Upper thoracic myelopathy caused by vertebral collapse and subluxation in rheumatoid arthritis: report of two cases

We report two cases of rheumatoid arthritis (RA) with upper thoracic myelopathy and a review of the literature. Clinical data of a 47-year-old woman (case 1) and a 54-year-old woman (case 2) are described. Case 1 showed a transverse-type myelopathy at the T2 segment level of the spinal cord and case 2 had the same type of myelopathy at the T4 segment level. Case 1 had anterior vertebral subluxation of C7 due to marked vertebral collapse and Case 2 had subluxation of T2 with vertebral destruction. These two patients had the mutilating type of RA with multilevel spontaneous fusion in the cervical spine. The lesions in the thoracic spine might be caused by the severe destructive inflammation that is characteristic in mutilating disease. The vertebral collapse might lead to subluxation of the upper thoracic vertebra, resulting in spinal cord compression. Upper thoracic subluxation might be caused by vertebral collapse due to RA and the increased motion as a compensation for decreased mobility caused by spontaneous fusion in the cervical spine.     

AF系统治疗胸腰椎骨折脱位的相关问题

目的 :探讨AF系统治疗胸腰椎骨折脱位的相关问题与效果。方法 :应用AF系统经椎弓根内固定治疗胸腰椎骨折脱位 3 6例 ,合并脊髓损伤 3 2例 ,同时行椎板减压 2 8例 ,植骨 6例。结果 :3 3例椎体高度完全恢复 ,神经功能按ASIA标准 2 5例有 1～ 3级恢复。结论 :AF系统治疗胸腰椎骨折脱位 ,椎体复位好 ,固定安全可靠 ,术中正确掌握椎弓根螺钉植入、椎管减压和复位技巧等环节 ,可进一步提高疗效。     

Anterior thoracic corpectomy without sternotomy: A strategy for malignant disease of the upper thoracic spine

SummaryBackground With increasing frequency, spine surgeons are being asked to provide decompression and stabilization in patients with spinal metastases. While no region of the spine is easily treated, the upper thoracic spine is perhaps the least accessible. Traditional approaches to this region involve either thoracotomy or at least limited sternotomy. The authors present an approach to anterior pathology of the upper thoracic spine that obviates the need for sternotomy.Methods Within the past two years, two patients with cervicothoracic metastases underwent anterior decompression and fusion without sternotomy. In both patients, the bodies of C7, T1, and T2 were removed. While both patients were prepared and draped for sternotomy, each required a neck dissection only. In both patients, left-sided incisions were made along the leading edge of the sternocleidomastoid. The platysma was divided with the overlying skin. With further dissection, the strap muscles were tagged and divided approximately one centimeter above their sternal attachments. The loose areolar tissue of the superior mediastinum was then bluntly dissected. Along the entire length of the incision, the vascular plane medial to the carotid sheath was developed to facilitate exposure of the anterior spine. A Farley-Thompson retractor system was then employed to retract and protect the superior mediastinal structures. With this exposure, corpectomies were carried out using a high speed drill. Fusion was accomplished through insertion of Steinmann pins into the adjacent intact bodies above and below. This was followed by application of methyl methacrylate. Both patients had immediate postoperative stability with preservation of spinal cord function. Both patients subsequently underwent removal of dorsally located tumor with posterior fusion.Conclusions The goal of cancer surgery is to provide for increased functional survival without undue morbidity. The authors feel that when possible, the pain of sternal and clavicular osteotomies should be avoided. The described approach works well in conjunction with a methyl methacrylate/Steinmann pin construct. Because of the intact sternum, the surgeon has a downward angle to access the superior endplate of T3. With adequate soft tissue dissection and retraction as described, however, T3 and perhaps even T4 are easily accessible. While this downward angle would likely not permit an anterior plating procedure, it lends itself nicely to Steinmann pin/methyl methacrylate fusion and spares the patient the pain and potential morbidity of sternotomy.     

腰椎椎弓崩裂CT征象的临床诊断价值

目的分析腰椎椎弓峡部裂的CT表现,探讨各个征象的诊断价值和意义.方法自可疑椎弓峡部裂脊椎的椎弓根的上缘至下一个椎弓根上缘,层厚2～3mm连续扫描.结果86例中发生L5椎弓峡部裂51例,L4者33例,L3,者2例.各种CT征象发现率为:环裂征91%,椎体前移征85%,双椎体征50%,椎管拉长征45%,双关节面征38%,葫芦征26%,游移征15%,磨旋征6%.结论环裂征是该病的特征性表现;双关节面征及葫芦征发现率较低,但特异性较高.椎管拉长征具有一定诊断价值,其它征象无论其发现率大小,均是该病的继发改变,不能作为确诊的直接依据.     

Cancellous Bone Structure in the Growing and Aging Lumbar Spine in a Historic Nubian Population

There is abundant data on cancellous bone in the aging human spine, but little relating to the growing vertebral cancellous bone in childhood and adolescence. The purpose of this study was to map vertebral cancellous bone in a growth and age series of historic skeletal samples and to make comparisons with data published on recent material. Lumbar vertebral bodies were collected from 65 skeletons (0–60 years) from a medieval Nubian population. Ethnohistoric information was collected to interpret conditions that might have influenced bone structure and metabolism. The cancellous bone was studied three dimensionally, using stereophotography and scanning electron microscopy and morphometrically by performing a semiautomatic structural analysis on digitized backscattered electron images of polymethacrylate-embedded material. The cancellous bone structure in the children consisted mainly of a densely packed, uniform network of small rodlike trabeculae. The greatest bone volume fraction with small, more platelike trabeculae was observed during adolescence. In young adults, larger platelike trabeculae were present in the central zone and smaller trabeculae in the superior and inferior zones, as described for modern skeletal material. Structural changes associated with aging were observed much sooner than in modern man. By the estimated age of approximately 50–60 years, the predominant architectural elements were slender rarified rods in both sexes. The ethnohistorical data suggest that this was essentially a black African population of physically active peasants, not likely to suffer Vitamin D insufficiency or deficient calcium intake. Thus an earlier onset of the biological age changes in cancellous bone found in modern populations was probably prevalent. Received: 1 March 1996 / Accepted: 31 December 1996     

A Study on Extension－Flexion Dynamic Lumbar Spine Radiographsin Patients with Lumbar Intervertebral Disc Herniation

ＡＳｔｕｄｙｏｎＥｘｔｅｎｓｉｏｎ－ＦｌｅｘｉｏｎＤｙｎａｍｉｃＬｕｍｂａｒＳｐｉｎｅＲａｄｉｏｇｒａｐｈｓｉｎＰａｔｉｅｎｔｓｗｉｔｈＬｕｍｂａｒＩｎｔｅｒｖｅｒｔｅｂｒａｌＤｉｓｃＨｅｒｎｉａｔｉｏｎＡＳｔｕｄｙｏｎＥｘｔｅｎｓｉｏｎ－Ｆｌｅｘｉ...     

经椎弓根椎间融合与AF治疗胸腰椎骨折

目的：总结32例经椎弓根椎间融合与AF治疗胸腰椎骨折的经验。方法：应用经伤椎椎弓根椎体间融合并AF系统复位内固定，以提高复位效果与脊柱的稳定性。结果：全部病例获随访，时间3～23个月，伤椎均与上位椎体间融合，无矫正角度与高度丢失，无断钉及螺钉松动，神经功能平均1．5级以上的恢复。结论：经椎弓根椎间融合与AF治疗胸腰椎骨折，操作简单，复位可靠，可重建脊柱的稳定性，椎体间融合更符合生物力学内环境的持久稳定。     

压缩回复式椎管扩大成形术治疗胸腰椎骨折并脊髓损伤

目的介绍压缩回复式椎管扩大成形加内固定术在胸腰椎骨折并脊髓损伤中的应用。方法对58例胸腰椎骨折合并脊髓损伤患者，采用自制组合式嵌打整复器对突入椎管的碎骨块，嵌击复位压缩成形，从而扩大椎管容积，同时重建病椎棘上棘间韧带，并行内固定，恢复脊柱后部结构的稳定性。结果50例获得随访，平均2年6个月，30例已恢复轻工作，9例可扶拐下地活动。结论压缩回复式椎管扩大成形术是治疗胸腰椎骨折合并脊髓损伤的新术式，值得在基层医院推广。