OBJECTIVE: To introduce a scout view scanning technique of back-forward bending CT (BFB-CT) in simulated surgical position for evaluating the remaining real angle and flexibility of thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture. METHODS: A total of 28 patients with thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture who met the selection criteria between June 2018 and December 2021 were included in the study. There were 6 males and 22 females with an average age of 69.5 years (range, 56-92 years). The injured vertebra were located at T ₁₀-L ₂, including 11 cases of single thoracic fracture, 11 cases of single lumbar fracture, and 6 cases of multiple thoracolumbar fractures. The disease duration ranged from 3 weeks to 36 months, with a median of 5 months. All patients received examinations of BFB-CT and standing lateral full-spine X-ray (SLFSX). The thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), local kyphosis of injured vertebra (LKIV), lumbar lordosis (LL), and the sagittal vertical axis (SVA) were measured. Referring to the calculation method of scoliosis flexibility, the kyphosis flexibility of thoracic, thoracolumbar, and injured vertebra were calculated respectively. The sagittal parameters measured by the two methods were compared, and the correlation of the parameters measured by the two methods was analyzed by Pearson correlation. RESULTS: Except LL ( P>0.05), TK, TLK, LKIV, and SVA measured by BFB-CT were significantly lower than those measured by SLFSX ( P<0.05). The flexibilities of thoracic, thoracolumbar, and injured vertebra were 34.1%±18.8%, 36.2%±13.8%, and 39.3%±18.6%, respectively. Correlation analysis showed that the sagittal parameters measured by the two methods were positively correlated ( P<0.001), and the correlation coefficients of TK, TLK, LKIV, and SVA were 0.900, 0.730, 0.700, and 0.680, respectively. CONCLUSION Thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture shows an excellent flexibility and BFB-CT in simulated surgical position can obtain the remaining real angle which need to be corrected surgically.
Male ; Female ; Humans ; Aged ; Fractures, Compression/surgery* ; Spinal Fractures/diagnostic imaging* ; Lumbar Vertebrae/surgery* ; Thoracic Vertebrae/surgery* ; Kyphosis/surgery* ; Osteoporotic Fractures/surgery* ; Lordosis ; Tomography, X-Ray Computed ; Retrospective Studies

BACKGROUND: The importance of identifying osteoporotic vertebral endplate or/and cortex fracture (ECF), which primarily includes endplate fracture (EPF) and vertebral anterior cortex buckling, has been recognized. However, some old traumatic ECFs with healing process in the elderly may be mistaken as osteoporotic. This study analyzes the radiological features of traumatic EPF. METHODS: This was a retrospective analysis of 194 spine trauma patients with 263 vertebral fractures (mean age: 42.11 ± 9.82 years, 118 males and 76 females). All patients had traumatic EPF identified by X-ray/CT/MRI. RESULTS: The involved vertebra was mostly L1 (29.7%), followed by T12 and L2. Except EPFs involved both superior and inferior endplates (12.6%), only 1.9% involved inferior endplate alone, with the majority involved superior endplate. If each endplate was divided into five segments of equal lengths (from anterior to posterior: a1, a2, m, p2, p1), the most depressed point of superior EPFs was mostly at segment-a2 (approximately 45%), followed by segment-a1 (approximately 20%) or segment-m (approximately 20%), and very rarely at segment-p1. The upper 1/3 of anterior vertebral wall was more likely to fracture, followed by middle 1/3 of anterior wall. For posterior vertebral wall fracture, 68.5% broke the bony wall surrounding the basivertebral vain. 58.6%, 30.0%, and 11.4% of vertebral fractures had <1/5, 1/5-1/3, and >1/3 vertebral body height loss. As the extent of vertebral height loss increased, the chance of having both superior and inferior EPFs also increased; however, the chance of having inferior EPF alone did not increase. CONCLUSION Traumatic EPF features are characterized, which may help the differentiation of traumatic and osteoporotic EPFs.
Adult ; Aged ; Female ; Fractures, Bone ; Humans ; Lumbar Vertebrae/diagnostic imaging* ; Male ; Middle Aged ; Osteoporotic Fractures/diagnostic imaging* ; Radiography ; Retrospective Studies ; Spinal Fractures/diagnostic imaging* ; Thoracic Vertebrae

An 82-year-old woman presented with neck pain and bilateral upper limb paraesthesia after sustaining an unwitnessed fall at home the day before. Physical examination revealed tenderness over the C4-6 region but no evidence of step deformity or neurological deficit. Magnetic resonance imaging of the cervical spine revealed multiple small fractures at the anteroinferior endplate corners of the C3, C5 and C6 vertebrae with focal kyphosis and marrow oedema at these levels, as well as associated disruption of the anterior longitudinal ligament and central spinal canal stenosis. The diagnosis of multiple flexion teardrop fractures was made based on these imaging findings, and the patient subsequently received conservative management. This paper illustrates the radiological features of flexion teardrop fractures and highlights the importance of prompt diagnosis and management of such cases.
Accidental Falls ; Aged, 80 and over ; Cervical Vertebrae ; diagnostic imaging ; Female ; Fracture Fixation, Internal ; methods ; Fractures, Bone ; diagnostic imaging ; Humans ; Neck Pain ; Radiography ; Range of Motion, Articular ; Spinal Fractures ; diagnostic imaging ; Treatment Outcome

OBJECTIVES: To explore the assessment method of original height of L_1-2 after vertebral compression fracture and its application value in forensic clinical practice. METHODS: A total of 154 normal thoracic and lumbar X-ray films were collected, and 140 cases were used as experimental group while 14 cases as validation group. The heights of anterior （Ha） and posterior （Hp） vertebral body of T₁₂-L₃ vertebrae in each X-ray image were measured. In the experimental group, the correlation analysis between Ha_L₁ and Ha_T₁₂, Hp_T₁₂, Hp_L₁, Ha_L₂ and Hp_L₂ was carried out, and regression equation was established via fitting. The correlation analysis between Ha_L₂ and Ha_L₁, Hp_L₁, Hp_L₂, Ha_L₃, Hp_L₃ was performed, and the regression equation was also established via fitting. The difference between the predicted and measured values of Ha_L₁ and Ha_L₂ in validation group was compared. RESULTS: In the 140 normal subjects, Ha_L₁ （y₁） was well correlated with Ha_T₁₂ （x₁） and Ha_L₂（x₂）, and the multiple linear regression equation was y₁=2.545+0.423 x₁+0.486 x₂ （determining coefficient R²=0.712, P<0.05; F=169.206, P<0.05）. There was no significant difference between the predicted and actual measured values of Ha_L₁ in the validation group （ P>0.05）. HaL₂ （y₂） was well correlated with Ha_L₁ （x₃） and Ha_L₃ （x₄）, and the multiple linear regression equation was y₂=4.354+0.530 x₃+0.349 x₄ （determining coefficient R²=0.689, P<0.05; F=151.575, P<0.05）. There was no significant difference between the predicted and actual measured values of Ha_L₂ in the validation group （ P>0.05）. CONCLUSIONS It is more appropriate to evaluate the original height of L₁ or L₂ single vertebrae by comparing with the height of the anterior edge of the upper and lower adjacent vertebral bodies.
Aged ; Fractures, Compression ; Humans ; Lumbar Vertebrae/diagnostic imaging* ; Middle Aged ; Spinal Fractures/surgery* ; Thoracic Vertebrae/diagnostic imaging*

OBJECTIVETo explore the diagnostic value of the radiologic characteristics of osteoporotic Kummell's disease.

METHODSTotal 16 patients with pathologically confirmed osteoporotic Kummell's diseases were reviewed from May 2010 to May 2012, including 4 males and 12 females with the mean age of 73.4 years (ranged, 67 to 83 years old). Radiologic imagings of all patients, including X-ray, CT and MRI, were analyzed retrospectively.

RESULTSIntravertebral linear clefts could be seen on the AP and lateral X-ray films of vertebrae. Sagittal and axial CT scans demonstrated the vacuum cleft phenomenon with liquid and air was identified within the vertebral body. Sagittal MRI showed the callapsed vertebral segment and the area of fluid signal with clear and intact border within the vertebral body. The fluid signal was low on T1-weighted images and high on T2-weighted images and stir images, which was corresponding to an intravertebral vacuum cleft.

CONCLUSIONThe radiologic characteristics of Kurmmell's diseases can provide valuable evidences for the early diagnosis.

Aged ; Aged, 80 and over ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Osteonecrosis ; diagnosis ; diagnostic imaging ; pathology ; Retrospective Studies ; Spinal Fractures ; diagnosis ; diagnostic imaging ; pathology ; Tomography, X-Ray Computed

Apophyseal injuries of the pelvis have increased recently with increased participation of teenagers in contact sports. Apophyseal fractures of the pelvis should be ruled out from apophysitis, os acetabuli and bony tumors. We report a case of fracture of anterior-inferior iliac spine following indirect injury to the hip in a young football player. The patient failed to get better with nonoperative management and continued to have pain in the left hip and signs and symptoms of impingement. He improved following surgical excision of the heterotopic bone and did not have any evidence of recurrence at 2 years follow- up.
Adolescent ; Athletic Injuries ; diagnostic imaging ; surgery ; Femoracetabular Impingement ; diagnostic imaging ; surgery ; Follow-Up Studies ; Football ; injuries ; Fracture Fixation ; adverse effects ; methods ; Fractures, Malunited ; diagnostic imaging ; surgery ; Humans ; Ilium ; diagnostic imaging ; injuries ; surgery ; Male ; Osteotomy ; methods ; Risk Assessment ; Spinal Fractures ; diagnostic imaging ; surgery ; Tomography, X-Ray Computed ; methods ; Treatment Outcome

Adjacent vertebral fractures are common in patients with osteoporotic vertebral compression fractures (OVCFs) after kyphoplasty. This finite element study was to examine whether short segment pedicle screw fixation (PSF) with kyphoplasty may decrease the fracture risk of the treated and adjacent non-treated vertebrae after kyphoplasty for OVCFs. By simulating cement augmentation with or without short segment pedicle screw fixation (PSF), two tridimensional, anatomically detailed finite element models of the T10-L2 functional spinal junction were developed. The insertion of pedicle screws into the intact vertebra apparently decreased the stress distribution of the treated vertebra in vertical compression and other load situations. The stress distribution in the bone structures of the intact vertebra adjacent to the intact-screwed vertebra was much less than that in the one adjacent to the treated vertebra. The insertion of pedicle screws into the intact vertebra greatly decreased the maximum displacement of the cortical bones and cancellous bones of the vertebrae. Our results indicated that short segment PSF with kyphoplasty may decrease the fracture risk of the treated and adjacent non-treated vertebrae in the management of OVCFs.
Computer Simulation ; Finite Element Analysis ; Fracture Fixation, Internal ; adverse effects ; instrumentation ; methods ; Humans ; Kyphoplasty ; adverse effects ; instrumentation ; methods ; Osteoporotic Fractures ; etiology ; prevention & control ; Pedicle Screws ; adverse effects ; Postoperative Complications ; prevention & control ; Spinal Fractures ; etiology ; prevention & control ; Spine ; diagnostic imaging ; surgery

OBJECTIVETo summary the characteristics of cervicothoracic junction (C7T1) fracture-dislocation,and explore the surgical treatment of combined anterior-posterior procedure.

METHODSFrom January 2005 to March 2010,8 cases of cervicothoracic junction (C7T1) fracture-dislocation were treated by stage I operation through anterior and posterior approacheg, supplemented by non-structural bone graft. All patients were male with a mean age of 45.0 years old ranging from 32 to 68 years. Six cases were diagnosed clearly by CT scan but with normal cervical spine X-ray film at admission. According to AO classification, 4 cases were of type B, 4 cases of type C, with unilateral locked articular process in 2 cases, bilateral in 2 cases. Preoperative MRI showed intervertebral disc injury in 6 cases.

RESULTSThe average operation time was 246.3 min ranging from 150 to 320 min. The blood loss was with an average of 307.5 ml (150 to 600 ml). One patient got hoarseness but recovered without special treatment 6 months later; No other complications happened. One patient of preoperative Frankel grade A died, the remaining patients were followed up from 12 to 63 months (38.6 months in average). These fracture-dislocations were completely reduction after operation, healed with bony union 12 months later, and no pseudoarthrosis. The function of the spinal cord improved obviously at the final follow-up, 1 patient of preoperative grade A had died,and the spinal cord function of the other one had no significant changes,the 2 cases of grade B recovered to C and D respectively, 1case recovered from grade C to D, and 3 case recovered from D to E.

CONCLUSIONCervicothoracic junction (C7T1) fracture-dislocation is a rare clinical spine trauma, and missed easily. The CT is a necessary complement to these patients highly suspected C7T1 fracture-dislocation but with negative cervical spine X-ray film. The patients diagnosed clearly could receive stage I operation of anterior and posterior approaches, supplemented with non-structural bone graft.

Adult ; Aged ; Cervical Vertebrae ; injuries ; surgery ; Female ; Humans ; Joint Dislocations ; surgery ; Male ; Middle Aged ; Spinal Fractures ; diagnostic imaging ; surgery ; Thoracic Vertebrae ; injuries ; surgery ; Tomography, X-Ray Computed

Type 2 manubriosternal dislocations with concomitant spinal fracture are rare and may be associated with thoracic visceral injuries. The complication of delayed haemothorax has not been reported yet. We report a case of a young male who suffered manubriosternal dislocation with chance type thoracic spine fracture due to fall of a tree branch over his back. The haemothorax presented late on day three. The possible injury mechanism is discussed along with review of literature. We conclude that a lateral chest radiograph is indicated in spinal fracture patients complaining of midsternal pain. Computerized axial tomography scan of chest with contrast is indicated to rule out visceral injuries and a chest radiograph should be repeated before the patient is discharged to look for delayed haemothorax.
Adult ; Hemothorax ; etiology ; Humans ; Joint Dislocations ; complications ; diagnostic imaging ; Male ; Manubrium ; injuries ; Radiography, Thoracic ; Spinal Fractures ; complications ; diagnostic imaging ; Sternum ; injuries ; Thoracic Vertebrae ; injuries

OBJECTIVETo investigate clinical effects of three-column reconstruction via single posterior approach for the treatment of unstable thoracolumbar fractures accompanied by posterior column injury.

METHODSFrom December 2008 to May 2010,three-column reconstruction via posterior approach was implemented to 21 patients with unstable thoracolumbar fractures accompanied by posterior column injuries. There were 13 males and 8 females, ranging in age from 23 to 54 years old(averaged,35.5 years old). Injured vertebrae: 1 patient had injury in T11, 4 patients had injuries in T12, 8 patients had injuries in L1, 5 patients had injuries in L2, 3 patients had injuries in L3. The Cobb angle was (25.34 +/- 3.42) degrees. The operation time,blood loss during operation, Cobb angle and the bony fusion were observed.

RESULTSTwenty-one patients were followed up, and the duration ranged from 24 to 27 years old, with an average of 25.6 months. The operation time ranged from 135 to 275 min, with a mean of 185 min. The blood loss during operation ranged from 700 to 1 650 ml (averaged, 870 ml). All the patients had complete decompression. Postoperative Cobb angle was (4.01 +/- 2.03) degrees, and (4.34 +/- 2.38) degrees at the latest follow-up. All the patients got bony fusion.

CONCLUSIONTo the patients with unstable thoracolumbar fractures accompanied by posterior column injuries, three-column reconstruction via single posterior approach has both anterior approach and posterior approach advantages, which can obtain excellent clinical outcomes.

Adult ; Female ; Follow-Up Studies ; Humans ; Lumbar Vertebrae ; injuries ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; adverse effects ; methods ; Spinal Fractures ; diagnostic imaging ; surgery ; Thoracic Vertebrae ; injuries ; Tomography, X-Ray Computed ; Treatment Outcome ; Young Adult