OBJECTIVETo compare the long-term influence of vertebral fixation through or across the affected vertebra on vertebral morphology.

METHODSClinical data of 48 patients with simple thoracic and lumbar spinal fractures who were admitted between Jan. 2008 and Dec. 2010 were analyzed retrospectively. Among them 36 cases (28 males and 8 females) were fixed through the injured vertebra (group A) and 12 cases (8 males and 4 females) were fixed across the injured vertebra (group B). All patients were followed up for 6-36 months (mean 11.5 months). The vertebral body height, endplate angle and neurofunction were compared between the two groups before surgery, a week after surgery and at the end of the follow-up period.

RESULTSThere was no statistically significant difference in vertebral body height,endplate angle and neurofunction before operation between group A and B (P > 0.05). Vertebral body height and endplate angle improved in both groups a week after operation and at the end of the follow-up period as compared with those before operation (P < 0.05), and the efficacy in group B was significantly better than that in group A (P < 0.05). There was no significant difference in neurofunction between the two groups (P > 0.05).

CONCLUSIONThe fixation method through the injured vertebra had a better reduction effect, more stable fixation, and a better long-term effect on vertebral morphology than that across the injured vertebra in the treatment of thoracolumbar vertebral fractures.

Adult ; Female ; Humans ; Lumbar Vertebrae ; injuries ; pathology ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Spinal Fractures ; surgery ; Thoracic Vertebrae ; injuries ; pathology ; surgery

OBJECTIVESTo evaluate and analyze the role of posterior ligament complex (PLC) in determining therapeutic principle for traumatic thoracic-lumbar fracture.

METHODSFrom August 2005 to May 2008, 60 patients (38 male, 22 female) who suffered from the traumatic thoracic-lumbar fracture were carried out posterior operations. According to the Magerl traumatic thoracic-lumbar fracture classification system, these cases were classified to subtype A, B and C. The average age was 34 years (21 - 65 years). Magnetic resonance imaging (MRI) scan, which including both T1/T2 weight and fat-stir sequence, as well as the MRI negative film reading technique were used to evaluate the state of PLC. Furthermore, related physical or neurological examinations (such as severe skin bruising and sinking, broadening spinous process gap and tenderness, spinal cord or nerve root injury) and another X-ray or CT reconstruction films were taken to evaluate the the state of PLC synthetically. Above-mentioned results were compared with the final exploration results during operation and some parameters were analyzed.

RESULTSThe sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), misdiagnosis rate and rate of missed diagnosis of these sixty patients were 85.3%, 80.8%, 83.3%, 85.3%, 80.8%, 19.2%, 14.7% respectively. After 13 cases of thoracic-lumbar fracture-dislocation were eliminated, the sensitivity, specificity, accuracy, PPV, NPV, misdiagnosis rate and rate of missed diagnosis of remaining 47 cases were 81.0%, 80.8%, 80.9%, 77.3%, 84.0%, 19.2%, 19.0% respectively. There were 5 cases with MRI negative results before operation but positive results during operation. Contrarily, 5 cases with MRI positive results before operation but negative results during operation occurred.

CONCLUSIONSMRI is a main means for evaluating the state of PLC. Although the MRI fat-stir sequence as well as the MRI negative film reading technique are adopted, the state of PLC can not be estimated exactly before operation (especially for those unfracture dislocation cases). In order to estimate the state of PLC exactly, the related local physical examination and image technology as well as the location of the abnormal image signal in MRI film and time of injury must be analyzed synthetically.

Adult ; Aged ; Female ; Humans ; Ligaments ; pathology ; Lumbar Vertebrae ; injuries ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Spinal Fractures ; pathology ; surgery ; Thoracic Vertebrae ; injuries ; Young Adult

OBJECTIVETo evaluate the biomechanical properties of geneX cements for use in vertebroplasty in a calf osteoporotic vertebral compression fracture model.

METHODSThirty vertebral bodies (T(9)-L(4)) were harvested from 4 fresh calf spines. The bone mineral density was measured with dual-energy radiographic absorption. Osteoporotic vertebral model was induced in each vertebra using decalcifying chemical agents, and was then compressed to determine their initial strength and stiffness before injecting the cement. Thirty vertebral bodies were divided randomly into geneX(®) cement group, CSC group, and PMMA group. The fractures were repaired using a transpedicular injection of cements and re-compressed to measure posttreatment strength and stiffness.

RESULTSThe normal mean BMD of the calf vertebra was 1.425∓0.072 g/cm(2), which was reduced significantly to 1.074∓0.065 g/cm(2) after decalcification. The mean injected volume was similar between geneX(®) (4.5∓0.7 ml), CSC (4.3∓0.8 ml) and PMMA (3.8∓0.4 ml) groups. The vertebral strength was restored after the treatment to 1198∓529 N in geneX(®) group, 1212∓430 N in CSC group and 1672∓704 N in PMMA group. All the cements produced significantly greater strength than the initial strength (P<0.05). The augmented strength in geneX(®) and CSC groups were similar (P>0.05), but both were significantly less than that in PMMA group (P<0.05). The stiffness in geneX(®), CSC, and PMMA groups was 233∓130, 242∓191, and 323∓145 N/mm, respectively, showing no significant difference between them (P>0.05). No significant difference was found in the augmented stiffness among the 3 cements (P>0.05).

CONCLUSIONgeneX(®) cement is a useful alternative to PMMA in vertebroplasty for osteoporotic vertebral compression fractures, but further study is needed to evaluate its biosorption in vivo.

Animals ; Biomechanical Phenomena ; Bone Cements ; therapeutic use ; Cattle ; Disease Models, Animal ; Fractures, Compression ; etiology ; surgery ; Lumbar Vertebrae ; injuries ; Osteoporosis ; complications ; pathology ; Thoracic Vertebrae ; injuries ; Vertebroplasty

OBJECTIVESTo compare short-term and long-term change of paraspinal muscle between percutaneous and open pedicle screw fixation in the treatment of thoracolumbar fractures.

METHODSThirty-three patients were divided into four groups: short-term percutaneous pedicle screw fixation group, short-term open pedicle screw fixation group, long-term percutaneous pedicle screw fixation group, and long-term open pedicle screw fixation group. Paraspinal muscle were studied by needle electromyography and CT. Cross-sectional area and color grade information of paraspinal muscle were measured using CT image.

RESULTSThe area and color grade of paraspinal muscle changed significantly after surgery. The color grade of paraspinal muscle showed significant change while the muscle area observed no significant change in the two short-term groups; There was significant change in paraspinal muscle area, however no significant change was found in muscle color grade of the two long-term groups. In electromyography study the results showed that there was significant difference in the two short-term groups, however no significant difference existed in the long-term groups. There was no significant difference of patients treated by the two surgical technique in long-term function evaluation.

CONCLUSIONBoth percutaneous and open pedicle screw fixation damage paraspinal muscle, however the muscle showed less injury treated by percutaneous pedicle fixation.

Adult ; Bone Screws ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; instrumentation ; methods ; Humans ; Lumbar Vertebrae ; injuries ; Male ; Middle Aged ; Muscles ; pathology ; physiopathology ; Spinal Fractures ; pathology ; physiopathology ; surgery ; Thoracic Vertebrae ; injuries ; Time Factors

OBJECTIVETo study the correlation between intrusion of nucleus gelatinosus into vertebral body and low back pain after thoracolumbar fractures.

METHODSOne hundred and two patients who were treated in Peking university third hospital from January 2005 to September 2007 were evaluated retrospectively and included into this study. They were followed up for an average of 18 months and complete data were kept. Fifty-four patients were treated operatively and forty-eight patients were treated conservatively. VAS questionnaire was applied to evaluate the low back pain. Spearman Correlation Coefficients module and Wilcoxon 2-Sample Test module of SAS software were used to analyze the relation between intrusion of nucleus gelatinosus, different treatments, kyphotic Cobb angles and VAS.

RESULTSThere were strong correlations between intrusion of nucleus gelatinosus and VAS in both operative group, P < 0.01 and non-operative group, P < 0.01; there were poor correlations between different treatments and VAS in both intrusion group, P > 0.05 and non-intrusion group, P > 0.05; and there were also poor correlations between Cobb angles and VAS, gamma = 0.2584, P > 0.05.

CONCLUSIONThere is correlation between the intrusion of nucleus gelatinosus into vertebral body and the low back pain after thoracolumbar fractures.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Back Pain ; etiology ; Female ; Humans ; Intervertebral Disc ; pathology ; Lumbar Vertebrae ; injuries ; Male ; Middle Aged ; Spinal Fractures ; complications ; pathology ; Thoracic Vertebrae ; injuries ; Young Adult

OBJECTIVE: To evaluate spine magnetic resonance imaging (MRI) inter-reader and intra-reader reliabilities using the thoracolumbar injury classification system and severity score (TLICS) and to analyze the effects of reader experience on reliability and the possible reasons for discordant interpretations. MATERIALS AND METHODS: Six radiologists (two senior, two junior radiologists, and two residents) independently scored 100 MRI examinations of thoracolumbar spine injuries to assess injury morphology and posterior ligamentous complex (PLC) integrity according to the TLICS. Inter-reader and intra-reader agreements were determined and analyzed according to the number of years of radiologist experience. RESULTS: Inter-reader agreement between the six readers was moderate (k = 0.538 for the first and 0.537 for the second review) for injury morphology and fair to moderate (k = 0.440 for the first and 0.389 for the second review) for PLC integrity. No significant difference in inter-reader agreement was observed according to the number of years of radiologist experience. Intra-reader agreements showed a wide range (k = 0.538-0.822 for injury morphology and 0.423-0.616 for PLC integrity). Agreement was achieved in 44 for the first and 45 for the second review about injury morphology, as well as in 41 for the first and 38 for the second review of PLC integrity. A positive correlation was detected between injury morphology score and PLC integrity. CONCLUSION: The reliability of MRI for assessing thoracolumbar spinal injuries according to the TLICS was moderate for injury morphology and fair to moderate for PLC integrity, which may not be influenced by radiologist' experience.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Female ; Humans ; *Injury Severity Score ; Ligamentum Flavum/pathology ; Lumbar Vertebrae/*injuries/pathology ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged ; Observer Variation ; Reproducibility of Results ; Retrospective Studies ; Spinal Injuries/*classification/*pathology ; Thoracic Vertebrae/*injuries/pathology ; Thoracic Wall/pathology ; Young Adult

OBJECTIVETo investigate the surgical treatment of thoracic ossification of the ligamentum flavum (TOLF) and analysis of the therapeutic effects.

METHODSSix patients with thoracic ossification of the ligamentum flavum were retrospectively studied from October 2006 to October 2009. All of the patients in this group were treated by en bloc hemi-articular process laminectomy. There were 4 males and 2 females, ranging in age from 45 to 66 years, averaged 55.2 years. The evaluate factors including the preoperative and postoperative JOA scores,and the function of the urinary bladder were analyzed.

RESULTSAll the 6 patients were followed after operation. The mean followed-up duration was 10.5 months, ranging from 2 to 18 months. According to JOA evaluation criteria, 4 patients got an excellent result, 1 good and 1 bad. The one patient with bad result had spinal cord compressed for too long time, and the T2-weight MRI showed nonreversible degeneration of spinal cord and combined with schizophrenia. The clinical symptoms improved with varying degrees.

CONCLUSIONThe en bloc hemi-articular process laminectomy is an effective method for ossification of the thoracic ligamentum flavum. A thorough decompression and real-time protection of the spinal cord is the key to the success of surgery.

Aged ; Decompression, Surgical ; Female ; Humans ; Ligamentum Flavum ; pathology ; Male ; Middle Aged ; Ossification, Heterotopic ; surgery ; Postoperative Complications ; etiology ; Retrospective Studies ; Spinal Cord Injuries ; etiology ; Thoracic Vertebrae ; pathology

OBJECTIVETo review imaging use in the diagnosis of thoracolumbar burst fractures and to determine the diagnostic value of different imaging methods.

METHODSOne hundred and fourteen patients with 120 thoracolumbar burst fractures were retrospectively reviewed. Plain radiographs were available in all cases; CT scans and MRI were obtained in 96 and 74 cases, respectively.

RESULTSA total of 27 burst fractures were misdiagnosed as other types of fractures on radiographs alone, and accounted for 22.5% of all fractures. The results indicated that plain radiographs often fail to delineate the pathological features of thoracolumbar burst fractures, leading to delay in diagnosis.

CONCLUSIONIn regard to thoracolumbar injury diagnosis, burst fractures should be differentiated from compression fractures. CT should be routinely indicated and MRI examination, when necessary, may be simultaneously considered.

Adolescent ; Adult ; Aged ; Female ; Humans ; Lumbar Vertebrae ; diagnostic imaging ; injuries ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Retrospective Studies ; Spinal Fractures ; diagnosis ; pathology ; Thoracic Vertebrae ; diagnostic imaging ; injuries ; Tomography, X-Ray Computed

According to the literature, thoracic outlet syndrome (TOS) secondary to the malunion of displaced fractures of the clavicle is rare. Various surgical methods, including simple neurolysis, resection of the first rib or clavicle and corrective osteotomy, have been reported. We report a case of TOS secondary to malunion of the clavicle that was treated by an anterior and middle scalenectomy without a rib resection.
Adult ; Humans ; Low Back Pain/etiology ; Lumbar Vertebrae/surgery ; Male ; Postoperative Complications/*microbiology ; Spondylitis/etiology/*microbiology ; Thoracic Vertebrae/*microbiology/pathology ; Tuberculosis/drug therapy/*microbiology ; Tuberculosis, Spinal/complications/drug therapy/*microbiology ; Adult ; Clavicle/*injuries ; Fractures, Malunited/*complications ; Humans ; Male ; Thoracic Outlet Syndrome/etiology/radiography/*surgery