OBJECTIVE: To explore the influencing factors of the residual back pain in patient with osteoporotic vertebral compression fractures(OVCFs) in the early and late stages after percutaneous vertebral augmentation(PVA), and analyze the correlation between these factors and the residual back pain after PVA. METHODS: From March 2018 to December 2019, 312 patients with OVCFs who treated with PVA were collected. According to the inclusion and exclusion criteria, a total of 240 patients were included in this retrospective study. There were 59 males and 181 females, aged from 50 to 95 years old with an average of (76.11±10.72) years old, and 50 cases of fractures located in the thoracic region (T₅-T₁₀), 159 cases in the thoracolumbar region (T₁₁-L₂), and 31 cases in the lumbar region (L₃ and below). The first day after PVA was regarded as the early postoperative period, and the seventh day was regarded as the late postoperative period. According to the visual analogue scale (VAS), the patients were divided into 4 groups:early postoperative pain relief group(group A, VAS≤4 scores), there were 121 patients, including 29 males and 92 females, aged from 50 to 90 years with an average of (75.71±11.00) years;early postoperative pain relief was not an obvious group (group B, VAS >4 scores), there were 119 patients, including 30 males and 89 females, aged from 53 to 95 years with an average of (76.51±10.46) years; late postoperative pain relief group (group C, VAS≤ 4 scores), there were 172 patients, including 42 males and 130 females, aged from 50 to 95 years with an average of (76.20±10.68) years; late postoperative pain relief was not obvious group (group D, VAS>4 scores), there were 68 patients, including 17 males and 51 females, aged from 53 to 94 years old with an average of (75.88±10.91) years old. The age, gender, bone mineral density(BMD), injured vertebral segment, preoperative thoracolumbar fascial condition, surgical methods, single or bilateral puncture, the amount of bone cement injection, anterior vertebral height recovery rate and central vertebral height recovery rate in the 4 groups were analyzed by univariate analysis. The statistically significant factors were put into a Logistic regression to analyze the correlation between these factors and residual back pain after PVA. RESULTS: Univariate analysis showed that the residual back pain in the early stage after PVA was correlated with BMD, preoperative thoracolumbar fascial injury, single or bilateral puncture, the amount of bone cement injection, anterior vertebral height recovery rate and central vertebral height recovery rate(P<0.05). The residual back pain in the late postoperative period was related to BMD, injured vertebral segment, surgical methods, the amount of bone cement injection, anterior vertebral height recovery rate and central vertebral height recovery rate(P<0.05). Multivariate Logistic regression analysis showed that thoracolumbar fascial injury(OR=4.938, P=0.001), single or bilateral puncture(OR=5.073, P=0.002) were positively correlated with the residual back pain in the early stage after PVA(B>0), which were risk factors;the BMD (OR=0.211, P=0.000) and anterior vertebral height recovery rate (OR=0.866, P=0.001) were negatively correlated with the residual back pain in the early stage after PVA(B<0), which were protective factors. In the late stage after PVA, the BMD(OR=0.448, P=0.003), the amount of bone cement injection (OR=0.648, P=0.004) and anterior vertebral height recovery rate (OR=0.820, P=0.000) were negatively correlated with residual back pain(B<0), which were protective factors. CONCLUSION The decrease of BMD, injury of the thoracolumbar fascia, single or bilateral puncture, poor recovery of anterior vertebral height and insufficient injection of bone cement are closely related to the occurrence of residual back pain after PVA, which affect the relief of residual back pain in the early and late postoperative periods.
Aged ; Aged, 80 and over ; Back Pain ; Bone Cements ; Disease Progression ; Female ; Fractures, Compression/etiology* ; Humans ; Male ; Middle Aged ; Osteoporotic Fractures/surgery* ; Pain, Postoperative/etiology* ; Retrospective Studies ; Spinal Fractures/surgery* ; Treatment Outcome ; Vertebroplasty/methods*

OBJECTIVE: To analyze the efficacy of percutaneous vertebroplasty for osteoporotic vertebral compression fractures with spinal origin abdominal pain as the main symptom. METHODS: A retrospective analysis was performed on 37 patients with osteoporotic vertebral compression fractures treated from January 2015 to January 2021, all of whom had spin-derived abdominal pain as the main symptom, and were divided into surgery group(21 cases) and conservative group (16 cases) according to different treatment methods. Patients in the surgery group were treated with percutaneous vertebroplasty, including 7 males and 14 females, with an average age of (75.95±6.84) years old and an average course of disease of (5.26±3.79) days. The conservative group received non-surgical treatment, including 5 males and 11 females, with an average age of (75.50±8.07) years old and an average course of disease of (4.28±3.42) days. Two groups of patients with preoperative mainly characterized by abdominal pain, abdominal distension and constipation, have no obvious chest waist back pain symptoms, the thoracolumbar MRI diagnosed as fresh osteoporotic vertebral compression fractures, record its postoperative abdominal pain visual analogue scale (VAS), medical outcomes study short form-36 (SF-36) score, defecation interval after treatment, etc. RESULTS: Thirty-seven patients were followed up for (14.90±14.11) months in surgery group and( 21.42±17.53) months in conservative group. Compared with before treatment, the VAS of surgery group at each time period after treatment, VAS of conservative group at 1 month after treatment and SF-36 score between two groups at 3 months after treatment were all improved(P<0.05), while VAS of conservative group at 3 days after treatment showed no statistically significant difference(P>0.05). Compared between two groups, there were no significant differences in VAS and SF-36 scores at 1 day before treatment(P>0.05), but VAS at 3 days after treatment in surgery group, life vitality and social function score at 3 months after treatment, and defecation time after treatment in surgery group were better than those in conservative group(P<0.05). There were no significant differences in other indexes(P>0.05). The incision healing of patients in surgery group was good, and no serious complications occurred in both groups. CONCLUSION Percutaneous vertebroplasty is an effective method for the treatment of osteoporotic vertebral compression fractures with spinal origin abdominal pain as the main symptom. Compared with conservative treatment, percutaneous vertebroplasty has more advantages in early relief of abdominal pain and constipation, recovery of vitality and social function.
Abdominal Pain ; Aged ; Aged, 80 and over ; Constipation ; Female ; Fractures, Compression/surgery* ; Humans ; Male ; Osteoporotic Fractures/surgery* ; Retrospective Studies ; Spinal Fractures/surgery* ; Treatment Outcome ; Vertebroplasty/methods*

OBJECTIVE: To compared with the modified Robert Jones bandage of 3M elastic bandage, to evaluate the fitness, convenience, safety and comfort of the modular combination lower limb elastic compression device. METHODS: Forty healthy adult college students, including 28 males and 12 females, aged 16 to 25 (20.3±2.2) years old and weighing 40 to 81 (60.4±20.2) kg, were randomly divided into two groups with 40 samples in each group. According to the body surface parameters of Chinese lower limbs and guided by the concept of modularization, a group of modular combined lower limb elastic compression device was designed. Each module was combined to evaluate the fitness of the modular combined compression device in thelength and circumference of the lower limbs. The left and right lower limbs were randomly paired and divided into groups, with 40 samples in each group. The convenience of the operation time, adjustment times and required time were compared between two groups. The safety of the two groups after 24 hours of application of pressure injury was compared. The subjective pain feeling changes within 24 hours were recorded by visual analogue scale (VAS) to evaluate the comfort. RESULTS: The device was composed of several elastic compression outer lining modules with different length and width of 15 cm, an inner lining module for buffering, positioning and attaching the main body, and an elastic ankle compression module. The length of the elastic compression outer lining module covers the circumference of the human lower limbs. The length of a single outer lining module increased from 15 cm to 80 cm every 5 cm interval, and the length of a single inner lining module increased from 62 cm to 83 cm every 3 cm interval. After the modules were selected and combined, the length and circumference of the lower limbs can reach 100% fitness. The operation time of the first placement(118.23±7.33) s and re operation(60.08±5.88) s of experimental group were significantly shorter than those of control group (164.68±8.93) s and re operation (131.23±7.91) s. The adjustment times (3) and operation time (3.50±0.71) s of experimental group were significantly shorter than those of control group(11)and operation time(139.00±5.66) s ( CONCLUSION The modular combined elastic compression device has good fitness, better placement and flexible adjustment, convenience and safety, and better comfort than modified Robert Jones bandage of 3M elastic bandage.
Adolescent ; Adult ; Compression Bandages ; Female ; Humans ; Lower Extremity ; Male ; Pain Measurement ; Pressure ; Treatment Outcome ; Young Adult

Ossification of the mamillo-accessory ligament (MAL) is a misunderstood phenomenon; however, many have posited that it can result in nerve entrapment of the medial branch of the dorsal ramus causing zygapophyseal joint related low back pain. The MAL has been studied anatomically by few, yet the data indicate possible associations between ossification of this ligament and spondylosis. It has been proposed that mechanical stress upon the lumbar spine may also lead to progressive ossification of the MAL into a bony foramen.
Ligaments ; Low Back Pain ; Nerve Compression Syndromes ; Spine ; Spondylosis ; Stress, Mechanical ; Zygapophyseal Joint

OBJECTIVE: There is a lack of knowledge regarding whether decompression is necessary in treating patients with epidural spinal cord compression (ESCC) grade 2. The purpose of this study was to compare the outcomes of minimally invasive surgery (MIS) without decompression and conventional open surgery (palliative laminectomy) for patients with hepatocellular carcinoma (HCC) spinal metastasis of ESCC grade 2.METHODS: Patients with HCC spinal metastasis requiring surgery were retrospectively reviewed. Patients with ESCC grade 2, medically intractable mechanical back pain, a Nurick grade better than 3, 3–6 months of life expectancy, Tomita score ≥5, and Spinal Instability Neoplastic Score ≥7 were included. Patients with neurological deficits, other systemic illnesses and less than 1 month of life expectancy were excluded. Thirty patients were included in the study, including 17 in the open surgery group (until 2008) and 13 in the MIS group (since 2009).RESULTS: The MIS group had a significantly shorter operative time (94.2±48.2 minutes vs. 162.9±52.3 minutes, p=0.001), less blood loss (140.0±182.9 mL vs. 1534.4±1484.2 mL, p=0.002), and less post-operative intensive care unit transfer (one patient vs. eight patients, p=0.042) than the open surgery group. The visual analogue scale for back pain at 3 months post-operation was significantly improved in the MIS group than in the open surgery group (3.0±1.2 vs. 4.3±1.2, p=0.042). The MIS group had longer ambulation time (183±33 days vs. 166±36 days) and survival time (216±38 days vs. 204±43 days) than the open surgery group without significant difference (p=0.814 and 0.959, respectively).CONCLUSION: MIS without decompression would be a good choice for patients with HCC spinal metastasis of ESCC grade 2, especially those with limited prognosis, mechanical instability and no neurologic deficit.
Back Pain ; Carcinoma, Hepatocellular ; Decompression ; Decompression, Surgical ; Humans ; Intensive Care Units ; Life Expectancy ; Minimally Invasive Surgical Procedures ; Neoplasm Metastasis ; Neurologic Manifestations ; Operative Time ; Prognosis ; Retrospective Studies ; Spinal Cord Compression ; Spinal Cord ; Spine ; Walking

OBJECTIVE: To compare the lumbar vertebral bone marrow fat-signal fractions obtained from six-echo modified Dixon sequence (6-echo m-Dixon) with those from single-voxel magnetic resonance spectroscopy (MRS) in patients with low back pain. MATERIALS AND METHODS: Vertebral bone marrow fat-signal fractions were quantified by 6-echo m-Dixon (repetition time [TR] = 7.2 ms, echo time (TE) = 1.21 ms, echo spacing = 1.1 ms, total imaging time = 50 seconds) and single-voxel MRS measurements in 25 targets (23 normal bone marrows, two focal lesions) from 24 patients. The point-resolved spectroscopy sequence was used for localized single-voxel MRS (TR = 3000 ms, TE = 35 ms, total scan time = 1 minute 42 seconds). A 2 × 2 × 1.5 cm³ voxel was placed within the normal L2 or L3 vertebral body, or other lesions including a compression fracture or metastasis. The bone marrow fat spectrum was characterized on the basis of the magnitude of measurable fat peaks and a priori knowledge of the chemical structure of triglycerides. The imaging-based fat-signal fraction results were then compared to the MRS-based results. RESULTS: There was a strong correlation between m-Dixon and MRS-based fat-signal fractions (slope = 0.86, R² = 0.88, p < 0.001). In Bland-Altman analysis, 92.0% (23/25) of the data points were within the limits of agreement. Bland-Altman plots revealed a slight but systematic error in the m-Dixon based fat-signal fraction, which showed a prevailing overestimation of small fat-signal fractions (< 20%) and underestimation of high fat-signal fractions (> 20%). CONCLUSION: Given its excellent agreement with single-voxel-MRS, 6-echo m-Dixon can be used for visual and quantitative evaluation of vertebral bone marrow fat in daily practice.
Bone Marrow ; Evaluation Studies as Topic ; Fractures, Compression ; Humans ; Low Back Pain ; Magnetic Resonance Spectroscopy* ; Neoplasm Metastasis ; Spectrum Analysis ; Spine ; Triglycerides

A 77-year-old female with a history of osteoarthritis visited our clinic complaining of lower back pain, paresthesia in both legs, and voiding difficulty. Her pain and temperature sensations were diminished below the L1 dermatome, and proprioception was decreased in both feet. The findings of a routine laboratory workup, echocardiogram, and cerebrospinal fluid studies were normal. Spine magnetic resonance imaging revealed high T2-weighted signal intensities and diffusion restriction in the posterior conus medullaris. The patient was diagnosed and treated for posterior spinal artery infarction.
Aged ; Arteries ; Cerebrospinal Fluid ; Conus Snail ; Diffusion ; Female ; Foot ; Humans ; Infarction ; Leg ; Low Back Pain ; Magnetic Resonance Imaging ; Osteoarthritis ; Paresthesia ; Proprioception ; Sensation ; Spinal Cord Compression ; Spinal Cord Ischemia ; Spinal Cord Vascular Diseases ; Spinal Cord ; Spine

STUDY DESIGN: Retrospective study (level of evidence=3). PURPOSE: We examine the relationship between residual symptoms after discectomy for lumbar disc herniation and peripheral nerve (PN) neuropathy. OVERVIEW OF LITERATURE: Patients may report persistent or recurrent symptoms after lumbar disc herniation surgery; others fail to respond to a variety of treatments. Some PN neuropathies elicit symptoms similar to those of lumbar spine disease. METHODS: We retrospectively analyzed data for 13 patients treated for persistent (n=2) or recurrent (n=11) low back pain (LBP) and/or leg pain after primary lumbar discectomy. RESULTS: Lumbar re-operation was required for four patients (three with recurrent lumbar disc herniation and one with lumbar canal stenosis). Superior cluneal nerve (SCN) entrapment neuropathy (EN) was noted in 12 patients; SCN block improved the symptoms for eight of these patients. In total, nine patients underwent PN surgery (SCN-EN, n=4; peroneal nerve EN, n=3; tarsal tunnel syndrome, n=1). Their symptoms improved significantly. CONCLUSIONS: Concomitant PN disease should be considered for patients with failed back surgery syndrome manifesting as persistent or recurrent LBP.
Diskectomy ; Failed Back Surgery Syndrome ; Humans ; Leg ; Low Back Pain ; Lumbosacral Region ; Nerve Compression Syndromes ; Peripheral Nerves ; Peripheral Nervous System Diseases ; Peroneal Nerve ; Retrospective Studies ; Spine ; Tarsal Tunnel Syndrome

In patients with tumors and spinal cord lesions, inflammation and tissue infection can result in mass effect detection on imaging. As a result, surgical biopsy procedures are often performed on the lesions. We report a rare case in which the thickening ligamentum flavum (LF) appeared to be a tumor in the epidural space of the cervical spine based on imaging findings. A 52-year-old man visited our outpatient clinic with severe shoulder pain and radicular pain in his right arm that had developed gradually after a traffic accident two months earlier. Magnetic resonance imaging of the cervical spine revealed an extradural mass at the cervicothoracic junction level. Suspecting a tumor, spinal decompression surgery was performed and a biopsy of the mass was obtained. At the time of surgery, the LF was thick and compressed the spinal cord. After successful removal of the LF, the spinal cord appeared normal. Histopathological examination confirmed the mass as the LF. The patient was discharged without pain or weakness two weeks postoperatively. This case demonstrated that when the LF of the cervicothoracic junction is thickened, it may be misdiagnosed as a cervical spine tumor compressing the spinal cord.
Accidents, Traffic ; Ambulatory Care Facilities ; Arm ; Biopsy ; Cervical Vertebrae ; Decompression ; Epidural Space* ; Female ; Humans ; Inflammation ; Ligamentum Flavum* ; Magnetic Resonance Imaging ; Middle Aged ; Radiculopathy ; Shoulder Pain ; Spinal Cord ; Spinal Cord Compression ; Spine*

Spinal extradural arachnoid cyst (SEAC) is a rare cause of spinal cord compression. Bifocal location of thoracic and sacral SEACs is rarely reported in the literature. We report a case of thoracic spinal cord compression by SEAC associated with asymptomatic multiple sacral Tarlov cysts (TC). The surgical management and postoperative outcome of the patient are discussed. A 34-year-old woman was referred to the hospital for acute thoracic pain with a history of chronic long-standing back pain. She complained of walking difficulties. Neurological examination demonstrated incomplete spastic paraplegia with sensory level in T9. Magnetic resonance imaging revealed a large cystic formation from T7-11 and at the level of the sacrum. We performed laminectomies at the level of interest from T7-11. The cysts were dissected from the underlying dura after removal of the cerebrospinal fluid. We found nerve tissue in the cysts. We excised the cyst and preserved the nerve roots. Subsequently, a duraplasty was performed with autologous grafts from the lumbar fascia. The condition of the patient improved after surgery and he was recovering well at follow-up. Although the surgical treatment of TC is controversial, especially at the sacral lumbar level, decompression at the dorsal level in this case is indisputable.
Adult ; Arachnoid ; Back Muscles ; Back Pain ; Cerebrospinal Fluid ; Decompression ; Female ; Follow-Up Studies ; Humans ; Laminectomy ; Magnetic Resonance Imaging ; Nerve Tissue ; Neurologic Examination ; Paraplegia ; Sacrum ; Spinal Cord Compression* ; Spinal Cord* ; Tarlov Cysts* ; Transplants ; Walking