No abstract available.
Asian Continental Ancestry Group ; Humans

STUDY DESIGN: Cross-sectional, matched-pair comparative study. PURPOSE: To determine whether a thin-sliced pedicular-oriented computed tomography (TPCT) scan reconstructed from an existing conventional computed tomography (CCT) scan is more accurate for identifying vertebral artery groove (VAG) anomalies than CCT. OVERVIEW OF LITERATURE: Posterior atlantoaxial transarticular screw fixation and C2 pedicle screws can cause vertebral artery (VA) injury. Two anatomic variations of VAG anomalies are associated with VA injury: a high-riding VA (HRVA) and a narrow pedicle of the C2 vertebra. CCT scan is a reliable method used to evaluate VAG anomalies; however, its accuracy level remains debatable. Literature comparing the prevalence of C2 VAG anomalies between CCT and TPCT is limited. METHODS: A total of 200 computed tomography scans of the upper cervical spine obtained between January 2008 and December 2011 were evaluated for C2 VAG anomalies (HRVA and narrow pedicular width) using CCT and TPCT. The prevalence of C2 VAG anomalies was compared using these two different measurement methods via a McNemar's test. RESULTS: Of the 200 patients studied, 23 HRVA (6.01%; 95% confidence interval [CI], 3.61%–8.39%) were detected with CCT, whereas 66 HRVA (16.54%; 95% CI, 12.85%–20.23%) were detected with TPCT (p<0.001). Sixty-two narrow pedicles (15.58%; 95% CI, 11.99%–19.15%) were detected with CCT, whereas 90 narrow pedicles (22.83%; 95% CI, 18.58%–26.87%) were detected with TPCT (p<0.001). CONCLUSIONS: VAG anomalies are commonly observed. A preoperative evaluation using TPCT reconstructed from an existing CCT revealed a significantly higher prevalence of C2 VAG anomalies than did CCT and showed comparable prevalence to previously published studies using more sophisticated and higher risk techniques. Therefore, we propose TPCT as an alternative preoperative evaluation for C2 screw placement and trajectory planning.
Humans ; Methods ; Pedicle Screws ; Prevalence* ; Spine ; Tomography, X-Ray Computed ; Vertebral Artery*

STUDY DESIGN: A prospective cohort. PURPOSE: To report the short and long term outcomes of fluoroscopically guided lumbar transforaminal epidural steroid injection (TFESI) in degenerative lumbar spondylolisthesis (DLS) patients. OVERVIEW OF LITERATURE: TFESI has been widely used for the treatment of lumbosacral radicular pains. However, to our knowledge, there has been no study which has evaluated the outcomes of TFESI in patients with DLS. METHODS: The DLS patients received fluoroscopically guided lumbar TFESI with 80 mg of methylprednisolone and 2 mL of 1% lidocaine hydrochloride. Patients were evaluated by an independent observer before the initial injection, at 2 weeks, at 6 weeks, at 3 months, and at 12 months after the injections. Visual analog scale (VAS), Roland 5-point pain scale, standing tolerance, walking tolerance, and patient satisfaction scale were evaluated for outcomes. RESULTS: Thirty three DLS patients treated with TFESI, who were completely followed up, were included in this study. The average number of injections per patient was 1.9 (range from 1 to 3 injections per patient). Significant improvements in VAS and Roland 5-point pain scale were observed over the follow up period from 2 weeks to 12 months. However, the standing and walking tolerance were not significantly improved after 2 weeks. At 2 weeks, the patient satisfaction scale was highest, although, these outcomes declined with time. The DLS patients with one level of spinal stenosis showed significantly better outcome than the DLS patients with two levels of spinal stenosis. Five patients (13%) underwent surgical treatment during the 3 to 12 months follow up. CONCLUSIONS: TFESI provides short term improvements in VAS and Roland 5-point pain scale, standing tolerance, walking tolerance and patient satisfaction scale in DLS patients. In the long term, it improves VAS but limits the improvements in Roland 5-point pain scale, standing tolerance, walking tolerance and patient satisfaction scale.
Cohort Studies ; Follow-Up Studies ; Humans ; Injections, Epidural ; Lidocaine ; Methylprednisolone ; Patient Satisfaction ; Prospective Studies ; Spinal Stenosis ; Spondylolisthesis* ; Visual Analog Scale ; Walking

STUDY DESIGN: Anatomical study. PURPOSE: To evaluate the anatomy of intervertebral disc (IVD) area in the triangular working zone of the lumbar spine based on cadaveric measurements. OVERVIEW OF LITERATURE: The posterolateral percutaneous approach to the lumbar spine has been widely used as a minimally invasive spinal surgery. However, to our knowledge, the actual perspective of disc boundaries and areas through posterolateral endoscopic approach are not well defined. METHODS: Ninety-six measurements for areas and dimensions of IVD in Kambin's triangle on bilateral sides of L1–S1 in 5 fresh human cadavers were studied. RESULTS: The trapezoidal IVD area (mean±standard deviation) for true working space was 63.65±14.70 mm2 at L1–2, 70.79±21.88 mm2 at L2–3, 99.03±15.83 mm2 at L3–4, 116.22±20.93 mm2 at L4–5, and 92.18±23.63 mm2 at L5–S1. The average dimension of calculated largest ellipsoidal cannula that could be placed in IVD area was 5.83×11.02 mm at L1–2, 6.97×10.78 mm at L2–3, 9.30×10.67 mm at L3–4, 8.84×13.15 mm at L4–5, and 6.61×14.07 mm at L5–S1. CONCLUSIONS: The trapezoidal perspective of working zone of IVD in Kambin's triangle is important and limited. This should be taken into consideration when developing the tools and instruments for posterolateral endoscopic lumbar spine surgery.
Cadaver* ; Catheters ; Humans ; Intervertebral Disc* ; Spine

Surgical treatment for spinal tuberculosis is necessary in particular cases that a large amount of necrotic tissue is encountered and there is spinal cord compression. A spinal shortening osteotomy procedure has previously been described for the correction of the sagittal balance in a late kyphotic deformity, but there have been no reports on this as a surgical treatment in the acute stage. Thus, the aim of this report is to present the surgical techniques and clinical results of 3 patients who were treated with this procedure. Three patients with tuberculous spondylitis at the thoracic spine were surgically treated with this procedure. All the patients presented with severe progressive back pain, kyphotic deformity and neurological deficit. The patients recovered uneventfully from surgery without further neurological deterioration. Their pain was improved and the patients remained free of pain during the follow-up period. In conclusion, posterior spinal shortening osteotomy is an alternative method for the management of tuberculous spondylitis.
Back Pain ; Congenital Abnormalities ; Follow-Up Studies ; Humans ; Osteotomy ; Spinal Cord Compression ; Spine ; Spondylitis ; Tuberculosis ; Tuberculosis, Spinal

Objectives: Ankle fractures are common in the elderly. However, their association with osteoporosis remains controversial. This systematic review aims to determine the relationship between ankle fracture and bone mineral density (BMD), and to investigate the risk of subsequent fractures after ankle fracture. Methods: MEDLINE and Scopus publications were searched from inception to March and April 2019, respectively. Articles were selected by 2 independent reviewers for cross-sectional, cohort, or casecontrol studies comparing BMD or subsequent fracture risk in low-energy ankle fractures patients with that of the normal population. Data extraction was performed by 2 investigators. Discrepancies were resolved with the third reviewer. Quality assessment was conducted using the modified NewcastleOttawa Scale. Results: Overall, 19 articles were included. The quality assessment showed a generally low-to-moderate risk of bias among studies, mainly due to potential confounders and inadequate follow-up. Of 13 studies exploring BMD in ankle fractured-patients, lower central and peripheral BMD was found in 3 and 2 studies, respectively. The risk of subsequent fracture was examined in 11 studies with relative risks ranging from 0.7 to 4.59. An increased risk of any subsequent fractures in women, both genders, and men was found in 5, 2, and 1 articles, respectively. Conclusions Despite the lack of clear association with BMD, the contribution of ankle fracture to increased subsequent fracture risk and its associated microarchitectural changes cannot be overlooked.Moreover, its potential role as an early predictor of future fracture may promote secondary prevention.Further studies with longer follow-up and stricter confounder control are recommended.