty-six patients with vertebral fractures admitted to our hospital from January 2020 to January 2022 were selected and divided into two groups based on the treatment method: the control group was treated with open arch root nail internal fixation surgery and the study group was treated with minimally invasive arch root nail internal fixation. The lumbar spine function, ODI, VAS, JOA score, complications, inflammation, and stress response were compared between the two groups.
RESULTS
After the operation, the ratio of intervertebral space and anterior edge height increased, and the Cobb angle decreased in both groups; the surgical incision, hospital stay, and operation time in the study group were shorter than those in the control group, and the intraoperative drainage volume and intraoperative blood loss were smaller than those in the control group ( < 0.05); before surgery, there was no significant difference in ODI and VAS scores between the two groups ( > 0.05). After surgery, the ODI and VAS scores in the two groups were significantly decreased, and the JOA score was significantly increased; complications occurred in the control group and the study. The incidence of complications in the study group was lower than that in the control group ( < 0.05); after surgery, compared with the control group, the serum TNF-, CRP levels, and stress response indexes of the study group decreased more significantly ( < 0.05).
CONCLUSION
Minimally invasive pedicle screw fixation has high safety and obvious advantages. The patient's stress response index and pain level are low, and it will not cause obvious damage to the patient. The postoperative lumbar spine function is significantly improved, which is beneficial to the patient's postoperative recovery. It is easy to operate, will not damage the thoracic and lumbar vertebrae significantly, and the fluoroscopy time is relatively short, and it has a good recovery effect. Therefore, minimally invasive internal arch nailing surgery can be used as the preferred treatment for patients with vertebral fractures.
Topics: Fracture Fixation, Intramedullary; Humans; Retrospective Studies; Spinal Fractures; Thoracic Vertebrae; Treatment Outcome
PubMed: 36072621
DOI: 10.1155/2022/2375883