脊柱骨软骨瘤的诊断与外科治疗

目的:探讨脊柱骨软骨瘤的诊断及手术治疗效果。方法:1995年1月～2006年6月我院手术治疗脊柱骨软骨瘤患者21例,男14例,女7例,平均年龄35岁(8～61岁)。其中19例为孤立性骨软骨瘤,2例为多发性骨软骨瘤病;病变位于颈椎14例(含颈胸交界段2例),胸椎5例,腰椎2例(含腰骶交界段1例);病变均起自椎弓根、椎板和/或关节突等附件结构。其中15例有神经功能损害,3例仅有局部疼痛或不适,3例为无痛肿物。术前脊髓功能Frankel分级C级1例,D级8例,E级12例。21例均行手术治疗、彻底切除肿瘤。随访观察手术时间、术中出血、术前症状和脊髓功能恢复情况,以及肿瘤复发、恶变和脊柱稳定性情况。结果:平均手术时间130min(45～360min);术中平均出血510ml(20～2000ml)。术后病理诊断均为骨软骨瘤。17例获得随访,平均7.1年(4～14年),术前有脊髓神经功能障碍者均恢复至Frankel E级,末次随访时CT检查均未发现肿瘤复发或恶变。结论:CT和/或MRI检查对诊断脊柱骨软骨瘤有重要意义,手术彻底切除可获得良好效果。     

幼儿胸腰椎置人椎弓根螺钉可行性临床研究

目的 探讨在1～3岁的幼儿下胸椎和腰椎置入椎弓根螺钉的可行性和安全性.方法 2002年1月至2007年1月,对10例1～3岁下胸椎和腰椎疾患患儿应用成人颈椎侧块螺钉进行固定矫形,男7例,女3例;年龄1～3岁,其中1～2岁4例,2～3岁6例.先天性半椎体畸形合并脊柱侧凸7例,均为完全分节的单个游离半椎体,不合并对侧分节不全;椎体肿瘤2例,为合并椎管内占位的嗜酸性肉芽肿;脊柱结核1例,为中心型椎体结核并后凸畸形.病变椎体:L3(1例),L2(3例),L1(4例),T12(2例).病变节段为1～2个.经测量T11～L5椎弓根的上下径为5.2～9.0 mm,平均6.5 mm;左右径为3.5～8.0 mm,平均4.6mm.结果 10例患儿共置入40枚螺钉,未发生大血管和神经损伤.3例患儿CT扫描发现各有1枚螺钉置人偏外,并穿破椎弓根和椎体的外缘皮质,其中1例患儿出现1枚螺钉过长超出椎体前缘,但均未损伤血管及内脏.随访时间2～3年,平均2.6年.1例L3椎体嗜酸性肉芽肿患儿,术后6个月时X线片显示L2～L4局部有轻度后凸畸形,但3年后后凸畸形基本自行矫正.10例内固定物在手术后2～3年取出,在随访期间未见内固定物松动及断裂.结论 在1～3岁幼儿的下胸椎和腰椎置入椎弓根螺钉在技术上可行、安全.     

Minimally Invasive Vertebral Replacement with Cages in Thoracic and Lumbar Spine

Patients and Methods: Anterior reconstruction of the thoracic and lumbar spine was performed using Synex™-cages for vertebral body replacement implanted via open but minimally invasive access in 57 patients with trauma (n = 48), metastasis (n = 6), pseudarthrosis (n = 2), and spondylodiscitis (n = 1). Results: No case had to be changed into an open procedure. The upper thoracic spine was approached by a right-sided (n = 10), the thoracolumbar junction by a left-sided (n = 37) mini-thoracotomy, and the lumbar spine by a left-sided mini-retroperitoneal approach (n = 10). The overall mean operating time was 150 min (range 40-325 min) but varied depending on the spine pathology and the magnitude of the intervention to the anterior part of the spine. There were neither visceral/vascular complications nor other intra- or postoperative complications related to the minimal access in particular. No intercostal neuralgias, no post-thoracotomy pain syndromes and no superficial or deep wound infections occurred. One patient with metastatic destruction of the vertebra died intraoperatively due to a thromboembolic complication caused by his underlying disease. Two cases of pseudo-obstruction were treated conservatively. Conclusion: In this study, we describe the use of a new vertebral body replacement for reconstruction of the thoracic and lumbar spine which had been implanted by minimal-access technology.     

Spinal deformity following selective dorsal rhizotomy

The authors performed a review of 79 patients treated by selective dorsal rhizotomy with laminoplasty, 78 of whom were ambulatory, to determine the prevalence of spinal deformities. The mean radiographic follow-up was 4.2 years, the mean clinical follow-up 5.8 years. Scoliosis (11 degrees -24 degrees ) was identified in 13 children, none of whom had a preexisting deformity. There were no significant differences between preoperative and follow-up thoracic kyphosis or lumbar lordosis, although there was a significant difference in lumbar lordosis between sitting and standing radiographs. No progressive or rigid hyperlordotic deformities were observed in the lumbar spine. Spondylolisthesis was identified in nine children (12%) (8/9 grade I), and one patient required an arthrodesis for pain. Spondylolisthesis was correlated with greater lumbar lordosis, stronger hip abductors, and increased popliteal femoral angles preoperatively, and with stronger hip flexors postoperatively. Back pain was identified in 4 of the 79 patients at last follow-up, 2 of whom had spondylolisthesis. As some cases of spondylolisthesis will remain asymptomatic, periodic radiographic follow-up is recommended.     

Is lumbar stenosis associated with thoracic stenosis? A study of 1,072 human cadaveric specimens

Background contextTandem stenosis of the cervical and lumbar spine is known to occur in 5% to 25% of individuals with symptomatic neural compression in one region. However, the prevalence of concurrent lumbar and thoracic stenosis is not known. Whether this relationship is because of an increased risk of degenerative diseases in these individuals or because of the tandem presence of stenosis in lumbar and thoracic canal is unknown.PurposeTo determine the prevalence of concurrent lumbar and thoracic stenosis, and whether the presence of stenosis in the lumbar spine is associated with stenosis in the thoracic spine.Study designA morphoanatomic study of lumbar and thoracic cadaveric spines.MethodsOne thousand seventy-two adult skeletal specimens from the Hamann-Todd Collection in the Cleveland Museum of Natural History were selected. Canal area at each level was also calculated using a geometric formula. A standard distribution for each level was created, and values that were 2 standard deviations below mean were considered as being stenotic. Linear regression analysis was used to determine the association between the additive canal areas at all levels in the lumbar and thoracic spine and between the number of stenotic lumbar and thoracic levels. Logistic regression was used to calculate the odds ratios (OR) for concurrent lumbar and thoracic stenosis.ResultsThe prevalence of concurrent lumbar and thoracic stenosis is 1.42%. A positive association was found between the additive areas of all lumbar and thoracic levels (p<.01). No association, however, was found between the number of stenotic lumbar and thoracic levels (p=.7). Log regression demonstrated no significant association (OR <1) between stenosis in the lumbar and thoracic spine.ConclusionsThe stenosis of the lumbar spine is not associated with the thoracic stenosis. Thus, stenosis in lumbar and thoracic levels does not seem to be contributed by tandem stenosis.     

Single-stage posterolateral vertebrectomy for the management of metastatic disease of the thoracic and lumbar spine: a prospective study of an evolving surgical technique

Appropriate surgical management of spinal metastases combines maximal neural decompression with simultaneous immediate spinal column stabilization in the context of a paliative operation undertaken to improve patients' quality of life. We have used a single-stage posterolateral vertebrectomy (SPLV) for disease of the lumbar spine, combined with bilateral costotransversectomies in the thoracic spine, for these challenging cases. In this prospective cohort study of 96 consecutive patients with metastatic disease of the spinal column for we describe our surgical technique in detail, we examine our learning curve in its use and we analyze the long-term surgical and "quality of life" results in 42 patients who underwent SPLV. The mean and maximum operative blood loss was significantly lower for the SPLV group when compared with combined approaches. All patients either remained neurologically stable or had improved with surgery. Both the mean and the range visual analog scale scores were significantly improved after the SPLV. The SPLV was the only surgical approach to demonstrate a statistically significant improvement in Eastern Cooperative Oncology Group scores at 3 months after the surgery. Seventy-five percent of patients were alive at 6 months and 50% of patients survived for more than 12 months after the surgery. Eleven patients had a major complication (26%) with 9 (21%) patients required early reoperation, 7 of them for wound failure. Our data demonstrates that the SPLV represents a technically achievable improvement in surgical approach to spinal metastases when key parameters are examined. On the basis of these results, we recommend that the SPLV should be considered in all cases where resection of thoracic or lumbar spinal metastatic disease and reconstruction is contemplated.     

微创腰椎360°固定术

目的评估微创腰椎360°固定术的疗效。方法从2002年5月至2005年5月,应用微创腰椎360°固定术治疗患者25例,其中男11例,女14例;年龄45~67岁,平均56岁。腰椎滑脱16例,其中Ⅰ度13例、Ⅱ度3例;腰椎不稳7例;椎间盘源性腰痛2例。行L4,5节段融合14例,L5~S111例。功能评估采用Oswestry D isab ility Index(OD I),统计患者术前、术后2周、3、6、12个月的OD I评分。术后即刻、3、6、12个月摄X线片,观察椎体的融合情况和融合器(cage)有无下沉。结果手术时间从110~180 m in。术中发生1例下腔静脉破裂出血。术后全部病例获得随访,随访时间12~35个月,平均22.3个月。OD I评分手术前为34.15±5.17,术后2周为43.27±10.43,术后3个月为46.14±6.85,术后6个月为44.97±3.65,术后12个月为46.38±4.48,与术前相比有显著差异(P<0.05)。25例植骨手术后3个月融合。1例患者术后3个月X线片显示相邻椎体滑移2 mm,6个月时融合。2例患者发生椎间高度丢失1 mm。无一例发生内置物松动、滑落及逆向射精等并发症。结论微创腰椎360°固定术适用于腰椎不稳、局限节段椎间盘变性及Ⅱ度以下腰椎滑脱伴神经根管狭窄患者。手术出血少、损伤小,但操作时应特别注意大血管的暴露和牵开。     

Radiographic outcome of vertebral bone bruise associated with fracture of the thoracic and lumbar spine in adults

Bone bruising associated with long bone injury is a defined entity with known radiological, pathologic and clinical features. Vertebral bone bruise (VBB) has been described through magnetic resonance imaging (MRI) of the injured spine, but to date the consequences of this entity are unknown. The objective of this retrospective study was to describe the plain radiographic outcome of MRI-defined VBB associated with thoracic and lumbar spine fracture in adults, and to assess whether VBBs caused abnormalities of the bone–implant interface at instrumented levels. Levels of VBB were identified through analysis of the full spine MRI in a consecutive series of adult patients admitted to a spinal injuries unit for thoracic and lumbar spine fractures. The anterior wedge angles (AWAs) of thoracic and lumbar vertebrae demonstrating VBB were measured on radiographs taken at time of injury and at follow-up. Abnormalities of the bone–implant interface were recorded at instrumented levels associated with VBB on follow-up radiographs. Thirty VBBs were identified in 18 adult patients who had suffered 21 vertebral fractures. At an average follow-up of 19 months (range, 12–30 months), the mean AWAs of the VBB vertebrae at the time of injury and at the most recent follow-up were 3.5° and 3.8°, respectively (p=0.33, paired t-test). A total of 12 out of 30 (40%) bruised levels were instrumented in 13 out of 18 (72%) operated patients. No bone–implant interface failure was observed at these levels. It is concluded that VBB associated with thoracic and lumbar vertebral fracture in adult patients does not appear to cause significant progressive vertebral deformity or bone–implant interface failure.An erratum to this article can be found at     

Shear fracture-dislocations of the thoracic and lumbar spine associated with forceful hyperextension (lumberjack paraplegia).

Twelve patients sustained a shear fracture-dislocation of their thoracic or lumbar spines by a hyperextension mechanism of injury. Ten male and two female patients were injured; their average age was 29 years (range, 22 months to 56 years). Ten fracture-dislocations occurred in the thoracic spine, one at the thoracolumbar junction, and one in the lumbar spine. Eleven patients had complete paraplegia, and one had incomplete paraplegia at the time of injury. Dural tears were found in six of the patients. Eleven patients were treated by posterior spinal fusion with instrumentation, and one was treated with a brace. Three patients were treated with Harrington distraction rods alone, six had Harrington distraction rods supplemented with a midline Harrington compression rod or interspinous wiring, and two were treated with Cotrel-Dubousset instrumentation. No patient was lost to follow-up. The average length of follow-up was 3.5 years (range, 1-9 years). Six of the patients treated with Cotrel-Dubousset instrumentation or Harrington distraction rods supplemented with either a midline compression rod or interspinous wiring healed anatomically; two patients developed pseudarthroses. None of the patients treated with Harrington distraction rods alone healed in an anatomic position. The use of Harrington distraction rods alone was associated with overdistraction and nonanatomic alignment of the spine. The disruption of the anterior stabilizing structures of the spine associated with hyperextension injuries necessitates the use of instrumentation that can stabilize the spine and prevent overdistraction. This injury can be successfully treated with Cotrel-Dubousset or Harrington distraction rods supplemented with either a midline compression rod or interspinous wiring.     

Eosinophilic granuloma of spine in adults: a report of 30 cases and outcome

Background

Eosinophilic granuloma (EG) of the spine is rare, especially in adults. There had been few large and long-term studies reported in the literature. The management goals of this disease in adults are preservation of neurologic function, relief of pain and reconstruction of spinal stability. However, there are still controversies over appropriate management modality of eosinophilic granuloma.

Methods

Clinical manifestations, radiographic presentations, therapeutic outcomes and follow-up findings of 30 adults who were histiologically diagnosed with spinal eosinophilic granuloma, including 28 patients who received surgical treatment at our institutions from 1985 to 2008 were reviewed retrospectively.

Results

There were 25 males and five females with a mean age of 34.5 years (range, 18–71 years). The post-operative follow-up period ranged from 2 to 22.4 years (mean, 8.3 years). Neurologic deficits developed in 21 patients, apparent kyphosis developed in four cases. In contrast to the classic feature of vertebra plana in children, we found that more severe lesions often led to asymmetric collapse in adult patients and only three patients presented with vertebra plana. Thirty-three vertebral lesions distributed throughout the spine column. Twenty-one lesions were in cervical spine, seven in the thoracic spine and five in the lumbar spine. Twenty-eight adult patients underwent surgical resection with or without chemotherapy or radiotherapy, and four (13.3%) patients had recurrence after surgery. No patient in our series died.

Conclusions

The onset of spinal EG is insidious and mainly presents as osteolytic destruction. There is a particular high prevalence of lesions in the cervical spine and more severe lesions often led to asymmetric collapse. As the skeleton of adults is well-developed and the epiphysis has stopped growing, individualized management including surgical intervention should be considered in adult patients with spinal EG who present with neurological damage and spinal instability.     

QCT measures of bone strength at the thoracic and lumbar spine: the Framingham Study

We used volumetric quantitative computed tomography (QCT) scans to evaluate volumetric bone density (vBMD), geometry, and strength in the thoracic (T8 to T10) and lumbar (L3 to L5) spine and determined how these parameters varied with age, sex, and spinal region. Participants included 690 participants of the Framingham Study, 40 to 87 years old (mean, 61 years). In both women and men, trabecular vBMD declined with age similarly for lumbar and thoracic regions, whereas cortical vBMD and integral vBMD, vertebral strength, and compressive force declined more at the lumbar spine than thoracic spine (interaction, p < 0.01). Notably, in men, cortical vBMD increased (β = 0.0004, p = 0.01), and vertebral strength did not change (β = 1.9305, p = 0.66) at the thoracic spine with age. In both women and men, vertebral cross-sectional area increased less and the factor-of-risk increased more with age at the lumbar than at the thoracic region (interaction, p < 0.01). For example, in women, the factor-of-risk for forward flexion increased (worsened) with age 6.8-fold more in the lumbar spine (β = 0.0157), compared with the thoracic spine (β = 0.0023). vBMD and vertebral strength declined more and the factor-of-risk increased more with age in women than men (interaction, p < 0.01). For instance, integral vBMD for the lumbar spine declined 36% from 40 to 75 years of age in women compared with 18% in men. There was little or no age-related change in the forces applied to the thoracic vertebrae in either women or men. Age-related changes were greater in the lumbar spine than in the thoracic region and greater in women than men. Whereas women lost bone density and strength at both the thoracic and lumbar spine, in men, vertebral strength declined only at the lumbar spine. Our study confirms the importance of evaluating determinants of vertebral strength in both the thoracic and lumbar spine and in both women and men to understand mechanisms underlying the structural failure of vertebral bodies with aging.     

骨包虫病的诊断及治疗

目的 回顾性分析骨包虫病的临床表现和X线征象，探讨其诊断、鉴别诊断及治疗方法。方法 自1957年10月～2004年2月收治的骨包虫病患者37例，男16例，女21例。年龄14～58岁，平均29岁。病史0．5～12年，平均3．1年。发病部位：颈椎2例，肩胛骨1例，胸椎11例，肋骨2例，腰椎5例，髂骨1例，骶骨6例，耻骨1例，髋关节2例，股骨转子间1例，股骨上段2例，胫骨上段1例，肱骨头1例，桡骨上段1例。所有患者均采用手术治疗，以病灶清除为主，部分患者行自体骨、异体骨、人工骨或骨水泥填塞。术后口服阿苯达唑(片剂或原粉每日20mg／kg；阿苯达唑脂质体每日10mg／kg)3个月，预防复发。结果 25例行皮内Casoni试验，阳性2l例(84%）。4例行包虫病八项免疫试验，均为阳性。21例行MR检查，18例诊断为骨包虫病。24例获随访者，随访时间2～20年，平均3．6年。11例复发(45．83％)，其中胸椎4例，腰椎2例，骶骨4例，髋关节l例。6例四肢骨包虫病患者未见复发。24例脊柱骨包虫病患者中16例有神经系统损害，Frankel分级A级l例，B级3例，C级3例，D级9例，所有病例术后均有不同程度改善。结论 骨包虫病好发于躯干骨，尤其是脊柱。其影像学表现与结核、转移癌、骨巨细胞瘤、骨囊肿等相似，应注意鉴别。MRI有助于脊柱包虫病的诊断，血清学检查是诊断骨包虫病的主要方法；脊柱包虫病伴脊髓压迫采用手术治疗症状改善明显，但病灶不易清除彻底，容易复发。     

Bone Mineral Density in French Canadian Women

This cross-sectional study investigated bone mineral density (BMD) at the lumbar spine (L2–4) and femoral neck in French Canadian women residing in the Quebec city area. Data collection was initiated in 1988 and completed in 1994. A total of 747 French Canadian Caucasian women (16–79 years of age) with no metabolic bone disease were evaluated. BMD measurements were obtained using dual-photon absorptiometry (DPA) or dual-energy X-ray absorptiometry (DXA). Anthropometric measures such as weight, height and body mass index (BMI) were recorded. Medical files provided information on demographic characteristics, hormonal profile and lifestyle habits. Results show a curvilinear trend of BMD with aging. Furthermore, the peak BMD at the lumbar spine (L2–4) was reached at 29 years followed by a stable phase until 35 years, after which BMD started to decrease. The pattern of bone evolution at the femoral neck was different, peak BMD being achieved earlier, at 21 years, while after age 26 years a significant decrease was already observed. Women older than 60 years showed the lowest BMD. Regression analysis showed that age, weight and height are determinants of BMD at the lumbar spine and explained 33.9% of inter-individual variation. At the femoral neck, 29.1% of variation was explained by age and height only. In conclusion, our data suggest that French Canadian women have a different pattern of bone loss at the femoral neck compared with the lumbar spine, according to their mean BMD values. Received: 21 July 1997 / Accepted: 15 October 1997     

Evaluation of spinal curvatures after a recent osteoporotic vertebral fracture

OBJECTIVES: To evaluate spinal curvature changes over a 3-year period in postmenopausal women who had had an osteoporotic vertebral fracture within the last 3 months. METHODS: Thoracic kyphosis and lumbar lordosis were measured using a curviscope at baseline and after 1, 3, 6, 12, and 36 months. Anteroposterior and lateral radiographs of the thoracolumbar spine were obtained after 1 and 3 years. RESULTS: Sixty-one patients were included. At baseline, a significant increase in thoracic curvature was found in the subgroup with thoracic fractures as compared to the subgroups with thoracolumbar or lumbar fractures (64 degrees +/- 9 degrees, 56 degrees +/- 10, and 56 degrees +/- 13, respectively; P < 0.05). No lumbar curvature differences were found. Thoracic curvature was significantly correlated with age (r = -0.48, P < 0.001) and with the vertebral deformity index (r = 0.6, P < 0.001). A significant increase in thoracic curvature was apparent 3 months into the study; after 3 years, the increase was 5.6 degrees +/- 0.7 (P < 0.01). A moderate increase in lumbar curvature was found after 3 years (P < 0.01). Five of 13 patients and five of 10 patients had at least one incident fracture after 1 and 3 years, respectively. Mean thoracic curvature was greater among the patients with than without incident fractures after 1 and 3 years, although the difference was not statistically significant. CONCLUSION: Thoracic compression fractures significantly increase thoracic kyphosis as compared to dorsolumbar and lumbar fractures. Thoracic kyphosis worsens overtime in patients with prevalent vertebral fractures. These data invite an evaluation of techniques capable of providing early correction of alignment disorders, such as widespread use of bracing or kyphoplasty.     

Langerhans cell histiocytosis with multiple spinal involvement

To stress the clinical and radiologic presentation and treatment outcome of Langerhans cell histiocytosis (LCH) with multiple spinal involvements. A total of 42 cases with spinal LCH were reviewed in our hospital and 5 had multifocal spinal lesions. Multiple spinal LCH has been reported in 50 cases in the literature. All cases including ours were analyzed concerning age, sex, clinical and radiologic presentation, therapy and outcome. Of our five cases, three had neurological symptom, four soft tissue involvement and three had posterior arch extension. Compiling data from the eight largest case series of the spinal LCH reveals that 27.2% multiple vertebrae lesions. In these 55 cases, there were 26 female and 29 male with the mean age of 7.4 years (range 0.2–37). A total of 182 vertebrae were involved including 28.0% in the cervical spine, 47.8% in thoracic and 24.2% in the lumbar spine. Extraspinal LCH lesion was documented in 54.2% cases, visceral involvement in 31.1% and vertebra plana in 50% cases. Paravertebral and epidural extension were not documented in most cases. Pathological diagnosis was achieved in 47 cases including 8 open spine biopsy. The treatment strategy varied depending on different hospitals. One patient died, two had recurrence and the others had no evidence of the disease with an average of 7.2 years (range 1–21) of follow-up. Asymptomatic spinal lesions could be simply observed with or without bracing and chemotherapy is justified for multiple lesions. Surgical decompression should be reserved for the uncommon cases in which neurologic compromise does not respond to radiotherapy or progresses too rapidly for radiotherapy.     

粗套管穿刺针在胸腰椎椎体病变穿刺活检中的应用

目的:探讨粗套管穿刺活检针在胸腰椎椎体病变穿刺活检中的应用价值.方法:对2004年2月～2009年8月在我院行手术治疗并于术前行病变穿刺活检病理检查的54例胸腰椎椎体病变患者进行回顾性分析,患者年龄15～78岁,平均50.6岁;男30例,女24例.均有局部疼痛,12例伴下肢不同程度的放射痛;43例局部压痛,下肢不同程度的感觉异常.术前均行脊柱X线片和CT检查,均为单椎体病变,表现为不同程度的椎体骨质破坏,其中胸椎30例(T4 7例,T5 2例,T6 7例,T7 8例,T8 5例,T11 1例),腰椎24例(L1 1例,L28例,L3 4例,L4 5例,L5 6例),均在手术治疗前行CT引导下粗套管穿刺活检针病变穿刺活检.比较穿刺活检病理诊断与术后病理诊断的符合情况.结果:无穿刺活检并发症发生.穿刺活检病理诊断恶性肿瘤28例,良性肿瘤1例,可疑恶性肿瘤1例,正常组织1例,炎性病变23例,共52例有明确的病理诊断,穿刺活检病理诊断阳性率为96.3％;穿刺活检病理诊断与术后病理诊断一致51例,诊断符合率为98.1％.1例穿刺活检病理诊断为可疑恶性肿瘤,术后病理诊断为腺癌;1例穿刺活检病理诊断为正常组织,术后病理诊断为非特异性炎症;1例穿刺活检病理诊断为化脓性感染,术后病理诊断为结核.结论:粗套管穿刺活检针在胸腰椎椎体病变穿刺活检中能够取得较为充足的标本量,穿刺活检病理诊断阳性率及穿刺活检病理诊断与术后病理诊断符合率均较高.     

Spinal mobility in adolescent girls with idiopathic scoliosis and in structurally normal controls

Spinal mobility and posture were studied in 29 adolescent girls (mean age, 13.9 years) with thoracal idiopathic scoliosis, and in 30 healthy girls (mean age, 14.0 years) of the same age. Measurements of the mobility were conducted by inclinometers and a compass in three planes; sagittal, frontal, and horizontal. The structurally healthy girls were taller and heavier than the scoliotics; the difference was statistically significant for weight (P less than 0.01). The positional inclines of sacrum, upper lumbar and thoracic areas were significantly smaller in the scoliotics, resulting in smaller lumbar lordosis and thoracic kyphosis in them (P less than 0.001). In the thoracic spine, forward flexion was smaller (P less than 0.01), whereas extension (P less than 0.001) and the total sagittal mobility (P less than 0.01) were greater in the scoliotics. In the healthy controls, the thoracic clockwise rotation was significantly (P less than 0.05) larger than the counterclockwise. This side difference had disappeared in the scoliotics, and their total thoracic rotation was indicatively smaller than in the controls. In the lumbar spine, extension was smaller (P less than 0.01) in the scoliotics than in the controls. All spinal mobility measurements noted there was no change of general spinal flexibility in the scoliotics.     

Prevalence of Paget's disease of bone and spinal hemangioma in French women older than 75 years: data from the EPIDOS study

OBJECTIVE: To evaluate the prevalence in France of Paget's disease in elderly women. PATIENTS AND METHODS: The prevalences of Paget's disease and of thoracic and lumbar vertebral hemangioma were determined in a random nested cohort of 770 women from the EPIDOS study cohort. EPIDOS is a prospective study of the risk of proximal femoral fracture in 7,598 female, community-dwelling volunteers older than 75 years of age. The EPIDOS study patients were recruited at five centers in France (Amiens, Lyon, Paris, Montpellier, and Toulouse). For the nested study, anteroposterior and lateral radiographs of the thoracic and lumbar spine were read by two rheumatologists and classified into four groups: no Paget's disease or hemangioma, possible Paget's disease or hemangioma, definite Paget's disease, and definite hemangioma. Radiographs in the last three groups were read by a rheumatology professor and a radiology professor, both independent from the study. RESULTS: Twenty-five patients had incomplete or poor-quality radiograph sets, leaving 745 patients for the study. A vertebral hemangioma was found in four patients (0.54%; 95% confidence interval [CI], 0.01-1.1%) and vertebral Paget's disease in four other patients (0.54%; 95% CI, 0.01-1.1 %). All the pagetic vertebrae were at the lumbar spine. Three of the four Paget's disease patients were unaware of the condition before their inclusion in the study. Based on previous estimates that thoracic and lumbar foci are present in 30 to 50% of Paget's disease patients, our data suggest that the overall prevalence of Paget's disease in French women older than 75 years may be in the 1.1-1.8% range. CONCLUSION: The prevalence of Paget's disease in elderly French women is similar to that recently reported in Britain.     

Unilateral transforaminal posterior lumbar interbody fusion (TLIF): indications, technique, and 2-year results

A prospective analysis of consecutive cases of lumbar fusion using the unilateral transforaminal posterior lumbar interbody fusion (TLIF) technique with pedicle screw fixation. The objective of the study was to assess the clinical and radiographic outcome of TLIF and describe the technique and indications in the treatment of degenerative disease of the lumbar spine. Forty patients treated with TLIF for degenerative diseases of the lumbar spine were followed up for a minimum of 2.5 years (mean: 36 months; range: 30-42 months). Twenty-three patients had degenerative disc disease alone, 13 had associated isthmic or degenerative spondylolisthesis, and 4 had recurrent disc herniations at the L4-L5 level. Thirty-six (90%) had solid fusions radiographically at latest follow-up. Seventy-nine percent had excellent or good clinical outcomes. Our patients demonstrated high fusion rates and patient satisfaction.     

Ⅰ期病灶清除植骨内固定治疗胸腰椎结核

目的：探讨Ⅰ期手术脊柱内固定治疗胸腰椎结核的疗效。方法：2002年1月-2004年6月手术治疗胸腰椎结核31例，其中胸椎15例，胸腰椎5例，腰椎11例；平均年龄31．6岁；病程4个月～2．8年，平均9．2个月。全部病例经彻底病灶清除后Ⅰ期植骨内固定，前路固定21例，后路固定10例。结果：术后随访平均13．6个月（4个月～2年），植骨全部骨性融合，后凸畸形矫正满意，有神经症状患者得到改善，无感染和窦道形成。结论：彻底病灶清除是外科治疗脊柱结核的主要方法，在此基础上引进脊柱内固定系统治疗脊柱结核增加了术后节段稳定性，植骨块牢固，植骨融合率提高，后凸畸形矫正满意。Ⅰ期内固定安全可靠。