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

No abstract available.
Adolescent ; Back Pain/diagnosis/*etiology/surgery ; Decompression, Surgical ; Humans ; Laminectomy ; Magnetic Resonance Imaging ; Male ; Osteoblastoma/*complications/pathology/radiography/surgery ; Pain Measurement ; Radiotherapy, Adjuvant ; Spinal Neoplasms/*complications/pathology/radiography/surgery ; *Thoracic Vertebrae/pathology/radiography/surgery ; Tomography, X-Ray Computed ; Treatment Outcome

Glucocorticosteroid-induced osteoporosis is the most frequent of all secondary types of osteoporosis, and can increase the risk of vertebral compression fractures (VCFs). There are promising additions to current medical treatment for appropriately selected osteoporotic patients. Few studies have reported on the efficiency of percutaneous vertebroplasty (PVP) or kyphoplasty for whole thoracic and lumbar glucocorticosteroid-induced osteoporotic vertebral compression fractures. We report a case of a 67-year-old man with intractable pain caused by successional VCFs treated by PVP.
Aged ; Arthritis, Rheumatoid/drug therapy ; Fractures, Compression/*radiography ; Glucocorticoids/*adverse effects/therapeutic use ; Humans ; Kyphoplasty ; Lumbar Vertebrae/radiography/surgery ; Male ; Osteoporosis/*chemically induced/radiography/surgery ; Pulmonary Fibrosis/drug therapy ; Thoracic Vertebrae/radiography/surgery ; Vertebroplasty

BACKGROUNDAmong the various treatments of neurologically involved unstable thoracolumbar burst fractures, the combination of anterior and posterior instrumentation provides the most stable reconstruction. However, the use of both approaches on a trauma patient may increase the morbidity. This study is a retrospective matched cohort study to evaluate the advantages of a single stage posterior approach for spinal canal decompression in combination with circumferential reconstruction by comparing the clinical and radiographic results.

METHODSFrom March 2005 to September 2009, patients with matched type spinal fracture, ages at surgery, and involved levels in our institute underwent either a single stage posterior approach (group one, n = 12) or traditional combined approach (group two, n = 14) for spinal canal decompression and circumferential reconstruction were reviewed. Pre- and post-operative X-ray flms were reviewed and changes in Cobb angle of thoracolumbar spine were documented. Intra-operative, post-operative, and general complications were registered.

RESULTSThe mean follow-up was (27.7 ± 9.6) months (range, 14 to 56 months) in group one and (29.2 ± 7.4) months (range, 20 to 60 months) in group two (P > 0.05). The mean operation time was 214 minutes (range, 186 ± 327 minutes) in group one and 284 minutes (range, 219 ± 423 minutes) in group two (P < 0.05). The average volume of intraoperative blood loss was 1856 ml (range, 1250 ± 3480 ml) in group one and 2453 ml (range, 1600 ± 3680 ml) in group two (P < 0.05). There was no statistical difference between the groups one and two in average vertebral body height loss at the injured level and the average Cobb angle in sagittal plane before and immediately after surgery. Postoperatively, there was an epidural hematoma in one patient in group one and two patients in group two. Bony union after stabilization was obtained in all patients, without loosening or breakage of screws. Loss of correction (5°) was seen in 1 patient in group one at the 6th month owing to the subsidence of the Titanium mesh cages into the vertebra. In group two, totally four patients suffered respiratory-related complication, including pneumonia in two, severe atelectasis in one and pleural effusions in one. Importantly, there were no intraoperative or postoperative deaths in any group. All patients with incomplete neurologic deficits improved at least 1 Frankel grade.

CONCLUSIONSingle-stage posterior vertebra resection in combination with circumferential reconstruction is a new option to manage severe thoracolumbar burst fractures.

Decompression, Surgical ; adverse effects ; methods ; Humans ; Lumbar Vertebrae ; injuries ; surgery ; Operative Time ; Radiography ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Rotation ; Spinal Canal ; surgery ; Spinal Fractures ; diagnostic imaging ; surgery ; Thoracic Vertebrae ; injuries ; surgery

OBJECTIVETo measure important parameters of anterior internal fixation for the cervicothoracic junction by us-ing imaging measurement, and provide reference for cervicothoracic junction surgery and design of steel plate screw internal fixation.

METHODSFrom June to November 2012, 120 health people's median sagittal plane MRI of cervical spine were ran-domly collected. Of the 120 cases, there were 58 males and 62 females with an average age of 48.3 +/- 13.7, ranging the age of 20 to 78 years old. The anterior,middle and posterior height of vertebral, anterior, upper, medium and lower sagittal diameter, an-terior height of different segments and Cobb angle were measured by measuring machine in the PACS system.

RESULTSThe an-terior, middle and posterior height of vertebral, medium and lower sagittal diameter gradually increased from cranial to caudal of cervicothoracic junction (P < 0.01). For single vertebral,posterior> anterior>middle height (P < 0.01), lower > upper>medium sagittal diameter (P < 0.01). The lower sagittal diameter of upper vertebral body was close to upper sagittal diameter of lower vertebral body. Cobb angle of male was (7.61 +/- 3.85) degrees, while female's was (5.58 +/- 2.59) degrees .

CONCLUSIONDuring the anterior in-ternal fixation of cervicothoracic junction, it is suggested that the entry points of upper vertebral body should locate on the lower and middle 1/3 of vertebral body, and screws could slightly incline towards cranial,the entry points of lower vertebral body should locate on the upper and middle 1/3 of vertebral body, while screws could slightly incline towards caudal, also can be prebent according to Cobb angle of health.

Adult ; Aged ; Cervical Vertebrae ; anatomy & histology ; diagnostic imaging ; surgery ; Female ; Fracture Fixation, Internal ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Radiography ; Thoracic Vertebrae ; anatomy & histology ; diagnostic imaging ; surgery ; Young Adult

INTRODUCTIONThis study aimed to evaluate the clinical and radiological outcomes, and safety and efficacy of percutaneous pedicle screw fixation (PPSF) in the treatment of thoracolumbar burst fractures.

METHODSThis was a retrospective review of patients with thoracolumbar burst fractures treated with PPSF in a single hospital from 2010 to 2011. Baseline data included patient demographics, mechanism of injuries, fracture level, neurologic status and the number of percutaneous screws inserted. Kyphotic angle correction, vertebral body height restoration and mid-sagittal canal diameter improvement were used to assess radiological outcome. Screw misplacement, operative complications, functional improvement (ASIA score) and pain score on visual analogue scale were used to assess safety and clinical outcomes.

RESULTS21 patients with 25 thoracolumbar burst fractures were treated with 134 percutaneous screws. There was significant improvement in kyphotic angle correction (mean difference 6.1 degrees, p = 0.006), restoration of anterior and posterior vertebral height (mean difference 19.7%, p < 0.01 and mean difference 6.6%, p = 0.007, respectively) and mid-sagittal canal diameter (mean difference 15.6%, p = 0.007) on discharge. These improvements remained statistically significant at six months post operation for restoration of anterior vertebral body height (mean difference 9.8%, p = 0.05) and mid-sagittal diameter (mean difference 30.0%, p < 0.01).

CONCLUSIONIn this first local review, we have shown that PPSF is a relatively safe and effective technique for treating selected thoracolumbar burst fractures, and that it yields satisfactory results. However, its long-term outcome and efficacy need to be further evaluated.

Adult ; Aged ; Bone Screws ; Female ; Fracture Fixation, Internal ; adverse effects ; instrumentation ; methods ; Humans ; Lumbar Vertebrae ; injuries ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Radiography ; Retrospective Studies ; Safety ; Singapore ; Spinal Fractures ; diagnostic imaging ; surgery ; Thoracic Vertebrae ; injuries ; Treatment Outcome

BACKGROUND: Detection of postoperative spinal cord level change can provide basic information about the spinal cord status, and electrophysiological studies regarding this point should be conducted in the future. METHODS: To determine the changes in the spinal cord level postoperatively and the possible associated factors, we prospectively studied 31 patients with scoliosis. All the patients underwent correction and posterior fusion using pedicle screws and rods between January 2008 and March 2009. The pre- and postoperative conus medullaris levels were determined by matching the axial magnetic resonance image to the sagittal scout image. The patients were divided according to the change in the postoperative conus medullaris level. The change group was defined as the patients who showed a change of more than one divided section in the vertebral column postoperatively, and the parameters of the change and non-change groups were compared. RESULTS: The mean pre- and postoperative Cobb's angle of the coronal curve was 76.80degrees +/- 17.19degrees and 33.23degrees +/- 14.39degrees, respectively. Eleven of 31 patients showed a lower conus medullaris level postoperatively. There were no differences in the pre- and postoperative magnitude of the coronal curve, lordosis and kyphosis between the groups. However, the postoperative degrees of correction of the coronal curve and lumbar lordosis were higher in the change group. There were also differences in the disease entities between the groups. A higher percentage of patients with Duchene muscular dystrophy had a change in level compared to that of the patients with cerebral palsy (83.3% vs. 45.5%, respectively). CONCLUSIONS: The conus medullaris level changed postoperatively in the patients with severe scoliosis. Overall, the postoperative degree of correction of the coronal curve was higher in the change group than that in the non-change group. The degrees of correction of the coronal curve and lumbar lordosis were related to the spinal cord level change after scoliosis correction.
Adolescent ; Adult ; Cerebral Palsy/complications ; Child ; Female ; Humans ; Kyphosis/radiography ; Lordosis/radiography ; Lumbar Vertebrae/radiography/surgery ; *Magnetic Resonance Imaging ; Male ; Muscular Dystrophy, Duchenne/complications ; Prospective Studies ; Scoliosis/complications/radiography/*surgery ; Severity of Illness Index ; Spinal Cord/*pathology ; Thoracic Vertebrae/radiography/surgery ; Young Adult

INTRODUCTIONThe optimal management of thoracolumbar spine fractures remains a matter of controversy. The current literature implies that the use of short-segment pedicle screw fixation may be inappropriate because of its high reported failure rate. The purpose of this study is to report the short-term results of thoracolumbar burst and compression fractures treated with short-segment pedicle instrumentation.

MATERIALS AND METHODSFrom 2002 to 2007, 19 patients with thoracolumbar acute traumatic fractures were instrumented with posterior short-segment pedicle screws. The patients' case notes, operation records, preoperative and postoperative radiographs (sagittal index, anterior body compression and regional kyphosis), computed tomography scans, neurological findings (Frankel functional classification), and follow-up records up to 18 months were reviewed.

RESULTSA statistically significant difference was found between the patients' preoperative, postoperative and follow-up sagittal index, anterior body compression and regional kyphosis measurement. One case resulted in screw pedicle screw pullout and subsequently, kyphotic deformity. The patient underwent revision surgery to long-segment posterior instrumentation and fusion. None of the patients showed an increase in neurological deficit.

CONCLUSIONIn conclusion, the short-term follow-up results suggest a favourable outcome for short-segment instrumentation. Load shearing classification is essential for the selection of patient for short-segment instrumentation. However, the long-term follow-up evaluation will be needed to verify our findings.

Acute Disease ; Adult ; Analysis of Variance ; Bone Screws ; Female ; Health Status Indicators ; Humans ; Kyphosis ; diagnostic imaging ; surgery ; Lumbar Vertebrae ; injuries ; surgery ; Male ; Middle Aged ; Radiography ; Retrospective Studies ; Spinal Fractures ; surgery ; Spinal Fusion ; methods ; Thoracic Vertebrae ; injuries ; surgery ; Time Factors ; Treatment Outcome

We report here on a new technique using polymethylmethacrylate to manage vertebral osteoporotic compression fractures in three patients. These patients presented with acute back pain that manifested itself after minor trauma. Osteoporotic compression fractures were diagnosed via plain X-ray and magnetic resonance imaging studies. The patients were treated with absolute bed rest and non-steroidal anti-inflammatory drugs. Despite of the conservative treatment, the patients experienced severe, recalcitrant and progressive pain. The vertebrae were collapsed over 50% or kyphotic deformity was seen on the radiologic materials. We performed a new technique called lordoplasty, which is derived from percutaneous vertebroplasty. The patients experienced a reduction in pain after the procedure. The wedge and kyphotic angles of the fractured vertebrae were significantly restored.
Aged ; Female ; Fractures, Compression/radiography/*surgery ; Humans ; Magnetic Resonance Imaging ; Orthopedic Procedures/*methods ; Osteoporotic Fractures/radiography/*surgery ; Spinal Fractures/radiography/*surgery ; Thoracic Vertebrae/*injuries/radiography/surgery

OBJECTIVESTo investigate the spatial structure of pedicle rib units in normal thoracic human spines and to compare the dimensions of the pedicle rib unit with corresponding dimensions.

METHODSThoracic spine specimens in four fresh adult cadaveric were used. Computerized tomographic (CT) images (including two-dimensional, three-dimensional reconstruction) of the thoracic spines were obtained. Measurement parameters include:the width, the height, the chord length and the sagittal angles of the pedicle rib unit compared with pedicle, especially for the pedicle-rib overlapping height.

RESULTSThe pedicle rib unit was not a simple two-dimensional structure but a three-dimensional structure. The shortest height of pedicle rib unit was (12.6 ± 0.8) mm (T(1)), while the longest was (16.9 ± 1.1) mm (T(11)). The shortest height of pedicle-rib overlap was (7.2 ± 0.3) mm (T(1)), while the longest was (11.8 ± 1.0) mm (T(10)). The height of pedicle rib unit and the height of pedicle were significantly larger than that of the pedicle-rib overlap (P < 0.05), while there was no significantly difference between the height of pedicle rib unit and the height of pedicle (P > 0.05).

CONCLUSIONSThe pedicle rib unit is a complicated spatial structure, and the longitudinal height of pedicle-rib overlap should be taken as the real height of the unit.

Adult ; Bone Screws ; Humans ; Male ; Radiography ; Ribs ; anatomy & histology ; diagnostic imaging ; Thoracic Vertebrae ; anatomy & histology ; diagnostic imaging ; surgery