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Turkish Journal of Medical Sciences Apr 2021Vertebral compression fracture is a hallmark of osteoporosis (OP) and by far the most prevalent fragility fracture. It is well proven that patients who develop a... (Review)
Review
Vertebral compression fracture is a hallmark of osteoporosis (OP) and by far the most prevalent fragility fracture. It is well proven that patients who develop a vertebral compression fracture are at substantial risk for additional fractures. Diagnosis is based on adequate clinical evaluation, imaging, and laboratory tests. The imaging of OP and fragility fractures includes conventional radiology to evaluate spinal fractures, bone mineral density (BMD) testing by dual energy x-ray densitometry, quantitative computerized tomography, magnetic resonance imaging, bone scintigraphy (if necessary), and ultrasound. Screening and treatment of individuals with high risk of osteoporotic fracture are cost-effective, but approximately two-thirds of the vertebral compression fractures (VCF) that occur each year are not accurately diagnosed and, therefore, not treated. Evaluation of VCFs, even though they may be asymptomatic, seems essential to health-related and/or clinical research on OP.
Topics: Bone Density; Female; Fractures, Compression; Humans; Lumbar Vertebrae; Male; Mass Screening; Osteoporosis; Osteoporotic Fractures; Spinal Fractures; Spine; Thoracic Vertebrae
PubMed: 32967415
DOI: 10.3906/sag-2005-315 -
Anatomical Record (Hoboken, N.J. : 2007) Sep 2022The notarium is a rigid bony structure, which resulted from the fusion of thoracic vertebrae of some pterosaurs and birds. It is high variable, ranging from two to six... (Review)
Review
The notarium is a rigid bony structure, which resulted from the fusion of thoracic vertebrae of some pterosaurs and birds. It is high variable, ranging from two to six fused thoracic vertebrae. In this study, we reviewed and analyzed approximately 270 specimens of neornithine birds (representing 80% of the living orders) and some fossils in order to identify the number of fused vertebrae, degree and sites of vertebral fusion, occurrence of sutures, and other structures of potential phylogenetic and functional significance. These data were analyzed using a recent time-calibrated molecular phylogenetic tree and principal component analyses analysis evaluating the relationship with long bones in order to reconstruct macroevolutionary trends related to the evolution of the notarium. The occurrence of this structure shows a mosaic distribution over neornithine phylogeny, originating several times independently, especially during the Paleogene, in predominantly ground-dwelling forms. The notarium of these groups is characterized by: neural spines fused into single structure, intervertebral openings small to absent, large ventral keels forming ventral plates, and fused transverse processes. Derived neornithines, such as aquatic forms and long-legged birds, have a tendency to display a decreased degree of fusion between the vertebrae, which may indicate a reduction or disappearance of the notarium.
Topics: Animals; Biological Evolution; Birds; Fossils; Phylogeny; Thoracic Vertebrae
PubMed: 34910372
DOI: 10.1002/ar.24852 -
The Journal of the American Osteopathic... Jul 2020
Topics: Humans; Thoracic Vertebrae
PubMed: 32598464
DOI: 10.7556/jaoa.2020.078 -
Korean Journal of Anesthesiology Oct 2020Paravertebral block, especially thoracic paravertebral block, is an effective regional anesthetic technique that can provide significant analgesia for numerous surgical... (Review)
Review
Paravertebral block, especially thoracic paravertebral block, is an effective regional anesthetic technique that can provide significant analgesia for numerous surgical procedures, including breast surgery, pulmonary surgery, and herniorrhaphy. The technique, although straightforward, is not devoid of potential adverse effects. Proper anatomic knowledge and adequate technique may help decrease the risk of these effects. In this brief discourse, we discuss the anatomy and technical aspects of paravertebral blocks and emphasize the importance of appropriate needle manipulation in order to minimize the risk of complications. We propose that, when using a landmark-based approach, limiting medial and lateral needle orientation and implementing caudal (rather than cephalad) needle redirection may provide an extra margin of safety when performing this technique. Likewise, recognizing a target that is not in close proximity to the neurovascular bundle when using ultrasound guidance may be beneficial.
Topics: Anesthetics, Local; Humans; Nerve Block; Pneumothorax; Punctures; Thoracic Vertebrae
PubMed: 32172551
DOI: 10.4097/kja.20065 -
International Orthopaedics Dec 2023The purpose of this study is to present a classification of thoracic spine fractures based on anatomical and biomechanical characteristics. (Review)
Review
PURPOSE
The purpose of this study is to present a classification of thoracic spine fractures based on anatomical and biomechanical characteristics.
METHODS
This is a narrative review of the literature.
RESULTS
The classification is based on the relationship between movement and common forces acting on the spine. A mechanistic concept is incorporated into the classification, which considers both movements and the application of forces, leading to pathomorphological characteristics. A hierarchical ranking determines the severity of fractures within the thoracic spine, and treatment recommendations are presented in each category. The fourth column of the spine is incorporated into the classification through direct and indirect mechanisms.
CONCLUSIONS
The proposed classification accommodates several advantages, such as simplicity and practicality, that make this classification helpful in daily practice. The dynamic relationship between movement and force provides a better understanding of the fracture mechanism. Finally, incorporating the fourth column will strengthen the indication for surgical management. To the best of our knowledge, this classification is the first classification developed uniquely for the thoracic spine fractures and will help to address a critical gap in the literature.
Topics: Humans; Spinal Fractures; Sternum; Thoracic Vertebrae; Fractures, Bone; Thoracic Injuries
PubMed: 36943457
DOI: 10.1007/s00264-023-05778-x -
Spine Oct 2023A retrospective cohort study of consecutive patients.
STUDY DESIGN
A retrospective cohort study of consecutive patients.
OBJECTIVE
To investigate the clinical value of thoracic tilt (TT) in characterizing thoracic compensation and predicting proximal junctional kyphosis (PJK) in degenerative lumbar scoliosis (DLS).
SUMMARY OF BACKGROUND DATA
Thoracic compensation has been shown to be associated with the development of PJK, while thoracic shape and morphology in patients with DLS remain understudied.
METHODS
Patients with DLS who underwent long-segment fusion were divided into a PJK group and a non-PJK group. Asymptomatic elderly volunteers were recruited as healthy controls. Thoracic parameters were measured in both cohorts, including the TT, T1-L1 pelvic angle (TLPA), T12 slope, thoracic kyphosis (TK, T4-T12), global thoracic kyphosis (GTK, T1-T12), and thoracolumbar kyphosis (TLK, T10-L2). Multivariate logistic regression was used to assess the association between TT and the development of PJK, adjusting for confounders. Multivariate linear regression was used to establish the predictive formula for TT.
RESULTS
A total of 126 patients with DLS were enrolled, of which 37 (29.4%) developed PJK. Compared with 110 healthy controls, DLS patients had significantly greater TT, TLPA, T12 slope, and TLK as well as smaller TK and GTK (all P <0.001). Preoperatively, the PJK group showed significantly greater TT ( P =0.013), TLPA ( P <0.001), and TLK ( P =0.034) than the non-PJK group. No significant differences were found in TK and GTK before surgery. Postoperatively, the PJK group showed significantly greater TT ( P <0.001), TLPA ( P <0.001), TLK ( P <0.001), and proximal junctional angle ( P <0.001). Multivariate logistic regression analysis showed that greater postoperative TT was associated with the development of PJK. Multivariate linear regression analysis suggested that the regression formula was postoperative TT=0.675×T12slope+0.412×TK+0.158×TLK-4.808 ( R2 =0.643, P <0.001).
CONCLUSIONS
The novel sagittal parameter TT can be used for the evaluation of thoracic compensation. Greater preoperative TT might represent a decompensated state of TK. Rebalancing the TT in a sagittal neutral position might help to prevent PJK in patients with DLS.
Topics: Humans; Aged; Scoliosis; Retrospective Studies; Spinal Fusion; Lumbar Vertebrae; Thoracic Vertebrae; Kyphosis; Risk Factors; Postoperative Complications
PubMed: 37530101
DOI: 10.1097/BRS.0000000000004788 -
Veterinary Medicine and Science Sep 2022Computed tomography currently has a prominent role in diagnosis and evaluation of vertebral column. On the other hand, a thorough knowledge about vertebral column...
BACKGROUND
Computed tomography currently has a prominent role in diagnosis and evaluation of vertebral column. On the other hand, a thorough knowledge about vertebral column property in normal state is prerequisite an accurate diagnosis of different abnormalities in this region.
OBJECTIVE
The purpose of this study was to present a complete and exact descriptive and morphometric evaluation of thoracic vertebrae in rabbits with computed tomography. In images which were constructed by CT, several structures and different parts of the thoracic vertebrae have been named.
METHODS
Ten healthy, mature, White New Zealand rabbits were evaluated. The morphologic and morphometric parameters of the thoracic vertebrae were studied. In this study, several parameters of thoracic vertebrae, such as vertebral body height, spinous process height, transverse process length, transverse process width, etc., were measured by computed tomography.
RESULTS
Some parameters, such as spinal canal height, spinal canal width, pedicle length, pedicle width, end plate width, and endplate height, had no significant difference through thoracic vertebrae but other parameters, such as vertebral body height, transverse process length, transverse process width, spinous process angle, transverse process angle, and vertebral body length, had a significant difference.
CONCLUSIONS
In this study, a comprehensive anatomic atlas of CT anatomy of the thoracic vertebrae was produced for use by veterinary radiologists, clinicians, and surgeons. Finally, we must mention these two important points: (1) Many of the differences observed between rabbits and humans are based on the way the trunks of these two creatures are located on the ground and the differences in the way their bodies move. (2) In studies that are done by modelling humans on animals, it should be noted that the terms used in animal anatomy are different and the names are used using the principles of veterinary anatomy.
Topics: Animals; Humans; Rabbits; Thoracic Vertebrae; Tomography, X-Ray Computed
PubMed: 35763843
DOI: 10.1002/vms3.847 -
Archives of Orthopaedic and Trauma... Jul 2022The aim of this study was to give a systematic overview over the rate and location of concomitant injuries, the probability of suffering from neurological deficits, and... (Review)
Review
PURPOSE
The aim of this study was to give a systematic overview over the rate and location of concomitant injuries, the probability of suffering from neurological deficits, and to give evidence of the timing of surgery in severely injured patients with unstable thoracic 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 up to November 2020 dealing with unstable fractures of the mid-thoracic spine.
RESULTS
Altogether, 1109 articles were retrieved from the literature search. A total of 1095 articles were excluded. Thus, 16 remaining original articles were included in this systematic review depicting the topics timing of surgery in polytraumatized patients, outcome neurologic deficits, and impact of concomitant injuries. The overall level of evidence of the vast majority of studies is low.
CONCLUSION
The evidence of the available literature is low. The cited studies reveal that thoracic spinal fractures are associated with a high number of neurological deficits and concomitant injuries, particularly of the thoracic cage and the lung. Thereby, diagnostic algorithm should include computer tomography of the whole thoracic cage if there is any clinical sign of concomitant injuries. Patients with incomplete neurologic deficits benefit from early surgery consisting of decompression and long-segmental stabilization.
Topics: Humans; Lumbar Vertebrae; Spinal Fractures; Thoracic Injuries; Thoracic Vertebrae; Vertebral Body
PubMed: 33649914
DOI: 10.1007/s00402-021-03830-2 -
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