To compare long term clinical and radiographic outcomes in osteoporotic vertebral compression fractures of the thoracolumbar spine treated with conservative treatment and percutaneous vertebroplasty.
Methods
The retrospective study with inclusion criteria focused on osteoporotic fractures of the thoracolumbar junction (T10–L2). Clinical outcomes were evaluated by using the VAS, Oswestry and SF36 questionnaires. Radiographic outcomes were evaluated by comparing the following sagittal parameters: body angle, sagittal index of fractured vertebral body and adjacent vertebral segments kyphosis. Complications in terms of adjacent vertebral fractures and cement leakage are reported.
Results
Percutaneous vertebroplasty provided better vertebral body height restoration, but was associated with a higher incidence of adjacent fractures (20%) than conservative treatment (3.5%). This fact may explain why patients treated with percutaneous vertebroplasty had worse overall kyphotic alignment at final follow-up. Cement leakage was frequent, but always asymptomatic and generally no serious complications occurred.
Conclusions
Percutaneous vertebroplasty represents a safe treatment for osteoporotic vertebral compression fractures, although it may be associated with a higher incidence of adjacent fractures and therefore worse thoracolumbar kyphosis and long-term follow-up than conservative treatment.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.
To present a classification system for vertebral body osteonecrosis (VBON) based on imaging findings and sagittal alignment and consequently to propose treatment guidelines.
Methods
Chart review and classification of imaging and clinical findings. An analysis of literature about VBON has been evaluated to conceive the classification. The current data allows to correlate radiological findings with different stages of the pathophysiological process and consequently to propose a patient-tailored treatment plan.
Results
The classification identifies 4 stages: stage 0 (theoretical phase), stage 1 (early phase), stage 2 (instability phase) and stage 3 (fixed deformity phase). Local (angular kyphosis expressed as anterior–posterior wall height ratio) and global (sagittal vertical axis and pelvic tilt) sagittal alignment are considered as complementary modifiers to tailor the most suitable treatment. Stage 1 is generally managed conservatively. Stage 2 and 3 often require different surgical approaches according to local and global sagittal alignment.
Conclusions
The classification allows a systematic staging of this disease and can help establish a proper and patient-oriented treatment plan. Further researches are advocated to fully validate the proposed classification system.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.
To investigate the effect of the preoperative cross-sectional area (CSA) of the semispinalis cervicis on postoperative loss of cervical lordosis (LCL) after laminoplasty.
Methods
A total of 144 patients who met the inclusion criteria between January 1999 and December 2015 were enrolled. Radiographic assessments were performed to evaluate the T1 slope, C2-7 sagittal vertical axis (SVA), cephalad vertebral level undergoing laminoplasty (CVLL), preoperative C2-7 Cobb angle, and preoperative CSA of the semispinalis cervicis.
Results
The T1 slope and the summation of the CSAs (SCSA) at each level of the semispinalis cervicis correlated with LCL, whereas the C2-7 SVA, CVLL, and preoperative C2-7 Cobb angle did not. Multiple regression analysis demonstrated that a high T1 slope and a low SCSA of the semispinalis cervicis were associated with LCL after laminoplasty in patients with cervical spondylotic myelopathy (CSM). The CSA of the semispinalis cervicis at the C6 level had the greatest association with LCL, which suddenly decreased with a LCL of 10°. The best cutoff point of the CSA of the semispinalis cervicis at the C6 level, which predicts LCL?>?10°, was 154.5 mm2 (sensitivity 74.3%; specificity 71.6%; area under the curve 0.828; 95% confidence interval 0.761–0.895).
Conclusion
Preoperative SCSA of the semispinalis cervicis was a risk factor for LCL after laminoplasty. Spine surgeons should evaluate semispinalis cervicis muscularity at the C6 level when planning laminoplasty for patients with CSM.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.
Kyphoplasty has been widely used to treat vertebral compression fractures (VCFs). In standard procedure of kyphoplasty, two balloons were inserted into the vertebral body through bipedicular and inflated simultaneously, while using a single balloon two times is also a common method in clinic to lessen the financial burden of patients. However, the effect and safety of single balloon versus double balloon bipedicular kyphoplasty are still controversy.
Methods
In this systematic review and meta-analysis, eligible studies were identified through a comprehensive literature search of PubMed, Cochrane library EMBASE, Web of Science, Wanfang, CNKI, VIP and CBM until January 1, 2018. Results from individual studies were pooled using a random or fixed effects model.
Results
Seven articles were included in the systematic review and five studies were consisted in meta-analysis. We observed no significant difference between single balloon and double balloon bipedicular kyphoplasty in visual analog scale (VAS), angle (kyphotic angle and Cobb angle), consumption (operation time, cement volume and volume of bleeding), vertebral height (anterior height, medium height and posterior height) and complications (cement leakage and new VCFs), while the cost of single balloon bipedicular kyphoplasty is lower than that of double balloon bipedicular kyphoplasty. The results of our meta-analysis also demonstrated that single balloon can significantly improve the VAS, angle and vertebral height of patients suffering from VCFs.
Conclusion
This systematic review and meta-analysis collectively concludes that single balloon bipedicular kyphoplasty is as effective as double balloon bipedicular kyphoplasty in improving clinical symptoms, deformity and complications of VCFs but not so expensive.
Graphical Abstract
These slides can be retrieved under Electronic Supplementary Material.
Growing evidence suggests an association between lumbar paraspinal muscle degeneration and low back pain (LBP). Currently, time-consuming and laborious manual segmentations of paraspinal muscles are commonly performed on magnetic resonance imaging (MRI) axial scans. Automated image analysis algorithms can mitigate these drawbacks, but they often require individual MRIs to be aligned to a standard “reference” atlas. Such atlases are well established in automated neuroimaging analysis. Our aim was to create atlases of similar nature for automated paraspinal muscle measurements.
Methods
Lumbosacral T2-weighted MRIs were acquired from 117 patients who experienced LBP, stratified by gender and age group (30–39, 40–49, and 50–59 years old). Axial MRI slices of the L4–L5 and L5–S1 levels at mid-disc were obtained and aligned using group-wise linear and nonlinear image registration to produce a set of unbiased population-averaged atlases for lumbar paraspinal muscles.
Results
The resulting atlases represent the averaged morphology and MRI intensity features of the corresponding cohorts. Differences in paraspinal muscle shapes and fat infiltration levels with respect to gender and age can be visually identified from the population-averaged data from both linear and nonlinear registrations.
Conclusion
We constructed a set of population-averaged atlases for developing automated algorithms to help analyze paraspinal muscle morphometry from axial MRI scans. Such an advancement could greatly benefit the fields of paraspinal muscle and LBP research.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.
The objective of this article is to report a case of type V osteogenesis imperfecta (OI) undergoing posterior instrumented fusion for scoliosis. Type V OI is a moderately severe dysplasia causing primary defects in endochondral bone ossification or mineralisation. It is characterised by hyperplastic callus (HPC) formation, interosseous membrane calcifications, poor bone quality and spinal deformities including scoliosis. Data on the surgical management of spinal deformities in this patient group are lacking.
Case report
A 16-year-old patient with a confirmed diagnosis of type V OI presented with a progressive scoliosis. The patient underwent a T3–L4 posterior instrumented correction and fusion utilising pedicle screws, pedicle hooks and sub-laminar wiring. At 4 months after surgery, the pedicle hooks pulled out and required partial metalwork removal after CT scanning confirmed bony union and no evidence of HPC formation. The patient was successfully discharged with satisfactory correction, confirmed bony union, no neurologic complication and absence of any hyperplastic callus formation.
Conclusion
Type V OI patients requiring surgical intervention for scoliosis correction can safely undergo posterior instrumented fusion using sublaminar wiring and pedicle hook/screw constructs without apparent risk of HPC formation around neural elements. Surgery in this patient group remains challenging due to the associated poor bone quality.
Methicillin-sensitive Staphylococcus aureus (MSSA) carriage may confer a significant risk of surgical site infection (SSI) and is common amongst the UK population. Screening for MSSA is not routinely offered to patients in the UK. Primary aim was to review the impact of introducing a MSSA screening programme, in addition to established Methicillin-resistant Staphylococcus aureus (MRSA) screening, on the incidence of SSIs following lumbar spine surgery.
Methods
A consecutive group of 1307 patients during 12 months before (phase 1: n?=?716) and after (phase 2: n?=?591) introduction of the MSSA screening programme were compared. Analysis was restricted to those with inpatient stay greater than 4 days, readmission within 6 weeks and a rising CRP 7 or more days following the procedure. Diagnosis of SSI was based around the CDC guidelines for wound surveillance. Patients were excluded where the primary surgery was to treat infection, or the procedure was percutaneous. Chi-squared test was used to compare the two groups.
Results
Seven hundred and sixteen patients were in phase 1. Rate of infection was 2.65%. Rate of MRSA colonisation was 0%. Five hundred and ninety-one patients were in phase 2. Rate of infection was 1.02%. Rate of MRSA colonisation was 0%, and rate of MSSA colonisation was 26%. Reduction in incidence of SSIs was 62% (p?=?0.0409).
Conclusion
MSSA colonisation is common, although wound infection following lumbar spinal surgery remains a rare event. A screening programme for MSSA can significantly reduce incidence of SSIs in this patient group. These findings may be applicable to wider elective orthopaedic practice.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.
Intervertebral kinematic assessments have been used to investigate mechanical causes when back pain is resistant to treatment, and recent studies have identified intervertebral motion markers that discriminate patients from controls. However, such patients are a heterogeneous group, some of whom have structural disruption, but the effects of this on intervertebral kinematics are unknown.
Methods
Thirty-seven patients with treatment-resistant back pain referred for quantitative fluoroscopy were matched to an equal number of pain-free controls for age and sex. All received passive recumbent flexion assessments for intervertebral motion sharing inequality (MSI), variability (MSV), laxity and translation. Comparisons were made between patient subgroups, between patients and controls and against normative levels from a separate group of controls.
Results
Eleven patients had had surgical or interventional procedures, and ten had spondylolisthesis or pars defects. Sixteen had no disruption. Patients had significantly higher median MSI values (0.30) than controls (0.27, p?=?0.010), but not MSV (patients 0.08 vs controls 0.08, p?=?0.791). Patients who received invasive procedures had higher median MSI values (0.37) than those with bony defects (0.30, p?=?0.018) or no disruption (0.28, p?=?0.0007). Laxity and translation above reference limits were not more prevalent in patients.
Conclusion
Patients with treatment-resistant nonspecific back pain have greater MSI values than controls, especially if the former have received spinal surgery. However, excessive laxity, translation and MSV are not more prevalent in these patients. Thus, MSI should be investigated as a pain mechanism and for its possible value as a prognostic factor and/or target for treatment in larger patient populations.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.
The purpose of this study was to compare the rates of adjacent segment degeneration (ASD), sagittal alignment parameters, and patient-reported outcomes in patients who underwent multi-level versus single-level anterior cervical discectomy and fusion (ACDF).
Methods
A retrospective cohort analysis was performed on consecutive patients who underwent an ACDF. Pre- and post-operative radiographic assessment included ASD, change in C2–C7 lordosis, T1 angle, levels fused, sagittal vertical axis (SVA), fusion mass lordosis, proximal and distal adjacent segment lordosis. Patient-reported outcomes were obtained.
Results
Of the 404 that underwent an ACDF with a minimum of 6 months of follow-up (average 28 months), there was no significant difference in the rate of radiographic ASD overall (p = 0.479) or in the proximal or distal adjacent segments on multivariate analysis. Secondarily, the multi-level fusions appear to restore significantly greater amounts of lordosis compared to single-level procedures (p < 0.001) and are able to maintain the corrected cervical lordosis and fusion segment lordosis over time. From the immediate post-operative period to final follow-up, the single-level ACDFs show continuing lordosis improvement (p = 0.005) that is significantly greater than that of the multi-level constructs. There were no significant differences between pre-operative, post-operative, or change in patient-reported outcomes.
Conclusions
Two years following an ACDF, patients who underwent multi-level fusions appear to restore significantly greater amounts of lordosis compared to single-level procedures, while single-level ACDFs show significantly greater amounts of lordosis improvement over time. Multi-level procedures may not be at a significantly greater risk of developing early radiographic evidence of ASD compared to single-level procedure.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.
This study aims to determine whether secondary CT findings can predict posterior ligament complex (PLC) injury in patients with acute thoracic (T) or lumbar (L) spine fractures.
Methods
This is a retrospective study of 105 patients with acute thoracic and lumbar spine fractures on CT, with MRI as the reference standard for PLC injury. Three readers graded CT for facet joint alignment (FJA), widening (FJW), pedicle or lamina fracture (PLF), spinous fracture (SPF), interspinous widening (ISW), vertebral translation (VBT), and posterior endplate fracture (PEF). Univariate and multivariate logistic regression analyses were performed separately for each reader to test for associations between CT and PLC injury, and diagnostic performance of CT was calculated.
Results
Fifty-three of 105 patients had PLC injury by MRI. Statistically significant predictors of PLC injury were VBT, PLF, ISW, and SPF. Using these four CT findings, odds of PLC injury ranged from 3.8 to 5.6 for one positive finding, but increased to 13.6–25.1 for two or more. At least one positive CT finding was found to yield average sensitivity of 82% and specificity 59%, while two or more yielded sensitivity 46% and specificity 88%.
Conclusion
While no individual CT finding is sufficiently accurate to diagnose or exclude PLC injury, greater the number of positive CT findings (VBT, PLF, ISW, and SPF), the higher the odds of PLC injury. The presence of a single abnormal CT finding may warrant confirmatory MRI for PLC injury, while two or more CT findings may have adequate specificity to avoid need for MRI prior to surgical intervention.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.
To clarify the clinical manifestation and radiological characteristics of idiopathic syringomyelia (IS) and to investigate the relationship between syrinx and scoliotic curves in IS-related scoliosis patients.
Methods
Fifty-five patients with IS and scoliosis were identified and reviewed retrospectively from June 2009 to December 2016. Radiographic features of syrinx, scoliosis and clinical manifestations of neurological deficits were collected. The syrinx/cord (S/C) ratio was defined as the anteroposterior diameter of syrinx divided by the diameter of spinal cord at the same level. Patients were classified into two groups, the thoracic group (T group, apex vertebra located from T2 to intervertebral disk of T11–T12) and the thoracolumbar/lumbar group (TL/L group, apex vertebra located from T12 to L5).
Results
There was no correlation between the radiological features of idiopathic syrinx and scoliotic curve parameters. The TL/L group had a lower level of most caudal extent (13.7 compared with 10.6, P?=?0.029) and lower level of largest S/C ratio (12.0 compared with 8.7, P?=?0.016) than that in T group. The deviated side of syrinx was not coincident with major curve convexity (27.2% concordance rate, P?=?0.522) or dominant side of neurological deficit (16.3% concordance rate, P?=?0.212).
Conclusions
Patients with major curves located on the thoracolumbar or lumbar spine had a much lower caudal extent and lower level of greatest S/C ratio compared to patients with major curves located on the thoracic spine. No significant relationships were detected between syrinx features, scoliotic curve parameters and neurological deficits.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.
To examine the incidence of occult infection in revision spine surgeries and its correlation with preoperative inflammatory markers.
Methods
We retrospectively reviewed all patients who underwent revision spine surgery and hardware removal between 2010 and 2016. Patients who had preoperative clinical signs of infection were excluded. The hardware and surrounding tissue culture results were obtained. The patients’ diagnosis and preoperative inflammatory marker (ESR, CRP, and procalcitonin) levels were recorded.
Results
A total of 162 consecutive patients were included in this study. The patients’ mean age was 61 years (range 14–88). One hundred and three patients (63.6%) were female. Seventy-two patients (44.4%) had loose hardware and 88 patients (54.3%) had pseudarthrosis. Postoperatively, the hardware and/or surrounding tissue culture was positive in 15 patients (9.3%). The most commonly identified organisms were Propionibacterium acnes (7/15, 46.7%) and Staphylococcus (6/15, 40.0%). The other identified organisms were Pseudomonas aeruginosa (1/15, 6.7%) and Serratia marcescens (1/15, 6.7%). Only four patients with positive cultures had elevated preoperative ESR and CRP levels. Only two patients with positive cultures had elevated preoperative procalcitonin levels. There is no correlation between the patients’ preoperative ESR, CRP, procalcitonin levels, and positive culture results (p?>?0.05).
Conclusions
Our study shows that occult infections are present in 9.3% of patients who underwent revision spine surgery and hardware removal although they did not have clinical signs of infection. Those commonly used preoperative inflammatory markers such as ESR, CRP, and procalcitonin may not be sensitive enough to detect occult infections in these patients.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.
Preoperative planning of scoliosis surgery is essential in the effective treatment of spine pathology. Thus, precontoured rods have been recently developed to avoid iatrogenic sagittal misalignment and rod breakage. Some specific issues exist in adolescent idiopathic scoliosis (AIS), such as a less distal lower instrumented level, a great variability in the location of inflection point (transition from lumbar lordosis to thoracic kyphosis), and sagittal correction is limited by both bone–implant interface. Since 2007, stereoradiographic imaging system is used and allows for 3D reconstructions. Therefore, a software was developed to perform preoperative 3D surgical planning and to provide rod’s shape and length. The goal of this preliminary study was to assess the feasibility, reliability, and the clinical relevance of this new software.
Methods
Retrospective study on 47 AIS patients operated with the same surgical technique: posteromedial translation through posterior approach with lumbar screws and thoracic sublaminar bands. Pre- and postoperatively, 3D reconstructions were performed on stereoradiographic images (EOS system, Paris, France) and compared. Then, the software was used to plan the surgical correction and determine rod’s shape and length. Simulated spine and rods were compared to postoperative real 3D reconstructions. 3D reconstructions and planning were performed by an independent observer.
Results
3D simulations were performed on the 47 patients. No difference was found between the simulated model and the postoperative 3D reconstructions in terms of sagittal parameters. Postoperatively, 21% of LL were not within reference values. Postoperative SVA was 20 mm anterior in 2/3 of the cases. Postoperative rods were significantly longer than precontoured rods planned with the software (mean 10 mm). Inflection points were different on the rods used and the planned rods (2.3 levels on average).
Conclusion
In this preliminary study, the software based on 3D stereoradiography low-dose system used to plan AIS surgery seems reliable for preoperative planning and precontoured rods. It is an interesting tool to improve surgeons’ practice, since 3D planning is expected to reduce complications such as iatrogenic malalignment and to help for a better understanding of the complications, choosing the location of the transitional vertebra. However, further work is needed to improve thoracic kyphosis planning.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.
Stiff-knee gait is a common gait deviation in individuals with cerebral palsy (CP) due to rectus femoris (RF) muscle spasticity. The Duncan-Ely test is a velocity-dependent measurement of spasticity that is recorded as positive or negative. At our institution, we use a modification of the Duncan-Ely test, a 5-point ordinal rating scale, which delineates where the catch occurs within the rapid arc of knee flexion. It has been named the Root-Ely test.
Questions/Purposes
We sought to determine the intra- and inter-rater reliability of the Duncan-Ely and Root-Ely tests in pediatric patients with CP.
Methods
A convenience sample of 20 ambulatory subjects was recruited; mean age was 10.5?±?4.5 years, and the Gross Motor Function Classification System (GMFCS) levels were I–III. Five clinicians measured each individual’s RF spasticity using the Root-Ely protocol during a single visit. Simple κ statistics with 95% confidence intervals (CI) were utilized for intra-rater reliability and weighted κ statistics with 95% CI for inter-rater reliability.
Results
The Root-Ely scale intra-rater reliability was 0.77 to 0.90 and inter-rater reliability was 0.32 to 0.87. Inter-rater reliability was good to excellent among experienced clinicians and fair to moderate in new clinicians.
Conclusion
The Root-Ely 5-point scale has acceptable intra- and inter-rater reliability in pediatric individuals with CP among experienced clinicians. The Root-Ely test allows experienced clinicians to reliably quantify severity of RF spasticity and may give orthopaedic surgeons a clinical tool to better predict ideal candidates for RF transfers in individuals with CP in order to improve stiff-knee gait.
Surgical site infection (SSI) is a main complication after adolescent idiopathic scoliosis (AIS) surgery. Nasal colonization with S. aureus is a known risk factor for developing nosocomial infections in cardiac surgery. However, the risk in orthopedic surgery remains unclear, especially in spine surgery. This study aims to report the efficacy of a preoperative nasal decontamination program in S. aureus carriers on the incidence of early SSI after AIS posterior surgery.
Methods
Between January 2014 and July 2017, all AIS patients were screened preoperatively with nasal swabs and decontaminated if positive 5 days before surgery. Early SSI was identified, and microorganisms findings were analyzed within nasal carriage and compared to a previous series published before the decontamination program (2007–2011).
Results
Among the 331 AIS posterior fusion performed during the study period, incidence of positive nasal swab was 23% (n?=?75). Those were preoperatively decontaminated. In comparison with the period before the nasal decontamination program, incidence of S. aureus early SSI significantly decreased from 5.1 to 1.3%, p?<?0.05. None of those S. aureus decontaminated patients had an early S. aureus SSI. In all cases of S. aureus infections, S. aureus nasal screening was negative with a mean delay of 315 days (±?115) before surgery, which was significantly different from the global cohort (104 days?±?67, p?<?0.05).
Conclusions
Preoperative S. aureus nasal decontamination was associated with a significant decrease in S. aureus SSI. Optimal delay of nasal screening needs to be optimized in order to diagnose intermittent S. aureus carriers.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.
The purpose of this study was to examine whether Hounsfield units (HUs), as an alternative bone mineral density measurement to dual-energy X-ray absorptiometry and quantitative computed tomography, which lead to additional radiation exposure for patients, has an effect on the maintenance of reduction in bisegmental Cobb angle (CA) and cage subsidence in patients who receive bisegmental spine stabilization after traumatic thoracolumbar spine fractures.
Methods
A total of 81 patients with a mean follow-up of 12 months were analyzed. CAs and cage subsidence were measured intraoperatively and at follow-up. HU was measured, and patients were subsequently assigned based on HU to three HU subgroups (group 1: HU?<?110 [poor bone quality (BQ)]; group 2: HU 180–110 [diminished BQ]; group 3: HU?>?180 [good BQ]).
Results
Following anterior stabilization, loss of reduction and cage subsidence differed between patients with poor and diminished BQ but not significantly, and both groups showed significantly more loss of reduction and cage subsidence than patients with good BQ.
Conclusion
BQ, estimated with HU, had significant effects on cage subsidence and loss of reduction. We recommend measuring HU before surgery and applying additional treatment strategies, such as polymethylmethacrylate augmentation of endplates or anterior plates, for patients with HU?<?180.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.
To investigate differences in functional intervertebral disk (IVD) characteristics between low back pain (LBP) patients and controls using T2-mapping with axial loading during MRI (alMRI).
Methods
In total, 120 IVDs in 24 LBP patients (mean age 39 years, range 25–69) were examined with T2-mapping without loading of the spine (uMRI) and with alMRI (DynaWell® loading device) and compared with 60 IVDs in 12 controls (mean age 38 years, range 25–63). The IVD T2-value was acquired after 20-min loading in five regions of interests (ROI), ROI1-5 from anterior to posterior. T2-values were compared between loading states and cohorts with adjustment for Pfirrmann grade.
Results
In LBP patients, mean T2-value of the entire IVD was 64 ms for uMRI and 66 ms for alMRI (p?=?0.03) and, in controls, 65 ms and 65 ms (p?=?0.5). Load-induced T2-differences (alMRI–uMRI) were seen in all ROIs in both patients (0.001?>?p?<?0.005) and controls (0.0001?>?p?<?0.03). In patients, alMRI induced an increase in T2-value for ROI1-3 (23%, 18% and 5%) and a decrease for ROI4 (3%) and ROI5 (24%). More pronounced load-induced decrease was detected in ROI4 in controls (9%/p?=?0.03), while a higher absolute T2-value was found for ROI5 during alMRI in patients (38 ms) compared to controls (33 ms) (p?=?0.04).
Conclusion
The alMRI-induced differences in T2-value in ROI4 and ROI5 between patients and controls most probably indicate biomechanical impairment in the posterior IVD regions. Hence, alMRI combined with T2-mapping offers an objective and clinical feasible tool for biomechanical IVD characterization that may deepen the knowledge regarding how LBP is related to altered IVD matrix composition.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.
In this paper, the authors propose classifying the epiphenomenon of spinal deformity in two different categories: structural deformity, when the main driver of the observed deformity is a fixed and stiff alteration of the spinal segments, and compensatory deformity, which includes cases where the observed deformity is due to focal abnormalities. This last category comprises, but is not limited to, spinal stenosis, spondylolisthesis, disc herniation, infection or tumor, hip disease or neurological disease (such as Parkinson’s disease).
Method
Narrative review article.
Results
We analyzed the focal diseases of the spine that may cause a compensatory deformity inducing adaptation in the unaffected part of the spine.
Conclusion
The compensatory mechanisms involved in adaptive deformity represent an attempt to maintain a global alignment, to escape from pain or to control body posture.
Graphical abstract
These slides can be retrieved under Electronic Supplementary material.
To use radiofrequency ablation (RFA) in the resection of C4 cervical chordoma with a giant paravertebral tumor mass to achieve tumor-free exposed margins and perform a gross total excision.
Methods
A gross total excision using combined posterior and anterior approaches was performed. In the posterior stage, the C4 posterior arch was removed and the C4/C5 nerve roots and vertebral artery were released from the tumor. In the anterior stage, the giant soft mass of tumor from C3 to C6 was treated with RFA to make it shrink and solidify visually to achieve tumor-free exposed margins before resecting the tumor. Finally, a gross total excision was performed followed by the implantation of titanium plate and mesh filled with allograft bone.
Results
A gross total excision was performed with tumor-free exposed margins and radiotherapy. The patient survived more than 5 years without recurrence.
Conclusions
RFA can help achieve tumor-free exposed margins. A gross total excision combined with RFA can improve the local relapse-free survival of patients with cervical chordoma.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.
