BACKGROUND: Dynamic radiographs are recommended to investigate non-healing evidence such as the dynamic mobility or intravertebral clefts in osteoporotic vertebral compression fractures (VCFs). However, it is difficult to examine standing flexion and extension lateral radiographs due to severe pain. The use of prone cross-table lateral radiographs (PrLRs) as a diagnostic tool has never been proposed to our knowledge. The purpose of this study is to clarify the usefulness of PrLRs in diagnosis and treatment of VCFs. METHODS: We reviewed 62 VCF patients examined with PrLRs between January 1, 2008 and June 30, 2011. To compare the degree of pain provoked between standing extension lateral radiographs (StLRs) and PrLRs, numeric rating scale (NRS) scores were assessed and compared by a paired t-test. Vertebroplasty was done for 40 patients and kyphoplasty was done for 9 patients with routine manners. To assess the degree of postural reduction, vertebral wedge angles (VWA) and vertebral height ratios (VHR) were calculated by using preoperative StLRs, PrLRs, and postoperative lateral radiographs. Two variables derived from changes in VWA and VHR between preoperative and postoperative radiographs were compared by a paired t-test. RESULTS: The average NRS scores were 6.23 +/- 1.67 in StLRs and 5.18 +/- 1.47 in PrLRs. The degree of pain provocation was lower in using PrLRs than StLRs (p < 0.001). The average changes of VWA between preoperative and postoperative status were 5.24degrees +/- 6.16degrees with PrLRs and 3.46degrees +/- 3.47degrees with StLRs. The average changes of VHR were 0.248 +/- 0.178 with PrLRs and 0.148 +/- 0.161 with StLRs. The comparisons by two variables showed significant differences for both parameters (p = 0.021 and p < 0.001, respectively). The postoperative radiological status was reflected more precisely when using PrLRs than StLRs. CONCLUSIONS: In comparison with StLR, the PrLR was more accurate in predicting the degree of restoration of postoperative vertebral heights and wedge angles, and provoked less pain during examination. The PrLR could be a useful diagnostic tool to detect intravertebral cleft or intravertebral dynamic instability.
Aged ; Aged, 80 and over ; Female ; Fractures, Compression/*radiography/surgery ; Humans ; Male ; Osteoporosis/pathology/radiography ; Posture/physiology ; Radiography/*methods ; Retrospective Studies ; Spinal Fractures/*radiography/surgery ; Spine/pathology/*radiography/surgery ; Vertebroplasty

OBJECTIVE: To compare the sagittal morphological features of the spine and pelvis between L₅S₁ dysplastic spondylolisthesis and isthmus spondylolisthesis in adolescent. METHODS: Retrospective analysis of 24 cases of adolescent L₅S₁ spondylolisthesis with complete imaging data from May 2002 to December 2016. Those included 8 males and 16 females, aged from 10 to 18 years old with an average of (13.4±2.0) years. Among them, 9 cases were diagnosed as dysplastic spondylolisthesis (dysplasia group) and 15 cases isthmic spondylolisthesis (ischemic group). Radiographic parameters including slippage distance, slippage degree, slippage angle, sagittal vertical axis(SVA), thoracic kyphosis(TK), lumbar lordosis(LL), L₅ incidence(L₅I), pelvic incidence(PI), pelvic tilt(PT), sacral slope(SS), sagittal pelvic thickness(SPT), lumbosacral angle (LSA), sacral table angle (STA) were measured on the spinal lateral X-ray of the standing position. Independent-samples t-test was used in the comparison of each variable between two groups. <0.05 was considered statistically significant. RESULTS: There were no significant differences in slippage distance, slippage rate, slippage angle between two groups. In dysplasia group, SVA, L₅I, PT, SPT were (37.0±48.4) mm, (57.0±14.8)°, (42.3±15.4)°, (56.1±21.2) mm, respectively, and (-11.0±22.2) mm, (31.7±19.3) °, ( 15.5±10.2)°, (31.4±19.1) mm in ischemic group; and the differences between the two groups were significant(<0.05). In ischemic group, SS, LSA, STA were (44.1±12.6)°, (103.9±21.7)°, (92.7±9.9)°, respectively, and (25.9±20.2) °, (75.4±16.4) °, (75.4±9.7) ° in dysplasia group; and the differences between the two groups were significant(<0.05). There was no significant difference in TK, LL between two groups(>0.05). CONCLUSIONS Significant different from isthmic spondylolisthesis, adolescents with dysplastic spondylolisthesis present a different spino-pelvic sagittal alignment, characterized with trunk forward leaning and pelvic retroversion. In case of sagittal imbalance, early surgical intervention is required to restore a balanced spino-pelvic alignment.
Adolescent ; Child ; Female ; Humans ; Lumbar Vertebrae ; Male ; Pelvis ; Postural Balance ; Radiography ; Retrospective Studies ; Spine ; Spondylolisthesis ; surgery

OBJECTIVETo explore the method of implanting upper-middle thoracic pedicle screws under monitoring by X-ray and evaluate accuracy and safety.

METHODS(1) Six normal adult thoracic spine samples (T1-T8) were selected, from which single spine units were separated. A surgical probe went in along the pedicle axis. By C-shaped arm X-ray, the four probe positions were recorded: at the entering point, the front end of the probe in the middle of the pedicle, at the pack of the spine, and under the cortex of the front of the spine. The position of the front end of the probe at the entering point, and the front end of the probe at different depth at central-side perspective position were analyzed. The related positions and their corresponding changing rules were also analyzed. (2) Based on the changing rules mentioned above, different steps were adopted under the guidance of the C-shaped arm X-ray, to safely implant upper-middle thoracic pedicle screws. First, six T1-T8 spine samples were used, and under the guidance of the C-shaped arm device, 96 pedicle screws were implanted. After the operation,the sping samples were scanned through CT, and the positions of the screws were determined.

RESULTSAccording to the result of the CT scanning, the result were excellent (the screw was safely inside the pedicle) in 90 screws; Medium (the screw penetrated a little of the inside or outside bone cortex, within 2 mm) in 6; No one was had (the screw penetrated a lot, more than 2 mm).

CONCLUSIONThe implantation of upper-middle thoracic pedicle screw under the guidance of the C-shaped arm X-ray perspective is a simple and feasible method, and improve the accuracy and safety.

Adult ; Bone Screws ; Humans ; Radiography, Thoracic ; Safety ; Spine ; surgery ; Thoracic Surgery ; methods ; Thorax ; Tomography, X-Ray Computed

PURPOSE: Anterior cervical discectomy and fusion (ACDF) has become a common spine procedure, however, there have been no previous studies on whole spine alignment changes after cervical fusion. Our purpose in this study was to determine whole spine sagittal alignment and pelvic alignment changes after ACDF. MATERIALS AND METHODS: Forty-eight patients who had undergone ACDF from January 2011 to December 2012 were enrolled in this study. Cervical lordosis, thoracic kyphosis, lumbar lordosis, sagittal vertical axis (SVA), and pelvic parameters were measured preoperatively and at 1, 3, 6, and 12 months postoperatively. Clinical outcomes were assessed using Visual Analog Scale (VAS) scores and Neck Disability Index (NDI) values. RESULTS: Forty-eight patients were grouped according to operative method (cage only, cage & plate), operative level (upper level: C3/4 & C4/5; lower level: C5/6 & C6/7), and cervical lordosis (high lordosis, low lordosis). All patients experienced significant improvements in VAS scores and NDI values after surgery. Among the radiologic parameters, pelvic tilt increased and sacral slope decreased at 12 months postoperatively. Only the high cervical lordosis group showed significantly-decreased cervical lordosis and a shortened SVA postoperatively. Correlation tests revealed that cervical lordosis was significantly correlated with SVA and that SVA was significantly correlated with pelvic tilt and sacral slope. CONCLUSION: ACDF affects whole spine sagittal alignment, especially in patients with high cervical lordosis. In these patients, alteration of cervical lordosis to a normal angle shortened the SVA and resulted in reciprocal changes in pelvic tilt and sacral slope.
Adult ; Aged ; Cervical Vertebrae/physiopathology/radiography/*surgery ; Cross-Sectional Studies ; *Diskectomy ; Female ; Humans ; Lordosis/etiology/*surgery ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neck/surgery ; Retrospective Studies ; Spinal Diseases/complications/physiopathology/radiography/*surgery ; Spinal Fusion/*methods ; Spine ; Treatment Outcome ; Young Adult

OBJECTIVE: We report magnetic resonance imaging (MRI) findings on focal anterior displacement of the thoracic spinal cord in asymptomatic patients without a spinal cord herniation or intradural mass. MATERIALS AND METHODS: We identified 12 patients (male:female = 6:6; mean age, 51.7; range, 15-83 years) between 2007 and 2011, with focal anterior displacement of the spinal cord and without evidence of an intradural mass or spinal cord herniation. Two radiologists retrospectively reviewed the MRI findings in consensus. RESULTS: An asymmetric spinal cord deformity with a focal dented appearance was seen on the posterior surface of the spinal cord in all patients, and it involved a length of 1 or 2 vertebral segments in the upper thoracic spine (thoracic vertebrae 1-6). Moreover, a focal widening of the posterior subarachnoid space was also observed in all cases. None of the patients had myelopathy symptoms, and they showed no focal T2-hyperintensity in the spinal cord with the exception of one patient. In addition, cerebrospinal fluid (CSF) flow artifacts were seen in the posterior subarachnoid space of the affected spinal cord level. Computed tomography myelography revealed preserved CSF flow in the two available patients. CONCLUSION: Focal anterior spinal cord indentation can be found in the upper thoracic level of asymptomatic patients without a spinal cord herniation or intradural mass.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cerebrospinal Fluid/physiology ; Female ; Hernia/pathology ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Retrospective Studies ; Spinal Cord Diseases/pathology/*radiography/surgery ; Spine/pathology/radiography ; Thoracic Vertebrae/pathology/*radiography ; Tomography, X-Ray Computed ; Young Adult

OBJECTIVETo explore the clinical outcomes of percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in treating osteoporotic vertebral compression fracture (OVCF).

METHODSFrom January 2007 to February 2010, the data of 40 patients with osteoporotic vertebral compression fracture underwent treatment were retrospectively analyzed. Of them,20 patients were treated with PVP (PVP group), there were 8 males and 12 females with an average age of (66.37 +/- 2.34) years old (54 to 81); 20 patients were treated with PKP (PKP group), there were 11 males and 9 females with an average of (65.12 +/- 3.21) years old (56 to 79). Postoperative at 1 week, 12 weeks, 1 year, pain and daily life function were respectively assessed by visual analogue scale (VAS) and Barthel index (BI); and anterior height of responsibility vertebra, Cobb angle were measured by X-rays.

RESULTSIn PVP group, 1 case complicated with bone cement leakage without clinical symptoms and no operation to treat. No postoperative infection and deep vein thrombosis were found between two groups. All patients were followed up more than 1 year, pain and daily life function has obviously improved than preoperative (P < 0.01); and there was no significant difference on 1 week, 12 weeks, 1 year after operation (P > 0.05); there was no significant difference between two groups (P > 0.05). In PVP group, there was no significant difference in anterior height of responsibility vertebra, Cobb angle before and after operation;and in PKP group, postoperative data has obviously improved than preoperative (P < 0.01), but there was no significant difference postoperative at 1 week, 12 weeks, 1 year (P > 0.05); there was no significant difference between two groups at 1 week, 12 weeks, 1 year after operation.

CONCLUSIONBoth the methods can obviously relieve pain and completely or partly recover daily life function in treating OVCF. But PKP has advantages of recovery of anterior height of responsibility vertebra and correction of Cobb angle, especially for serious compression.

Aged ; Aged, 80 and over ; Female ; Fractures, Compression ; diagnostic imaging ; physiopathology ; surgery ; Humans ; Kyphoplasty ; Male ; Middle Aged ; Osteoporotic Fractures ; diagnostic imaging ; physiopathology ; surgery ; Radiography ; Recovery of Function ; Retrospective Studies ; Spinal Fractures ; diagnostic imaging ; physiopathology ; surgery ; Spine ; surgery ; Treatment Outcome

OBJECTIVETo identify radiographic predictors of residual low back pain (LBP) after laminectomy for lumbar canal stenosis (LCS).

METHODSClinical results and radiographic findings in 69 patients who underwent single level laminectomy for LCS were retrospectively reviewed. Patients who had an improvement in LBP scores evaluated by Japanese Orthopaedic Association (JOA) scoring system during the follow-up periods were classified as the recovery group, and others were classified as the non-recovery group. Patients'clinical data and radiographic parameters like lordosis angle, range of motion and intervertebral rotational angle were analyzed using binary logistic regression analysis to detect factors significantly related with the occurrence of residual LBP.

RESULTSThe average preoperative JOA score of 14.8+/-5.05 improved to 21.59+/-5.51 at the final follow-up. Binary logistic regression analysis revealed that significant predictors of residual LBP were preoperative lumbar lordosis angle and range of motion.

CONCLUSIONSOur results suggest that patients with flat back and limited lumbar mobility before surgery tend to have poor results in terms of LBP. Therefore, these sagittal radiographic parameters should be taken into account when choosing laminectomy as the surgical option for LCS.

Aged ; Female ; Humans ; Laminectomy ; Low Back Pain ; diagnostic imaging ; Lumbosacral Region ; Male ; Prognosis ; Radiography ; Retrospective Studies ; Spinal Stenosis ; surgery ; Spine ; diagnostic imaging ; Treatment Outcome

Adult ; Bone Cysts, Aneurysmal ; diagnostic imaging ; pathology ; surgery ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Giant Cell Tumor of Bone ; pathology ; Humans ; Osteosarcoma ; pathology ; Radiography ; Spinal Diseases ; diagnostic imaging ; pathology ; surgery ; Spinal Neoplasms ; pathology ; Spine ; diagnostic imaging ; pathology ; surgery

OBJECTIVETo evaluate the effect of vertebral height restoration of vertebroplasty for osteoporotic vertebra compression fractures (VCFs).

METHODSFrom October 2004 to June 2007, a total of 37 patients with 40 VCFs were treated by vertebroplasty. There were 12 males and 25 females with a mean age of (72.4 +/- 12.7) years (ranged, 48 to 87). Pain easement state was evaluated by visual analog scale (VAS) before and after operation, as well as in followed-up. Preoperative and postoperative vertebral height, kyphosis angle at fractured levels were measured on X-rays.

RESULTSAll of patients were followed-up for 12 to 47 months (averaged, 35.8 +/- 9.6). The VAS score was 8.4 +/- 1.6 before operative, 2.1 +/- 1.2 at the 2nd day after operative, there were significant difference between pre-and postoperative (P < 0.05); the average follow-up VAS was 1.6 +/- 0.9, there were significant difference as compared with the preoperative (P < 0.05). Lateral X-ray showed that the preoperative degree of vertebral height in the of anterior and middle vertebral were (72.0 +/- 10.6)% and (68.0 +/- 15.6)%, and postoperative were (76.0 +/- 8.6)% and (73.0 +/-6.1)%, respectively. There were no significant difference in vertebral height between preoperative and postoperative. The vertebral kyphosis angle was corrected from preoperative (7.8 +/- 2.7) degree to postoperative (8.1 +/- 2.3) degree.

CONCLUSIONVertebroplasty is a safe and effective method for treatment of osteoporotic VCFs, it can relieve the pain effectively. Failure to restore vertebaral height does not seem to interfere with the excellent pain management.

Aged ; Aged, 80 and over ; Female ; Fractures, Compression ; complications ; diagnostic imaging ; surgery ; Humans ; Male ; Middle Aged ; Osteoporosis ; complications ; Radiography ; Spinal Fractures ; complications ; diagnostic imaging ; surgery ; Spine ; diagnostic imaging ; pathology ; surgery ; Treatment Outcome ; Vertebroplasty ; methods

OBJECTIVETo analyze the influence of segmental pedicle screws versus hybrid instrumentation on the correction results in adolescent idiopathic scoliosis patients undergoing posterior selective thoracic fusion,

METHODSBy reviewing the medical records and roentgenograms of adolescent idiopathic scoliosis patients who underwent selective thoracic fusion from February 2000 to January 2007 in our hospital, the patients were divided into 2 groups according to different instrumentation fashions: Group A was hook-screw-rod (hybrid) internal fixation type, Group B was screw-rod (all pedicle screws) internal fixation type, and the screws were used in every segment on the concave side of the thoracic curve. The parameters of the scoliosis were measured and the correction results were analyzed,

RESULTSTotally, 48 patients (7 males, 41 females) were included, with an average age of 14.4 years old and a mean follow-up time of 12.3 months. Thirty and 18 patients were assigned to group A and group B, respectively. The mean preoperative coronal Cobb angles of the thoracic curve were 48.8 degrees and 47.4 degrees, respectively. After surgery, they were corrected to 13.7 degrees and 6.8 degrees, respectively. At final follow-up, they were 17.0 degrees and 9.5 degrees, with an average correction rate of 64.6% and 79.0%, respectively, and the correction rate of group B was significantly higher than that of group A (P = 0.003). The mean preoperative coronal Cobb angles of the lumbar curve were 32.6 degrees and 35.2 degrees, respectively. After surgery, they were corrected to 8.6 degrees and 8.3 degrees, respectively. At final follow-up, they were 10.3 degrees and 11.1 degrees, with an average correction rate of 66.8% and 69.9%, respectively, and the correction rate of group B was significantly higher than that of group A (P = 0.003). The correction loss of the thoracic curve and lumbar curve in the 2 groups were 3.1 degrees and 1.8 degrees, 2.4 degrees and 2.4 degrees, respectively. No significant difference was noted (both P > 0.05). The decompensation rate at final follow-up in these 2 groups were 4% (1/25) and 7.1% (1/14) respectively, with no significant difference (P > 0.05).

CONCLUSIONSBoth all pedicle screws and hybrid instrumentation can offer good correction results of the thoracic curve and lumbar curve in posterior selective thoracic fusion in patients with adolescent idiopathic scoliosis. While with all pedicle screws, the correction results of the thoracic curve and lumbar curve are both better than those with hybrid instrumentation without increased decompensation rate.

Adolescent ; Bone Screws ; Child ; Female ; Humans ; Lumbosacral Region ; diagnostic imaging ; pathology ; Male ; Postural Balance ; Radiography ; Retrospective Studies ; Scoliosis ; diagnostic imaging ; pathology ; surgery ; Spinal Fusion ; instrumentation ; methods ; Spine ; diagnostic imaging ; pathology ; surgery ; Thoracic Vertebrae ; diagnostic imaging ; surgery