Dry needling for the management of thoracic spine pain

PubMed Central

Fernández-de-las-Peñas, César; Layton, Michelle; Dommerholt, Jan

2015-01-01

Thoracic spine pain is as disabling as neck and low back pain without receiving the same level of attention in the scientific literature. Among the different structures that can refer pain to the thoracic spine, muscles often play a relevant role. Trigger points (TrPs) from neck, shoulder and spinal muscles can induce pain in the region of the thoracic spine. There is a lack of evidence reporting the presence of TrPs in the region of the thoracic spine, but clinical evidence suggests that TrPs can be a potential source of thoracic spine pain. The current paper discusses the role of TrPs in the thoracic spine and dry needling (DN) for the management of TrPs in the thoracic multifidi and longissimus thoracis. This paper also includes a brief discussion of the application of DN in other tissues such as tendons, ligaments and scars. PMID:26309385

Intradural Extramedullary Capillary Hemangioma In the Upper Thoracic Spine with Simultaneous Extensive Arachnoiditis

PubMed Central

Lee, Jae Ho; Jeon, Ikchan; Kim, Sang Woo

2017-01-01

Capillary hemangiomas are common benign vascular tumors on skin and soft tissues, but developing as an intradural and extramedullary (IDEM) tumor in spine is extremely rare. In this report, we present IDEM tumor compressing thoracic cord in T2–3 level with extensive arachnoiditis below the tumor level in a 60-year-old man. The lesion was removed and histological diagnosis was capillary hemangioma. Prompt diagnosis and resection are important to avoid neurological deterioration from acute hemorrhagic condition. Simultaneous arachnoiditis may be originated from old subarachnoid hemorrhage associated tumor before diagnosis, and we suggest it as a helpful diagnostic feature to suspect vascular tumors such as capillary hemangioma. PMID:28704911

Intradural Extramedullary Capillary Hemangioma In the Upper Thoracic Spine with Simultaneous Extensive Arachnoiditis.

PubMed

Lee, Jae Ho; Jeon, Ikchan; Kim, Sang Woo

2017-06-01

Capillary hemangiomas are common benign vascular tumors on skin and soft tissues, but developing as an intradural and extramedullary (IDEM) tumor in spine is extremely rare. In this report, we present IDEM tumor compressing thoracic cord in T2-3 level with extensive arachnoiditis below the tumor level in a 60-year-old man. The lesion was removed and histological diagnosis was capillary hemangioma. Prompt diagnosis and resection are important to avoid neurological deterioration from acute hemorrhagic condition. Simultaneous arachnoiditis may be originated from old subarachnoid hemorrhage associated tumor before diagnosis, and we suggest it as a helpful diagnostic feature to suspect vascular tumors such as capillary hemangioma.

Effect of Polyether Ether Ketone on Therapeutic Radiation to the Spine: A Pilot Study.

PubMed

Jackson, J Benjamin; Crimaldi, Anthony J; Peindl, Richard; Norton, H James; Anderson, William E; Patt, Joshua C

2017-01-01

Cadaveric model. To compare the effect of PEEK versus conventional implants on scatter radiation to a simulated tumor bed in the spine SUMMARY OF BACKGROUND DATA.: Given the highly vasculature nature of the spine, it is the most common place for bony metastases. After surgical treatment of a spinal metastasis, adjuvant radiation therapy is typically administered. Radiation dosing is primarily limited by toxicity to the spinal cord. The scatter effect caused by metallic implants decreases the accuracy of dosing and can unintentionally increase the effective dose seen by the spinal cord. This represents a dose-limiting factor for therapeutic radiation postoperatively. A cadaveric thorax specimen was utilized as a metastatic tumor model with two separate three-level spine constructs (one upper thoracic and one lower thoracic). Each construct was examined independently. All four groups compared included identical posterior instrumentation. The anterior constructs consisted of either: an anterior polyether ether ketone (PEEK) cage, an anterior titanium cage, an anterior bone cement cage (polymethyl methacrylate), or a control group with posterior instrumentation alone. Each construct had six thermoluminescent detectors to measure the radiation dose. The mean dose was similar across all constructs and locations. There was more variability in the upper thoracic spine irrespective of the construct type. The PEEK construct had a more uniform dose distribution with a standard deviation of 9.76. The standard deviation of the others constructs was 14.26 for the control group, 19.31 for the titanium cage, and 21.57 for the cement (polymethyl methacrylate) construct. The PEEK inter-body cage resulted in a significantly more uniform distribution of therapeutic radiation in the spine when compared with the other constructs. This may allow for the application of higher effective dosing to the tumor bed for spinal metastases without increasing spinal cord toxicity with either fractionated or hypofractionated radiotherapy. N/A.

Sagittal and transversal plane deformity in thoracic scoliosis.

PubMed

Kotwicki, Tomasz

2002-01-01

The aim of the study was to assess the sagittal and transversal plane deformity of the spine in thoracic scoliosis by the mean of 3-D radiographic analysis. 46 patients admitted for surgery for thoracic idiopathic scoliosis underwent preoperative radiographic assessment. All patients presented the same pattern of the coronal plane deformity: single right thoracic curve (Lenke 1, King 3). Neither lumbar nor proximal thoracic structural curve were present. The Cobb angle varied from 41gamma to 77 gamma (mean 55,4 gamma +/- 8,6 gamma). Long cassette standing antero-posterior and lateral radiographs were analysed. Three-dimensional reconstruction with Rachis 91TM software was performed for each pair of radiographs. The following parameters were assessed: sagittal thoracic Cobb angle (Th4-Th12), upper thoracic kyphosis angle (Th5-Th8), lower thoracic kyphosis angle (Th9-Th12), superior and inferior hemi-curve sagittal angles, lumbar lordosis, sacral slope, sacral incidence, vertebral plate index, segmental vertebral axial rotation throughout the thoracic and lumbar spine. Results showed great variability of parameters assessed. The non-harmonious distribution of kyphosis was demonstrated in the thoracic spine. Local Th9-Th12 hypokyphosis and adjacent local Th5-Th8 hyperkyphosis constitute the most typical sagittal pathologies. So called normokyphotic curves were composed of one hyperkyphotic and one hypokyphotic zone. Th1-Th4 segment revealed two patterns of segmental rotation distribution: a purely compensatory curve with no vertebral axial rotation or a rotated curve presenting the morphology intermediate between Lenke 1 and Lenke 2 types (or King 3 and King 5). curves presenting the same coronal plane deformity differ in their morphology assessed in the two other planes; global thoracic kyphosis angle is a misleading parameter because it covers hypo- and hyperkyphotic zones; local distal thoracic (Th9-Th12) hypokyphosis is present in idiopathic thoracic scoliosis.

A randomized clinical trial to compare the immediate effects of seated thoracic manipulation and targeted supine thoracic manipulation on cervical spine flexion range of motion and pain.

PubMed

Karas, Steve; Olson Hunt, Megan J

2014-05-01

Randomized clinical trial. To determine the effectiveness of seated thoracic manipulation versus targeted supine thoracic manipulation on cervical spine pain and flexion range of motion (ROM). There is evidence that thoracic spine manipulation is an effective treatment for patients with cervical spine pain. This evidence includes a variety of techniques to manipulate the thoracic spine. Although each of them is effective, no research has compared techniques to determine which produces the best outcomes. A total of 39 patients with cervical spine pain were randomly assigned to either a seated thoracic manipulation or targeted supine thoracic manipulation group. Pain and flexion ROM measures were taken before and after the intervention. Pain reduction (post-treatment-pre-treatment) was significantly greater in those patients receiving the targeted supine thoracic manipulation compared to the seated thoracic manipulation (P<0.05). Although not significant, we did observe greater improvement in flexion ROM in the targeted supine thoracic manipulation group. The results of this study indicate that a targeted supine thoracic manipulation may be more effective in reducing cervical spine pain and improving cervical flexion ROM than a seated thoracic manipulation. Future studies should include a variety of patients and physical therapists (PTs) to validate our findings.

A randomized clinical trial to compare the immediate effects of seated thoracic manipulation and targeted supine thoracic manipulation on cervical spine flexion range of motion and pain

PubMed Central

Karas, Steve; Olson Hunt, Megan J

2014-01-01

Design Randomized clinical trial. Objectives To determine the effectiveness of seated thoracic manipulation versus targeted supine thoracic manipulation on cervical spine pain and flexion range of motion (ROM). There is evidence that thoracic spine manipulation is an effective treatment for patients with cervical spine pain. This evidence includes a variety of techniques to manipulate the thoracic spine. Although each of them is effective, no research has compared techniques to determine which produces the best outcomes. Methods A total of 39 patients with cervical spine pain were randomly assigned to either a seated thoracic manipulation or targeted supine thoracic manipulation group. Pain and flexion ROM measures were taken before and after the intervention. Results Pain reduction (post-treatment–pre-treatment) was significantly greater in those patients receiving the targeted supine thoracic manipulation compared to the seated thoracic manipulation (P<0.05). Although not significant, we did observe greater improvement in flexion ROM in the targeted supine thoracic manipulation group. The results of this study indicate that a targeted supine thoracic manipulation may be more effective in reducing cervical spine pain and improving cervical flexion ROM than a seated thoracic manipulation. Future studies should include a variety of patients and physical therapists (PTs) to validate our findings. PMID:24976754

A Tunneled Subcricoid Approach for Anterior Cervical Spine Reoperation: Technical and Safety Results.

PubMed

Winkler, Ethan A; Rowland, Nathan C; Yue, John K; Birk, Harjus; Ozpinar, Alp; Tay, Bobby; Ames, Christopher P; Mummaneni, Praveen V; El-Sayed, Ivan H

2016-02-01

Anterior cervical spine decompression and fusion are common neurosurgical operations. Reoperation of the anterior cervical spine is associated with increased morbidity. The authors describe a novel subcricoid approach to protect the recurrent laryngeal nerve in a cuff of tissue while facilitating surgical access to the anterior cervical spine. Single institution, consecutive case review of 48 patients undergoing reoperation in the anterior cervical region including the level of C5 and below. Univariable and multivariable regression analysis was used to determine predictors of postoperative morbidity. No intraoperative complications were reported. Estimated blood loss for the approach was 13.6 ± 3.1 mL. Nine of 48 patients developed immediate postoperative complications, including vocal cord paresis (10.4%), moderate-to-severe dysphagia (10.4%), and neck edema requiring intubation (2.1%). No postoperative hematomas or death occurred. All complications occurred with 4 or more levels of exposure (1-3 disc levels, 0%, vs. ≥ 4 disc levels, 31%). Extension of the exposure to the upper thoracic spine was associated with odds for postoperative complications (adjusted odds ratio, 6.50; 95% confidence interval, 1.14-37.03) and prolonged hospital stay (adjusted increase 4.23 days, P < 0.01). The tunneled subcricoid approach is a relatively safe corridor to reapproach the anterior cervical spine at the level of C5 and below. However, caution must be exercised when using this approach to expose 4 or more disc levels and with extension of the exposure to the upper thoracic spine. Future comparative studies are needed to establish patient selection criteria in determining the use of this technique compared with classic approaches. Copyright © 2016 Elsevier Inc. All rights reserved.

Provocative mechanical tests of the peripheral nervous system affect the joint torque-angle during passive knee motion.

PubMed

Andrade, R J; Freitas, S R; Vaz, J R; Bruno, P M; Pezarat-Correia, P

2015-06-01

This study aimed to determine the influence of the head, upper trunk, and foot position on the passive knee extension (PKE) torque-angle response. PKE tests were performed in 10 healthy subjects using an isokinetic dynamometer at 2°/s. Subjects lay in the supine position with their hips flexed to 90°. The knee angle, passive torque, surface electromyography (EMG) of the semitendinosus and quadriceps vastus medialis, and stretch discomfort were recorded in six body positions during PKE. The different maximal active positions of the cervical spine (neutral; flexion; extension), thoracic spine (neutral; flexion), and ankle (neutral; dorsiflexion) were passively combined for the tests. Visual analog scale scores and EMG were unaffected by body segment positioning. An effect of the ankle joint was verified on the peak torque and knee maximum angle when the ankle was in the dorsiflexion position (P < 0.05). Upper trunk positioning had an effect on the knee submaximal torque (P < 0.05), observed as an increase in the knee passive submaximal torque when the cervical and thoracic spines were flexed (P < 0.05). In conclusion, other apparently mechanical unrelated body segments influence torque-angle response since different positions of head, upper trunk, and foot induce dissimilar knee mechanical responses during passive extension. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Thoracic spine x-ray

MedlinePlus

Vertebral radiography; X-ray - spine; Thoracic x-ray; Spine x-ray; Thoracic spine films; Back films ... The test is done in a hospital radiology department or in the health care provider's office. You will lie on the x-ray table in different positions. If the x-ray ...

[Precision of navigation-assisted surgery of the thoracic and lumbar spine].

PubMed

Arand, M; Schempf, M; Hebold, D; Teller, S; Kinzl, L; Gebhard, F

2003-11-01

The goal of these studies was to evaluate the accuracy of in vivo and in vitro application of CT- and C-arm-based navigation at the thoracic and lumbar spine. With CT based navigation, 82 pedicle screws were consecutively inserted, 53 into the thoracic and 29 into the lumbar spine. Seven (13%) perforations were detected at the thoracic spine and two (7%) at the lumbar spine. Additionally, minor perforations below the thread depth were seen in six (11%) thoracic and in two (7%) lumbar instrumentation. With C-arm-based navigation, 74 screws were consecutively placed into 38 thoracic and 36 lumbar pedicles. Perforations were noted in ten (26%) thoracic and four (11%) lumbar implants. Minor perforations were observed in another nine (24%) thoracic and ten (28%) lumbar pedicles. The observer-independent and standardized in vitro study based on a transpedicular 3.2-mm drill hole aiming a 4-mm steel ball in a plastic bone model showed pedicle perforations of the drill canal only in thoracic vertebrae, 1 of 15 in CT-based and 3 of 15 in C-arm navigation. The quantitative calculation of the smallest distance between the central line through the drill canal and the center of the steel ball resulted in 1.4 mm (0.5-4.8 mm) for the CT-based navigation at the thoracic spine and in 1.8 mm (0.5-3 mm) at the lumbar spine. For the C-arm based navigation the distance was 2.6 mm (0.9-4.8 mm) for the thoracic spine and 2 mm (1.2-3 mm) for the lumbar spine. In our opinion, the clinical results of the comparative accuracy of CT- and C-arm-based navigation in the present study showed moderate advantages of the CT-based technique in the thoracic spine, whereas CT- and C-arm based navigation had comparable perforation rates at the lumbar pedicle. The results of the experimental study correlated with the clinical data.

Effect of cervical vs. thoracic spinal manipulation on peripheral neural features and grip strength in subjects with chronic mechanical neck pain: a randomized controlled trial.

PubMed

Bautista-Aguirre, Francisco; Oliva-Pascual-Vaca, Ángel; Heredia-Rizo, Alberto M; Boscá-Gandía, Juan J; Ricard, François; Rodriguez-Blanco, Cleofás

2017-06-01

Cervical and thoracic spinal manipulative therapy has shown positive impact for relief of pain and improve function in non-specific mechanical neck pain. Several attempts have been made to compare their effectiveness although previous studies lacked a control group, assessed acute neck pain or combined thrust and non-thrust techniques. To compare the immediate effects of cervical and thoracic spinal thrust manipulations on mechanosensitivity of upper limb nerve trunks and grip strength in patients with chronic non-specific mechanical neck pain. Randomized, single-blinded, controlled clinical trial. Private physiotherapy clinical consultancy. Eighty-eight subjects (32.09±6.05 years; 72.7% females) suffering neck pain (grades I or II) of at least 12 weeks of duration. Participants were distributed into three groups: 1) cervical group (N.=28); 2) thoracic group (N.=30); and 3) control group (N.=30). One treatment session consisting of applying a high-velocity low-amplitude spinal thrust technique over the lower cervical spine (C7) or the upper thoracic spine (T3) was performed, while the control group received a sham-manual contact. Measurements were taken at baseline and after intervention of the pressure pain threshold over the median, ulnar and radial nerves. Secondary measures included assessing free-pain grip strength with a hydraulic dynamometer. No statistically significant differences were observed when comparing between-groups in any of the outcome measures (P>0.05). Those who received thrust techniques, regardless of the manipulated area, reported an immediate increase in mechanosensitivity over the radial (both sides) and left ulnar nerve trunks (P<0.05), and grip strength (P<0.001). For those in the control group, right hand grip strength and pain perception over the radial nerve also improved (P≤0.025). Low-cervical and upper-thoracic thrust manipulation is no more effective than placebo to induce immediate changes on mechanosensitivity of upper limb nerve trunks and grip strength in patients with chronic non-specific mechanical neck pain. A single treatment session using cervical or thoracic thrust techniques is not enough to achieve clinically relevant changes on neural mechanosensitivity and grip strength in chronic non-specific mechanical neck pain.

Three-dimensional primary and coupled range of motions and movement coordination of the pelvis, lumbar and thoracic spine in standing posture using inertial tracking device.

PubMed

Narimani, M; Arjmand, N

2018-03-01

Evaluation of spinal range of motions (RoMs) and movement coordination between its segments (thorax, lumbar, and pelvis) has clinical and biomechanical implications. Previous studies have not recorded three-dimensional primary/coupled motions of all spinal segments simultaneously. Moreover, magnitude/direction of the coupled motions of the thorax/pelvis in standing posture and lumbopelvic rhythms in the frontal/transverse planes have not been investigated. This study, hence, used an inertial tracking device to measure T1, T5, T12, total (T1-T12) thoracic, lower (T5-T12) and upper (T1-T5) thoracic, lumbar (T12-S1), and pelvis primary and coupled RoMs as well as their movement coordination in all anatomical planes/directions in twenty-two healthy individuals. RoMs were statistically compared between the anatomical planes and spinal segments as well as with available data in the literature. The spine had different primary RoMs in different planes/directions (flexion: lumbar: 55.4 ± 12.4°, pelvis: 42.8 ± 21.6°, and T1-T12 thoracic: 19.9 ± 6.4°, extension: lumbar: 23.4 ± 10.1°, thoracic: 11.7 ± 3.4°, and pelvis: 10.2 ± 6.4°, left/right lateral bending: thoracic: 24.5 ± 7.4°/26.5 ± 6.1°, lumbar: 16.4 ± 7.2°/18.3 ± 5.7°, and pelvis: 11.0 ± 4.4°/9.3 ± 6.2°, and left/right axial rotation: thoracic: 33.5 ± 10.0°/37.1 ± 11.7°, pelvis: 31.6 ± 12.5°/27.2 ± 12.0° and lumbar: 7.5 ± 4.5°/9.2 ± 7.3°). Pelvis, lumbar and thoracic spine had different/varying contributions/rhythms to generate total trunk (T1) movement, both within and between planes. Pattern of the coupled motions was inconsistent between subjects but side bending was generally associated with twisting to the same side at the thoracic spine and to the opposite side at the lumbar spine. Copyright © 2018 Elsevier Ltd. All rights reserved.

Upper cervical and upper thoracic thrust manipulation versus nonthrust mobilization in patients with mechanical neck pain: a multicenter randomized clinical trial.

PubMed

Dunning, James R; Cleland, Joshua A; Waldrop, Mark A; Arnot, Cathy F; Young, Ian A; Turner, Michael; Sigurdsson, Gisli

2012-01-01

Randomized clinical trial. To compare the short-term effects of upper cervical and upper thoracic high-velocity low-amplitude (HVLA) thrust manipulation to nonthrust mobilization in patients with neck pain. Although upper cervical and upper thoracic HVLA thrust manipulation and nonthrust mobilization are common interventions for the management of neck pain, no studies have directly compared the effects of both upper cervical and upper thoracic HVLA thrust manipulation to nonthrust mobilization in patients with neck pain. Patients completed the Neck Disability Index, the numeric pain rating scale, the flexion-rotation test for measurement of C1-2 passive rotation range of motion, and the craniocervical flexion test for measurement of deep cervical flexor motor performance. Following the baseline evaluation, patients were randomized to receive either HVLA thrust manipulation or nonthrust mobilization to the upper cervical (C1-2) and upper thoracic (T1-2) spines. Patients were reexamined 48-hours after the initial examination and again completed the outcome measures. The effects of treatment on disability, pain, C1-2 passive rotation range of motion, and motor performance of the deep cervical flexors were examined with a 2-by-2 mixed-model analysis of variance (ANOVA). One hundred seven patients satisfied the eligibility criteria, agreed to participate, and were randomized into the HVLA thrust manipulation (n = 56) and nonthrust mobilization (n = 51) groups. The 2-by-2 ANOVA demonstrated that patients with mechanical neck pain who received the combination of upper cervical and upper thoracic HVLA thrust manipulation experienced significantly (P<.001) greater reductions in disability (50.5%) and pain (58.5%) than those of the nonthrust mobilization group (12.8% and 12.6%, respectively) following treatment. In addition, the HVLA thrust manipulation group had significantly (P<.001) greater improvement in both passive C1-2 rotation range of motion and motor performance of the deep cervical flexor muscles as compared to the group that received nonthrust mobilization. The number needed to treat to avoid an unsuccessful outcome was 1.8 and 2.3 at 48-hour follow-up, using the global rating of change and Neck Disability Index cut scores, respectively. The combination of upper cervical and upper thoracic HVLA thrust manipulation is appreciably more effective in the short term than nonthrust mobilization in patients with mechanical neck pain. Therapy, level 1b.

Brown adipose tissue: a factor to consider in symmetrical tracer uptake in the neck and upper chest region.

PubMed

Hany, Thomas F; Gharehpapagh, Esmaiel; Kamel, Ehab M; Buck, Alfred; Himms-Hagen, Jean; von Schulthess, Gustav K

2002-10-01

Increased symmetrical fluorine-18 fluorodeoxyglucose (FDG) uptake in the cervical and thoracic spine region is well known and has been attributed to muscular uptake. The purpose of this study was to re-evaluate this FDG uptake pattern by means of co-registered positron emission tomography (PET) and computed tomography (CT) imaging, which allowed exact localisation of this uptake. Between April and November 2001, 638 consecutive patients referred for PET/CT were imaged on an in-line PET/CT system (GEMS). This system combines an advanced GE PET scanner and a multirow-detector computer tomograph (Lightspeed, GEMS). The examination included PET with FDG and one CT acquisition with 80 mA. For CT, the following parameters were used: 140 kV, 80 mA, reconstructed slice thickness 5 mm, scan length 867 mm, AT 22.5 s. CT data were used for attenuation correction as well as image co-registration. Image analysis was performed on an Entegra work-station (ELGEMS). All patients with symmetrical uptake within the neck, thorax and shoulder regions were selected and the exact localisation of uptake determined (muscle, bone, fatty tissue or articulation). In 17 of the 638 patients (2.5%), increased, symmetrical FDG uptake in the shoulder region in a typical pattern was found. If extensive, this pattern included FDG activity comparable to brain activity in the lower cervical spine, the shoulder region and the upper thoracic spine in the costovertebral region. A less extensive pattern only involved intermediate FDG uptake in the lower cervical spine and shoulder region or in the shoulder region alone. In seven female patients (average 32.3 years), the extensive uptake pattern was seen. The average body mass index (BMI) was 19.0 (range 16.8-23.4). In the other ten patients (two male, eight female, average age 37.1 years), the average BMI was 22.7 (18.7-27.7). In all patients, the soft tissue uptake was clearly localised within the fatty tissue of the shoulders as demonstrated by PET/CT co-registration. The uptake in the region of the thoracic spine was localised in the region of the costovertebral joints. Symmetrical FDG uptake in the shoulder, neck and thoracic spine region is probably related to uptake in adipose tissue, especially in underweight patients. Hypothetically, this FDG uptake could represent activated brown adipose tissue during increased sympathetic nerve system (SNS) activity due to cold stress.

Adjacent-segment disease after thoracic pedicle screw fixation.

PubMed

Agarwal, Nitin; Heary, Robert F; Agarwal, Prateek

2018-03-01

OBJECTIVE Pedicle screw fixation is a technique widely used to treat conditions ranging from spine deformity to fracture stabilization. Pedicle screws have been used traditionally in the lumbar spine; however, they are now being used with increasing frequency in the thoracic spine as a more favorable alternative to hooks, wires, or cables. Although safety concerns, such as the incidence of adjacent-segment disease (ASD) after cervical and lumbar fusions, have been reported, such issues in the thoracic spine have yet to be addressed thoroughly. Here, the authors review the literature on ASD after thoracic pedicle screw fixation and report their own experience specifically involving the use of pedicle screws in the thoracic spine. METHODS Select references from online databases, such as PubMed (provided by the US National Library of Medicine at the National Institutes of Health), were used to survey the literature concerning ASD after thoracic pedicle screw fixation. To include the authors' experience at Rutgers New Jersey Medical School, a retrospective review of a prospectively maintained database was performed to determine the incidence of complications over a 13-year period in 123 consecutive adult patients who underwent thoracic pedicle screw fixation. Children, pregnant or lactating women, and prisoners were excluded from the review. By comparing preoperative and postoperative radiographic images, the occurrence of thoracic ASD and disease within the surgical construct was determined. RESULTS Definitive radiographic fusion was detected in 115 (93.5%) patients. Seven incidences of instrumentation failure and 8 lucencies surrounding the screws were observed. One patient was observed to have ASD of the thoracic spine. The mean follow-up duration was 50 months. CONCLUSIONS This long-term radiographic evaluation revealed the use of pedicle screws for thoracic fixation to be an effective stabilization modality. In particular, ASD seems to be less of a problem in the relatively immobile thoracic spine than in the more mobile cervical and lumbar spines.

Anatomy of large animal spines and its comparison to the human spine: a systematic review.

PubMed

Sheng, Sun-Ren; Wang, Xiang-Yang; Xu, Hua-Zi; Zhu, Guo-Qing; Zhou, Yi-Fei

2010-01-01

Animal models have been commonly used for in vivo and in vitro spinal research. However, the extent to which animal models resemble the human spine has not been well known. We conducted a systematic review to compare the morphometric features of vertebrae between human and animal species, so as to give some suggestions on how to choose an appropriate animal model in spine research. A literature search of all English language peer-reviewed publications was conducted using PubMed, OVID, Springer and Elsevier (Science Direct) for the years 1980-2008. Two reviewers extracted data on the anatomy of large animal spines from the identified articles. Each anatomical study of animals had to include at least three vertebral levels. The anatomical data from all animal studies were compared with the existing data of the human spine in the literature. Of the papers retrieved, seven were included in the review. The animals in the studies involved baboon, sheep, porcine, calf and deer. Distinct anatomical differences of vertebrae were found between the human and each large animal spine. In cervical region, spines of the baboon and human are more similar as compared to other animals. In thoracic and lumbar regions, the mean pedicle height of all animals was greater than the human pedicles. There was similar mean pedicle width between animal and the human specimens, except in thoracic segments of sheep. The human spinal canal was wider and deeper in the anteroposterior plane than any of the animals. The mean human vertebral body width and depth were greater than that of the animals except in upper thoracic segments of the deer. However, the mean vertebral body height was lower than that of all animals. This paper provides a comprehensive review to compare vertebrae geometries of experimental animal models to the human vertebrae, and will help for choosing animal model in vivo and in vitro spine research. When the animal selected for spine research, the structural similarities and differences found in the animal studies must be kept in mind.

Repeated measures of recent headache, neck and upper back pain in Australian adolescents.

PubMed

Grimmer, K; Nyland, L; Milanese, S

2006-07-01

The epidemiological and clinical literature identifies strong associations between adult headache, cervical and thoracic spine dysfunction and spinal posture. This paper reports on the prevalence and incidence of headache, neck and upper back pain which occurred in the previous week, in urban Australians aged 13-17 years. Commencing in 1999, we followed a cohort of South Australian students through 5 years of secondary schooling. Of our commencing cohort of students, 132 (30%) provided data on bodily pain every year. For both girls and boys, there was a significantly decreasing prevalence of headache over the study period, while neck pain and upper back pain increased. There was a significantly increasing trend over time for boys with upper back pain. Twenty percent of girls and boys consistently reported headache, neck pain or upper back pain over 5 years. The progression of early adolescent headaches to mid-adolescent neck and upper back pain potentially reflects the adolescents' biomechanical responses to intrinsic and extrinsic imposts. This requires further investigation to understand the causes of adolescent headache, neck and upper thoracic pain.

49 CFR 572.85 - Lumbar spine flexure.

Code of Federal Regulations, 2011 CFR

2011-10-01

...) of this section, the lumbar spine assembly shall flex by an amount that permits the thoracic spine to... to the thoracic spine box. Apply the force at any torso deflection rate between 0.5 and 1.5 degrees... 49 Transportation 7 2011-10-01 2011-10-01 false Lumbar spine flexure. 572.85 Section 572.85...

Intradural Extramedullary Capillary Hemangioma in the Upper Thoracic Spine: A Review of the Literature

PubMed Central

Sakai, Toshinori; Higashino, Kosaku; Goda, Yuichiro; Tezuka, Fumitake; Sairyo, Koichi

2014-01-01

Capillary hemangiomas are benign tumors found in the skin and soft tissues in younger people. They occur in the central nervous system only rarely, and intradural occurrence is extremely rare. We report here a 60-year-old man presenting with thoracic girdle pain and progressive gait disturbance. Magnetic resonance images of the thoracic spine showed a 12 × 8 × 20 mm, well-defined intradural mass at the T2 level, compressing the spinal cord laterally. Relative to the spinal cord, the mass was hypo- to isointense on T1-weighted images and relatively hyperintense on T2-weighted images, with strong enhancement on contrast-enhanced T1-weighted images. The patient underwent T1-2 hemilaminectomy with resection of the intradural extramedullary tumor, which showed characteristics of a capillary hemangioma on histologic examination. The patient's symptoms improved following the surgery and no clinical or radiological evidence of recurrence was noted at the 2-year follow-up. We present this case with a review of the literature, highlighting features for differential diagnosis. PMID:25045565

Thoracolumbar spine model with articulated ribcage for the prediction of dynamic spinal loading.

PubMed

Ignasiak, Dominika; Dendorfer, Sebastian; Ferguson, Stephen J

2016-04-11

Musculoskeletal modeling offers an invaluable insight into the spine biomechanics. A better understanding of thoracic spine kinetics is essential for understanding disease processes and developing new prevention and treatment methods. Current models of the thoracic region are not designed for segmental load estimation, or do not include the complex construct of the ribcage, despite its potentially important role in load transmission. In this paper, we describe a numerical musculoskeletal model of the thoracolumbar spine with articulated ribcage, modeled as a system of individual vertebral segments, elastic elements and thoracic muscles, based on a previously established lumbar spine model and data from the literature. The inverse dynamics simulations of the model allow the prediction of spinal loading as well as costal joints kinetics and kinematics. The intradiscal pressure predicted by the model correlated well (R(2)=0.89) with reported intradiscal pressure measurements, providing a first validation of the model. The inclusion of the ribcage did not affect segmental force predictions when the thoracic spine did not perform motion. During thoracic motion tasks, the ribcage had an important influence on the predicted compressive forces and muscle activation patterns. The compressive forces were reduced by up to 32%, or distributed more evenly between thoracic vertebrae, when compared to the predictions of the model without ribcage, for mild thoracic flexion and hyperextension tasks, respectively. The presented musculoskeletal model provides a tool for investigating thoracic spine loading and load sharing between vertebral column and ribcage during dynamic activities. Further validation for specific applications is still necessary. Copyright © 2015 Elsevier Ltd. All rights reserved.

Characterization of the age-dependent shape of the pediatric thoracic spine and vertebrae using generalized procrustes analysis.

PubMed

Peters, James R; Campbell, Robert M; Balasubramanian, Sriram

2017-10-03

Generalized Procrustes Analysis (GPA) is a superimposition method used to generate size-invariant distributions of homologous landmark points. Several studies have used GPA to assess the three-dimensional (3D) shapes of or to evaluate sex-related differences in the human brain, skull, rib cage, pelvis and lower limbs. Previous studies of the pediatric thoracic vertebrae suggest that they may undergo changes in shape asa result of normative growth. This study uses GPA and second order polynomial equations to model growth and age- and sex-related changes in shape of the pediatric thoracic spine. We present a thorough analysis of the normative 3D shape, size, and orientation of the pediatric thoracic spine and vertebrae as well as equations which can be used to generate models of the thoracic spine and vertebrae for any age between 1 and 19years. Such models could be used to create more accurate 3D reconstructions of the thoracic spine, generate improved age-specific geometries for finite element models (FEMs) and used to assist clinicians with patient-specific planning and surgical interventions for spine deformity. Copyright © 2017 Elsevier Ltd. All rights reserved.

Vertebral sarcoidosis: demonstration of bone involvement by computerized axial tomography

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dinerstein, S.L.; Kovarsky, J.

1984-08-01

A report is given of a rare case of vertebral sarcoidosis with negative conventional spinal x-ray films, yet with typical cystic lesions of the spine found incidentally during abdominal computerized axial tomography (CAT). The patient was a 28-year-old black man, who was admitted for evaluation of a 1 1/2-year history of diffuse myalgias, intermittent fever to 102 F orally, bilateral hilar adenopathy, and leukopenia. A technetium polyphosphate bone scan revealed diffuse areas of increased uptake over the sternum, entire vertebral column, and pelvis. Conventional x-ray films of the cervical, thoracic, and lumbar spine, and an AP view of the pelvismore » were all normal. Chest x-ray film revealed only bilateral hilar adenopathy. During the course of an extensive negative evaluation for infection, an abdominal CAT scan was done, showing multiple, small, sclerotic-rimmed cysts at multiple levels of the lower thoracic and lumbar spine. Bone marrow biopsy revealed only changes consistent with anemia of chronic disease. Mediastinal lymph node biopsy revealed noncaseating granulomas. A tentative diagnosis of sarcoidosis was made, and treatment with prednisone, isoniazid and rifampin was begun. Within two weeks of initiation of prednisone therapy, the patient was symptom-free. A repeat technetium polyphosphate bone scan revealed only a small residual area of mildly increased uptake over the upper thoracic vertebrae.« less

Detecting severe injuries of the upper body in multiple trauma patients.

PubMed

Horst, Klemens; Hildebrand, Frank; Kobbe, Philipp; Pfeifer, Roman; Lichte, Philipp; Andruszkow, Hagen; Lefering, Rolf; Pape, Hans Christoph

2015-12-01

The clavicle limits the upper thoracic cage and connects the body and upper extremities. The clavicle is easy to examine and is visible on standard emergency room radiographs. We hypothesized that clavicular fracture in polytrauma patients would indicate the presence of further injuries of the upper extremities, head, neck, and thorax. A population-based trauma registry was used. All patients were documented between 2002 and 2013. Inclusion criteria were age ≥16 y and injury severity score (ISS) ≥16. Patients were divided into two groups according to the presence or absence of a clavicular fracture (group C+ and group C-). Scoring was based on the abbreviated injury scale, ISS, and new injury severity score. Trauma mechanisms, demographics, and the posttraumatic clinical course were compared. In total, 4790 patients with clavicular fracture (C+) and 41,775 without (C-) were included; the mean ISS was 30 ± 11 (C+) versus 28 ± 12 (C-). Patients with clavicular fracture had a longer stay on the intensive care unit with 12 ± 14 versus 10 ± 13 d. Injuries to the thoracic wall, severe lung injuries as well as injuries to the cervical spine were significantly increased in C+ patients. Thoracic injuries as well as injuries of the shoulder girdle and/or arm showed an increased abbreviated injury scale in the C+ group. A clinically relevant coincidence of clavicular fractures with injuries of the chest and upper extremity was found. As clavicular fractures can be diagnosed easily, it might also help to reduce the incidence of missed injuries of the chest and upper extremity. Therefore, special attention should be paid on thoracic as well as upper extremity injures during the second and tertiary surveys in case of clavicular fractures. Copyright © 2015 Elsevier Inc. All rights reserved.

Analytical and experimental investigations of human spine flexure.

NASA Technical Reports Server (NTRS)

Moffatt, C. A.; Advani, S. H.; Lin, C.-J.

1971-01-01

The authors report on experiments to measure the resistance of fresh human spines to flexion in the upper lumbar and lower thoracic regions and evaluate results by using a combination of strength of materials theory and effects of shear and comparing with data reported by other authors. The test results indicate that the thoraco-lumbar spine behaves approximately as a linear elastic beam, without relaxation effects. The authors formulate a simple continuum dynamic model of the spine simulating aircraft ejection and solve the resulting boundary value problem to illustrate the importance of the flexural mode. A constant cross-section, the selected model is a sinusoidally curved elastic beam with an end mass subjected to a Heaviside axial acceleration at the other end. The paper presents transient response results for the spinal model axial and bending displacements and axial force.-

Cervical spine alignment in the pediatric population: a radiographic normative study of 150 asymptomatic patients.

PubMed

Abelin-Genevois, K; Idjerouidene, A; Roussouly, P; Vital, J M; Garin, C

2014-07-01

To describe the normal cervical sagittal alignment of the pediatric spine in a normal population and to identify the changes during growth period. We randomly selected in PACS database 150 full-spine standing views. Exclusion criteria were: age >18 years, spinal deformity and any disease affecting the spine (medical charts reviewing). For cervical alignment we measured: OC-angle according to Mc Gregor, C1C7 angle, upper cervical angle, inferior cervical angle and C7 tilt. Spino pelvic parameters were analyzed: T1 tilt, thoracic kyphosis, lumbar lordosis, pelvic incidence, sacral slope and pelvic tilt. We compared two age subgroups (juvenile and adolescent). Differences between age groups and gender were tested using Student's t test. Correlations between sagittal spinal parameters were evaluated using Pearson's test. Cervical spine shape was correlated to cranio cervical orientation to maintain horizontal gaze (r = 0.60) and to thoracic kyphosis (r = -0.46). Cervical spine alignment was significantly different between the two age groups except for the global C1C7 cervical lordosis, which remained stable. A significant gender difference was found for all the cervical sagittal angles (p < 0.01) whereas no differences were demonstrated for the spino pelvic parameters, except the lumbar lordosis (p = 0.047). This study is the first to report the cervical spinal alignment in a normal pediatric Caucasian population. Even though cervical lordosis is the common shape, our results showed variability in cervical sagittal alignment. Cervical spine is a junctional area that adjusts its alignment to the head position and to the underlying spinal alignment.

Avoidance of Wrong-level Thoracic Spine Surgery Using Sterile Spinal Needles: A Technical Report.

PubMed

Chin, Kingsley R; Seale, Jason; Cumming, Vanessa

2017-02-01

A technical report. The aim of the present study was to present an improvement on localization techniques employed for use in the thoracic spine using sterile spinal needles docked on the transverse process of each vertebra, which can be performed in both percutaneous and open spinal procedures. Wrong-level surgery may have momentous clinical and emotional implications for a patient and surgeon. It is reported that one in every 2 spine surgeons will operate on the wrong level during his or her career. Correctly localizing the specific thoracic level remains a significant challenge during spine surgery. Fluoroscopic anteroposterior and lateral views were obtained starting in the lower lumbar spine, and an 18-G spinal needle was placed in the transverse process of L3 counting up from the sacrum and also at T12. The fluoroscopy was then moved cephalad and counting from the spinal needle at T12, the other spinal needles were placed at the targeted operating thoracic vertebrae. Once this was done, we were able to accurately determine the thoracic levels for surgical intervention. Using this technique, the markers were kept in place even after the incisions were made. This prevented us from losing our location in the thoracic spine. Correctly placed instrumentation was made evident with postoperative imaging. We have described the successful use of a new technique using spinal needles docked against transverse processes to correctly and reliably identify thoracic levels before instrumentation. The technique was reproducible in both open surgeries and for a percutaneous procedure. This technique maintains the correct spinal level during an open procedure. We posit that wrong-level thoracic spine surgery may be preventable.

Short-term combined effects of thoracic spine thrust manipulation and cervical spine nonthrust manipulation in individuals with mechanical neck pain: a randomized clinical trial.

PubMed

Masaracchio, Michael; Cleland, Joshua A; Hellman, Madeleine; Hagins, Marshall

2013-03-01

Randomized clinical trial. To investigate the short-term effects of thoracic spine thrust manipulation combined with cervical spine nonthrust manipulation (experimental group) versus cervical spine nonthrust manipulation alone (comparison group) in individuals with mechanical neck pain. Research has demonstrated improved outcomes with both nonthrust manipulation directed at the cervical spine and thrust manipulation directed at the thoracic spine in patients with neck pain. Previous studies have not determined if thoracic spine thrust manipulation may increase benefits beyond those provided by cervical nonthrust manipulation alone. Sixty-four participants with mechanical neck pain were randomized into 1 of 2 groups, an experimental or comparison group. Both groups received 2 treatment sessions of cervical spine nonthrust manipulation and a home exercise program consisting of active range-of-motion exercises, and the experimental group received additional thoracic spine thrust manipulations. Outcome measures were collected at baseline and at a 1-week follow-up, and included the numeric pain rating scale, the Neck Disability Index, and the global rating of change. Participants in the experimental group demonstrated significantly greater improvements (P<.001) on both the numeric pain rating scale and Neck Disability Index at the 1-week follow-up compared to those in the comparison group. In addition, 31 of 33 (94%) participants in the experimental group, compared to 11 of 31 participants (35%) in the comparison group, indicated a global rating of change score of +4 or higher at the 1-week follow-up, with an associated number needed to treat of 2. Individuals with neck pain who received a combination of thoracic spine thrust manipulation and cervical spine nonthrust manipulation plus exercise demonstrated better overall short-term outcomes on the numeric pain rating scale, the Neck Disability Index, and the global rating of change.

[Fractures of the thoracic and lumbar spine in children and adolescents].

PubMed

Kraus, R; Stahl, J-P; Heiss, C; Horas, U; Dongowski, N; Schnettler, R

2013-05-01

Only 1.5-2% of all fractures in children and adolescents are fractures of the thoracic and lumbar spine. Treatment is most often conservative. This study compares the own experience with the recent literature. Over a 48 month period all patients with fractures of the thoracic and lumbar spine, younger than 16 years were included prospectively. Of the patients 67 underwent follow-up investigations after 3-36 months. The average age of the patients was 11.9 years. Sports (53%) and traffic (28%) accidents were most frequent. Fractures most often appeared in the mid-thoracic (47%) and thoracolumbar spine (41%). Operative treatment was performed in 9 cases (10.4%). Secondary loss of alignment was not observed neither after conservative nor operative treatment. Neurological deficits (n=2) did not completely improve. Most fractures of the thoracic and lumbar spine heal fast and without any sequelae. Unstable fractures of type B and C (exclusively occurring as a result of traffic accidents) need operative stabilization as in adults.

Dumbbell-Shaped Epidural Cavernous Hemangioma in the Thoracic Spine Mimicking Schwannoma.

PubMed

Wang, Shantao; Wang, Mingwei; Wang, Fuchao; Yuan, Xunhui; Xiao, Hang; Bai, Yun'an; Liu, Fucun

2016-10-01

Dumbbell-shaped epidural cavernous hemangiomas (CHs) are extremely rare, and they are easily misdiagnosed as spinal schwannomas. Herein, the authors report 1 rare case of dumbbell-shaped epidural CH in the thoracic spine. To the best of our knowledge, only a few cases of dumbbell-shaped epidural CHs in thoracic spine have been reported. Furthermore, the clinical characteristics and treatments for spinal epidural CHs were investigated and reviewed.

Degenerative Changes of the Spine of Pilots of the RNLAF

DTIC Science & Technology

2000-08-01

views of the spine taken in standing 7-3 Table 2 Classification of disorders Disorder Levels General: Osteo-arthrosis / Spondylosis / Arthrosis...Deformans Cervical, thoracic, lumbar Scoliosis Cervical, thoracic, lumbar Abnormal alignment Cervical, lumbar Scheuermann’s disease / Enchondrosis Thoracic... lumbar Specific: Degenerative changes in the intervertebral disc / Discopathy Cervical, thoracic, lumbar Presence of Osteophyte’s / Osteophytic

Biomechanical Analysis of the Proximal Adjacent Segment after Multilevel Instrumentation of the Thoracic Spine: Do Hooks Ease the Transition?

PubMed Central

Metzger, Melodie F.; Robinson, Samuel T.; Svet, Mark T.; Liu, John C.; Acosta, Frank L.

2015-01-01

Study Design Biomechanical cadaveric study. Objective Clinical studies indicate that using less-rigid fixation techniques in place of the standard all-pedicle screw construct when correcting for scoliosis may reduce the incidence of proximal junctional kyphosis and improve patient outcomes. The purpose of this study is to investigate whether there is a biomechanical advantage to using supralaminar hooks in place of pedicle screws at the upper-instrumented vertebrae in a multilevel thoracic construct. Methods T7–T12 spines were biomechanically tested: (1) intact; (2) following a two-level pedicles screw fusion from T9 to T11; and after proximal extension of the fusion to T8–T9 with (3) bilateral supra-laminar hooks, (4) a unilateral hook + unilateral screw hybrid, or (5) bilateral pedicle screws. Specimens were nondestructively loaded while three-dimensional kinematics and intradiscal pressure at the supra-adjacent level were recorded. Results Supra-adjacent hypermobility was reduced when bilateral hooks were used in place of pedicle screws at the upper-instrumented level, with statistically significant differences in lateral bending and torsion (p < 0.05 and p < 0.001, respectively). Disk pressures in the supra-adjacent segment were not statistically different among top-off techniques. Conclusions The use of supralaminar hooks at the top of a multilevel posterior fusion construct reduces the stress at the proximal uninstrumented motion segment. Although further data is needed to provide a definitive link to the clinical occurrence of PJK, this in vitro study demonstrates the potential benefit of “easing” the transition between the stiff instrumented spine and the flexible native spine and is the first to demonstrate these results with laminar hooks. PMID:27190735

The cat vertebral column: stance configuration and range of motion

NASA Technical Reports Server (NTRS)

Macpherson, J. M.; Ye, Y.; Peterson, B. W. (Principal Investigator)

1998-01-01

This study examined the configuration of the vertebral column of the cat during independent stance and in various flexed positions. The range of motion in the sagittal plane is similar across most thoracic and lumbar joints, with the exception of a lesser range at the transition region from thoracic-type to lumbar-type vertebrae. The upper thoracic column exhibits most of its range in dorsiflexion and the lower thoracic and lumbar in ventroflexion. Lateral flexion is limited to less than 5 degrees at all segments. The range in torsion is almost 180 degrees and occurs primarily in the midthoracic region, T4-T11. Contrary to the depiction in most atlases, the standing cat exhibits several curvatures, including a mild dorsiflexion in the lower lumbar segments, a marked ventroflexion in the lower thoracic and upper lumbar segments, and a profound dorsiflexion in the upper thoracic (above T9) and cervical segments. The curvatures are not significantly changed by altering stance distance but are affected by head posture. During stance, the top of the scapula lies well above the spines of the thoracic vertebrae, and the glenohumeral joint is just below the bodies of vertebrae T3-T5. Using a simple static model of the vertebral column in the sagittal plane, it was estimated that the bending moment due to gravity is bimodal with a dorsiflexion moment in the lower thoracic and lumbar region and a ventroflexion moment in the upper thoracic and cervical region. Given the bending moments and the position of the scapula during stance, it is proposed that two groups of scapular muscles provide the major antigravity support for the head and anterior trunk. Levator scapulae and serratus ventralis form the lateral group, inserting on the lateral processes of cervical vertebrae and on the ribs. The major and minor rhomboids form the medial group, inserting on the spinous tips of vertebrae from C4 to T4. It is also proposed that the hypaxial muscles, psoas major, minor, and quadratus lumborum could support the lumbar trunk during stance.

Validity of the Digital Inclinometer and iPhone When Measuring Thoracic Spine Rotation.

PubMed

Bucke, Jonathan; Spencer, Simon; Fawcett, Louise; Sonvico, Lawrence; Rushton, Alison; Heneghan, Nicola R

2017-09-01

  Spinal axial rotation is required for many functional and sporting activities. Eighty percent of axial rotation occurs in the thoracic spine. Existing measures of thoracic spine rotation commonly involve laboratory equipment, use a seated position, and include lumbar motion. A simple performance-based outcome measure would allow clinicians to evaluate isolated thoracic spine rotation. Currently, no valid measure exists.   To explore the criterion and concurrent validity of a digital inclinometer (DI) and iPhone Clinometer app (iPhone) for measuring thoracic spine rotation using the heel-sit position.   Controlled laboratory study.   University laboratory.   A total of 23 asymptomatic healthy participants (14 men, 9 women; age = 25.82 ± 4.28 years, height = 170.26 ± 8.01 cm, mass = 67.50 ± 9.46 kg, body mass index = 23.26 ± 2.79) were recruited from a student population.   We took DI and iPhone measurements of thoracic spine rotation in the heel-sit position concurrently with dual-motion analysis (laboratory measure) and ultrasound imaging of the underlying bony tissue motion (reference standard). To determine the criterion and concurrent validity, we used the Pearson product moment correlation coefficient (r, 2 tailed) and Bland-Altman plots.   The DI (r = 0.88, P < .001) and iPhone (r = 0.88, P < .001) demonstrated strong criterion validity. Both also had strong concurrent validity (r = 0.98, P < .001). Bland-Altman plots illustrated mean differences of 5.82° (95% confidence interval [CI] = 20.37°, -8.73°) and 4.94° (95% CI = 19.23°, -9.35°) between the DI and iPhone, respectively, and the reference standard and 0.87° (95% CI = 6.79°, -5.05°) between the DI and iPhone.   The DI and iPhone provided valid measures of thoracic spine rotation in the heel-sit position. Both can be used in clinical practice to assess thoracic spine rotation, which may be valuable when evaluating thoracic dysfunction.

Physiological Motion Axis for the Seat of a Dynamic Office Chair.

PubMed

Kuster, Roman Peter; Bauer, Christoph Markus; Oetiker, Sarah; Kool, Jan

2016-09-01

The aim of this study was to determine and verify the optimal location of the motion axis (MA) for the seat of a dynamic office chair. A dynamic seat that supports pelvic motion may improve physical well-being and decrease the risk of sitting-associated disorders. However, office work requires an undisturbed view on the work task, which means a stable position of the upper trunk and head. Current dynamic office chairs do not fulfill this need. Consequently, a dynamic seat was adapted to the physiological kinematics of the human spine. Three-dimensional motion tracking in free sitting helped determine the physiological MA of the spine in the frontal plane. Three dynamic seats with physiological, lower, and higher MA were compared in stable upper body posture (thorax inclination) and seat support of pelvic motion (dynamic fitting accuracy). Spinal kinematics during sitting and walking were compared. The physiological MA was at the level of the 11th thoracic vertebra, causing minimal thorax inclination and high dynamic fitting accuracy. Spinal motion in active sitting and walking was similar. The physiological MA of the seat allows considerable lateral flexion of the spine similar to walking with a stable upper body posture and a high seat support of pelvic motion. The physiological MA enables lateral flexion of the spine, similar to walking, without affecting stable upper body posture, thus allowing active sitting while focusing on work. © 2016, Human Factors and Ergonomics Society.

Dose conformation to the spine during palliative treatments using dynamic wedges

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ormsby, Matthew A., E-mail: Matthew.Ormsby@usoncology.com; Herndon, R. Craig; Kaczor, Joseph G.

2013-07-01

Radiation therapy is commonly used to alleviate pain associated with metastatic disease of the spine. Often, isodose lines are manipulated using dynamic or physical wedges to encompass the section of spine needing treatment while minimizing dose to normal tissue. We will compare 2 methods used to treat the entire thoracic spine. The first method treats the thoracic spine with a single, nonwedged posterior-anterior (PA) field. Dose is prescribed to include the entire spine. Isodose lines tightly conform to the top and bottom vertebrae, but vertebrae between these 2 received more than enough coverage. The second method uses a combination ofmore » wedges to create an isodose line that mimics the curvature of the thoracic spine. This “C”-shaped curvature is created by overlapping 2 fields with opposing dynamic wedges. Machine constraints limit the treatment length and therefore 2 isocenters are used. Each of the 2 PA fields contributes a portion of the total daily dose. This technique creates a “C”-shaped isodose line that tightly conforms to the thoracic spine, minimizing normal tissue dose. Spinal cord maximum dose is reduced, as well as mean dose to the liver, esophagus, and heart.« less

An ergonomic evaluation comparing desktop, notebook, and subnotebook computers.

PubMed

Szeto, Grace P; Lee, Raymond

2002-04-01

To evaluate and compare the postures and movements of the cervical and upper thoracic spine, the typing performance, and workstation ergonomic factors when using a desktop, notebook, and subnotebook computers. Repeated-measures design. A motion analysis laboratory with an electromagnetic tracking device. A convenience sample of 21 university students between ages 20 and 24 years with no history of neck or shoulder discomfort. Each subject performed a standardized typing task by using each of the 3 computers. Measurements during the typing task were taken at set intervals. Cervical and thoracic spines adopted a more flexed posture in using the smaller-sized computers. There were significantly greater neck movements in using desktop computers when compared with the notebook and subnotebook computers. The viewing distances adopted by the subjects decreased as the computer size decreased. Typing performance and subjective rating of difficulty in using the keyboards were also significantly different among the 3 types of computers. Computer users need to consider the posture of the spine and potential risk of developing musculoskeletal discomfort in choosing computers. Copyright 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Differential growth and development of the upper and lower human thorax.

PubMed

Bastir, Markus; García Martínez, Daniel; Recheis, Wolfgang; Barash, Alon; Coquerelle, Michael; Rios, Luis; Peña-Melián, Angel; García Río, Francisco; O'Higgins, Paul

2013-01-01

The difficulties in quantifying the 3D form and spatial relationships of the skeletal components of the ribcage present a barrier to studies of the growth of the thoracic skeleton. Thus, most studies to date have relied on traditional measurements such as distances and indices from single or few ribs. It is currently known that adult-like thoracic shape is achieved early, by the end of the second postnatal year, with the circular cross-section of the newborn thorax transforming into the ovoid shape of adults; and that the ribs become inclined such that their anterior borders come to lie inferior to their posterior. Here we present a study that revisits growth changes using geometric morphometrics applied to extensive landmark data taken from the ribcage. We digitized 402 (semi) landmarks on 3D reconstructions to assess growth changes in 27 computed tomography-scanned modern humans representing newborns to adults of both sexes. Our analyses show a curved ontogenetic trajectory, resulting from different ontogenetic growth allometries of upper and lower thoracic units. Adult thoracic morphology is achieved later than predicted, by diverse modifications in different anatomical regions during different ontogenetic stages. Besides a marked increase in antero-posterior dimensions, there is an increase in medio-lateral dimensions of the upper thorax, relative to the lower thorax. This transforms the pyramidal infant thorax into the barrel-shaped one of adults. Rib descent is produced by complex changes in 3D curvature. Developmental differences between upper and lower thoracic regions relate to differential timings and rates of maturation of the respiratory and digestive systems, the spine and the locomotor system. Our findings are relevant to understanding how changes in the relative rates of growth of these systems and structures impacted on the development and evolution of modern human body shape.

Differential Growth and Development of the Upper and Lower Human Thorax

PubMed Central

Bastir, Markus; García Martínez, Daniel; Recheis, Wolfgang; Barash, Alon; Coquerelle, Michael; Rios, Luis; Peña-Melián, Ángel; García Río, Francisco; O’Higgins, Paul

2013-01-01

The difficulties in quantifying the 3D form and spatial relationships of the skeletal components of the ribcage present a barrier to studies of the growth of the thoracic skeleton. Thus, most studies to date have relied on traditional measurements such as distances and indices from single or few ribs. It is currently known that adult-like thoracic shape is achieved early, by the end of the second postnatal year, with the circular cross-section of the newborn thorax transforming into the ovoid shape of adults; and that the ribs become inclined such that their anterior borders come to lie inferior to their posterior. Here we present a study that revisits growth changes using geometric morphometrics applied to extensive landmark data taken from the ribcage. We digitized 402 (semi) landmarks on 3D reconstructions to assess growth changes in 27 computed tomography-scanned modern humans representing newborns to adults of both sexes. Our analyses show a curved ontogenetic trajectory, resulting from different ontogenetic growth allometries of upper and lower thoracic units. Adult thoracic morphology is achieved later than predicted, by diverse modifications in different anatomical regions during different ontogenetic stages. Besides a marked increase in antero-posterior dimensions, there is an increase in medio-lateral dimensions of the upper thorax, relative to the lower thorax. This transforms the pyramidal infant thorax into the barrel-shaped one of adults. Rib descent is produced by complex changes in 3D curvature. Developmental differences between upper and lower thoracic regions relate to differential timings and rates of maturation of the respiratory and digestive systems, the spine and the locomotor system. Our findings are relevant to understanding how changes in the relative rates of growth of these systems and structures impacted on the development and evolution of modern human body shape. PMID:24073239

Intradural Extramedullary Capillary Hemangioma in the Upper Cervical Spine: First Report.

PubMed

Bouali, Sofiene; Maatar, Nidhal; Bouhoula, Asma; Abderrahmen, Khansa; Kallel, Jalel; Jemel, Hafedh

2016-08-01

The occurrence of intradural extramedullary capillary hemangiomas is exceedingly rare. To date, only 39 cases of intradural extramedullary capillary hemangiomas have been reported in the English literature, and all of these cases have been described at the lumbar and thoracic spinal levels. To our knowledge, this report is the first case of capillary hemangiomas of the cervical spine in the literature. In general, this entity is misdiagnosed preoperatively as a neoplasm. A 29-year-old man presented with neck pain and progressive gait disturbance, and was diagnosed with an intradural extramedullary capillary hemangioma in the cervical region. Although rare, our case demonstrates that capillary hemangioma should be considered in the differential diagnosis of intradural extramedullary tumor of the cervical spine. Copyright © 2016 Elsevier Inc. All rights reserved.

The immediate effects of thoracic transverse mobilization in patients with the primary complaint of mechanical neck pain: a pilot study.

PubMed

McGregor, CIndy; Boyles, Robert; Murahashi, Laura; Sena, Tanya; Yarnall, Robert

2014-11-01

Posterior-to-anterior (PA) vertebral mobilization to the thoracic spine has been studied as an intervention for neck pain. Our purpose was to explore effects of a different mobilization technique, transverse vertebral pressure, on cervical range of motion (ROM) and pain when applied to the thoracic spine among participants with neck pain. A single-blinded quasi-experimental study with a one-group pretest-posttest design. A transverse group consisted of 21 participants whose neck pain increased with active movements. A non-intervention group of 20 asymptomatic participants was included simply to ensure rater blinding. The treatment group received Grades IV to IV+ transverse mobilizations at T1 through T4 bilaterally. Measurements taken immediately after intervention included pre/post cervical ROM, distant pressure pain threshold (PPT), and a numerical pain rating scale (NPRS). Analysis utilized t-tests and ordinal counterparts. The transverse group demonstrated significant gains in extension and bilateral rotation (P≤0.005) but not flexion or side-bend. A total of 57% of mobilized participants reported clinically meaningful decreased pain (P<0.001). Seven participants exceeded the PPT MDC95 of 0.36 kg/cm(2). The non-intervention group had no significant changes in ROM or NPRS scores. After 8 minutes of transverse mobilization to the upper thoracic spine, significant gains in cervical extension and bilateral rotation, and decreased pain scores were found. There were no adverse effects. Unlike other mobilization studies, PPT changes at a remote site were statistically but not clinically meaningful. Findings suggest that transverse mobilization would be a productive topic for controlled clinical trials.

The immediate effects of thoracic transverse mobilization in patients with the primary complaint of mechanical neck pain: a pilot study

PubMed Central

McGregor, CIndy; Boyles, Robert; Murahashi, Laura; Sena, Tanya; Yarnall, Robert

2014-01-01

Objective: Posterior-to-anterior (PA) vertebral mobilization to the thoracic spine has been studied as an intervention for neck pain. Our purpose was to explore effects of a different mobilization technique, transverse vertebral pressure, on cervical range of motion (ROM) and pain when applied to the thoracic spine among participants with neck pain. Methods: A single-blinded quasi-experimental study with a one-group pretest–posttest design. A transverse group consisted of 21 participants whose neck pain increased with active movements. A non-intervention group of 20 asymptomatic participants was included simply to ensure rater blinding. The treatment group received Grades IV to IV+ transverse mobilizations at T1 through T4 bilaterally. Measurements taken immediately after intervention included pre/post cervical ROM, distant pressure pain threshold (PPT), and a numerical pain rating scale (NPRS). Analysis utilized t-tests and ordinal counterparts. Results: The transverse group demonstrated significant gains in extension and bilateral rotation (P≤0.005) but not flexion or side-bend. A total of 57% of mobilized participants reported clinically meaningful decreased pain (P<0.001). Seven participants exceeded the PPT MDC95 of 0.36 kg/cm2. The non-intervention group had no significant changes in ROM or NPRS scores. Discussion: After 8 minutes of transverse mobilization to the upper thoracic spine, significant gains in cervical extension and bilateral rotation, and decreased pain scores were found. There were no adverse effects. Unlike other mobilization studies, PPT changes at a remote site were statistically but not clinically meaningful. Findings suggest that transverse mobilization would be a productive topic for controlled clinical trials. PMID:25395827

A longitudinal study of trunk muscle properties and severity of thoracic kyphosis in women and men: The Framingham Study.

PubMed

Lorbergs, Amanda L; Allaire, Brett T; Yang, Laiji; Kiel, Douglas P; Cupples, L Adrienne; Jarraya, Mohamed; Guermazi, Ali; Travison, Thomas G; Bouxsein, Mary L; Anderson, Dennis E; Samelson, Elizabeth J

2018-04-24

Cross-sectional studies suggest that trunk muscle morphology in the lumbar spine is an important determinant of kyphosis severity in older adults. The contribution of age-related changes in muscle morphology in the thoracic and lumbar spine to progression of kyphosis is not known. Our objective was to determine cross-sectional and longitudinal associations of thoracic and lumbar muscle size and density with kyphosis. Participants were 1,087 women and men (mean age 61y) of the Framingham Heart Study who underwent baseline and follow-up quantitative computed tomography (QCT) scanning 6y apart. We used QCT scans to measure trunk muscle cross-sectional area (CSA, cm2) and density (HU) at the thoracic and lumbar spine and Cobb angle (degrees) from T4 to T12. Linear regression models estimated the association between muscle morphology and kyphosis. At baseline, smaller muscle CSA and lower density of thoracic (but not lumbar) spine muscles were associated with a larger (worse) Cobb angle in women and men. For example, each standard deviation (SD) decrease in baseline thoracic paraspinal muscle CSA was associated with a larger baseline Cobb angle in women (3.7°, 95%CI:2.9, 4.5) and men (2.5°, 95%CI:1.6, 3.3). Longitudinal analyses showed that loss of muscle CSA and density at the thoracic and lumbar spine was not associated with progression of kyphosis. Our findings suggest that kyphosis severity is related to smaller and lower density trunk muscles at the thoracic spine. Future studies are needed to determine how strengthening mid-back musculature alters muscle properties and contributes to preventing kyphosis progression.

[Characteristic of the fractures of the cervical, thoracic and lumbar vertebrae in the victims of a traffic accident found in the passenger compartment of a modern motor vehicle].

PubMed

Pigolkin, Iu I; Dubrovin, I A; Sedykh, E P; Mosoian, A S

2016-01-01

The objective of the present work was to study peculiar features of the injuries to three spinal regions in the victims of a head-on car collision found in the passenger compartments of modern motor vehicles equipped with seat belts and other safety means. It was shown that most frequent fatal injuries to the driver include the fractures of the cervical, thoracic, and lumbar vertebrae. These injuries are much less frequent in the passengers occupying the front and the right back seats. The multilayer and multiple character of the fractures in different parts of the spinal column in the car drivers is attributable to more pronounced spine flexion and extension associated with injuries of this kind. The fractures of the lower cervical vertebrae in the front seat passengers occur more frequently than injuries of a different type whereas the passengers of the back seats most frequently experience fractures of the upper cervical vertebrae. The passengers of the left back seat less frequently suffer from injuries to the thoracic spine than from the fractures of the cervical and lumbar vertebrae. The passengers of the central back seat most frequently experience fractures of the thoracic part of the vertebral column and the passengers occupying the right back seat fractures of the lumbar vertebrae.

Diffuse idiopathic skeletal hyperostosis association with thoracic spine kyphosis: a cross-sectional study for the Health Aging and Body Composition Study.

PubMed

Nardo, Lorenzo; Lane, Nancy E; Parimi, Neeta; Cawthon, Peggy M; Fan, Bo; Shepherd, John; Cauley, Jane; Zucker-Levin, Audrey; Murphy, Rachel A; Katzman, Wendy B

2014-11-15

A descriptive study of the association between diffuse idiopathic skeletal hyperostosis (DISH) and kyphosis. To investigate the association of DISH with Cobb angle of kyphosis in a large cohort of older subjects from the Health Aging and Body Composition Study. DISH and thoracic kyphosis are well-defined radiographical findings in spines of older individuals. Characteristics of DISH (ossifications between vertebral segments) reflect changes of spine anatomy and physiology that may be associated with Cobb angle of kyphosis. Using data from 1172 subjects aged 70 to 79 years, we measured DISH and Cobb angle of kyphosis from computed tomographic lateral scout scans. Characteristics of participants with and without DISH were assessed using the χ² and t tests. Association between DISH and Cobb angle was analyzed using linear regression. Cobb angle and DISH relationship was assessed at different spine levels (thoracic and lumbar). DISH was identified on computed tomographic scout scan in 152 subjects with 101 cases in only the thoracic spine and 51 in both thoracic and lumbar spine segments. The mean Cobb angle of kyphosis in the analytic sample was 31.3° (standard deviation = 11.2). The presence of DISH was associated with a greater Cobb angle of 9.1° and 95% confidence interval (95% CI) (5.6-12.6) among African Americans and a Cobb angle of 2.9° and 95% CI (0.5-5.2) among Caucasians compared with those with no DISH. DISH in the thoracic spine alone was associated with a greater Cobb angle of 10.6° and 95% CI (6.5-14.7) in African Americans and a Cobb angle of 3.8° and 95% CI (1.0-6.5) in Caucasians compared with those with no DISH. DISH is associated with greater Cobb angle of kyphosis, especially when present in the thoracic spine alone. The association of DISH with Cobb angle is stronger within the African American population.

Immediate and lasting effects of a thoracic spine manipulation in a patient with signs of cervical radiculopathy and upper extremity hyperalgesia: A case report.

PubMed

Deschenes, Beth K; Zafereo, Jason

2017-01-01

Patients with cervical radiculopathy (CR) may present with accompanying symptoms of hyperalgesia, allodynia, heaviness in the arm, and non-segmental pain that do not appear to be related to a peripheral spinal nerve. These findings may suggest the presence of central or autonomic nervous system involvement, requiring a modified management approach. The purpose of this case report is to describe the treatment of a patient with signs of CR and upper extremity (UE) hyperalgesia who had a significant decrease in her UE pain and hypersensitivity after a single thoracic spine manipulation (TSM). A 48-year-old female presented to physical therapy with acute neck pain radiating into her left UE that significantly limited her ability to sleep and work. After a single TSM, the patient demonstrated immediate and lasting reduction in hyperalgesia, hypersensitivity to touch, elimination of perceived heaviness and coldness in her left UE, and improved strength in the C6-8 myotome, allowing for improved functional activity capacity and tolerance to a multi-modal PT program. Based on these results, clinicians should consider the early application of TSM in patients with CR who have atypical, widespread, or severe neurological symptoms that limit early mobilization and tolerance to treatment at the painful region.

Heritability of Thoracic Spine Curvature and Genetic Correlations With Other Spine Traits: The Framingham Study

PubMed Central

Yau, Michelle S; Demissie, Serkalem; Zhou, Yanhua; Anderson, Dennis E; Lorbergs, Amanda L; Kiel, Douglas P; Allaire, Brett T; Yang, Laiji; Cupples, L Adrienne; Travison, Thomas G; Bouxsein, Mary L; Karasik, David; Samelson, Elizabeth J

2017-01-01

Hyperkyphosis is a common spinal disorder in older adults, characterized by excessive forward curvature of the thoracic spine and adverse health outcomes. The etiology of hyperkyphosis has not been firmly established, but may be related to changes that occur with aging in the vertebrae, discs, joints, and muscles, which function as a unit to support the spine. Determining the contribution of genetics to thoracic spine curvature and the degree of genetic sharing among co-occurring measures of spine health may provide insight into the etiology of hyperkyphosis. The purpose of our study was to estimate heritability of thoracic spine curvature using T4–T12 kyphosis (Cobb) angle and genetic correlations between thoracic spine curvature and vertebral fracture, intervertebral disc height narrowing, facet joint osteoarthritis (OA), lumbar spine volumetric bone mineral density (vBMD), and paraspinal muscle area and density, which were all assessed from computed tomography (CT) images. Participants included 2063 women and men in the second and third generation offspring of the original cohort of the Framingham Study. Heritability of kyphosis angle, adjusted for age, sex, and weight, was 54% (95% confidence interval [CI], 43% to 64%). We found moderate genetic correlations between kyphosis angle and paraspinal muscle area ( ρ^G, −0.46; 95% CI, −0.67 to −0.26), vertebral fracture ( ρ^G, 0.39; 95% CI, 0.18 to 0.61), vBMD ( ρ^G,−0.23; 95% CI, −0.41 to −0.04), and paraspinal muscle density ( ρ^G,−0.22; 95% CI, −0.48 to 0.03). Genetic correlations between kyphosis angle and disc height narrowing ( ρ^G, 0.17; 95% CI, −0.05 to 0.38) and facet joint OA ( ρ^G, 0.05; 95% CI, −0.15 to 0.24) were low. Thoracic spine curvature may be heritable and share genetic factors with other age-related spine traits including trunk muscle size, vertebral fracture, and bone mineral density. PMID:27455046

[Metachronous Bilateral Hemothorax Due to Reverse Chance Type Thoracic Fracture].

PubMed

Fukada, Takehisa; Morita, Katsuhiko; Ueki, Takayuki; Hanaoka, Nobuharu

2017-06-01

Metachronous bilateral hemothorax due to reverse Chance type thoracic fracture is very rare. In this case, we experienced a case of metachronous bilateral hemothorax, triggered by a thoracic fracture in which the anterior component of the spine collapsed, so-called reverse Chance type thoracic fracture. An 83-year-old woman with spinal kyphosis traumatically injured thoracic spine burst fracture, and bone fragments appeared on both sides of the destroyed vertebra. After injury, the left hemothorax also appeared, followed by the right hemothorax causing hemorrhagic shock. In thoracic destructive anterior fracture, we should consider the possibility of metachronous bilateral hemothorax.

Extension of the Thoracic Spine Sign: A New Sonographic Marker of Pleural Effusion.

PubMed

Dickman, Eitan; Terentiev, Victoria; Likourezos, Antonios; Derman, Anna; Haines, Lawrence

2015-09-01

Dyspnea is a common emergency department (ED) condition, which may be caused by pleural effusion and other thoracic diseases. We present data on a new sonographic marker, the extension of the thoracic spine sign, for diagnosis of pleural effusion. In this prospective study, we enrolled a convenience sample of undifferentiated patients who underwent computed tomography (CT) of the abdomen or chest, which was performed as part of their emergency department evaluations. Patients underwent chest sonography to assess the utility of the extension of the thoracic spine sign for diagnosing pleural effusion. The point-of-care sonographic examinations were performed and interpreted by emergency physicians who were blinded to information in the medical records. Sonographic results were compared to radiologists' interpretations of the CT results, which were considered the criterion standard. Forty-one patients were enrolled, accounting for 82 hemithoraces. Seven hemithoraces were excluded from the analysis due to various limitations, leaving 75 hemithoraces for the final analysis. The median time for completion of the sonographic examination was 3 minutes. The sensitivity and specificity for extension of the thoracic spine were 73.7% (95% confidence interval [CI], 48.6%-89.9%) and 92.9% (95%CI, 81.9%-97.7%), respectively. Overall, there were 5 hemithoraces with false-negative results when using the extension sign. Of those 5 cases, 4 were found to have trace pleural effusions on CT. When trace pleural effusions were excluded in a subgroup analysis, the sensitivity and specificity of extension of the thoracic spine were 92.9% (95% CI, 64.2%-99.6%) and 92.9% (95% CI, 81.9%-97.7%). We found the extension of the thoracic spine sign to be an excellent diagnostic tool for clinically relevant pleural effusion. © 2015 by the American Institute of Ultrasound in Medicine.

[Abnormal growth of spine in patients with adolescent idiopathic thoracic scoliosis].

PubMed

Bao, Hongda; Liu, Zhen; Qiu, Yong; Zhu, Feng; Zhu, Zezhang; Zhang, Wen

2014-05-01

To investigate if the growth patterns of the spine and pelvis are consistent in adolescent idiopathic scoliosis (AIS) patients with single thoracic curves. Forty-eight thoracic adolescent idiopathic scoliosis (T-AIS) female patients and 48 healthy age-matched adolescents were recruited consecutively between December 2011 and October 2012. Radiographic parameters including height of spine (HOS), length of spine (LOS), height of thoracic spine (HOT), length of thoracic spine (LOT), height of pelvis (HOP), width of pelvis (WOP) and width of thorax (WOT) were measured on the long-cassette posteroanterior standing radiographs. In addition, ratios including HOS/HOP, LOS/HOP, HOT/HOP, LOT/HOP, LOS/LOT, WOT/WOP were also calculated. Independent t-test was performed to compare the radiographic parameters and ratios between the two groups. Compared to the age-matched healthy adolescents, T-AIS patients had a significantly higher LOS and LOT (t = -2.364 and -1.495, P = 0.020 and 0.043) and smaller HOS and HOT (t = 2.060 and 3.359, P = 0.042 and 0.001). Yet, all of HOP, WOP and WOT showed no significant difference between T-AIS patients and healthy adolescents. Similarly, LOS/HOP and LOT/HOP were significantly higher in T-AIS patients as may be expected with an average LOS/HOP of 2.26 ± 0.14 in normal controls.In addition, LOS/LOT in normal controls had a trend of increase with age which was different from the stable LOS/LOT in T-AIS patients, indicating an increased growth of thoracic vertebra compared to lumbar vertebra. Compared to the age-matched healthy adolescents, T-AIS patients have an abnormal growth characteristics with longer spine. The growth of pelvis and thorax show no significant differences between T-AIS patients and healthy adolescents.

Thoracic Spine Growth Revisited: How Accurate Is the Dimeglio Data?

PubMed

Dede, Ozgur; Büyükdoğan, Kadir; Demirkıran, Halil Gökhan; Akpınar, Erhan; Yazici, Muharrem

2017-06-15

Cross-sectional descriptive study. To describe the normal rate pattern of thoracic spine growth in children without any spinal deformity. The knowledge of thoracic spine growth and height is important for growing spine treatment and the decision of final fusion. Currently, pediatric spinal deformity is approached as early onset and late onset with an understanding of the fast growth during the first 5 years of life. The growth data that support this classification is often cited but has not been reconfirmed with follow-up studies. Sagittal computed tomography (CT) reformations of thoracic vertebrae were examined in children without spinal deformity. The sagittal CT cut at the widest canal diameter was identified and the measurements were performed on this image. The length of the thoracic spine was measured from the posterosuperior corner of T1 to the posteroinferior corner of the T12. One hundred forty-four thoracic CT scans satisfied the inclusion criteria. The analysis of the data identified two break points in the growth velocity; one at the end of the 4th year of life and the other at the beginning of the 12th year. Specifically, growth rate between 1 and 4 years was 1.71 cm/yr, between 4 and 8 years was 0.55 cm/yr, between 8 and 10 was 0.74 cm/yr, between 10 and 12 was 0.69 cm/yr, and between 12 and 16 was 1.61 cm/yr. The results show that in growing children the thoracic spine demonstrates two major growth spurts. The initial growth spurt is between the birth to the end of the fourth year of life and the second is between the 12 and 16 years of age. Between 4 and 12 years there is a steady but slower increase in thoracic height. The findings show that the fastest growth velocity may be limited to a younger age group than previously believed. This data will help guide growth friendly management strategies. 2.

The effect of adenotonsillectomy on the position of head, cervical and thoracic spine and scapular girdle of mouth breathing children.

PubMed

Neiva, Patricia Dayrell; Franco, Letícia Paiva; Kirkwood, Renata Noce; Becker, Helena Gonçalves

2018-04-01

The clinical decision for surgical treatment of children diagnosed with mouth breathing depends on the percentage of mechanical obstruction correlated with exacerbation of upper respiratory tract infections and systemic changes. The benefits of adenotonsillectomy include changes in the nasopharyngeal space, the mandibular plane and myofunctional alterations. Post-adenotonsilectomy postural benefits have not yet been described. To investigate the kinematics of the shoulder girdle, cervical and thoracic spine in children with mouth breathing before and after adenotonsillectomy. Forty-nine mouth breathing children (6.3 ± 1.8 years) of both sexes participated in the study. The measures of thoracic kyphosis, forward head position, shoulders protrusion and abduction, elevation, anterior tilt and internal rotation of the scapula were evaluated before and after surgery. The kinematic data were obtained using the system Qualysis ProReflex ® . There was a significant decrease in forward head position, shoulders protrusion, elevation and anterior tilt of the scapula after surgery compared to the pre-operative. One of adenotonsillectomy results is the improvement of the posture of the head and the shoulder girdle of mouth breathing children. Clinically these findings are important and will contribute to improving the quality of life of mouth breathing children. Copyright © 2018 Elsevier B.V. All rights reserved.

Experience with 161 cases of anterior exposure of the thoracic and lumbar spine in an acute care surgery model: impact of exposure level and underlying pathology on morbidity.

PubMed

Seoudi, Hani; Laporta, Matthew; Griffen, Margaret; Rizzo, Anne; Pullarkat, Ranjit

2013-08-15

Retrospective chart review. To evaluate the outcomes of anterior exposure of the thoracic and lumbar spine by an acute care surgery service. Spine surgeons typically require an "approach surgeon" to provide anterior exposure of the thoracic and lumbar spine. We hypothesized that a dedicated acute care surgery service can perform those operations with acceptable morbidity and mortality. A retrospective review of 161 trauma and nontrauma patients was performed. All cases were performed at a level I trauma center with a dedicated acute care surgery service. In-hospital morbidity and mortality were evaluated. A brief description of the operative techniques used by our group is also provided. Of the 161 patients, 59 (37%) were trauma patients. Ninety-three patients (58%) had anterolateral retroperitoneal exposure of the thoracic and lumbar spine. Sixty-eight patients (42%) had anterior retroperitoneal midline exposure of the lumbar and lumbosacral spine. Total morbidity was 9.3% (7.4% for trauma patients and 1.8% for non trauma patients). Morbidity was highest in patients who had anterolateral exposure of the thoracic and lumbar spine (6.8%). Morbidity in patients who had midline exposure of L4 to S1 was 0%. Total mortality was 1.2% (3.3% for trauma patients and 0% for nontrauma patients). The acute care surgery service gained 3141 physician work relative value units (RVU) by performing those operations. Anterior exposure of the thoracic and lumbar spine both for trauma and nontrauma related indications can be performed with acceptable morbidity and mortality by a dedicated acute care surgery service. Morbidity and mortality were higher in trauma patients and in those who underwent thoracolumbar procedures. Patients who had midline exposure of L4 to S1 for degenerative disc disease had the lowest morbidity. 4.

Postfixed brachial plexus radiculopathy due to thoracic disc herniation in a collegiate wrestler: a case report.

PubMed

Kuzma, Scott A; Doberstein, Scott T; Rushlow, David R

2013-01-01

To present the unique case of a collegiate wrestler with C7 neurologic symptoms due to T1-T2 disc herniation. A 23-year-old male collegiate wrestler injured his neck in a wrestling tournament match and experienced pain, weakness, and numbness in his left upper extremity. He completed that match and 1 additional match that day with mild symptoms. Evaluation by a certified athletic trainer 6 days postinjury showed radiculopathy in the C7 distribution of his left upper extremity. He was evaluated further by the team physician, a primary care physician, and a neurosurgeon. Cervical spine injury, stinger/burner, peripheral nerve injury, spinal cord injury, thoracic outlet syndrome, brachial plexus radiculopathy. The patient initially underwent nonoperative management with ice, heat, massage, electrical stimulation, shortwave diathermy, and nonsteroidal anti-inflammatory drugs without symptom resolution. Cervical spine radiographs were negative for bony pathologic conditions. Magnetic resonance imaging showed evidence of T1-T2 disc herniation. The patient underwent surgery to resolve the symptoms and enable him to participate for the remainder of the wrestling season. Whereas brachial plexus radiculopathy commonly is seen in collision sports, a postfixed brachial plexus in which the T2 nerve root has substantial contribution to the innervation of the upper extremity is a rare anatomic variation with which many health care providers are unfamiliar. The injury sustained by the wrestler appeared to be C7 radiculopathy due to a brachial plexus traction injury. However, it ultimately was diagnosed as radiculopathy due to a T1-T2 thoracic intervertebral disc herniation causing impingement of a postfixed brachial plexus and required surgical intervention. Athletic trainers and physicians need to be aware of the anatomic variations of the brachial plexus when evaluating and caring for patients with suspected brachial plexus radiculopathies.

Development of upper tract stones in patients with congenital neurogenic bladder.

PubMed

Stephany, Heidi A; Clayton, Douglass B; Tanaka, Stacy T; Thomas, John C; Pope, John C; Brock, John W; Adams, Mark C

2014-02-01

Patients with neurogenic bladder are at increased risk of developing upper tract stones. We hypothesized that patients with lower urinary tract stone disease are at greater risk of developing upper tract stones. We performed a 10-year retrospective case-control study of patients with neurogenic bladder to determine the association between bladder and upper tract stones. Independent risk factors for upper tract stones were assessed. Cases and controls were matched 1:1. Univariable analysis was performed by Fisher's exact test and the Mann-Whitney U test. Multivariable logistic regression was performed. 52 cases and controls were identified. Cases were significantly more likely to be non-ambulatory, have bowel-urinary tract interposition, thoracic level dysraphism, and history of bladder stones. On multivariable analysis, independent predictors of stone formation were male sex (OR 2.82; p = 0.02), dysraphism involving the thoracic spine (OR 3.37; p = 0.014) bowel-urinary tract interposition (OR 2.611; p = 0.038), and a history of bladder stones (OR 3.57; p = 0.015). Patients with neurogenic bladder are at increased risk for upper tract stones. The presence of bladder stones may herald the development of upper tract stones. The predictors of stone disease identified should guide prospective studies to better understand the natural history of upper tract stone development in this population. Copyright © 2013 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

A Knowledge Translation Programme to Increase the Utilization of Thoracic Spine Mobilization and Manipulation for Patients with Neck Pain.

PubMed

Karas, Steve; Westerheide, Angela; Daniel, Laura

2016-06-01

There is extensive evidence that mobilization and manipulation of the thoracic spine is associated with improved outcomes in patients with neck pain. However, these evidence-based techniques are not always utilized. Successful knowledge translation programmes are needed to move the best available evidence to clinical practice. The purpose of the present research was to evaluate the effects of a structured knowledge translation programme on the frequency of manual therapy techniques performed by physical therapists on patients with neck pain. Prior to our intervention, we assessed physical therapists' use of thoracic spine intervention for the treatment of neck pain and their knowledge of the evidence. We delivered a multimodal knowledge translation programme and then reassessed their use and knowledge of the interventions. The majority of our physical therapists increased the use of thoracic spine techniques for their patients with neck pain. The increase was greater in those who used the techniques infrequently. Overall knowledge of the evidence appeared unchanged. Knowledge translation programmes are essential in ensuring clinical use of evidence-based practice. Our programme results, although on a small scale and not statistically significant, showed a positive trend toward increased thoracic spine manual therapy use for neck pain. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

3D geometric morphometrics of thorax variation and allometry in Hominoidea.

PubMed

Bastir, Markus; García-Martínez, Daniel; Williams, Scott A; Recheis, Wolfgang; Torres-Sánchez, Isabel; García Río, Francisco; Oishi, Motoharu; Ogihara, Naomichi

2017-12-01

Ever since the seminal papers of Keith and Schultz, hominoid primate ribcages have been described as either "funnel-" or "barrel-shaped." Following this dichotomic typology, it is currently held that Homo sapiens and hylobatids (gibbons and siamangs) share a barrel-shaped ribcage and that they are more similar to each other than to the funnel-shaped thoraces of great apes (Gorilla, Pan, and Pongo). Other researchers hypothesized that thoracic width and the invagination of the thoracic spine into the thorax are related to allometry. However, analyses that take into account the complex three-dimensional (3D) shape of the ribcage are lacking. Here, we address hypotheses about thorax shape and evolution using 3D morphometrics of thoraces in anatomical connection obtained by computed tomography scans of 23 hominoid cadavers and 10 humans and examining thorax compartments composed of seven ribs (1-7 thorax) and of 11 ribs (1-11 thorax). In the 1-7 thorax analyses, the human thorax is uniquely flat because of torsion of the upper and central ribs, differing from all non-human hominoids including hylobatids. In the 1-11 thorax analyses, humans are markedly different from African great apes, with hylobatids and orangutans intermediate. In full shape space analyses, affinities between orangutans and humans on the one hand and between hylobatids and African great apes on the other are evident. Therefore, we reject the hypothesis that humans and hylobatids bear any special affinities in overall 3D thorax shape to each other. We find that larger thoraces are wider and flatter, with a more invaginated spine, supporting the allometric hypothesis. Hominoid thorax variation shows complex interactions between allometry, rib curves, torsion, and declination, and the morphology of the costo-vertebral joint and the thoracic vertebral column. When considering functional specializations alongside phylogenetic relationships, an overly simplistic dichotomy between funnel-shaped and barrel-shaped thoraces is not supported. Copyright © 2017 Elsevier Ltd. All rights reserved.

Vertebral Compression Fractures after Lumbar Instrumentation.

PubMed

Granville, Michelle; Berti, Aldo; Jacobson, Robert E

2017-09-29

Lumbar spinal stenosis (LSS) is primarily found in an older population. This is a similar demographic group that develops both osteoporosis and vertebral compression fractures (VCF). This report reviewed a series of patients treated for VCF that had previous lumbar surgery for symptomatic spinal stenosis. Patients that only underwent laminectomy or fusion without instrumentation had a similar distribution of VCF as the non-surgical population in the mid-thoracic, or lower thoracic and upper lumbar spine. However, in the patients that had previous short-segment spinal instrumentation, fractures were found to be located more commonly in the mid-lumbar spine or sacrum adjacent to or within one or two spinal segments of the spinal instrumentation. Adjacent-level fractures that occur due to vertebral osteoporosis after long spinal segment instrumentation has been discussed in the literature. The purpose of this report is to highlight the previously unreported finding of frequent lumbar and sacral osteoporotic fractures in post-lumbar instrumentation surgery patients. Important additional factors found were lack of preventative medical treatment for osteoporosis, and secondary effects related to inactivity, especially during the first year after surgery.

Preoperative Fiducial Marker Placement in the Thoracic Spine: A Technical Report.

PubMed

Madaelil, Thomas P; Long, Jeremiah R; Wallace, Adam N; Baker, Jonathan C; Ray, Wilson Z; Santiago, Paul; Buchowski, Jacob; Zebala, Lukas P; Jennings, Jack W

2017-05-15

A retrospective review. The aim of this study was to demonstrate proof-of-concept of preoperative percutaneous intraosseous fiducial marker placement before thoracic spine surgery. Wrong-level spine surgery is defined as a never event by Center for Medicare Services, yet the strength of data supporting the implementation of Universal Protocol to limit wrong level surgery is weak. The thoracic spine is especially prone to intraoperative mislocalization, particularly in cases of morbid obesity and anatomic variations. We retrospectively reviewed all cases of preoperative percutaneous image-guided intraosseous placement of a metallic marker in the thoracic spine. Indications for surgery included degenerative disc disease (16/19), osteochondroma resection, spinal metastasis, and ligation of dural arteriovenous malformation. All metallic markers were placed from a percutaneous transpedicular approach under imaging guidance [fluoroscopy and computed tomography (CT) or CT alone]. Patient body mass index (BMI) was recorded. Overweight and obese BMI was defined greater than 25 and 30 kg/m, respectively. All 19 patients underwent fiducial marker placement and intraoperative localization successfully without complication. Twenty-two thoracic spine levels were localized. The T7, T9, T10, and T11 levels were the most often localized at rate of 18.1% for each level (4/22). The most cranial and caudal levels localized were T4 and T11. About 84.2% (16/19) of the cohort was overweight (57.9%; 11/19) or obese (26.3%; 5/19). The median BMI was 30.2 kg/m (range, 23.9-54.3 kg/m). Preoperative percutaneous thoracic fiducial marker placement under imaging guidance is a safe method for facilitating intraoperative localization of the target spinal level, especially in obese patients. Further studies are needed to quantify changes in operative time and radiation exposure. 4.

Training intensity and sagittal curvature of the spine in male and female artistic gymnasts.

PubMed

Sanz-Mengibar, Jose M; Sainz-de-Baranda, Pilar; Santonja-Medina, Fernando

2018-04-01

Specific adaptations of the spine in the sagittal plane have been described according to different sports disciplines. The goal of this study was to describe the integrative diagnosis of the sagittal morphotype of the spine in male and female artistic gymnasts. Forty-eight gymnasts were measured with an inclinometer. Thoracic and lumbar curves were quantified in standing position, in Sit and Reach and Slump Sitting in order to assess the sagittal spine posture and analyze if adaptations were related to training intensity. Correlation values of the sagittal plane spine measurements showed significantly increased thoracic kyphosis in men (-0.445, P<0.001). No significant correlations have been found between training hours per year or training volume and any measurements of the spine on the sagittal plane. When data from the two sitting tests were integrated, 62.5% of gymnasts had a functional thoracic kyphosis and 39.6% had lumbar kyphotic attitude. Our hypothesis has only been partially confirmed, because training intensity did not influence the sagittal curvatures in artistic gymnastics; however, this sport seems to cause specific adaptations in postural hypolordosis, functional thoracic kyphosis and lumbar kyphotic attitude during sitting and trunk flexion. The implications of the functional adaptations observed in our results may require a preventive intervention in male and female artistic gymnasts can be assessed with the integrative diagnosis of the sagittal morphotype of the spine.

A simulation study of spine biofidelity in the hybrid-III 6-year-old ATD.

PubMed

Wu, Jun; Cao, Libo; Reed, Matthew P; Hu, Jingwen

2013-01-01

Because of the lack of pediatric biomechanical data, Hybrid-III (HIII) child anthropomorphic test devices (ATDs) are essentially scaled from the mid-size male ATD based on the geometric considerations. These ATDs inherit a rigid thoracic spine from the adult HIII ATDs, which has been criticized as unrealistic. Therefore, the objective of this study was to explore possible design modifications for improving the spine biofidelity of the HIII 6-year-old ATD. A previously developed and validated HIII 6-year-old MADYMO ATD model was used as the baseline model to investigate the effects of design modifications on the spine biofidelity of the current ATD. Several sets of child volunteer and cadaver test data were considered as the design targets, including child volunteer low-speed crash test data, pediatric cadaver cervical spine tensile test data, and child cadaver crash test data. ATD design modifications include adding an additional joint to the thoracic spine region and changing the joint characteristics at the cervical and lumbar spine regions. Optimization techniques were used to match simulation results to each set of test results. The results indicate that the translational characteristics of the cervical and lumbar spine in the current child ATD need to be reduced to achieve realistic spine flexibility. Adding an additional joint at the thoracic spine region with degree of freedom in both flexion/extension and tension would significantly improve the ATD biofidelity in terms of predicting the overall spine curvature and head excursion in frontal crashes. Future ATD spine modification should focus on reducing the neck and lumbar tension stiffness and adding additional flexibility both in flexion/extension and tension at the thoracic spine region. The child ATD model developed in this study can be used as an important tool to improve child ATD biofidelity and child restraint system design in motor vehicle crashes.

Pressure pain sensitivity maps of the neck-shoulder and the low back regions in men and women.

PubMed

Binderup, Asbjørn T; Arendt-Nielsen, Lars; Madeleine, Pascal

2010-10-12

Musculoskeletal pain in the low back and neck-shoulder regions is a major problem among the working population all over the world. The prevalence of musculoskeletal pain is found to be higher among women. Women also have lower pressure pain thresholds (PPTs) than men. Pressure pain topography aims at mapping the spatial distribution of PPT within a muscle in an attempt to track changes in mechanical sensitivity. In order to assess gender differences in the pain topography, it is necessary to map the distribution in both healthy men and women. The aim of this study was to assess PPT maps from the cervico-thoracic and lumbar regions in men and women. Eleven men and eleven women without any known musculoskeletal disorders participated in the study. PPT was measured twice at 36 points over the trapezius muscle of the dominant arm, at 36 points over the trapezius muscle on the contralateral side and at 12 points over the spine between the left and right trapezius. Further, 11 points were measured over the erector spinae muscle on the left side of the spine between the first and the fifth lumbar vertebrae, 11 on the right side and 5 points on the spine itself. The measurements on each trapezius muscle were divided according to anatomical subdivisions. Three-way and two-way ANOVAs were used to analyse the differences in PPTs with the following factors: gender, locations and sub-divisions (only for cervico-thoracic region). There were no differences between left and right side in neither the cervico-thoracic nor the lumbar region, but there were (large effect) differences between the subdivisions in the trapezius with the lowest values in the upper part (P < 0.001; partial η2 = 0.19). Women had (small effect) lower PPT in both cervico-thoracic and lumbar regions (P ≤ 0.001; partial η2 = 0.02 for both regions), but gender had no effect on neither location nor subdivisions. The pain topography was not found to be different between genders in the cervico-thoracic and lumbar regions. This study can be used as basis for further clinical studies on musculoskeletal disorders.

Changes in the body posture of women occurring with age

PubMed Central

2013-01-01

Background A current topic in the field of geriatrics still needing a great deal of study is the changes in body posture occurring with age. Symptoms of these changes can be observed starting between the ages of 40–50 years with a slow progression that increases after 60 years of age. The aims of this study were to evaluate parameters characterizing the posture of women over the age of 60 years compared with a control group and to determine the dynamics of body posture changes in the following decades. Methods The study included 260 randomly selected women. The study group consisted of 130 women between the ages of 60–90 years (Older Women). The control group (Younger Women) consisted of 130 women between the ages of 20–25 years (posture stabilization period). The photogrammetric method was used to evaluate body posture using the phenomenon of the projection chamber. The study was conducted according to generally accepted principles. Results In the analysis of parameters characterizing individual slope curves, results were varied among different age groups. The lumbar spine slope did not show significant differences between different age groups (p = 0.6952), while statistically significant differences (p = 0.0000) were found in the thoracic-lumbar spine slope (p = 0.0033) and upper thoracic spine slope. Body angle was shown to increase with age (p = 0.0000). Thoracic kyphosis depth significantly deepened with age (p = 0.0002), however, the thoracic kyphosis angle decreased with age (p = 0.0000). An increase in asymmetries was noticed, provided by a significantly higher angle of the shoulder line (p = 0.0199) and the difference in height of the lower shoulder blade angle (p = 0.0007) measurements in the group of older women. Conclusions Changes in the parameters describing body posture throughout consecutive decades were observed. Therapy for women over the age of 60 years should involve strengthening of the erector spinae muscles and controlling body posture with the aim of reducing trunk inclination and deepening of thoracic kyphosis. Moreover, exercises shaping lumbar lordosis should be performed to prevent its flattening. PMID:24119004

EUROSPINE 2016 FULL PAPER AWARD: Wire cerclage can restore the stability of the thoracic spine after median sternotomy: an in vitro study with entire rib cage specimens.

PubMed

Liebsch, Christian; Graf, Nicolas; Wilke, Hans-Joachim

2017-05-01

The influence of the anterior rib cage on the stability of the human thoracic spine is not completely known. One of the most common surgical interventions on the anterior rib cage is the longitudinal median sternotomy and its fixation by wire cerclage. Therefore, the purpose of this in vitro study was to examine, if wire cerclage can restore the stability of the human thoracic spine after longitudinal median sternotomy. Six fresh frozen human thoracic spine specimens (C7-L1, 56 years in average, range 50-65), including the intact rib cage without intercostal muscles, were tested in a spinal loading simulator and monitored with an optical motion tracking system. While applying 2 Nm pure moment in flexion/extension (FE), lateral bending (LB), and axial rotation (AR), the range of motion (ROM) and neutral zone (NZ) of the functional spinal units of the thoracic spine (T1-T12) were studied (1) in intact condition, (2) after longitudinal median sternotomy, and (3) after sternal closure using wire cerclage. The longitudinal median sternotomy caused a significant increase of the thoracic spine ROM relative to the intact condition (FE: 12° ± 5°, LB: 18° ± 5°, AR: 25° ± 10°) in FE (+12 %) and AR (+22 %). As a result, the sagittal cut faces of the sternum slipped apart visibly. Wire cerclage fixation resulted in a significant decrease of the ROM in AR (-12 %) relative to condition after sternotomy. ROM increased relative to the intact condition, in AR even significantly (+8 %). The NZ showed a proportional behavior compared to the ROM in all loading planes, but it was distinctly higher in FE (72 %) and in LB (82 %) compared to the ROM than in AR (12 %). In this in vitro study, the longitudinal median sternotomy resulted in a destabilization of the thoracic spine and relative motion of the sternal cut faces, which could be rectified by fixation with wire cerclage. However, the stability of the intact condition could not be reached. Nevertheless, a fixation of the sternum should be considered clinically to avoid instability of the spine and sternal pseudarthrosis.

Dumbbell-shaped intrathoracic-extradural haemangioma of the thoracic spine.

PubMed

Doyle, P M; Abou-Zeid, A; Du Plessis, D; Herwadkar, A; Gnanalingham, K K

2008-04-01

Spinal haemangiomas are benign vasoproliferative lesions that are typically intra-osseous and generally asymptomatic, although localized pain can be a symptom. Capillary and cavernous variants have been described. We describe a rare case of a dumbbell-shaped haemangioma of the thoracic spine with both an intraspinal-extradural and intrathoracic component.

Prenatal development of the normal human vertebral corpora in different segments of the spine.

PubMed

Nolting, D; Hansen, B F; Keeling, J; Kjaer, I

1998-11-01

Vertebral columns from 13 normal human fetuses (10-24 weeks of gestation) that had aborted spontaneously were investigated as part of the legal autopsy procedure. The investigation included spinal cord analysis. To analyze the formation of the normal human vertebral corpora along the spine, including the early location and disappearance of the notochord. Reference material on the development of the normal human vertebral corpora is needed for interpretation of published observations on prenatal malformations in the spine, which include observations of various types of malformation (anencephaly, spina bifida) and various genotypes (trisomy 18, 21 and 13, as well as triploidy). The vertebral columns were studied by using radiography (Faxitron X-ray apparatus, Faxitron Model 43,855, Hewlett Packard) in lateral, frontal, and axial views and histology (decalcification, followed by toluidine blue and alcian blue staining) in and axial view. Immunohistochemical marking with Keratin Wide Spectrum also was done. Notochordal tissue (positive on marking with Keratin Wide Spectrum [DAKO, Denmark]) was located anterior to the cartilaginous body center in the youngest fetuses. The process of disintegration of the notochord and the morphology of the osseous vertebral corpora in the lumbosacral, thoracic, and cervical segments are described. Marked differences appeared in axial views, which were verified on horizontal histologic sections. Also, the increase in size was different in the different segments, being most pronounced in the thoracic and upper lumbar bodies. The lower thoracic bodies were the first to ossify. The morphologic changes observed by radiography were verified histologically. In this study, normal prenatal standards were established for the early development of the vertebral column. These standards can be used in the future--for evaluation of pathologic deviations in the human vertebral column in the second trimester.

A preliminary study comparing the use of cervical/upper thoracic mobilization and manipulation for individuals with mechanical neck pain.

PubMed

Griswold, David; Learman, Ken; O'Halloran, Bryan; Cleland, Josh

2015-05-01

Neck pain is routinely managed using manual therapy (MT) to the cervical and thoracic spines. While both mobilizations and manipulations to these areas have been shown to reduce neck pain, increase cervical range of motion, and reduce disability, the most effective option remains elusive. The purpose of this preliminary trial was to compare the pragmatic use of cervical and thoracic mobilizations vs. manipulation for mechanical neck pain. This trial included 20 patients with mechanical neck pain. Each patient was randomized to receive either mobilization or manipulation to both the cervical and thoracic spines during their plan of care. Within-group analyses were made with Wilcoxon signed-rank tests and between-group analyses were made with Mann-Whitney U. There were no between-group differences for any of the dependent variables including cervical active range of motion (CAROM) (P = 0.18), deep cervical flexion (DCF) endurance (P = 0.06), numerical pain rating scale (NPRS) (P = 0.26), the neck disability index (NDI, P = 0.33), patient-specific functional scale (PSFS, P = 0.20), or the global rating of change (GROC) scale (P = 0.94). Within-group results were significant for all outcome variables (P<0.001) from initial evaluation to discharge for both groups. These findings were consistent with other trials previously conducted that applied the MT techniques in a pragmatic fashion, but varied from previous trials where the treatment was standardized. A larger experimental study is necessary to further examine the differences between mobilization and manipulation for neck pain.

Cervical Spine Stiffness and Geometry of the Young Human Male

DTIC Science & Technology

1982-11-01

angle of zero degrees, i.e., the well-known vertical apposition of facets in the thoracic and lumbar area; d) The cervical articular facet areas are...were used by Rolander (1966) and White (1969) to study the motion segments of the lumbar and thoracic spines, respectively. When forces and moments are...unaer axial tension and compression as well as bending with axial load, Evans and Lissner (1959) gave load-deflection curves for the lumbar spine in

T9 versus T10 as the upper instrumented vertebra for correction of adult deformity-rationale and recommendations.

PubMed

Hey, Hwee Weng Dennis; Tan, Kimberly-Anne; Neo, Christabel Shao-En; Lau, Eugene Tze-Chun; Choong, Denise Ai-Wen; Lau, Leok-Lim; Liu, Gabriel Ka-Po; Wong, Hee-Kit

2017-05-01

Adult spinal deformity correction sometimes involves long posterior pedicle screw constructs extending from the lumbosacral spine to the thoracic vertebra. As fusion obliterates motion and places supraphysiological stress on adjacent spinal segments, it is crucial to ascertain the ideal upper instrumented vertebra (UIV) to minimize risk of proximal junctional failure (PJF). The T10 vertebra is often chosen to allow bridging of the thoracolumbar junction into the immobile thoracic vertebrae on the basis that it is the lowest immobile thoracic vertebra strut by the rib cage. This study aimed to characterize the range of motion (ROM) of each vertebral segment from T7 to S1 to determine if T10 is truly the lowest immobile thoracic vertebra. This is a prospective, comparative study. Seventy-nine adults (mean age of 45.4 years) presenting with low back pain or lower limb radiculopathy or both, without previous spinal intervention, metastases, fractures, infection, or congenital deformities of the spine, were included in the study. A ROM >5° across two vertebral segments as determined by the Cobb method from radiographs. Lumbar flexion-extension and neutral erect radiographs were obtained in randomized order using a slot scanner. Segmental ROM was measured from T7-T8 to L5-S1 and analyzed for significant differences using t tests. Age, gender, radiographical indices such as standard spinopelvic parameters, sagittal vertical axis (SVA), C7-T12 SVA, T1 slope, thoracic kyphosis (TK), and lumbar lordosis (LL) were studied via multivariate analysis to identify predictive factors for >5° change in ROM at the various segmental levels. There were no sources of funding and no conflicts of interest associated with this study. In the thoracolumbar spine, significant decreases in ROM when compared with the adjacent caudad segment occurs up to T9-T10, with mean total ROM of 1.98±1.47° (p<.001) seen in T9-T10, 2.19±1.67° (p<.001) in T10-T11, and 3.92±3.21°(p<.001) in T11-T12. The total ROM of T8-T9 (2.53±1.79°) was not significantly different from that of T9-T10 (p=.261). At the thoracolumbar junction, absence of scoliosis (OR 11.37, p=.020), high pelvic incidence (OR 1.14, p=.046), and low T1 slope (OR 1.45, p=.030) were predictive of ROM >5°. Lumbar spine flexion-extension ROM decreases as it approaches the thoracolumbar junction. T10 is indeed the lowest immobile thoracic vertebra strut by the rib cage, and the last significant decrease in ROM is observed at T9-T10, in relation to T10-T11. However, because this also implies that a UIV of T10 would mean there is only one level of fixation above the relatively mobile segment, while respecting other factors that influence UIV selection, we propose the T9 vertebra as a more ideal UIV to fulfill the biomechanical concept of bridge fixation. However, this decision should still be taken on a case-by-case basis. Copyright © 2016 Elsevier Inc. All rights reserved.

Brown-Séquard syndrome after a gun shot wound to the cervical spine: a case report.

PubMed

Leven, Dante; Sadr, Ali; Aibinder, William R

2013-12-01

Brown-Séquard syndrome is characterized by a hemisection of the spinal cord most commonly after spinal trauma or neoplastic disease. The injury causes ipsilateral hemiplegia and proprioceptive sensory disturbances with contralateral loss of pain and temperature sensation. Patients with Brown-Séquard syndrome have the best prognosis of all spinal cord injury patterns. At this time, the ideal management for Brown-Séquard syndrome after penetrating trauma has yet to be defined. To report a case of a gun shot wound to the upper cervical spine that resulted in Brown-Séquard syndrome and was treated effectively with early cervical spine decompression and fusion. Observational case report. A 28-year-old woman presented after sustaining a low-velocity gun shot wound in to the upper cervical spine in a civilian assault. On initial presentation, she had 0/5 motor scores in the left upper and lower extremities and normal motor scores on the right. Sensory examination was limited as she was intubated and sedated on admission due to airway compromise. A computed tomography scan revealed a bullet lodged in the vertebral body of C3 with boney fragments and soft tissue encroaching on the spinal cord. Subsequently, she underwent C3 corpectomy, bulletectomy, and anterior cervical decompression with fusion. Intraoperatively, no dural disruption or cerebral spinal fluid leak was noted, and her posterior longitudinal ligament was intact. One month postoperatively, her left lower extremity motor score was 5/5 with movement of her left thumb and all fingers. Strength in her biceps, triceps, and wrist extensors and flexors was 3/5. Her functional capacity and strength gradually improved. Reinke et al. support surgical intervention for patients with incomplete paraplegia after the patient is medically stabilized, although their case report discussed lower thoracic injury, which carries a more favorable prognosis. All other prior case reports and prospective studies that reported favorable outcomes after Brown-Séquard syndrome involved the midthoracic, low thoracic, or lumbar spinal levels. This report is the first case of Brown-Séquard syndrome after a high cervical gun shot wound, which was managed with immediate decompression and fusion, where near complete recovery was obtained. Copyright © 2013 Elsevier Inc. All rights reserved.

Changes in shoulder pain and disability after thrust manipulation in subjects presenting with second and third rib syndrome.

PubMed

Dunning, James; Mourad, Firas; Giovannico, Giuseppe; Maselli, Filippo; Perreault, Thomas; Fernández-de-Las-Peñas, César

2015-01-01

The purpose of this preliminary study was to investigate changes in shoulder pain, disability, and perceived level of recovery after 2 sessions of upper thoracic and upper rib high-velocity low-amplitude (HVLA) thrust manipulation in patients with shoulder pain secondary to second and third rib syndrome. This exploratory study evaluated 10 consecutive individuals with shoulder pain, with or without brachial pain, and a negative Neer impingement test, who completed the Shoulder Pain and Disability Index (SPADI), the numeric pain rating scale (NPRS), and the global rating of change. Patients received 2 sessions of HVLA thrust manipulation targeting the upper thoracic spine bilaterally and the second and third ribs on the symptomatic side. Outcome measures were completed after the first treatment session, at 48 hours, 1 month, and 3 months. Patients showed a significant decrease in SPADI (F = 59.997; P = .001) and significant decrease in resting shoulder NPRS (F = 63.439; P = .001). For both NPRS and SPADI, there were significant differences between the pretreatment scores and each of the postintervention scores through 3-month follow-up (P < .05). Large within-group effect sizes (Cohen's d ≥ 0.8) were found between preintervention data and all postintervention assessments in both outcomes. Mean global rating of change scores (+6.8 at 3 months) indicated "a very great deal better" outcome at long-term follow-up. This group of patients with shoulder pain secondary to second and third rib syndrome who received upper thoracic and upper rib HVLA thrust manipulations showed significant reductions in pain and disability and improvement in perceived level of recovery. Copyright © 2015 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

Early or delayed stabilization in severely injured patients with spinal fractures? Current surgical objectivity according to the Trauma Registry of DGU: treatment of spine injuries in polytrauma patients.

PubMed

Bliemel, Christopher; Lefering, Rolf; Buecking, Benjamin; Frink, Michael; Struewer, Johannes; Krueger, Antonio; Ruchholtz, Steffen; Frangen, Thomas Manfred

2014-02-01

Because of a lack of evidence, the appropriate timing of surgical stabilization of thoracic and lumbar spine injuries in severely injured patients is still controversial. Data of a large international trauma register were analyzed to investigate the medical care situation of unstable spinal column fractures in patients with multiple injuries, so as to examine the outcome related to timing of surgical stabilization. Data sets of the Trauma Registry of German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie [DGU]) (1993-2010) were analyzed. The Trauma Registry of DGU is a prospective, multicenter register that provides information on severely injured patients. All patients with an Injury Severity Score (ISS) of 16 or greater caused by blunt trauma, subsequent treatment of 7 days or more, 16 years or older, and thoracic or lumbar spine injuries (spine Abbreviated Injury Scale [AIS] score ≥ 2) were included in our analysis. Patients with relevant spine injuries classified as having a spine AIS score of 3 or greater were further analyzed in terms of whether they got early (<72 hours) or late (>72 hours) surgical treatment due to unstable spinal column fractures. Of 24,974 patients, 8,994 (36.0%) had documented spinal injuries (spine AIS score ≥ 2). A total of 1,309 patients who sustained relevant thoracic spine injuries (spine AIS score ≥ 3) and 994 patients who experienced lumbar spine trauma and classified as having spine AIS score of 3 or greater were more precisely analyzed. Of these, 68.2% and 71.0%, respectively, received an early thoracic or lumbar spine fixation. With an increase in spinal injury severity, an increase in early stabilization in the thoracic and lumbar spine was seen. In the group of patients with early surgical stabilization, significantly shorter hospital stays, shorter intensive care unit stays, fewer days on mechanical ventilation, and lower rates of sepsis were seen. In the case that additional body regions were affected, for example, when patients were critically ill, a delayed spinal stabilization was more often performed. A spinal stabilization at an early stage (<72 hours) is presumed to be beneficial. Although some patients may require delay due to necessary medical improvement, every reasonable effort should be made to treat patients with instable spinal column fractures as soon as possible. If an early surgical treatment is feasible, severely injured patients may benefit from a shorter period of hospital treatment and a lower rate of complications. Therapeutic study, level III.

Novel technique for preoperative pedicle localization in spinal surgery with challenging anatomy.

PubMed

Young, Richard M; Prasad, Vikram; Wind, Joshua J; Olan, Wayne; Caputy, Anthony J

2014-04-01

Accurately localizing a spine level in the thoracic spine is often not easily achieved with the existing imaging modalities available in the operating room. The coordination of the preoperative imaging pathology with intraoperative imaging is even more difficult in patients with challenging anatomy. Using standard percutaneous techniques, the authors placed a radiopaque embolization coil into the pedicle of interest under biplanar fluoroscopy in 1 patient. Thoracic spine MRI along with scout MRI was then performed to confirm coil marker placement in relation to the actual spine pathology prior to surgical intervention. No complications were observed during placement of the radiopaque marker. Intraoperatively, the marker was immediately and easily visualized, leading to a confident identification of the correct thoracic spinal level. The preoperative placement of a radiopaque marker into the vertebral pedicle of the identified pathological level combined with postplacement MRI verification provides an advantage over previously proposed techniques in the literature.

The investigation of vertebral injury sustained during aircrew ejection

NASA Technical Reports Server (NTRS)

Benedict, J. V.

1972-01-01

A series of tests were performed on excised human vertebral segments to determine the static and dynamic response of the thoraco-lumbar spine when loaded in flexion. A total of fifteen tests were performed on eleven specimens. Specimens were obtained from male donors ranging in age from 34 to 60 years. Demographic data pertinent to each specimen and the elapsed time between death of the donor and testing of each corresponding specimen are presented. Only spinal segments comprised of lower thoracic and upper lumbar vertebrae were tested because in aircraft ejection injuries clinical complications in this anatomical region predominate. A complex continuum mathematical model describing the dynamic response of the human spine was formulated, solved, and verified experimentally. Detailed results are presented in figures, tables, and equations.

Intra- and interrater reliability of the 'lumbar-locked thoracic rotation test' in competitive swimmers ages 10 through 18 years.

PubMed

Feijen, Stef; Kuppens, Kevin; Tate, Angela; Baert, Isabel; Struyf, Thomas; Struyf, Filip

2018-04-17

Measuring thoracic spine mobility can be of interest to competitive swimmers as it has been associated with shoulder girdle function and scapular position in subjects with and without shoulder pain. At present, no reliability data of thoracic spine mobility measurements are available in the swimming population. This study aims to evaluate the within-session intra- and interrater reliability of the "lumbar-locked rotation test" for thoracic spine rotation in competitive swimmers aged 10 to 18 years. This reliability study is part of a larger prospective cohort study investigating potential risk factors for the development of shoulder pain in competitive swimmers. Within-session, intra- and inter-rater reliability. Competitive swimming clubs in Belgium. 21 competitive swimmers. Intra- and inter-rater reliability of the lumbar-locked thoracic rotation test. Intraclass correlation coefficients (ICCs) ranged from 0.91 (95% CI 0.78 to 0.96) to 0.96 (0.89-0.98) for intra-rater reliability. Results for inter-rater reliability ranged from 0.89 (0.72-0.95) to 0.86 (0.65-0.94) respectively for right and left thoracic rotation. Results suggest good to excellent reliability of the lumbar-locked thoracic rotation test, indicating this test can be used reliably in clinical practice. Copyright © 2018 Elsevier Ltd. All rights reserved.

[New treatment concept for children with thoracic insufficiency syndrome due to congenital spine deformity].

PubMed

Hell, A K; Campbell, R M; Hefti, F

2005-01-01

Children with congenital thoracic scoliosis associated with fused ribs and unilateral unsegmented bars adjacent to convex hemivertebrae will inevitably develop thoracic insufficiency syndrome and curve progression with hemithorax compression without treatment. It is assumed that the concave side of such curves and their unilateral unsegmented bars do not grow. In the past early spinal fusion was performed with consecutive short thoracic spines and loss of lung volume. Little attention has been paid to lung function. These patients often suffered from lung failure and early death due to a small thorax. A new surgical technique is based on an indirect deformity correction and enlargement of the thorax due to a longitudinal implant, the vertical expandable prosthetic titanium rib (VEPTR). The spine is not fused, thus promoting growth of the spine, the thorax and the lungs. Elongation of the implant is done every six months. Since 2002 this method has been performed on fifteen children in Basel as the first European center. Patients (mean age 6 years; 11 months to 12 years) were suffering from thoracic insufficiency syndrome due to unilateral unsegmented bars with fused ribs (n = 4), absent ribs (n = 2), bilaterally fused ribs (n = 2), hemivertebrae (n = 3) or neuromuscular scoliosis (n = 6). Doing fifteen primarily implantations and thirteen elongations there were three complications (two hook dislocations, one skin breakage). All patients improved cosmetically, functionally and radiologically which was shown on X-rays as a reduction of the Cobb angle from an average of 76 degrees (40-110 degrees ) to 55 degrees (30-67 degrees ). Expansion thoracoplasty and VEPTR implantation is a new treatment concept for children with thoracic insufficiency syndrome due to spinal deformities, which is based on distraction and expansion of the thorax thus allowing growth of the spine, the thorax and probably lungs. Presently it seems to be superior to any other method for the treatment of small children with progressive scoliosis and thoracic insufficiency syndrome.

Accuracy of DXA scanning of the thoracic spine: cadaveric studies comparing BMC, areal BMD and geometric estimates of volumetric BMD against ash weight and CT measures of bone volume.

PubMed

Sran, Meena M; Khan, Karim M; Keiver, Kathy; Chew, Jason B; McKay, Heather A; Oxland, Thomas R

2005-12-01

Biomechanical studies of the thoracic spine often scan cadaveric segments by dual energy X-ray absorptiometry (DXA) to obtain measures of bone mass. Only one study has reported the accuracy of lateral scans of thoracic vertebral bodies. The accuracy of DXA scans of thoracic spine segments and of anterior-posterior (AP) thoracic scans has not been investigated. We have examined the accuracy of AP and lateral thoracic DXA scans by comparison with ash weight, the gold-standard for measuring bone mineral content (BMC). We have also compared three methods of estimating volumetric bone mineral density (vBMD) with a novel standard-ash weight (g)/bone volume (cm3) as measured by computed tomography (CT). Twelve T5-T8 spine segments were scanned with DXA (AP and lateral) and CT. The T6 vertebrae were excised, the posterior elements removed and then the vertebral bodies were ashed in a muffle furnace. We proposed a new method of estimating vBMD and compared it with two previously published methods. BMC values from lateral DXA scans displayed the strongest correlation with ash weight (r=0.99) and were on average 12.8% higher (p<0.001). As expected, BMC (AP or lateral) was more strongly correlated with ash weight than areal bone mineral density (aBMD; AP: r=0.54, or lateral: r=0.71) or estimated vBMD. Estimates of vBMD with either of the three methods were strongly and similarly correlated with volumetric BMD calculated by dividing ash weight by CT-derived volume. These data suggest that readily available DXA scanning is an appropriate surrogate measure for thoracic spine bone mineral and that the lateral scan might be the scan method of choice.

Disproportionate growth between the spine and pelvis in patients with thoracic adolescent scoliosis: a new look into the pattern's growth.

PubMed

Bao, H; Liu, Z; Yan, P; Qiu, Y; Zhu, F

2015-12-01

A self-control ratio, the spine-pelvis index (SPI), was proposed for the assessment of patients with adolescent idiopathic scoliosis (AIS) in this study. The aim was to evaluate the disproportionate growth between the spine and pelvis in these patients using SPI. A total of 64 female patients with thoracic AIS were randomly enrolled between December 2010 and October 2012 (mean age 13 years, standard deviation (sd) 2.17; 9 to 18) and a further 73 healthy female patients with a mean age of 12.4 years (mean age 12.4 years, sd 2.24; 9 to 18), were randomly selected from a normal control database at our centre. The radiographic parameters measured included length of spine (LOS), height of spine (HOS), length of thoracic vertebrae (LOT), height of thoracic vertebrae (HOT), width of pelvis (WOP), height of pelvis (HOP) and width of thorax (WOT). SPI was defined as the ratio LOS/HOP. The SPI and LOT/HOP in patients with AIS showed a significant increase when compared with normal girls (p < 0.001 and p < 0.001 respectively), implying an abnormal pattern of growth of the spine relative to the pelvis in patients with AIS. No significant difference in SPI was found in different age groups in the control group, making the SPI an age-independent parameter with a mean value of 2.219 (2.164 to 2.239). We also found that the SPI was not related to maturity in the control group. This study, for the first time, used a self-control ratio to confirm the disproportionate patterns of growth of the spine and pelvis in patients with thoracic AIS, highlighting that the SPI is not affected by age or maturity. ©2015 The British Editorial Society of Bone & Joint Surgery.

Sagittal Thoracic and Lumbar Spine Profiles in Upright Standing and Lying Prone Positions Among Healthy Subjects: Influence of Various Biometric Features.

PubMed

Salem, Walid; Coomans, Ysaline; Brismée, Jean-Michel; Klein, Paul; Sobczak, Stéphane; Dugailly, Pierre-Michel

2015-08-01

A prospective study was performed on the assessment of both thoracic and lumbar spine sagittal profiles (from C7 to S1). To propose a new noninvasive method for measuring the spine curvatures in standing and lying prone positions and to analyze their relationship with various biometric characteristics. Modifications of spine curvatures (i.e. lordosis or kyphosis) are of importance in the development of spinal disorders. Studies have emphasized the development of new devices to measure the spine sagittal profiles using a noninvasive and low-cost method. To date, it has not been applied for analyzing both lumbar and thoracic alterations for various positioning. Seventy-five healthy subjects (mean 22.6 ± 4.3 yr) were recruited to participate in this study. Thoracic and lumbar sagittal profiles were assessed in standing and lying prone positions using a 3D digitizer. In addition, several biometric data were collected including maximal trunk isometric strength for flexion and extension movement. Statistical analysis consisted in data comparisons of spine profiles and a multivariate analysis including biometric features, to classify individuals considering low within- and high between-variability. Kyphosis and lordosis angles decreased significantly from standing to lying prone position by an average of 13.4° and 16.6°, respectively. Multivariate analysis showed a sample clustering of 3 homogenous subgroups. The first group displayed larger lordosis and flexibility, and had low data values for height, weight, and strength. The second group had lower values than the overall trend of the whole sample, whereas the third group had larger score values for the torques, height, weight, waist, body mass index, and kyphosis angle but a reduced flexibility. The present results demonstrate a significant effect of the positioning on both thoracic and lumbar spine sagittal profiles and highlight the use of cluster analysis to categorize subgroups after biometric characteristics including curvature measurement. N/A.

Prevalence of joint-related pain in the extremities and spine in five groups of top athletes.

PubMed

Jonasson, Pall; Halldin, Klas; Karlsson, Jon; Thoreson, Olof; Hvannberg, Jonas; Swärd, Leif; Baranto, Adad

2011-09-01

Joint-related pain conditions from the spine and extremities are common among top athletes. The frequency of back pain has, however, been studied in more detail, and the frequency of low-back pain in top athletes in different high-load sports has been reported to be as high as 85%. Sport-related pain from different joints in the extremities is, however, infrequently reported on in the literature. Seventy-five male athletes, i.e. divers, weight-lifters, wrestlers, orienteers and ice-hockey players and 12 non-athletes (control group) were included in the study. A specific self-assessed pain-oriented questionnaire related to the cervical, thoracic and lumbar spine, as well as the various joints, i.e. shoulders, elbows, wrists, hips, knees and ankles, was filled out by the athletes and the non-athletes. The overall frequency of pain reported by the athletes during the last week/last year was as follows; cervical spine 35/55%; thoracic spine 22/33%; lumbar spine 50/68%; shoulder 10/21%; elbow 7/7%; wrist 7/8%; hip 15/23%; knee 22/44%; and ankle 11/25%. The corresponding values for non-athletes were cervical spine 9/36%; thoracic spine 17/33%; lumbar spine 36/50%; shoulder 0/9%; elbow 9/0%; wrist 0/0%; hip 9/16%; knee 10/9%; and ankle 0/0%. A higher percentage of athletes reported pain in almost all joint regions, but there were no statistically significant differences (n.s.), with the exception of the knees (P = 0.05). Over the last year, athletes reporting the highest pain frequency in the lumbar spine were ice-hockey players and, in the cervical spine, wrestlers and ice-hockey players. The highest levels of knee pain were found among wrestlers and ice-hockey players, whereas the highest levels for wrist pain were found among divers, hip pain among weight-lifters, orienteers and divers and ankle pain among orienteers. For the thoracic spine, shoulder and elbow regions, only minor differences were found. There was no statistically significant difference in prevalence of pain in the neck, spine and joints between top athletes in different sports or between athletes and non-athletes. However, pain in one spinal region was correlated to reported pain in other regions of the spine. Moreover, pain in the spine was also correlated to pain in the shoulders, hips and knees.

The Immediate Effects of Upper Thoracic Translatoric Spinal Manipulation on Cervical Pain and Range of Motion: A Randomized Clinical Trial

PubMed Central

Krauss, John; Creighton, Doug; Ely, Jonathan D.; Podlewska-Ely, Joanna

2008-01-01

This study examined the effect of translatoric spinal manipulation (TSM) on cervical pain and cervical active motion restriction when applied to upper thoracic (T1-T4) segments. Active cervical rotation range of motion was measured re- and post-intervention with a cervical inclinometer (CROM), and cervical pain status was monitored before and after manipulation with a Faces Pain Scale. Study participants included a sample of convenience that included 32 patients referred to physical therapy with complaints of pain in the mid-cervical region and restricted active cervical rotation. Twenty-two patients were randomly assigned to the experimental group and ten were assigned to the control group. Pre- and post-intervention cervical range of motion and pain scale measurements were taken by a physical therapist assistant who was blinded to group assignment. The experimental group received TSM to hypomobile upper thoracic segments. The control group received no intervention. Paired t-tests were used to analyze within-group changes in cervical rotation and pain, and a 2-way repeated-measure ANOVA was used to analyze between-group differences in cervical rotation and pain. Significance was accepted at p = 0.05. Significant changes that exceeded the MDC95 were detected for cervical rotation both within group and between groups with the TSM group demonstrating increased mean (SD) in right rotation of 8.23° (7.41°) and left rotation of 7.09° (5.83°). Pain levels perceived during post-intervention cervical rotation showed significant improvement during right rotation for patients experiencing pain during bilateral rotation only (p=.05). This study supports the hypothesis that spinal manipulation applied to the upper thoracic spine (T1-T4 motion segments) significantly increases cervical rotation ROM and may reduce cervical pain at end range rotation for patients experiencing pain during bilateral cervical rotation. PMID:19119394

Thoracic and lumbar spine responses in high-speed rear sled tests.

PubMed

Viano, David C; Parenteau, Chantal S; Burnett, Roger

2018-07-04

This study analyzed thoracic and lumbar spine responses with in-position and out-of-position (OOP) seated dummies in 40.2 km/h (25 mph) rear sled tests with conventional and all-belts-to-seat (ABTS) seats. Occupant kinematics and spinal responses were determined with modern (≥2000 MY), older (<2000 MY), and ABTS seats. The seats were fixed in a sled buck subjected to a 40.2 km/h (25 mph) rear sled test. The pulse was a 15 g double-peak acceleration with 150 ms duration. The 50th percentile Hybrid III was lap-shoulder belted in the FMVSS 208 design position or OOP, including leaning forward and leaning inboard and forward. There were 26 in-position tests with 11 <2000 MY, 8 ≥2000 MY, and 7 ABTS and 14 OOP tests with 6 conventional and 8 ABTS seats. The dummy was fully instrumented. This study addressed the thoracic and lumbar spine responses. Injury assessment reference values are not approved for the thoracic and lumbar spine. Conservative thresholds exist. The peak responses were normalized by a threshold to compare responses. High-speed video documented occupant kinematics. The extension moments were higher in the thoracic than lumbar spine in the in-position tests. For <2000 MY seats, the thoracic extension moment was 76.8 ± 14.6% of threshold and the lumbar extension moment was 50.5 ± 17.9%. For the ≥2000 MY seats, the thoracic extension moment was 54.2 ± 26.6% of threshold and the lumbar extension moment was 49.8 ± 27.7%. ABTS seats provided similar thoracic and lumbar responses. Modern seat designs lowered thoracic and lumbar responses. For example, the 1996 Taurus had -1,696 N anterior lumbar shear force and -205.2 Nm extension moment. There was -1,184 N lumbar compression force and 1,512 N tension. In contrast, the 2015 F-150 had -500 N shear force and -49.7 Nm extension moment. There was -839 N lumbar compression force and 535 N tension. On average, the 2015 F-150 had 40% lower lumbar spine responses than the 1996 Taurus. The OOP tests had similar peak lumbar responses; however, they occurred later due to the forward lean of the dummy. The design and performance of seats have significantly changed over the past 20 years. Modern seats use a perimeter frame allowing the occupant to pocket into the seatback. Higher and more forward head restraints allow a stronger frame because the head, neck, and torso are more uniformly supported with the seat more upright in severe rear impacts. The overall effect has been a reduction in thoracic and lumbar loads and risks for injury.

[Current status of thoracoscopic surgery for thoracic and lumbar spine. Part 2: treatment of the thoracic disc hernia, spinal deformities, spinal tumors, infections and miscellaneous].

PubMed

Verdú-López, Francisco; Beisse, Rudolf

2014-01-01

Thoracoscopic surgery or video-assisted thoracic surgery (VATS) of the thoracic and lumbar spine has evolved greatly since it appeared less than 20 years ago. It is currently used in a large number of processes and injuries. The aim of this article, in its two parts, is to review the current status of VATS of the thoracic and lumbar spine in its entire spectrum. After reviewing the current literature, we developed each of the large groups of indications where VATS takes place, one by one. This second part reviews and discusses the management, treatment and specific thoracoscopic technique in thoracic disc herniation, spinal deformities, tumour pathology, infections of the spine and other possible indications for VATS. Thoracoscopic surgery is in many cases an alternative to conventional open surgery. The transdiaphragmatic approach has made endoscopic treatment of many thoracolumbar junction processes possible, thus widening the spectrum of therapeutic indications. These include the treatment of spinal deformities, spinal tumours, infections and other pathological processes, as well as the reconstruction of injured spinal segments and decompression of the spinal canal if lesion placement is favourable to antero-lateral approach. Good clinical results of thoracoscopic surgery are supported by growing experience reflected in a large number of articles. The degree of complications in thoracoscopic surgery is comparable to open surgery, with benefits in regard to morbidity of the approach and subsequent patient recovery. Copyright © 2012 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

Biomechanical studies of spinal manipulative therapy

PubMed Central

Herzog, Walter

1991-01-01

The purpose of this article is to present a review of our research related to spinal manipulative therapy (SMT). The first part of this review will concentrate on studies that were aimed at quantifying possible changes in the mechanics of locomotion associated with SMT. The second part will focus on studies that were aimed at measuring the forces exerted by chiropractors on patients during SMT. In the locomotion studies, we found that SMT was associated with changes in the mechanics of walking. In particular, sacroiliac joint patients were found to become more symmetrical in their ground reaction force patterns with increasing exposure to SMT. In the force studies we found that the force-time histories of SMT on the sacroiliac joint and thoracic spine were similar, however, the mean peak and preload forces recorded for SMT on the thoracic spine were about 60 N larger than those recorded on the sacroiliac joint. Treatments on the cervical spine were executed faster and with less force than treatments on the sacroiliac joint or the thoracic spine.

Epithelioid Hemangioma of the Thoracic Spine: A Case Report and Review of the Literature.

PubMed

Okada, Eijiro; Matsumoto, Morio; Nishida, Mitsuhiro; Iga, Takahito; Morishita, Midori; Tezuka, Masaki; Mukai, Kiyoshi; Kobayashi, Eisuke; Watanabe, Kota

2017-10-25

Osseous epithelioid hemangioma is uncommon, and reports of epithelioid hemangiomas of the spine are especially rare. Case report. A 43-year-old male was referred to our department with progressive gait disturbance. CT scans showed a lucent mass in the vertebral body at the T3 level. MRI of the thoracic spine showed a strongly enhanced mass compressing the spinal cord. The patient underwent laminectomy from T2 to T4, debulking of the tumor, and posterior fusion from T1 to T5. After the operation, the patient's neurological status improved significantly, and he was able walk without assistance. Histological examination determined that the tumor was an epithelioid hemangioma. The patient was treated with 40 Gy radiation for local control of the tumor. The patient could walk without difficulty 12 months after the surgery. This is a rare example of an epithelioid hemangioma that developed in the thoracic spine and compressed the spinal cord, and was treated successfully.

Trauma patient adverse outcomes are independently associated with rib cage fracture burden and severity of lung, head, and abdominal injuries.

PubMed

Dunham, C Michael; Hileman, Barbara M; Ransom, Kenneth J; Malik, Rema J

2015-01-01

We hypothesized that lung injury and rib cage fracture quantification would be associated with adverse outcomes. Consecutive admissions to a trauma center with Injury Severity Score ≥ 9, age 18-75, and blunt trauma. CT scans were reviewed to score rib and sternal fractures and lung infiltrates. Sternum and each anterior, lateral, and posterior rib fracture was scored 1 = non-displaced and 2 = displaced. Rib cage fracture score (RCFS) = total rib fracture score + sternal fracture score + thoracic spine Abbreviated Injury Score (AIS). Four lung regions (right upper/middle, right lower, left upper, and left lower lobes) were each scored for % of infiltrate: 0% = 0; ≤ 20% = 1, ≤ 50% = 2, > 50% = 3; total of 4 scores = lung infiltrate score (LIS). Of 599 patients, 193 (32%) had 854 rib fractures. Rib fracture patients had more abdominal injuries (p < 0.001), hemo/pneumothorax (p < 0.001), lung infiltrates (p < 0.001), thoracic spine injuries (p = 0.001), sternal fractures (p = 0.0028) and death or need for mechanical ventilation ≥ 3 days (Death/Vdays ≥ 3) (p < 0.001). Death/Vdays ≥ 3 was independently associated with RCFS (p < 0.001), LIS (p < 0.001), head AIS (p < 0.001) and abdominal AIS (p < 0.001). Of the 193 rib fracture patients, Glasgow Coma Score 3-12 or head AIS ≥ 2 occurred in 43%. A lung infiltrate or hemo/pneumothorax occurred in 55%. Thoracic spine injury occurred in 23%. RCFS was 6.3 ± 4.4 and Death/Vdays ≥ 3 occurred in 31%. Death/Vdays ≥ 3 rates correlated with RCFS values: 19% for 1-3; 24% for 4-6; 42% for 7-12 and 65% for ≥ 13 (p < 0.001). Death/Vdays ≥ 3 was independently associated with RCFS (p = 0.02), LIS (p = 0.001), head AIS (p < 0.001) and abdominal AIS (p < 0.001). Death/Vdays ≥ 3 association was better for RCFS (p = 0.005) than rib fracture score (p = 0.08) or number of fractured ribs (p = 0.80). Rib fracture patients have increased risk for truncal injuries and adverse outcomes. Adverse outcomes are independently associated with rib cage fracture burden. Severity of head, abdominal, and lung injuries also influence rib fracture outcomes.

Lung cancer in pregnancy.

PubMed

Holzmann, Kornelia; Kropfmüller, Roland; Schinko, Herwig; Bogner, Stephan; Fellner, Franz; Arzt, Wolfgang; Lamprecht, Bernd

2015-08-01

In the 26th week of gestation, a 29-year-old pregnant office employee was referred to the pulmonary department of Linz General Hospital (AKH) under the suspicion of tuberculosis. She complained of a cough with intermittent hemoptysis and pain in the thoracic spine from which she had been suffering the past 9 weeks. A plain chest X-ray showed a dense infiltrate on the right side and multiple smaller shadows in both lungs. Laboratory testing revealed anemia, leukocytosis, and an increase of C-reactive protein. All tests for tuberculosis were negative.A bronchoscopy was performed and biopsies were taken from the right upper and middle lobe. The histopathological examination found cells of an adenocarcinoma. A magnetic resonance imaging (MRI) revealed a large tumor and surrounding atelectasis were seen in the right upper and middle lobe, as well as multiple intrapulmonary metastases in both lungs. In addition, not only metastases in the thoracic spine (level Th2/3) but also at other osseous locations and multiple cerebral metastases were detected. The patient received one cycle of chemotherapy consisting of docetaxel and carboplatin (AUC5) in the 27th week of gestation. Additional radiotherapy was applied to the involved thoracic spine. Due to positive epidermal growth factor receptor mutation, therapy with gefitinib 250 mg/day was started 2 days after a Caesarean section (preceded by treatment for fetal lung maturation). A healthy girl was delivered in the 30th week of pregnancy. Staging with computed tomography (CT) after delivery revealed an unstable fracture of Th2 with compression of the spinal cord. Neurosurgery was performed, consisting of a ventral corporectomy of Th1-2 followed by an anterior and posterior osteosynthesis for stabilization. The patient was discharged without neurological deficits within 1 week. Subsequent treatment with gefitinib improved the performance status of the patient, and CT scans of the chest and an MRI of the brain showed the size of the tumor to be shrinking. Meanwhile, the infant developed appropriately for her age.After 14 months of the first diagnosis, the patient experienced neurological symptoms (aphasia, confusion) due to neoplastic meningeosis and cerebral venous sinus thrombosis together with local tumor progression in the lung. One course of chemotherapy, combining carboplatin/pemetrexed/bevacizumab, was given without clinical response. Despite best supportive care, the patient died 17 months after diagnosis in October 2013.

Thoracolumbar spine loading associated with kinematics of the young and the elderly during activities of daily living.

PubMed

Ignasiak, Dominika; Rüeger, Andrea; Sperr, Ramona; Ferguson, Stephen J

2018-03-21

Excessive mechanical loading of the spine is a critical factor in vertebral fracture initiation. Most vertebral fractures develop spontaneously or due to mild trauma, as physiological loads during activities of daily living might exceed the failure load of osteoporotic vertebra. Spinal loading patterns are affected by vertebral kinematics, which differ between elderly and young individuals. In this study, the effects of age-related changes in spine kinematics on thoracolumbar spinal segmental loading during dynamic activities of daily living were investigated using combined experimental and modeling approach. Forty-four healthy volunteers were recruited into two age groups: young (N = 23, age = 27.1 ± 3.8) and elderly (N = 21, age = 70.1 ± 3.9). The spinal curvature was assessed with a skin-surface device and the kinematics of the spine and lower extremities were recorded during daily living tasks (flexion-extension and stand-sit-stand) with a motion capture system. The obtained data were used as input for a musculoskeletal model with a detailed thoracolumbar spine representation. To isolate the effect of kinematics on predicted loads, other model properties were kept constant. Inverse dynamics simulations were performed in the AnyBody Modeling System to estimate corresponding spinal loads. The maximum compressive loads predicted for the elderly motion patterns were lower than those of the young for L2/L3 and L3/L4 lumbar levels during flexion and for upper thoracic levels during stand-to-sit (T1/T2-T8/T9) and sit-to-stand (T3/T4-T6/T7). However, the maximum loads predicted for the lower thoracic levels (T9/T10-L1/L2), a common site of vertebral fractures, were similar compared to the young. Nevertheless, these loads acting on the vertebrae of reduced bone quality might contribute to a higher fracture risk for the elderly. Copyright © 2017 Elsevier Ltd. All rights reserved.

Surgical Navigation Technology Based on Augmented Reality and Integrated 3D Intraoperative Imaging: A Spine Cadaveric Feasibility and Accuracy Study.

PubMed

Elmi-Terander, Adrian; Skulason, Halldor; Söderman, Michael; Racadio, John; Homan, Robert; Babic, Drazenko; van der Vaart, Nijs; Nachabe, Rami

2016-11-01

A cadaveric laboratory study. The aim of this study was to assess the feasibility and accuracy of thoracic pedicle screw placement using augmented reality surgical navigation (ARSN). Recent advances in spinal navigation have shown improved accuracy in lumbosacral pedicle screw placement but limited benefits in the thoracic spine. 3D intraoperative imaging and instrument navigation may allow improved accuracy in pedicle screw placement, without the use of x-ray fluoroscopy, and thus opens the route to image-guided minimally invasive therapy in the thoracic spine. ARSN encompasses a surgical table, a motorized flat detector C-arm with intraoperative 2D/3D capabilities, integrated optical cameras for augmented reality navigation, and noninvasive patient motion tracking. Two neurosurgeons placed 94 pedicle screws in the thoracic spine of four cadavers using ARSN on one side of the spine (47 screws) and free-hand technique on the contralateral side. X-ray fluoroscopy was not used for either technique. Four independent reviewers assessed the postoperative scans, using the Gertzbein grading. Morphometric measurements of the pedicles axial and sagittal widths and angles, as well as the vertebrae axial and sagittal rotations were performed to identify risk factors for breaches. ARSN was feasible and superior to free-hand technique with respect to overall accuracy (85% vs. 64%, P < 0.05), specifically significant increases of perfectly placed screws (51% vs. 30%, P < 0.05) and reductions in breaches beyond 4 mm (2% vs. 25%, P < 0.05). All morphometric dimensions, except for vertebral body axial rotation, were risk factors for larger breaches when performed with the free-hand method. ARSN without fluoroscopy was feasible and demonstrated higher accuracy than free-hand technique for thoracic pedicle screw placement. N/A.

Medical Standards for Experimental Human Use in Acceleration Stress Research

DTIC Science & Technology

1983-01-01

or re- teroposterior and lateral X-rays of the cervical , thoracic, sources, we consider a positive treadmill test to be dis- and lumbar spine. These...Gz stress. The requirement for a complete cervical , thoracic and dividuals who developed significant stress dysrhythmias lumbar spine X-ray series...hematoma h. Hernia Ill. Cardiac Stress: a. Dywrhythmla (Tachyarrhythmias and Bradyarrhythmim) b. Heart blocks c. Stress caadlomyopmt U244 Awono. spme

Intramedullary capillary hemangioma of the thoracic spine: case report and review of the literature

PubMed Central

Kasukurthi, Rahul; Ray, Wilson Z; Blackburn, Spiros L; Lusis, Eriks A; Santiago, Paul

2009-01-01

Capillary hemangiomas are benign vascular neoplasms. When associated with the spine, these growths frequently involve the vertebral body, but rarely have they been reported to occur as intradural lesions, while even more rarely occurring in a true intramedullary location. We report a rare case of an intramedullary capillary hemangioma of the thoracic spinal cord and a review of the literature. PMID:21139881

Morphology study of thoracic transverse processes and its significance in pedicle-rib unit screw fixation.

PubMed

Cui, Xin-gang; Cai, Jin-fang; Sun, Jian-min; Jiang, Zhen-song

2015-03-01

Thoracic transverse process is an important anatomic structure of the spine. Several anatomic studies have investigated the adjacent structures of the thoracic transverse process. But there is still a blank on the morphology of the thoracic transverse processes. The purpose of the cadaveric study is to investigate the morphology of thoracic transverse processes and to provide morphology basis for the pedicle-rib unit (extrapedicular) screw fixation method. Forty-five adult dehydrated skeletons (T1-T10) were included in this study. The length, width, thickness, and the tilt angle (upward and backward) of the thoracic transverse process were measured. The data were then analyzed statistically. On the basis of the morphometric study, 5 fresh cadavers were used to place screws from transverse processes to the vertebral body in the thoracic spine, and then observed by the naked eye and on computed tomography scans. The lengths of thoracic transverse processes were between 16.63±1.59 and 18.10±1.95 mm; the longest was at T7, and the shortest was at T10. The widths of thoracic transverse processes were between 11.68±0.80 and 12.87±1.48 mm; the widest was at T3, and the narrowest was at T7. The thicknesses of thoracic transverse processes were between 7.86±1.24 and 10.78±1.35 mm; the thickest was at T1, and the thinnest was at T7. The upward tilt angles of thoracic transverse processes were between 24.9±3.1 and 3.0±1.56 degrees; the maximal upward tilt angle was at T1, and the minimal upward tilt angle was at T7. The upward tilt angles of T1 and T2 were obviously different from the other thoracic transverse processes (P<0.01). The backward tilt angles of thoracic transverse processes gradually increased from 24.5±2.91 degrees at T1 to 64.5±5.12 degrees at T10. The backward tilt angles were significantly different between each other, except between T5 and T6. In the validation study, screws were all placed successfully from transverse processes to the vertebrae of thoracic spine. The length, width, and thickness of the thoracic transverse processes are suitable for screw placement. And the obvious upward and backward tilt angles provide an excellent screw passage from transverse process to the vertebral body. Screw placement from the transverse processes to the vertebral body is feasible in the thoracic spine. However, there is still some place for improvement of the pedicle-rib unit screw fixation method.

The association between athletic training time and the sagittal curvature of the immature spine.

PubMed

Wojtys, E M; Ashton-Miller, J A; Huston, L J; Moga, P J

2000-01-01

Strenuous physical activity is known to cause structural abnormalities in the immature vertebral body. Concern that exposure to years of intense athletic training may increase the risk for developing adolescent hyperkyphosis in certain sports, as well as the known association between hyperkyphosis and adult-onset back pain, led us to examine the association between cumulative hours of athletic training and the magnitude of the sagittal curvature of the immature spine. A sample of 2,270 children (407 girls and 1,863 boys) between 8 and 18 years of age were studied. An optical raster-stereographic method was used to measure the mid-sagittal curvatures of the surface of the back while the subject was in the upright standing position to quantify the angles of thoracic kyphosis and lumbar lordosis. These data were then correlated with self-reported hours of training measured by interview and questionnaire. The possible effects of age, sex, sport, and upper and lower body weight training were investigated. The results in these young athletes showed that larger angles of thoracic kyphosis and lumbar lordosis were associated with greater cumulative training time. Gymnasts showed the largest curves. Lack of sports participation, on the other hand, was associated with the smallest curves. Age and sex did not appear to affect the degree of curvature.

Pregnancy-associated osteoporosis with eight fractures in the vertebral column treated with kyphoplasty and bracing: a case report.

PubMed

Bonacker, J; Janousek, M; Kröber, M

2014-02-01

Pregnancy-associated osteoporosis is a rare condition, which imposes multiple symptoms in the musculoskeletal system. Common complaints announced by patients are severe pain in the lower back, hips and the joints of the lower extremities with a reduced and less mobility status in general. Most of the patients' problems occur in the last trimester of pregnancy or postpartum and are often not diagnosed as side effects of osteoporosis but as problems associated with pregnancy. Although vertebral fractures are rare complications of pregnancy-associated osteoporosis, they should be always considered in women presenting with an acute pain syndrome in peripregnancy period. This case presents a 40-year-old primagravid woman who developed pain in hips and severe pain in the lower back causing an immobilization diagnosed with a pregnancy-associated osteoporosis with eight compression fractures in the thoracic and lumbar spine. Because of sagittal imbalance of the spine, she was treated with kyphoplasty at the four lumbar fractures and with bracing for the upper, thoracic ones, additional to the conservative anti-osteoporotic therapy. The authors discuss pregnancy-associated osteoporosis and its clinical presentation, as well as the indications of kyphoplasty, spinal alignment and the risk of single conservative treatment.

[Pott's Disease in Upper Thoracic Vertebrae in a Two-Year-Old Boy: Case Report].

PubMed

Cortez-Bazán, Nathaly; Delgado, Jennifer R; Galdos, Omar; Huicho, Luis

2018-01-01

Pott's disease is a health problem in developing countries and its diagnosis in children is a challenge. Here we present the case of a two-year-old boy with Pott's disease involving T1 to T3 thoracic vertebrae. The clinical presentation was characterized by difficulty walking, fever, cough, and dyspnea. At physical examination, kyphosis and bony prominence were observed in the cervicodorsal area. A positive tuberculin test was obtained, and Mycobacterium tuberculosis was isolated via culture of the gastric aspiration sample. The spine MRI showed a chronic abscess, destruction of two vertebrae, and bone marrow compression. The patient experienced some improvement with anti-TB therapy. Here, we emphasize the importance of giving consideration to the clinical suspicion for the early detection of this condition, as well as a quick TB-treatment start so as to avoid the disability and mortality associated to this disease.

Ligamentum flavum hematomas of the cervical and thoracic spine.

PubMed

Wild, Florian; Tuettenberg, Jochen; Grau, Armin; Weis, Joachim; Krauss, Joachim K

2014-01-01

To report extremely rare cases of ligamentum flavum hematomas in the cervical and thoracic spine. Only six cases of thoracic ligamentum flavum hematomas and three cases of cervical ligamentum flavum hematomas have been reported so far. Two patients presented with tetraparesis and one patient presented with radicular pain and paresthesias in the T3 dermatome. MRI was performed in two patients, which showed a posterior intraspinal mass, continuous with the ligamentum flavum. The mass was moderately hypointense on T2-weighted images and hyperintense on T1-weighted images with no contrast enhancement. The third patient underwent cervical myelography because of a cardiac pacemaker. The myelography showed an intraspinal posterior mass with compression of the dural sac at C3/C4. All patients underwent a hemilaminectomy to resect the ligamentum flavum hematoma and recovered completely afterwords, and did not experience a recurrence during follow-up of at least 2 years. This case series shows rare cases of ligamentum flavum hematomas in the cervical and thoracic spine. Surgery achieved complete recovery of the preoperative symptoms in all patients within days. Copyright © 2013 Elsevier B.V. All rights reserved.

Development of Predictive Models of Injury for the Lower Extremity, Lumbar, and Thoracic Spine after discharge from Physical Rehabilitation

DTIC Science & Technology

2017-10-01

discharge from Physical Rehabilitation PRINCIPAL INVESTIGATOR: MAJ Daniel Rhon CONTRACTING ORGANIZATION: The Geneva Foundation Tacoma, WA 98402...and Thoracic Spine after discharge from Physical Rehabilitation 5b. GRANT NUMBER W81XWH-14-2-0141 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S...The objective and overall hypothesis is that service member performance on a battery of physical performance tests performed upon discharge from

Pseudogout of the cervical and thoracic spine mimicking infection after lumbar fusion: case report.

PubMed

Bridges, Kelly J; Bullis, Carli L; Wanchu, Ajay; Than, Khoi D

2017-08-01

Pseudogout is a form of acute calcium pyrophosphate deposition (CPPD) disease that typically afflicts the elderly. CPPD commonly involves larger joints, such as the knees, wrists, shoulders, and hips, and has been known to involve the spine. The authors report the case of a 66-year-old woman with a recent history of lumbar laminectomy and fusion who presented 5 weeks postprocedure with a clinical and radiographic picture consistent with multilevel skip lesions involving the cervical and thoracic spine, thoracic discitis, and epidural abscess. Serial blood cultures and repeat biopsy samples were sterile. Subsequent wrist and ankle erythema, pain, and swelling led to synovial fluid analysis, and pseudogout was diagnosed. She was treated with an interleukin-1 inhibitor with immediate symptom relief. To the authors' knowledge, this is only the second report of spinal pseudogout presenting with a clinical and radiographic picture consistent with discitis and epidural abscess. This report is the first to report skip lesions of pseudogout occurring throughout the spine that are uniquely remote from a recent lumbar surgery.

Disc herniations in the national football league.

PubMed

Gray, Benjamin L; Buchowski, Jacob M; Bumpass, David B; Lehman, Ronald A; Mall, Nathan A; Matava, Matthew J

2013-10-15

Retrospective analysis of a prospectively collected database. To determine the overall incidence, location, and type of disc herniations in professional football players to target treatment issues and prevention. Disc herniations represent a common and debilitating injury to the professional athlete. The NFL's (National Football League's) Sports Injury Monitoring System is a surveillance database created to monitor the league for all injuries, including injuries to the cervical, thoracic, and lumbar spine. A retrospective analysis was performed on all disc herniations to the cervical, thoracic, and lumbar spine during a 12-season period (2000-2012) using the NFL's surveillance database. The primary data points included the location of the injury, player position, activity at time of injury, and playing time lost due to injury. During the 12 seasons, 275 disc herniations occurred in the spine. In regard to location, 76% occurred in the lumbar spine and most frequently affected the L5-S1 disc. The offensive linemen were most frequently injured. As expected, blocking was the activity that caused most injuries. Lumbar disc herniations rose in prevalence and had a mean loss of playing time of more than half the season (11 games). Thoracic disc herniations led to the largest mean number of days lost overall, whereas players with cervical disc herniations missed the most practices. Disc herniations represent a significant cause of morbidity in the NFL. Although much attention is placed on spinal cord injuries, preventive measures targeting the cervical, thoracic, and lumbar spine may help to reduce the overall incidence of these debilitating injuries.Level of Evidence: N/A.

Disc herniations in the National Football League.

PubMed

Gray, Benjamin L; Buchowski, Jacob M; Bumpass, David B; Lehman, Ronald A; Mall, Nathan A; Matava, Matthew J

2013-10-15

Retrospective analysis of a prospectively collected database. To determine the overall incidence, location, and type of disc herniations in professional football players to target treatment issues and prevention. Disc herniations represent a common and debilitating injury to the professional athlete. The NFL's (National Football League's) Sports Injury Monitoring System is a surveillance database created to monitor the league for all injuries, including injuries to the cervical, thoracic, and lumbar spine. A retrospective analysis was performed on all disc herniations to the cervical, thoracic, and lumbar spine during a 12-season period (2000–2012) using the NFL's surveillance database. The primary data points included the location of the injury, player position, activity at time of injury, and playing time lost due to injury. During the 12 seasons, 275 disc herniations occurred in the spine. In regard to location, 76% occurred in the lumbar spine and most frequently affected the L5–S1 disc. The offensive linemen were most frequently injured. As expected, blocking was the activity that caused most injuries. Lumbar disc herniations rose in prevalence and had a mean loss of playing time of more than half the season (11 games). Thoracic disc herniations led to the largest mean number of days lost overall, whereas players with cervical disc herniations missed the most practices. Disc herniations represent a significant cause of morbidity in the NFL. Although much attention is placed on spinal cord injuries, preventive measures targeting the cervical, thoracic, and lumbar spine may help to reduce the overall incidence of these debilitating injuries. N/A

Reduction of Current Migraine Headache Pain Following Neck Massage and Spinal Manipulation

PubMed Central

Noudeh, Younes Jahangiri; Vatankhah, Nasibeh; Baradaran, Hamid R.

2012-01-01

Background Migraine headache significantly impacts the health of individuals and of society. The application of simple physical nonpharmacological techniques could greatly reduce the therapeutic costs and side effects in acute onset of such headaches. Methods Ten male patients (mean age was 32.0 ± 10.59 years) with acute onset of a migraine headache according to IHS-2004 diagnostic criteria were enrolled in the study. Neck and upper thoracic spine massage and manipulation technique was performed. Headache pain intensity was assessed before and after the intervention by means of a verbal analog scale. Results Following treatment, headache pain intensity was significantly reduced compared to the pretreatment values (1.85 ± 1.11 vs. 5.80 ± 2.25, p = .005). As a percentage, this represents a mean pain reduction of 68.77% ± 18.56. No side effects were observed, and all of the patients reported satisfaction with the intervention. Conclusion Our results show that the applied cervical and upper thoracic massage and manipulation technique could reduce the headache attack pain intensity in patients with migraine headaches, though further testing, including study designs that make use of control groups, is needed. PMID:22553478

Intra-operative localisation of thoracic spine level: a simple "'K'-wire in pedicle" technique.

PubMed

Thambiraj, Sathya; Quraishi, Nasir A

2012-05-01

To describe a simple and reliable method of intra-operative localisation of thoracic spine in a single surgical setting. Intra-operative localisation of thoracic spine levels can be difficult due to anatomical constraints, such as scapular shadow, patient's size and poor bone quality. This is particularly true in cases of thoracic discectomies in which the vertebral bodies appear normal. There are several methods described in recent literature to address this. Many of them require a separate procedure which was performed often the previous day. We report a technique which addresses the issue of localising thoracic level intra-operatively. After induction of general anaesthesia, the patient was placed prone and the pedicle of interest was identified using fluoroscopy. A K-wire was then inserted percutaneously into this pedicle under image guidance [confirmed in the antero-posterior (AP) and lateral views]. The wire was then cut close to the skin after bending it. The patient was now positioned laterally and the intended procedure performed through an anterior trans-thoracic approach. The 'K' wire was removed at the end of the procedure. We routinely used this technique in all our thoracic discectomies (four cases in 2 years). There were no intra-operative complications. This method is simple, avoids the patient undergoing two procedures and requires no more ability than placing an implant in the pedicle under fluoroscopy. Placing the 'K' wire into a fixed point like the pedicle facilitates rapid intra-operative viewing of the level of interest and is removed easily at the conclusion of surgery.

The forces applied by female and male chiropractors during thoracic spinal manipulation.

PubMed

Forand, D; Drover, J; Suleman, Z; Symons, B; Herzog, Walter

2004-01-01

On average, women weigh less, have a smaller frame, and are less muscular than men. Since the peak thrust force applied during spinal manipulative treatments can be quite high and must be reached in a very short period of time, one might question the physical ability of women to generate such high forces. To study the forces generated by male and female chiropractors as they deliver spinal manipulation to the thoracic spine. Fourteen male and 14 female experience-matched chiropractors participated in this study. They each manipulated 1 of 9 asymptomatic male adult subjects of similar height and weight. The clinicians were asked to manipulate a transverse process in the vicinity of T4 and T9. Any technique could be used as long as the treatment thrust was in a posterior to anterior direction and the hand contact fit onto the sensor pad (area = 100 cm2). There were no significant differences (P<.05) between male and female chiropractors for any measurements in the upper thoracic area. For the lower thoracic manipulations, the preload forces for the male chiropractors were significantly greater (P<.05) than those for the female chiropractors. The remaining variables were the same between the 2 groups. Female chiropractors produce, from a mechanical point of view, similar manual treatments as their male colleagues.

Arachnoiditis ossificans of the thoracic spine.

PubMed

Bagley, Jacob H; Owens, T Ryan; Grunch, Betsy H; Moreno, Jessica R; Bagley, Carlos A

2014-03-01

Arachnoiditis ossificans is a rare disorder characterized by the development of calcifications of the arachnoid membrane of the thoracic and lumbar spines. It is an extremely rare cause of spinal canal stenosis and consequent neurological compromise, and its origins and optimal management remain unclear. We review of the literature that illustrates the challenges of diagnosis and treatment of arachnoiditis ossificans. A patient with arachnoiditis ossificans is discussed to illustrate the presentation, treatment, and prognosis of the disease. Copyright © 2013 Elsevier Ltd. All rights reserved.

Functional anatomy of human scalene musculature: rotation of the cervical spine.

PubMed

Olinger, Anthony B; Homier, Phillip

2010-10-01

Actions of the scalene muscles include flexion and lateral flexion of the cervical spine and elevation of the first and second ribs. The cervical rotational qualities of the scalene muscles remain unclear. Textbooks and recent studies report contradictory findings with respect to the cervical rotational properties of the scalene muscles. The present study was designed to take a mechanical approach to determining whether the scalene muscles produce rotation of the cervical spine. The scalene muscles were isolated, removed, and replaced by a durable suture material. The suture material was attached at the origin and then passed through a hole on the corresponding rib near the central point of the insertion. The suture material was pulled down through the corresponding costal insertion hole to simulate contraction of each muscle. The simulated anterior, middle, and posterior scalene muscles, working independently and jointly, produced ipsilateral rotation of the cervical spine. The upper cervical spine rotated in the ipsilateral direction in response to the simulated muscle contraction. Findings were similar for the lower cervical spine with the exception of 2 specimens, which rotated contralaterally in response to the simulation. Experimental models of the scalene muscles are capable of producing ipsilateral rotation of the cervical spine. The findings of this study support the accepted main actions of the scalene muscles. The clinical applications for understanding the cervical rotational properties of the scalene muscles include the diagnosis, management, and treatment of cervical pain conditions as well as thoracic outlet syndrome. Copyright © 2010 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

Clinical presentation and manual therapy for upper quadrant musculoskeletal conditions

PubMed Central

Isabel de-la-Llave-Rincón, Ana; Puentedura, Emilio J; Fernández-de-las-Peñas, César

2011-01-01

In recent years, increased knowledge of the pathogenesis of upper quadrant pain syndromes has translated to better management strategies. Recent studies have demonstrated evidence of peripheral and central sensitization mechanisms in different local pain syndromes of the upper quadrant such as idiopathic neck pain, lateral epicondylalgia, whiplash-associated disorders, shoulder impingement, and carpal tunnel syndrome. Therefore, a treatment-based classification approach where subjects receive matched interventions has been developed and, it has been found that these patients experience better outcomes than those receiving non-matched interventions. There is evidence suggesting that the cervical and thoracic spine is involved in upper quadrant pain. Spinal manipulation has been found to be effective for patients with elbow pain, neck pain, or cervicobrachial pain. Additionally, it is known that spinal manipulative therapy exerts neurophysiological effects that can activate pain modulation mechanisms. This paper exposes some manual therapies for upper quadrant pain syndromes, based on a nociceptive pain rationale for modulating central nervous system including trigger point therapy, dry needling, mobilization or manipulation, and cognitive pain approaches. PMID:23115473

Whole vertebral bone segmentation method with a statistical intensity-shape model based approach

NASA Astrophysics Data System (ADS)

Hanaoka, Shouhei; Fritscher, Karl; Schuler, Benedikt; Masutani, Yoshitaka; Hayashi, Naoto; Ohtomo, Kuni; Schubert, Rainer

2011-03-01

An automatic segmentation algorithm for the vertebrae in human body CT images is presented. Especially we focused on constructing and utilizing 4 different statistical intensity-shape combined models for the cervical, upper / lower thoracic and lumbar vertebrae, respectively. For this purpose, two previously reported methods were combined: a deformable model-based initial segmentation method and a statistical shape-intensity model-based precise segmentation method. The former is used as a pre-processing to detect the position and orientation of each vertebra, which determines the initial condition for the latter precise segmentation method. The precise segmentation method needs prior knowledge on both the intensities and the shapes of the objects. After PCA analysis of such shape-intensity expressions obtained from training image sets, vertebrae were parametrically modeled as a linear combination of the principal component vectors. The segmentation of each target vertebra was performed as fitting of this parametric model to the target image by maximum a posteriori estimation, combined with the geodesic active contour method. In the experimental result by using 10 cases, the initial segmentation was successful in 6 cases and only partially failed in 4 cases (2 in the cervical area and 2 in the lumbo-sacral). In the precise segmentation, the mean error distances were 2.078, 1.416, 0.777, 0.939 mm for cervical, upper and lower thoracic, lumbar spines, respectively. In conclusion, our automatic segmentation algorithm for the vertebrae in human body CT images showed a fair performance for cervical, thoracic and lumbar vertebrae.

Kinematic analysis of work-related musculoskeletal loading of trunk among dentists in Germany.

PubMed

Ohlendorf, Daniela; Erbe, Christina; Hauck, Imke; Nowak, Jennifer; Hermanns, Ingo; Ditchen, Dirk; Ellegast, Rolf; Groneberg, David A

2016-10-18

In Germany, about 86.7 % of the dentists have stated to suffer from pain in the neck and shoulder region. These findings are predominantly based on surveys. Therefore the objective of this study is to conduct a kinematic analysis of occupational posture in dentistry. Twenty one dentists (11 f/10 m; age: 40.1 ± 10.4 years) have participated in this examination. The CUELA-System was used to collect kinematic data of the activities on an average dental workday. A detailed, computer-based task analysis took place parallel to the kinematic examination. Through the synchronization of data collected from both measurements, patterns of posture were arranged chronologically and in conjunction with the tasks performed: (I) "treatment" (II) "office" and (III) "other activities". For the data analysis, characteristic data of joint angular distributions (percentiles P05, P25, P50, P75 and P95) of head, neck and torso at pre-defined tasks were examined and assessed corresponding to ergonomic standards. Forty one percent of tasks executed on an average dental workday can be categorized as the treatment of patients. These tasked are most frequently performed in "straight back" positions (78.7 %), whereas 20.1 % were carried out in a "twisted or inclined" torso posture, 1.1 % "bowed" and only 0.1 % "bowed and twisted/inclined to the side" upper body position. In particular, it can be observed that in the area of the cervical and thoracic spine the 75th and 95th percentile show worse angular values during treatment than during non-dental tasks. For the period of treatment (at a standardized dental chair construction), a seated position with a strong inclination of the thoracic spine to the right while the lumbar spine is inclined towards the left is adopted. The kinematic analysis of dentists illustrates typical patterns of postures during tasks that are essential to the dental treatment of patients. The postures in the area of the cervical and thoracic spine have higher angular values during treatment compared to other dental tasks. Consistently, appropriate ergonomic design measures to optimize the dental chair and equipment as well as integrated training in ergonomics as part of the study of dentistry to prevent musculoskeletal are recommended.

Vertebral coplanar alignment: a standardized technique for three dimensional correction in scoliosis surgery: technical description and preliminary results in Lenke type 1 curves.

PubMed

Vallespir, Gabriel Pizà; Flores, Jesús Burgos; Trigueros, Ignacio Sanpera; Sierra, Eduardo Hevia; Fernández, Pedro Doménech; Olaverri, Juan Carlos Rodríguez; Alonso, Manuel García; Galea, Rafael Ramos; Francisco, Antonio Pérez; Rodríguez de Paz, Beatriz; Carbonell, Pedro Gutiérrez; Thomas, Javier Vicente; López, José Luís González; Paulino, José Ignacio Maruenda; Pitarque, Carlos Barrios; García, Oscar Riquelme

2008-06-15

Prospective multicentric study. To present the preliminary results of an innovative method for standardized correction of scoliosis, vertebral coplanar alignment (VCA), based on a novel concept: the relocation of vertebral axis in a single plane. Normal standing spine has no rotation in coronal or transverse planes, therefore X and Z axis of vertebrae are in the same plane: they are coplanar. VCA intends to relocate these axis in one plane, correcting rotation and translation, while X axis are returned to its normal posterior divergence in sagittal plane in thoracic spine. Twenty-five consecutive adolescent idiopathic scoliosis patients (Lenke type 1) underwent posterior surgery with segmental pedicle screw fixation. Slotted tubes were attached to convex side screws. Two longitudinal rods were inserted through the end of tubes. Then, they were separated along the slots, driving the tubes into one plane, making the axis of the vertebrae coplanar and thus correcting transverse rotation and coronal translation. To obtain kyphosis, distal ends of the tubes were spread in thoracic spine. Correction was maintained by locking a definitive rod in the concave side, then tubes were retrieved and the convex side rod, inserted and tightened. Correction was assessed on preoperative and postoperative full-spine standing radiograph. Vertebral rotation was measured on computed tomography-scan and magnetic resonance imaging. Preoperative average thoracic curves of 61 degrees were corrected to 16 degrees (73%). Preoperative average thoracolumbar curves of 39 degrees were corrected to 12 degrees (70%). Preoperative average thoracic apical rotation of 24 degrees was corrected to 11 degrees (56%). Preoperative average thoracic kyphosis of 18 degrees remained unchanged after surgery; however, no patients had kyphosis <10 degrees after surgery. Rib hump improved from 30 to 11 mm (65%). There were no perioperative complications. VCA provided excellent correction of coronal and transverse planes with normalization of thoracic kyphosis in Lenke type 1 adolescent idiopathic scoliosis surgery.

Low back pain and postural control, effects of task difficulty on centre of pressure and spinal kinematics.

PubMed

Schelldorfer, Sarah; Ernst, Markus Josef; Rast, Fabian Marcel; Bauer, Christoph Michael; Meichtry, André; Kool, Jan

2015-01-01

Association of low back pain and standing postural control (PC) deficits are reported inconsistently. Demands on PC adaptation strategies are increased by restraining the input of visual or somatosensory senses. The objectives of the current study are, to investigate whether PC adaptations of the spine, hip and the centre of pressure (COP) differ between patients reporting non-specific low back pain (NSLBP) and asymptomatic controls. The PC adaption strategies of the thoracic and lumbar spine, the hip and the COP were measured in fifty-seven NSLBP patients and 22 asymptomatic controls. We tested three "feet together" conditions with increasing demands on PC strategies, using inertial measurement units (IMUs) on the spine and a Wii balance board for centre of pressure (COP) parameters. The differences between NSLBP patients and controls were most apparent when the participants were blindfolded, but remaining on a firm surface. While NSLBP patients had larger thoracic and lumbar spine mean absolute deviations of position (MADpos) in the frontal plane, the same parameters decreased in control subjects (relative change (RC): 0.23, 95% confidence interval: 0.03 to 0.45 and 0.03 to 0.48). The Mean absolute deviation of velocity (MADvel) of the thoracic spine in the frontal plane showed a similar and significant effect (RC: 0.12 95% CI: 0.01 to 0.25). Gender, age and pain during the measurements affected some parameters significantly. PC adaptions differ between NSLBP patients and asymptomatic controls. The differences are most apparent for the thoracic and lumbar parameters of MADpos, in the frontal plane and while the visual condition was removed. Copyright © 2014 Elsevier B.V. All rights reserved.

Complications of growth-sparing surgery in early onset scoliosis.

PubMed

Akbarnia, Behrooz A; Emans, John B

2010-12-01

Review of available literature, authors' opinion. To describe complications associated with growth-sparing surgical treatment of early onset scoliosis (EOS). EOS has many potential etiologies and is often associated with thoracic insufficiency syndrome. The growth of the spine, thorax, and lungs are interrelated, and severe EOS typically involves disturbance of the normal development of all 3. Severe EOS may be treated during growth with surgical techniques, intended to preserve growth while controlling deformity, the most common of which are spinal "growing rods" (GR) or "vertical expandable prosthetic titanium rib" (VEPTR). Although presently popular, there is minimal long-term data on the outcome of growth-sparing surgical techniques on EOS. Review. Potential adverse outcomes of GR or VEPTR treatment of EOS include failure to prevent progressive deformity or thoracic insufficiency syndrome, an unacceptably short or stiff spine or deformed thorax, increased family burden of care, and potentially negative psychological consequences from repeated surgical interventions. Neither technique reliably controls all deformity over the entirety of growth period. Infections are common to both GR and VEPTR. Rod breakage and spontaneous premature spinal fusion beneath rods are troublesome complications in GR, whereas drift of rib attachments and chest wall scarring are anticipated complications in VEPTR treatment. Indications for GR and VEPTR overlap, but thoracogenic scoliosis and severe upper thoracic kyphosis are best treated by VEPTR and GR, respectively. Surgeons planning treatment of EOS should anticipate the many complications common to growth-sparing surgery, share their knowledge with families, and use complications as one factor in the complex decision as to when and whether to initiate the repetitive surgeries associated with GR or VEPTR in the treatment of severe EOS.

Cadaveric verification of the Eclipse AAA algorithm for spine SBRT treatments with titanium hardware.

PubMed

Grams, Michael P; Fong de Los Santos, Luis E; Antolak, John A; Brinkmann, Debra H; Clarke, Michelle J; Park, Sean S; Olivier, Kenneth R; Whitaker, Thomas J

2016-01-01

To assess the accuracy of the Eclipse Analytical Anisotropic Algorithm when calculating dose for spine stereotactic body radiation therapy treatments involving surgically implanted titanium hardware. A human spine was removed from a cadaver, cut sagittally along the midline, and then separated into thoracic and lumbar sections. The thoracic section was implanted with titanium stabilization hardware; the lumbar section was not implanted. Spine sections were secured in a water phantom and simulated for treatment planning using both standard and extended computed tomography (CT) scales. Target volumes were created on both spine sections. Dose calculations were performed using (1) the standard CT scale with relative electron density (RED) override of image artifacts and hardware, (2) the extended CT scale with RED override of image artifacts only, and (3) the standard CT scale with no RED overrides for hardware or artifacts. Plans were delivered with volumetric modulated arc therapy using a 6-MV beam with and without a flattening filter. A total of 3 measurements for each plan were made with Gafchromic film placed between the spine sections and compared with Eclipse dose calculations using gamma analysis with a 2%/2 mm passing criteria. A single measurement in a homogeneous phantom was made for each plan before actual delivery. Gamma passing rates for measurements in the homogeneous phantom were 99.6% or greater. Passing rates for measurements made in the lumbar spine section without hardware were 99.3% or greater; measurements made in the thoracic spine containing titanium were 98.6 to 99.5%. Eclipse Analytical Anisotropic Algorithm can adequately model the effects of titanium implants for spine stereotactic body radiation therapy treatments using volumetric modulated arc therapy. Calculations with standard or extended CT scales give similarly accurate results. Copyright © 2016 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

Multilevel non-contiguous spinal injuries: incidence and patterns based on whole spine MRI.

PubMed

Kanna, Rishi Mugesh; Gaike, Chandrasekar V; Mahesh, Anupama; Shetty, Ajoy Prasad; Rajasekaran, S

2016-04-01

Multi-level non-contiguous spinal injuries are not uncommon and their incidence varies from 1.6 to 77% depending on the type of imaging modality used. Delayed diagnosis and missed spinal injuries in non-contiguous spine fractures have been frequently described which can result in significant pain, deformity and neurological deficit. The efficacy of whole spine MRI in detecting asymptomatic significant vertebral fractures is not known. Consecutive spinal injury patients treated between 2011 and 2013 were retrospectively evaluated based on clinical and radiographic records. Patients' demographics, mode of injury, presence of associated injuries, clinical symptoms and the presence of neurological deficit were studied. Radiographs of the fractured region and whole spine MRI were evaluated for the presence of multi-level injuries. Among 484 patients, 95 (19.62%) patients had multilevel injuries including 86 (17.76%) with non-contiguous injuries. Five common patterns of non-contiguous spinal injuries were observed. Pattern I: cervical and thoracic--29.1%, Pattern II: thoracolumbar and lumbosacral--22.1%, Pattern III: thoracic and thoracolumbar--12.8 %, Pattern IV: cervical and thoracolumbar--9.1% and Pattern V: lumbosacral and associated injuries--9.0 %. The incidence of intra-regional non-contiguous injuries was 17.4%. Whole spine MRI scan detected 24 (28.6%) missed secondary injuries of which 5 were unstable. The incidence of multilevel non-contiguous spine injury using whole spine MRI imaging is 17.76%. Five different patterns of multi-level non-contiguous injuries were found with the most common pattern being the cervical and thoracic level injuries. The incidence of unstable injuries can be as high as 21% of missed secondary injuries.

Thoracic dysfunction in whiplash associated disorders: A systematic review

PubMed Central

Smith, Richard; Tyros, Isaak; Falla, Deborah; Rushton, Alison

2018-01-01

Background Research investigating Whiplash Associated Disorder (WAD) has largely focused on the cervical spine yet symptoms can be widespread. Thoracic spine pain prevalence is reported ~66%; perhaps unsurprising given the forceful stretch/eccentric loading of posterior structures of the spine, and the thoracic spine’s contribution to neck mobility/function. Approximately 50% WAD patients develop chronic pain and disability resulting in high levels of societal and healthcare costs. It is time to look beyond the cervical spine to fully understand anatomical dysfunction in WAD and provide new directions for clinical practice and research. Purpose To evaluate the scope and nature of dysfunction in the thoracic region in patients with WAD. Methods A systematic review and data synthesis was conducted according to a pre-defined, registered (PROSPERO, CRD42015026983) and published protocol. All forms of observational study were included. A sensitive topic-based search strategy was designed from inception to 1/06/16. Databases, grey literature and registers were searched using a study population terms and key words derived from scoping search. Two reviewers independently searched information sources, assessed studies for inclusion, extracted data and assessed risk of bias. A third reviewer checked for consistency and clarity. Extracted data included summary data: sample size and characteristics, outcomes, and timescales to reflect disorder state. Risk of bias was assessed using the Newcastle-Ottawa Scale. Data were tabulated to allow enabling a semi-qualitative comparison and grouped by outcome across studies. Strength of the overall body of evidence was assessed using a modified GRADE. Results Thirty eight studies (n>50,000) which were conducted across a range of countries were included. Few authors responded to requests for further data (5 of 9 contacted). Results were reported in the context of overall quality and were presented for measures of pain or dysfunction and presented, where possible, according to WAD severity and time point post injury. Key findings include: 1) high prevalence of thoracic pain (>60%); higher for those with more severe presentations and in the acute stage, 2) low prevalence of chest pain (<22%), 3) evidence of thoracic outlet syndrome, with some association to and involvement of the brachial plexus, 4) muscle dysfunction in the form of heightened activity of the sternocleidomastoid or delayed onset of action of the serratus anterior, 5) high prevalence of myofascial pain and trigger points in the scalene muscles, sternocleidomastoid and mid/lower fibres of trapezius muscle (48–65%), and 6) inconclusive evidence of altered thoracic posture or mobility. Conclusions Considerable evidence supports thoracic pain and dysfunction in patients with WAD, involving primarily nerves and muscles. Notwithstanding the low/very low level of evidence from this review, our findings do support a more extensive clinical evaluation of patients presenting with WAD. Additional high quality research is required to further characterise dysfunction across other structures in the thoracic region, including but not limited to the thoracic spine (mobility and posture) and thoracic muscles (stiffness, activation patterns). In turn this may inform the design of clinical trials targeting such dysfunction. PMID:29570722

Functional anatomy of the spine.

PubMed

Bogduk, Nikolai

2016-01-01

Among other important features of the functional anatomy of the spine, described in this chapter, is the remarkable difference between the design and function of the cervical spine and that of the lumbar spine. In the cervical spine, the atlas serves to transmit the load of the head to the typical cervical vertebrae. The axis adapts the suboccipital region to the typical cervical spine. In cervical intervertebrtal discs the anulus fibrosus is not circumferential but is crescentic, and serves as an interosseous ligament in the saddle joint between vertebral bodies. Cervical vertebrae rotate and translate in the sagittal plane, and rotate in the manner of an inverted cone, across an oblique coronal plane. The cervical zygapophysial joints are the most common source of chronic neck pain. By contrast, lumbar discs are well designed to sustain compression loads, but rely on posterior elements to limit axial rotation. Internal disc disruption is the most common basis for chronic low-back pain. Spinal muscles are arranged systematically in prevertebral and postvertebral groups. The intrinsic elements of the spine are innervated by the dorsal rami of the spinal nerves, and by the sinuvertebral nerves. Little modern research has been conducted into the structure of the thoracic spine, or the causes of thoracic spinal pain. © 2016 Elsevier B.V. All rights reserved.

Single-image hard-copy display of the spine utilizing digital radiography

NASA Astrophysics Data System (ADS)

Artz, Dorothy S.; Janchar, Timothy; Milzman, David; Freedman, Matthew T.; Mun, Seong K.

1997-04-01

Regions of the entire spine contain a wide latitude of tissue densities within the imaged field of view presenting a problem for adequate radiological evaluation. With screen/film technology, the optimal technique for one area of the radiograph is sub-optimal for another area. Computed radiography (CR) with its inherent wide dynamic range, has been shown to be better than screen/film for lateral cervical spine imaging, but limitations are still present with standard image processing. By utilizing a dynamic range control (DRC) algorithm based on unsharp masking and signal transformation prior to gradation and frequency processing within the CR system, more vertebral bodies can be seen on a single hard copy display of the lateral cervical, thoracic, and thoracolumbar examinations. Examinations of the trauma cross-table lateral cervical spine, lateral thoracic spine, and lateral thoracolumbar spine were collected on live patient using photostimulable storage phosphor plates, the Fuji FCR 9000 reader, and the Fuji AC-3 computed radiography reader. Two images were produced from a single exposure; one with standard image processing and the second image with the standard process and the additional DRC algorithm. Both sets were printed from a Fuji LP 414 laser printer. Two different DRC algorithms were applied depending on which portion of the spine was not well visualized. One algorithm increased optical density and the second algorithm decreased optical density. The resultant image pairs were then reviewed by a panel of radiologists. Images produced with the additional DRC algorithm demonstrated improved visualization of previously 'under exposed' and 'over exposed' regions within the same image. Where lung field had previously obscured bony detail of the lateral thoracolumbar spine due to 'over exposure,' the image with the DRC applied to decrease the optical density allowed for easy visualization of the entire area of interest. For areas of the lateral cervical spine and lateral thoracic spine that typically have a low optical density value, the DRC algorithm used increased the optical density over that region improving visualization of C7-T2 and T11-L2 vertebral bodies; critical in trauma radiography. Emergency medicine physicians also reviewing the lateral cervical spine images were able to clear 37% of the DRC images compared to 30% of the non-DRC images for removal of the cervical collar. The DRC processed images reviewed by the physicians do not have a typical screen/film appearance; however, these different images were preferred for the three examinations in this study. This method of image processing after being tested and accepted, is in use clinically at Georgetown University Medical Center Department of Radiology for the following examinations: cervical spine, lateral thoracic spine, lateral thoracolumbar examinations, facial bones, shoulder, sternum, feet and portable chest. Computed radiography imaging of the spine is improved with the addition of histogram equalization known as dynamic range control (DRC). More anatomical structures are visualized on a single hard copy display.

[Accidents in equestrian sports : Analysis of injury mechanisms and patterns].

PubMed

Schröter, C; Schulte-Sutum, A; Zeckey, C; Winkelmann, M; Krettek, C; Mommsen, P

2017-02-01

Equestrian sports are one of the most popular forms of sport in Germany, while also being one of the most accident-prone sports. Furthermore, riding accidents are frequently associated with a high degree of severity of injuries and mortality. Nevertheless, there are insufficient data regarding incidences, demographics, mechanisms of accidents, injury severity and patterns and outcome of injured persons in amateur equestrian sports. Accordingly, it was the aim of the present study to retrospectively analyze these aspects. A total of 503 patients were treated in the emergency room of the Hannover Medical School because of an accident during recreational horse riding between 2006 and 2011. The female gender was predominantly affected with 89.5 %. The mean age of the patients was 26.2 ± 14.9 years and women (24.5 ± 12.5 years) were on average younger than men (40.2 ± 23.9 years). A special risk group was girls and young women aged between 10 and 39 years. The overall injury severity was measured using the injury severity score (ISS). Based on the total population, head injuries were the most common location of injuries with 17.3 % followed by injuries to the upper extremities with 15.2 % and the thoracic and lumbar spine with 10.9 %. The three most common injury locations after falling from a horse were the head (17.5 %), the upper extremities (17.4 %), the thoracic and lumbar spine (12.9 %). The most frequent injuries while handling horses were foot injuries (17.2 %), followed by head (16.6 %) and mid-facial injuries (15.0 %). With respect to the mechanism of injury accidents while riding were predominant (74 %), while accidents when handling horses accounted for only 26 %. The median ISS was 9.8 points. The proportion of multiple trauma patients (ISS > 16) was 18.1 %. Based on the total sample, the average in-hospital patient stay was 5.3 ± 5.4 days with a significantly higher proportion of hospitalized patients in the group of riding accidents. Fatal cases were not found in this study but the danger of riding is not to be underestimated. The large number of sometimes severe injuries with ISS values up to 62 points can be interpreted as an indication that recreational riding can easily result in life-threatening situations. Girls and young women could be identified as a group at particular risk. It has been demonstrated in this study that the three most common injury locations after falling from a horse were the head, the upper extremities, the thoracic and lumbar spine. The most frequent injury locations while handling horses were foot injuries, followed by head and mid-facial injuries.

Hypervitaminosis A in the cat: a case report and review of the literature.

PubMed

Polizopoulou, Zoe S; Kazakos, George; Patsikas, Michael N; Roubies, Nikolaos

2005-12-01

A case of hypervitaminosis A with secondary entrapment and compression of the left brachial plexus nerve roots is described. A 9-year-old male castrated domestic shorthair, fed a home-made diet based on raw pork liver, was submitted for examination for a left forelimb lameness that evolved to paralysis over a 2-month period. Clinical examination revealed a flaccid paralysis and atrophy of all left forelimb muscles. An ipsilateral Horner's syndrome was also noted. Radiological examination of the cervical and thoracic spine showed massive new bone formation at the ventral aspect of the second cervical to sixth thoracic vertebra. The diagnosis of hypervitaminosis A was made, based on the clinical and radiographic findings, as well as the determination of serum vitamin A concentration, which was 630 microg/dl, three times above the upper normal limit for this species. Despite the unfavourable initial prognosis, the cat progressively regained function of the affected limb approximately 6 months after the diet was changed to a commercial canned food.

Short-Term Effects of Thoracic Spine Manipulation on the Biomechanical Organisation of Gait Initiation: A Randomized Pilot Study

PubMed Central

Ditcharles, Sébastien; Yiou, Eric; Delafontaine, Arnaud; Hamaoui, Alain

2017-01-01

Speed performance during gait initiation is known to be dependent on the capacity of the central nervous system to generate efficient anticipatory postural adjustments (APA). According to the posturo-kinetic capacity (PKC) concept, any factor enhancing postural chain mobility and especially spine mobility, may facilitate the development of APA and thus speed performance. “Spinal Manipulative Therapy High-Velocity, Low-Amplitude” (SMT-HVLA) is a healing technique applied to the spine which is routinely used by healthcare practitioners to improve spine mobility. As such, it may have a positive effect on the PKC and therefore facilitate gait initiation. The present study aimed to investigate the short-term effect of thoracic SMT-HVLA on spine mobility, APA and speed performance during gait initiation. Healthy young adults (n = 22) performed a series of gait initiation trials on a force plate before (“pre-manipulation” condition) and after (“post-manipulation” condition) a sham manipulation or an HVLA manipulation applied to the ninth thoracic vertebrae (T9). Participants were randomly assigned to the sham (n = 11) or the HVLA group (n = 11).The spine range of motion (ROM) was assessed in each participant immediately after the sham or HVLA manipulations using inclinometers. The results showed that the maximal thoracic flexion increased in the HVLA group after the manipulation, which was not the case in the sham group. In the HVLA group, results further showed that each of the following gait initiation variables reached a significantly lower mean value in the post-manipulation condition as compared to the pre-manipulation condition: APA duration, peak of anticipatory backward center of pressure displacement, center of gravity velocity at foot-off, mechanical efficiency of APA, peak of center of gravity velocity and step length. In contrast, for the sham group, results showed that none of the gait initiation variables significantly differed between the pre- and post-manipulation conditions. It is concluded that HVLA manipulation applied to T9 has an immediate beneficial effect on spine mobility but a detrimental effect on APA development and speed performance during gait initiation. We suggest that a neural effect induced by SMT-HVLA, possibly mediated by a transient alteration in the early sensory-motor integration, might have masked the potential mechanical benefits associated with increased spine mobility. PMID:28713254

Thoracic myelopathy caused by ossification of the ligamentum flavum: a report of 18 cases.

PubMed

Ben Hamouda, Karim; Jemel, Hafedh; Haouet, Slim; Khaldi, Moncef

2003-09-01

Thoracic myelopathy caused by ossification of the ligamentum flavum (OLF) is a rare entity, most evident in Japan. The authors studied the clinical manifestations, radiological aspects, surgical treatment, and pathogenesis of this disease. Eighteen patients with OLF-induced thoracic myelopathy underwent laminectomy. The severity of myelopathy varied. Complete paraplegia was seen in three cases. Compression of the upper and middle third of the thoracic spine was evident in six cases and of the lower third in 12 cases. Multilevel OLF was demonstrated in 13 cases. In most cases, the ossified ligamentum flavum appears as a V-shaped lesion on computerized tomography and magnetic resonance images. In all patients the diameter of the posterior spinal canal, already narrowed, was further exacerbated by the OLF. Laminectomy was limited to the levels of compression, and the ligamentum flavum was resected in all cases. The symptoms and signs improved in 13 cases and stabilized in four cases. In one case symptoms recurred as a result of ossified lesions forming at other sites. Histological examination showed that the mode of development of the ossified ligaments was endochondral ossification. Reports of OLF-induced myelopathy are rare and mainly described in Japan. The incidence also seems high in North Africa. An early laminectomy limited to the level of compression is recommended. Ossified ligamentum flavum is different from the calcification of the ligamentum flavum, which is due to crystal deposits.

Dosimetric comparison of photon and proton treatment techniques for chondrosarcoma of thoracic spine

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yadav, Poonam, E-mail: yadav@humonc.wisc.edu; Department of Medical Physics, University of Wisconsin, Madison, WI; University of Wisconsin Riverview Cancer Center, Wisconsin Rapids, WI

2013-10-01

Chondrosarcomas are relatively radiotherapy resistant, and also delivering high radiation doses is not feasible owing to anatomic constraints. In this study, the feasibility of helical tomotherapy for treatment of chondrosarcoma of thoracic spine is explored and compared with other available photon and proton radiotherapy techniques in the clinical setting. A patient was treated for high-grade chondrosarcoma of the thoracic spine using tomotherapy. Retrospectively, the tomotherapy plan was compared with intensity-modulated radiation therapy, dynamic arc photon therapy, and proton therapy. Two primary comparisons were made: (1) comparison of normal tissue sparing with comparable target volume coverage (plan-1), and (2) comparison ofmore » target volume coverage with a constrained maximum dose to the cord center (plan-2). With constrained target volume coverage, proton plans were found to yield lower mean doses for all organs at risk (spinal cord, esophagus, heart, and both lungs). Tomotherapy planning resulted in the lowest mean dose to all organs at risk amongst photon-based methods. For cord dose constrained plans, the static-field intensity-modulated radiation therapy and dynamic arc plans resulted target underdosing in 20% and 12% of planning target volume2 volumes, respectively, whereas both proton and tomotherapy plans provided clinically acceptable target volume coverage with no portion of planning target volume2 receiving less than 90% of the prescribed dose. Tomotherapy plans are comparable to proton plans and produce superior results compared with other photon modalities. This feasibility study suggests that tomotherapy is an attractive alternative to proton radiotherapy for delivering high doses to lesions in the thoracic spine.« less

Thoracic manual therapy is not more effective than placebo thoracic manual therapy in patients with shoulder dysfunctions: A systematic review with meta-analysis.

PubMed

Bizzarri, Paolo; Buzzatti, Luca; Cattrysse, Erik; Scafoglieri, Aldo

2018-02-01

Manual treatments targeting different regions (shoulder, cervical spine, thoracic spine, ribs) have been studied to deal with patients complaining of shoulder pain. Thoracic manual treatments seem able to produce beneficial effects on this group of patients. However, it is not clear whether the patient improvement is a consequence of thoracic manual therapy or a placebo effect. To compare the efficacy of thoracic manual therapy and placebo thoracic manual treatment for patients with shoulder dysfunction. Electronic databases (MEDLINE, CENTRAL, PEDro, CINAHL, WoS, EMBASE, ERIC) were searched through November 2016. Randomized Controlled Trials assessing pain, mobility and function were selected. The Cochrane bias estimation tool was applied. Outcome results were either extracted or computed from raw data. Meta-analysis was performed for outcomes with low heterogeneity. Four studies were included in the review. The methodology of the included studies was generally good except for one study that was rated as high risk of bias. Meta-analysis showed no significant effect for "pain at present" (SMD -0.02; 95% CI: -0.35, 0.32) and "pain during movement" (SMD -0.12; 95% CI: -0.45, 0.21). There is very low to low quality of evidence that a single session of thoracic manual therapy is not more effective than a single session of placebo thoracic manual therapy in patients with shoulder dysfunction at immediate post-treatment. Copyright © 2017 Elsevier Ltd. All rights reserved.

Morphometric analysis of the relationships between intervertebral disc and vertebral body heights: an anatomical and radiographic study of the human thoracic spine

PubMed Central

Kunkel, Maria E; Herkommer, Andrea; Reinehr, Michael; Böckers, Tobias M; Wilke, Hans-Joachim

2011-01-01

The main aim of this study was to provide anatomical data on the heights of the human intervertebral discs for all levels of the thoracic spine by direct and radiographic measurements. Additionally, the heights of the neighboring vertebral bodies were measured, and the prediction of the disc heights based only on the size of the vertebral bodies was investigated. The anterior (ADH), middle (MDH) and posterior heights (PDH) of the discs were measured directly and on radiographs of 72 spine segments from 30 donors (age 57.43 ± 11.27 years). The radiographic measurement error and the reliability of the measurements were calculated. Linear and non-linear regression analyses were employed for investigation of statistical correlations between the heights of the thoracic disc and vertebrae. Radiographic measurements displayed lower repeatability and were shorter than the anatomical ones (approximately 9% for ADH and 37% for PDH). The thickness of the discs varied from 4.5 to 7.2 mm, with the MDH approximately 22.7% greater. The disc heights showed good correlations with the vertebral body heights (R2, 0.659–0.835, P-values < 0.005; anova), allowing the generation of 10 prediction equations. New data on thoracic disc morphometry were provided in this study. The generated set of regression equations could be used to predict thoracic disc heights from radiographic measurement of the vertebral body height posterior. For the creation of parameterized models of the human thoracic discs, the use of the prediction equations could eliminate the need for direct measurement on intervertebral discs. Moreover, the error produced by radiographic measurements could be reduced at least for the PDH. PMID:21615399

Acute proximal junctional failure in patients with preoperative sagittal imbalance.

PubMed

Smith, Micah W; Annis, Prokopis; Lawrence, Brandon D; Daubs, Michael D; Brodke, Darrel S

2015-10-01

Proximal junctional failure (PJF) is a recognized complication of spinal deformity surgery. Acute PJF (APJF) has recently been demonstrated to be 5.6% in the adult spinal deformity (ASD) population. The incidence and rate of return to the operating room for APJF have not been specifically investigated in individuals with sagittal imbalance. The purpose of this study was to report the incidence of APJF in patients with preoperative sagittal imbalance and the rate of return to the operating room for APJF. This study is based on a retrospective review of prospectively collected database of ASD patients. One hundred seventy-three consecutive patients were included with preoperative sagittal imbalance according to one of the following common parameters: sagittal vertical axis (SVA) greater than 50 mm, global sagittal alignment greater than 45°, or pelvic incidence minus lumbar lordosis greater than 10°. Outcome measure was presence and/or absence of APJF defined as fracture at the upper instrumented vertebra (UIV) or UIV+1, failure of UIV fixation, 15° or more proximal junctional kyphosis, or need for extension of instrumentation within 6 months of surgery. We performed radiographic measurements on X-rays at preoperative, immediate postoperative, and 6-month follow-up visits. The APJF rate was reported for the entire patient population with preoperative sagittal imbalance. Acute PJF incidence was calculated postoperatively for each of the accepted sagittal balance parameters and/or formulas. Patients with persistent postoperative sagittal imbalance were compared with the sagittally balanced group. We also assessed for threshold values. Acute PJF was observed in 60 of 173 patients (35%) and was least common in fusions with the UIV in the upper thoracic (UT) spine (p=.035). Of those who developed APJF, 21.7% required surgery. Proximal junctional kyphosis 15° or more was the most common form of APJF in fusions to the UT spine but least likely to need revision (p=.014). The most common mode of failure in lower thoracic (LT) or lumbar (L) fusions was UIV fracture. Postoperative SVA less than 50 mm was a significant risk factor for APJF (p=.009). Acute PJF is more common in patients with preoperative sagittal imbalance (35%) than the general adult deformity patient population, and 37% of those with APJF require revision. It is least common when the UIV is in the UT spine, compared with the LT or L spine. Sagittal balance correction to an SVA 50 mm or less was a significant risk factor in patients with preoperative sagittal imbalance. Copyright © 2015 Elsevier Inc. All rights reserved.

Osteoporosis in pregnancy: more than postural backache.

PubMed

Topping, J; Black, A J; Farquharson, R G; Fraser, W D

1998-01-01

Though uncommon, osteoporosis can occur in pregnancy or shortly after delivery. The most common feature is back pain, often severely disabling. Suspect osteoporosis if pain of sudden onset in the upper lumbar or thoracic spine is not relieved by simple analgesia, or if there is a noticeable loss of height. X-rays reveal low bone density and fractures of the vertebrae. 70% of cases occur in first pregnancies. Recurrence is unusual. Most cases resolve spontaneously; a minority cause disability lasting months or years. If osteoporosis is diagnosed, breast feeding should be discouraged because of its effect on bone mineral density. Anyone who has had osteoporosis of pregnancy is at risk of postmenopausal osteoporosis and should take medical advice.

Full fusion of proximal thoracic curve helps to prevent postoperative cervical tilt in Lenke type 2 adolescent idiopathic scoliosis patients with right-elevated shoulder.

PubMed

Jiang, Jun; Qian, Bang-Ping; Qiu, Yong; Wang, Bin; Yu, Yang; Zhu, Ze-Zhang

2017-08-23

To date, no study had reported the phenomenon of deteriorated postoperative cervical tilt in Lenke type 2 adolescent idiopathic scoliosis patients. The purpose of this study is to evaluate the cervical tilt in Lenke type 2 adolescent idiopathic scoliosis patients with right-elevated shoulder treated by either full fusion or partial/non fusion of the proximal thoracic curve. A total of 30 Lenke type 2 AIS patients with preoperative right-elevated shoulder underwent posterior spinal instrumentation from 2009 to 2011 were included in this study. All the subjects were divided into 2 groups according to the selection of upper instrumented vertebra. There were 14 cases proximally fused to T1 or T2 (Group A) and 16 cases proximally fused to T3 or below (Group B). Both standing anteroposterior and sagittal X-ray films of the spine obtained preoperatively, one week after the operation, and at a minimum of two-year follow-up were analyzed with respect to the following parameters: cervical tilt, T1 tilt, proximal thoracic Cobb angle, main thoracic Cobb angle, apical vertebral translation of proximal thoracic curve, apical vertebral translation of main thoracic curve, radiographic shoulder height, cervical lordosis, proximal thoracic kyphosis and main thoracic kyphosis. Most (83.3%) of the patients in these two groups gained satisfactory shoulder balance after surgery. However, the cervical tilt significantly improved in group A (p < 0.001) but deteriorated in group B (p < 0.001). In group A, the decrease of cervical tilt significantly positively correlated with that of T1 tilt (p < 0.001). In group B, the increase of cervical tilt significantly positively correlated with both the increase of T1 tilt (p < 0.001) and the increase of apical vertebral translation of proximal thoracic curve (p < 0.05). Lenke type 2 AIS patients with right-elevated shoulder gain improved shoulder but deteriorated cervical tilt after partial/non fusion of proximal thoracic curve. Full fusion of proximal thoracic curve helps to prevent the residual cervical tilt in these patients.

Surgical Navigation Technology Based on Augmented Reality and Integrated 3D Intraoperative Imaging

PubMed Central

Elmi-Terander, Adrian; Skulason, Halldor; Söderman, Michael; Racadio, John; Homan, Robert; Babic, Drazenko; van der Vaart, Nijs; Nachabe, Rami

2016-01-01

Study Design. A cadaveric laboratory study. Objective. The aim of this study was to assess the feasibility and accuracy of thoracic pedicle screw placement using augmented reality surgical navigation (ARSN). Summary of Background Data. Recent advances in spinal navigation have shown improved accuracy in lumbosacral pedicle screw placement but limited benefits in the thoracic spine. 3D intraoperative imaging and instrument navigation may allow improved accuracy in pedicle screw placement, without the use of x-ray fluoroscopy, and thus opens the route to image-guided minimally invasive therapy in the thoracic spine. Methods. ARSN encompasses a surgical table, a motorized flat detector C-arm with intraoperative 2D/3D capabilities, integrated optical cameras for augmented reality navigation, and noninvasive patient motion tracking. Two neurosurgeons placed 94 pedicle screws in the thoracic spine of four cadavers using ARSN on one side of the spine (47 screws) and free-hand technique on the contralateral side. X-ray fluoroscopy was not used for either technique. Four independent reviewers assessed the postoperative scans, using the Gertzbein grading. Morphometric measurements of the pedicles axial and sagittal widths and angles, as well as the vertebrae axial and sagittal rotations were performed to identify risk factors for breaches. Results. ARSN was feasible and superior to free-hand technique with respect to overall accuracy (85% vs. 64%, P < 0.05), specifically significant increases of perfectly placed screws (51% vs. 30%, P < 0.05) and reductions in breaches beyond 4 mm (2% vs. 25%, P < 0.05). All morphometric dimensions, except for vertebral body axial rotation, were risk factors for larger breaches when performed with the free-hand method. Conclusion. ARSN without fluoroscopy was feasible and demonstrated higher accuracy than free-hand technique for thoracic pedicle screw placement. Level of Evidence: N/A PMID:27513166

Reliability and concurrent validity of the iPhone® Compass application to measure thoracic rotation range of motion (ROM) in healthy participants

PubMed Central

Schram, Ben; Cox, Alistair J.; Anderson, Sarah L.; Keogh, Justin

2018-01-01

Background Several water-based sports (swimming, surfing and stand up paddle boarding) require adequate thoracic mobility (specifically rotation) in order to perform the appropriate activity requirements. The measurement of thoracic spine rotation is problematic for clinicians due to a lack of convenient and reliable measurement techniques. More recently, smartphones have been used to quantify movement in various joints in the body; however, there appears to be a paucity of research using smartphones to assess thoracic spine movement. Therefore, the aim of this study is to determine the reliability (intra and inter rater) and validity of the iPhone® app (Compass) when assessing thoracic spine rotation ROM in healthy individuals. Methods A total of thirty participants were recruited for this study. Thoracic spine rotation ROM was measured using both the current clinical gold standard, a universal goniometer (UG) and the Smart Phone Compass app. Intra-rater and inter-rater reliability was determined with a Intraclass Correlation Coefficient (ICC) and associated 95% confidence intervals (CI). Validation of the Compass app in comparison to the UG was measured using Pearson’s correlation coefficient and levels of agreement were identified with Bland–Altman plots and 95% limits of agreement. Results Both the UG and Compass app measurements both had excellent reproducibility for intra-rater (ICC 0.94–0.98) and inter-rater reliability (ICC 0.72–0.89). However, the Compass app measurements had higher intra-rater reliability (ICC = 0.96 − 0.98; 95% CI [0.93–0.99]; vs. ICC = 0.94 − 0.98; 95% CI [0.88–0.99]) and inter-rater reliability (ICC = 0.87 − 0.89; 95% CI [0.74–0.95] vs. ICC = 0.72 − 0.82; 95% CI [0.21–0.94]). A strong and significant correlation was found between the UG and the Compass app, demonstrating good concurrent validity (r = 0.835, p < 0.001). Levels of agreement between the two devices were 24.8° (LoA –9.5°, +15.3°). The UG was found to consistently measure higher values than the compass app (mean difference 2.8°, P < 0.001). Conclusion This study reveals that the iPhone® app (Compass) is a reliable tool for measuring thoracic spine rotation which produces greater reproducibility of measurements both within and between raters than a UG. As a significant positive correlation exists between the Compass app and UG, this supports the use of either device in clinical practice as a reliable and valid tool to measure thoracic rotation. Considering the levels of agreement are clinically unacceptable, the devices should not be used interchangeably for initial and follow up measurements. PMID:29568701

Reliability and concurrent validity of the iPhone® Compass application to measure thoracic rotation range of motion (ROM) in healthy participants.

PubMed

Furness, James; Schram, Ben; Cox, Alistair J; Anderson, Sarah L; Keogh, Justin

2018-01-01

Several water-based sports (swimming, surfing and stand up paddle boarding) require adequate thoracic mobility (specifically rotation) in order to perform the appropriate activity requirements. The measurement of thoracic spine rotation is problematic for clinicians due to a lack of convenient and reliable measurement techniques. More recently, smartphones have been used to quantify movement in various joints in the body; however, there appears to be a paucity of research using smartphones to assess thoracic spine movement. Therefore, the aim of this study is to determine the reliability (intra and inter rater) and validity of the iPhone ® app (Compass) when assessing thoracic spine rotation ROM in healthy individuals. A total of thirty participants were recruited for this study. Thoracic spine rotation ROM was measured using both the current clinical gold standard, a universal goniometer (UG) and the Smart Phone Compass app. Intra-rater and inter-rater reliability was determined with a Intraclass Correlation Coefficient (ICC) and associated 95% confidence intervals (CI). Validation of the Compass app in comparison to the UG was measured using Pearson's correlation coefficient and levels of agreement were identified with Bland-Altman plots and 95% limits of agreement. Both the UG and Compass app measurements both had excellent reproducibility for intra-rater (ICC 0.94-0.98) and inter-rater reliability (ICC 0.72-0.89). However, the Compass app measurements had higher intra-rater reliability ( ICC  = 0.96 - 0.98; 95% CI [0.93-0.99]; vs. ICC  = 0.94 - 0.98; 95% CI [0.88-0.99]) and inter-rater reliability ( ICC  = 0.87 - 0.89; 95% CI [0.74-0.95] vs. ICC  = 0.72 - 0.82; 95% CI [0.21-0.94]). A strong and significant correlation was found between the UG and the Compass app, demonstrating good concurrent validity ( r  = 0.835, p  < 0.001). Levels of agreement between the two devices were 24.8° (LoA -9.5°, +15.3°). The UG was found to consistently measure higher values than the compass app (mean difference 2.8°, P  < 0.001). This study reveals that the iPhone ® app (Compass) is a reliable tool for measuring thoracic spine rotation which produces greater reproducibility of measurements both within and between raters than a UG. As a significant positive correlation exists between the Compass app and UG, this supports the use of either device in clinical practice as a reliable and valid tool to measure thoracic rotation. Considering the levels of agreement are clinically unacceptable, the devices should not be used interchangeably for initial and follow up measurements.

Spinal manipulative therapy versus Graston Technique in the treatment of non-specific thoracic spine pain: Design of a randomised controlled trial

PubMed Central

Crothers, Amy; Walker, Bruce; French, Simon D

2008-01-01

Background The one year prevalence of thoracic back pain has been estimated as 17% compared to 64% for neck pain and 67% for low back pain. At present only one randomised controlled trial has been performed assessing the efficacy of spinal manipulative therapy (SMT) for thoracic spine pain. In addition no high quality trials have been performed to test the efficacy and effectiveness of Graston Technique® (GT), a soft tissue massage therapy using hand-held stainless steel instruments. The objective of this trial is to determine the efficacy of SMT and GT compared to a placebo for the treatment of non specific thoracic spine pain. Methods Eighty four eligible people with non specific thoracic pain mid back pain of six weeks or more will be randomised to one of three groups, either SMT, GT, or a placebo (de-tuned ultrasound). Each group will receive up to 10 supervised treatment sessions at the Murdoch University Chiropractic student clinic over a 4-week period. Treatment outcomes will be measured at baseline, one week after their first treatment, upon completion of the 4-week intervention period and at three, six and twelve months post randomisation. Outcome measures will include the Oswestry Back Pain Disability Index and the Visual Analogue Scale (VAS). Intention to treat analysis will be utilised in the statistical analysis of any group treatment effects. Trial Registration This trial was registered with the Australia and New Zealand Clinical Trials Registry on the 7th February 2008. Trial number: ACTRN12608000070336 PMID:18959807

Musculoskeletal disorders of the upper cervical spine in women with episodic or chronic migraine.

PubMed

Ferracini, Gabriela N; Florencio, Lidiane L; Dach, Fabíola; Bevilaqua Grossi, Débora; Palacios-Ceña, María; Ordás-Bandera, Carlos; Chaves, Thais C; Speciali, José G; Fernández-de-Las-Peñas, César

2017-06-01

The role of musculoskeletal disorders of the cervical spine in migraine is under debate. To investigate differences in musculoskeletal impairments of the neck including active global and upper cervical spine mobility, the presence of symptomatic upper cervical spine joints, cervicocephalic kinesthesia and head/neck posture between women with episodic migraine, chronic migraine, and controls. A cross-sectional study. Tertiary university-based hospital. Fifty-five women with episodic migraine, 16 with chronic migraine, and 22 matched healthy women. Active cervical range of motion, upper cervical spine mobility (i.e., flexion-rotation test), referred pain from upper cervical joints, cervicocephalic kinesthesia (joint position sense error test, JPSE), and head/neck posture (i.e. the cranio-vertebral and cervical lordosis angles) were assessed by an assessor blinded to the subject's condition. Women with migraine showed reduced cervical rotation than healthy women (P=0.012). No differences between episodic and chronic migraine were found in cervical mobility. Significant differences for flexion-rotation test were also reported, suggesting that upper cervical spine mobility was restricted in both migraine groups (P<0.001). Referred pain elicited on manual examination of the upper cervical spine mimicking pain symptoms was present in 50% of migraineurs. No differences were observed on the frequency of symptomatic upper cervical joints between episodic and chronic migraine. No differences on JPSE or posture were found among groups (P>0.121). Women with migraine exhibit musculoskeletal impairments of the upper cervical spine expressed as restricted cervical rotation, decreased upper cervical rotation, and the presence of symptomatic upper cervical joints. No differences were found between episodic or chronic migraine. Identification treatment of the musculoskeletal impairments of the cervical spine may help to clinician for better management of patients with migraine.

Annual changes in radiographic indices of the spine in cerebral palsy patients.

PubMed

Lee, Seung Yeol; Chung, Chin Youb; Lee, Kyoung Min; Kwon, Soon-Sun; Cho, Kyu-Jung; Park, Moon Seok

2016-03-01

We estimated the annual changes in radiographic indices of the spine in cerebral palsy (CP) patients and analyzed the factors that influence its progression rate. We included CP patients who had undergone whole-spine radiography more than twice and were followed for at least 1 year. The scoliosis Cobb angle, coronal balance, apical vertebral translation, apical rotation, and pelvic obliquity were measured on anteroposterior (AP) radiographs; thoracic kyphosis and lumbar lordosis angles, and sagittal balance was measured on lateral radiographs; and migration percentage was measured on AP hip radiographs to determine hip instability. For each gross motor function classification system (GMFCS) level, the Cobb angles, apical vertebral translation, coronal and sagittal balance, and pelvic obliquity were adjusted by multiple factors with a linear mixed model. A total of 184 patients (774 radiographs) were included in this study. There was no significant annual change in scoliosis Cobb, thoracic kyphosis, and lumbar lordosis angles in the GMFCS level I-II and III groups. In the GMFCS level IV-V group, there was an annual increase of 3.4° in the scoliosis Cobb angle (p = 0.020). The thoracic kyphosis angle increased by 2.2° (p = 0.018) annually in the GMFCS level IV-V group. Apical vertebral translation increased by 5.4 mm (p = 0.029) annually in the GMFCS level IV-V group. Progression of coronal and sagittal balance and pelvic obliquity with aging were not statistically significant. Sex, hip instability, hip surgery, and triradiate cartilage did not affect the progression of scoliosis and the balance of the spine and pelvis. The scoliosis Cobb angle, thoracic kyphosis angle, and apical vertebral translation in the GMFCS level IV-V CP patients progressed with age. These findings can predict radiographic progression of scoliosis in CP patients.

Contrasting natural histories of thoracic spine pneumatocysts: resolution versus rapid enlargement

PubMed Central

Wilkinson, V H; Carroll, T; Hoggard, N

2011-01-01

An intraosseous pneumatocyst is an unusual cause of gas in a vertebral body and is rarely reported in the thoracic spine. We report the evolution of thoracic spine pneumatocysts, one that enlarged rapidly with resorption of fluid and one that resolved. A 65-year-old female with lower back and left leg pain underwent MRI of the lumbar spine, which demonstrated a well-defined lesion in a T10 vertebral body of low-signal on T1 and T2 weighted imaging. CT confirmed this as a gas-containing cyst. Review of previous imaging showed that this lesion had initially contained fluid and had expanded rapidly over 14 months. It also showed smaller pneumatocysts, which had resolved. The variable natural history and imaging features of pneumatocysts make them an important differential diagnosis of an intravertebral lesion. Their aetiology is not known, but previous case reports suggest that they can occur spontaneously or in association with vacuum phenomenon in adjacent discs or facet joints. Previous reports have observed that they can fill with granulation tissue or fluid, and the case we report demonstrates that this fluid can be resorbed and that the pneumatocyst can undergo rapid enlargement. A pneumatocyst is a differential diagnosis for an expanding intravertebral lesion of indeterminate MRI characteristics. The diagnosis can be made with CT if the lesion is gas or gas and fluid filled. PMID:21415298

Anterior Cervical Discectomy and Fusion Alters Whole-Spine Sagittal Alignment

PubMed Central

Kim, Jang Hoon; Yi, Seong; Kim, Kyung Hyun; Kuh, Sung Uk; Chin, Dong Kyu; Kim, Keun Su; Cho, Yong Eun

2015-01-01

Purpose Anterior cervical discectomy and fusion (ACDF) has become a common spine procedure, however, there have been no previous studies on whole spine alignment changes after cervical fusion. Our purpose in this study was to determine whole spine sagittal alignment and pelvic alignment changes after ACDF. Materials and Methods Forty-eight patients who had undergone ACDF from January 2011 to December 2012 were enrolled in this study. Cervical lordosis, thoracic kyphosis, lumbar lordosis, sagittal vertical axis (SVA), and pelvic parameters were measured preoperatively and at 1, 3, 6, and 12 months postoperatively. Clinical outcomes were assessed using Visual Analog Scale (VAS) scores and Neck Disability Index (NDI) values. Results Forty-eight patients were grouped according to operative method (cage only, cage & plate), operative level (upper level: C3/4 & C4/5; lower level: C5/6 & C6/7), and cervical lordosis (high lordosis, low lordosis). All patients experienced significant improvements in VAS scores and NDI values after surgery. Among the radiologic parameters, pelvic tilt increased and sacral slope decreased at 12 months postoperatively. Only the high cervical lordosis group showed significantly-decreased cervical lordosis and a shortened SVA postoperatively. Correlation tests revealed that cervical lordosis was significantly correlated with SVA and that SVA was significantly correlated with pelvic tilt and sacral slope. Conclusion ACDF affects whole spine sagittal alignment, especially in patients with high cervical lordosis. In these patients, alteration of cervical lordosis to a normal angle shortened the SVA and resulted in reciprocal changes in pelvic tilt and sacral slope. PMID:26069131

Analysis of preexistent vertebral rotation in the normal infantile, juvenile, and adolescent spine.

PubMed

Janssen, Michiel M A; Kouwenhoven, Jan-Willem M; Schlösser, Tom P C; Viergever, Max A; Bartels, Lambertus W; Castelein, René M; Vincken, Koen L

2011-04-01

Vertebral rotation was systematically analyzed in the normal, nonscoliotic thoracic spine of children aged 0 to 16 years. Subgroups were created to match the infantile, juvenile, and adolescent age groups according to the criteria of the Scoliosis Research Society. To determine whether a distinct pattern of vertebral rotation in the transverse plane exists in the normal, nonscoliotic infantile, juvenile, and adolescent spine. We assume that, once the spine starts to deteriorate into a scoliotic deformity, it will follow a preexisting rotational pattern. Recently, we identified a rotational pattern in the normal nonscoliotic adult spine that corresponds to the most common curve types in adolescent idiopathic scoliosis. In infantile idiopathic scoliosis, curves are typically left sided and boys are affected more often than girls, whereas in adolescent idiopathic scoliosis, the thoracic curve is typically right sided and predominantly girls are affected. The present study is the first systematic analysis of vertebral rotation in the normal children's spine. Vertebral rotation in the transverse plane of T2-T12 was measured by using a semiautomatic method on 146 computed tomographic scans of children (0-16 years old) without clinical or radiologic evidence of spinal pathology. Scans were mainly made for reasons such as recurrent respiratory tract infections, malignancies, or immune disorders. Vertebral rotational patterns were analyzed in the infantile (0-3-year-old), juvenile (4-9-year-old), and adolescent (10-16-year-old) boys and girls. In the infantile spine, vertebrae T2-T6 were significantly rotated to the left (P < 0.001). In the juvenile spine, T4 was significantly rotated to the left. In the adolescent spine, T6-T12 were significantly rotated to the right (P ≤ 0.001). Rotation to the left was more pronounced in infantile boys than in the girls (P = 0.023). In juvenile and adolescent children, no statistical differences in rotation were found between the sexes. These data support the hypothesis that the direction of the spinal curve in idiopathic scoliosis is determined by the built-in rotational pattern that the spine exhibits at the time of onset. The well-known predominance of right-sided thoracic curves in adolescent idiopathic scoliosis and left-sided curves in infantile idiopathic scoliosis can be explained by the observed patterns of vertebral rotation that preexist at the corresponding age.

Neisseria gonorrhoeae paravertebral abscess.

PubMed

Low, Sharon Y Y; Ong, Catherine W M; Hsueh, Po-Ren; Tambyah, Paul Ananth; Yeo, Tseng Tsai

2012-07-01

The authors present the case of an isolated gonococcal paravertebral abscess with an epidural component in a 42-year-old man. A primary epidural abscess of the spine is a rare condition and is most commonly caused by Staphylococcus aureus. In this report, the authors present their therapeutic decisions and review the relevant literature on disseminated gonococcal infection in a patient presenting with an epidural abscess. A 42-year-old Indonesian man was admitted with symptoms of neck and upper back pain and bilateral lower-limb weakness. Clinical examination was unremarkable apart from tenderness over the lower cervical spine. Postgadolinium T1-weighted MRI of the cervical and thoracic spine demonstrated an enhancing lesion in the right paraspinal and epidural soft tissue at C-6 to T1-2, in keeping with a spinal epidural abscess. The patient underwent laminectomy of C-7 and T-1 with abscess drainage. Tissue cultures subsequently grew Neisseria gonorrhoeae that was resistant to quinolones by genotyping. Upon further questioning, the patient admitted to unprotected sexual intercourse with commercial sex workers. Further investigations showed that he was negative for other sexually transmitted infections. Postoperatively, he received a course of beta-lactam antibiotics with good recovery. Clinicians should be aware of this unusual disseminated gonococcal infection manifested in any patient with the relevant risk factors.

An 8-week thoracic spine stabilization exercise program improves postural back pain, spine alignment, postural sway, and core endurance in university students:a randomized controlled study.

PubMed

Toprak Çelenay, Şeyda; Özer Kaya, Derya

2017-04-18

To investigate the effects of an 8-week thoracic stabilization exercise program on back pain, spinal alignment, postural sway, and core endurance in university students. University students were randomly allocated into exercise (n: 28) and control (n: 25) groups. The exercise program was carried out 3 days a week for 8 weeks. Postural pain, spinal alignment, postural sway, and core endurance were assessed via visual analogue scale, Spinal Mouse, Biodex Balance System, and McGill's trunk muscle endurance tests at the baseline and after 8 weeks of training. Differences were observed for postural pain, thoracic and lumbar curvature, dynamic stability index (eyes closed), and core endurance scores in the exercise group between baseline and week 8 (P < 0.05) and all the parameters were significantly different when compared to those of the control group (P < 0.05). The program decreased postural pain, spinal curvatures, and postural sway, and increased core endurance in university students. The program can be effective in postural pain and misalignment of spine problems related to core weakness and balance disorders.

The biomechanical analysis of sublaminar wires and cables using luque segmental spinal instrumentation.

PubMed

Parsons, J R; Chokshi, B V; Lee, C K; Gundlapalli, R V; Stamer, D

1997-02-01

Data was gathered from biomechanical testing of 10 thoracic human cadaveric spines. Spines were tested intact and with a Luque rectangle fixed with wire or cable. To compare the rigidity of fixation and intraspinal penetration of sublaminar monofilament wire and multistrand cable under identical conditions using human cadaveric spines. Reports of neurologic and mechanical complications associated with sublaminar wiring techniques have led to the recent development of more flexible multistrand cable systems. The relative performance of flexible cable versus monofilament wire has not been explored fully in a controlled mechanical environment. A servohydraulic mechanical testing machine was used to measure the static mechanical stiffness of sublaminar wire or cable fixation in conjunction with a Luque rectangle for thoracic human cadaveric spine segments in flexion-extension and torsion modes. Cyclic testing was performed in the flexion-extension mode. Intraspinal penetration of wires and cables was measured. Spine fixation with sublaminar wire and cable resulted in constructs of equal stiffness in flexion-extension and torsion modes. Cyclic testing also indicated similar fatigue profiles for wire- and cable-instrumented spines. Wire and cable fixed spines displayed greater stiffness than the intact spines. Cable encroachment of the spinal canal was less than that seen with wire. Sublaminar multistrand cable may be a rational alternative to monofilament wire in segmental spinal instrumentation because it provides less encroachment into the spinal canal. Further, cadaveric spines instrumented with wire and cable display equivalent mechanical behavior, statically and under cyclic loading. The potential advantages of cable, however, must be balanced against a substantial increase in cost relative to wire.

Hemangiopericytoma of thoracic spine: a rare bony tumor.

PubMed

Kumar, Raj; Vaid, Vivek Kumar; Kumar, Vimal; Kalra, Samir Kumar

2007-10-01

We report the case of a 16-year-old girl who developed hemangiopericytoma of the thoracic spine; the main clinical symptoms were of spastic paraparesis with sensory involvement and uro-fecal incontinence. She was initially put on antitubercular treatment keeping in mind the endemicity of tuberculosis in the region. When she deteriorated on conservative management, she was operated upon, and the histopathological report was suggestive of hemangiopericytoma. Additional immunocytochemistry was performed in the paraffin-embedded tumor sections. An extremely rare case of primary epidural malignant hemangiopericytoma of the thoracic spinal column is described. It is a rare tumor, which is locally aggressive, and a potentially malignant tumor. The tumor is more commonly found in the cranium, and spinal involvement is rare, and only few case reports could be retrieved from the literature. We discuss the clinical profile, management, and outcome of spinal hemangiopericytomas along with pertinent review of the literature.

Aspergillus spondylitis involving the cervico-thoraco-lumbar spine in an immunocompromised patient: a case report.

PubMed

Son, Jeong-Min; Jee, Won-Hee; Jung, Chan-Kwon; Kim, Sang-Il; Ha, Kee-Yong

2007-01-01

Aspergillosis is a rare cause of spondylitis. Moreover, early diagnosis by MR imaging and adequate treatment can prevent the serious complications of fungal infection. To our knowledge, the MR findings of multilevel aspergillus spondylitis in the cervico-thoraco-lumbar spine have not been previously described. Here, we report the MR findings of aspergillus spondylitis involving the cervical, thoracic, and lumbar spine in a liver transplant recipient.

Aspergillus Spondylitis involving the Cervico-Thoraco-Lumbar Spine in an Immunocompromised Patient: a Case Report

PubMed Central

Son, Jeong-Min; Jung, Chan-Kwon; Kim, Sang-Il; Ha, Kee-Yong

2007-01-01

Aspergillosis is a rare cause of spondylitis. Moreover, early diagnosis by MR imaging and adequate treatment can prevent the serious complications of fungal infection. To our knowledge, the MR findings of multilevel aspergillus spondylitis in the cervico-thoraco-lumbar spine have not been previously described. Here, we report the MR findings of aspergillus spondylitis involving the cervical, thoracic, and lumbar spine in a liver transplant recipient. PMID:17923789

Biomedical Influences on Spinal Cord Function

DTIC Science & Technology

1989-06-14

Larson SJ: Failure levels and dimensions of lumbar spinal ligaments. Orthoaic Transactions 8(3):425-426, 1984. 8. Sances A Jr, Maiman DJ, Myklebust JB...Injury of the Head and Spine, Charles C. Thomas, Publisher, Springfield, IL, 654 pp, 1983. 61. Farfan, H.F., Muscular mechanism of the lumbar spine and...lesions of the thoracic and lumbar spine, J Neurosurg, 45:628-637, 1976. 113. Larson, S.J., The lateral extrapleural and extraperitoneal approach to

Associations between vertebral fractures, increased thoracic kyphosis, a flexed posture and falls in older adults: a prospective cohort study.

PubMed

van der Jagt-Willems, Hanna C; de Groot, Maartje H; van Campen, Jos P C M; Lamoth, Claudine J C; Lems, Willem F

2015-03-28

Vertebral fractures, an increased thoracic kyphosis and a flexed posture are associated with falls. However, this was not confirmed in prospective studies. We performed a prospective cohort study to investigate the association between vertebral fractures, increased thoracic kyphosis and/or flexed posture with future fall incidents in older adults within the next year. Patients were recruited at a geriatric outpatient clinic. Vertebral fractures were evaluated on lateral radiographs of the spine with the semi-quantitative method of Genant; the degree of thoracic kyphosis was assessed with the Cobb angle. The occiput-to-wall distance was used to determine a flexed posture. Self-reported falls were prospectively registered by monthly phone contact for the duration of 12 months. Fifty-one older adults were included; mean age was 79 years (SD = 4.8). An increased thoracic kyphosis was independently associated with future falls (OR 2.13; 95% CI 1.10-4.51). Prevalent vertebral fractures had a trend towards significancy (OR 3.67; 95% CI 0.85-15.9). A flexed posture was not significantly associated with future falls. Older adults with an increased thoracic kyphosis are more likely to fall within the next year. We suggest clinical attention for underlying causes. Because patients with increased thoracic curvature of the spine might have underlying osteoporotic vertebral fractures, clinicians should be aware of the risk of a new fracture.

Effectiveness of the Thoracic Pedicle Screw Placement Using the Virtual Surgical Training System: A Cadaver Study.

PubMed

Hou, Yang; Lin, Yanping; Shi, Jiangang; Chen, Huajiang; Yuan, Wen

2018-03-14

The virtual simulation surgery has initially exhibited its promising potentials in neurosurgery training. To evaluate effectiveness of the Virtual Surgical Training System (VSTS) on novice residents placing thoracic pedicle screws in a cadaver study. A total of 10 inexperienced residents participated in this study and were randomly assigned to 2 groups. The group using VSTS to learn thoracic pedicle screw fixation was the simulation training (ST) group and the group receiving an introductory teaching session was the control group. Ten fresh adult spine specimens including 6 males and 4 females with a mean age of 58.5 yr (range: 33-72) were collected and randomly allocated to the 2 groups. After exposing anatomic structures of thoracic spine, the bilateral pedicle screw placement of T6-T12 was performed on each cadaver specimen. The postoperative computed tomography scan was performed on each spine specimen, and experienced observers independently reviewed the placement of the pedicle screws to assess the incidence of pedicle breach. The screw penetration rates of the ST group (7.14%) was significantly lower in comparison to the control group (30%, P < .05). Statistically significant difference in acceptable rates of screws also occurred between the ST (100%) and control (92.86%) group (P < .05). In addition, the average screw penetration distance in control group (2.37 mm ± 0.23 mm) was significantly greater than ST group (1.23 mm ± 0.56 mm, P < .05). The virtual reality surgical training of thoracic pedicle screw instrumentation effectively improves surgical performance of novice residents compared to those with traditional teaching method, and can help new beginners to master the surgical technique within shortest period of time.

Kinematics of the trunk and the lower extremities during restricted and unrestricted squats.

PubMed

List, Renate; Gülay, Turgut; Stoop, Mirjam; Lorenzetti, Silvio

2013-06-01

Squatting is a common strength training exercise used for rehabilitation, fitness training, and in preparation for competition. Knowledge about the loading and the motion of the back during the squat exercise is crucial to avoid overuse or injury. The aim of this study was the measurement and comparison of the kinematics of the lower leg, trunk, and spine during unrestricted and restricted (knees are not allowed beyond toes) squats. A total of 30 subjects performed unrestricted and restricted barbell squats with an extra load of 0, 25, and 50% bodyweight. Motion was tracked using a 12-camera Vicon system. A newly developed marker set with 24 trunk and 7 pelvic markers allowed us to measure 3D segmental kinematics between the pelvic and the lumbar regions, between the lumbar and the thoracic segments, and the sagittal curvatures of the lumbar and the thoracic spine. In an unrestricted squat, the angle of the knee is larger and the range of motion (ROM) between the lumbar and the thoracic segments is significantly smaller compared with a restricted squat (p < 0.05). The studied subjects showed significantly increased ROM for thoracic curvature during restricted squats. The unrestricted execution of a squat leads to a larger ROM in the knee and smaller changes in the curvature of the thoracic spine and the range of smaller segmental motions within the trunk. This execution in turn leads to lower stresses in the back. To strengthen the muscles of the leg, the unrestricted squat may be the best option for most people. Thus, practitioners should not be overly strict in coaching against anterior knee displacement during performance of the squat.

Langerhans Cell Histiocytosis of the Adult Cervical Spine: A Case Report and Literature Review.

PubMed

Schär, Ralph T; Hewer, Ekkehard; Ulrich, Christian T

2018-06-11

A 36-year-old man was diagnosed with Langerhans cell histiocytosis (LCH) of the cervical spine with a unifocal expansive osteolytic lesion of C4. The surgical management with a 2-year follow-up and a review of the literature on LCH of the cervical spine are presented. Although a rare condition, LCH is an important differential diagnosis of any osteolytic lesion in the cervical spine with localized pain in a young adult patient. Review of the literature suggests a higher prevalence of LCH lesions affecting the cervical spine as compared with the thoracic or lumbar spine than historically reported. Georg Thieme Verlag KG Stuttgart · New York.

Clinical and radiographic outcomes of thoracic and lumbar pedicle subtraction osteotomy for fixed sagittal imbalance.

PubMed

Yang, Benson P; Ondra, Stephen L; Chen, Larry A; Jung, Hee Soo; Koski, Tyler R; Salehi, Sean A

2006-07-01

The authors conducted a study to evaluate the radiographically documented and functional outcomes obtained in patients who underwent pedicle subtraction osteotomy (PSO). They also compared outcomes after classification of cases into thoracic and lumbar PSO subgroups. The authors analyzed data obtained in 35 consecutive PSO-treated patients with sagittal imbalance. One surgeon performed all surgeries. The minimal follow-up period was 2 years. Events during the perioperative course and complications were noted. Standing long-film radiographs of the spine were obtained and measurements were made preoperatively, immediately postoperatively, and at most recent follow-up examination. The modified Prolo Scale and the 22-item Scoliosis Research Society (SRS-22) Outcomes Questionnaire were administered. Early complications after PSO included neurological injury, wound-related problems, and nosocomial infections. Late complications were limited to pseudarthrosis and attendant instrumentation failure. Early and late complication rates ranged from 10 to 30% for both thoracic and lumbar PSO cohorts. Lumbar PSO was associated with improvements in local, segmental, and global measures of sagittal balance, whereas thoracic PSO was only associated with local improvement. Most patients rated their functional status as fair to good according to the modified Prolo Scale and reported, according to the SRS-22 Outcomes Questionnaire, that they were satisfied with the overall treatment of their back condition. The ability to perform a PSO at both lumbar and thoracic levels is a powerful asset for the spine surgeon treating spinal deformity. In the present study radiographic and clinical outcomes were superior when PSO was used to treat lumbar deformity rather than thoracic deformity because of several anatomical and technical obstacles that hindered the thoracic procedure. Nevertheless, the thoracic PSO proved a useful addition with which to produce regional improvement in sagittal balance for patients with a fixed thoracic kyphosis.

Rapidly progressive Scheuermann's disease in an adolescent after pectus bar placement treated with posterior vertebral-column resection: case report and review of the literature.

PubMed

Sugrue, Patrick A; OʼShaughnessy, Brian A; Blanke, Kathy M; Lenke, Lawrence G

2013-02-15

Case report and review of the literature. This case illustrates the importance of the costosternal complex in maintaining the stability and alignment of the thoracic spine. The patient was iatrogenically destabilized by placement of a pectus bar leading to rapid symptomatic progression of his Scheuermann's kyphosis, ultimately requiring surgical correction. Scheuermann's kyphosis is a disease process defined by strict radiographical and clinical criteria. Surgical treatment is generally recommended for curves greater than 75°. This case demonstrates the critical role of the costosternal complex in maintaining the stability of the thoracic spine. The patient described in this report underwent placement of a pectus bar for correction of symptomatic pectus excavatum. He subsequently developed a progressive symptomatic Scheuermann's kyphosis as a result of the destabilization of his costosternal complex. This patient ultimately required removal of the pectus bar and posterior instrumented kyphosis correction. Progressive symptomatic Scheuermann's kyphosis (105°) corrected by removal of the pectus bar, T11 posterior vertebral-column resection and T4-L3 instrumented posterior spinal fusion. The patient had an uneventful immediate postoperative course. He was discharged neurologically intact with dramatic kyphosis correction and significant symptomatic improvement. Radiographs obtained 3 years postoperatively reveal stable thoracolumbar correction. The costosternal complex plays a critically important role in the intrinsic stability of the thoracic spine. Iatrogenic disruption of the costosternal complex can result in rapid progression of thoracic/thoracolumbar kyphosis in the setting of Scheuermann's disease.

Rehabilitation of patients with thoracic spine injury treated by spring alloplasty.

PubMed

Kiwerski, J

1983-12-01

Stabilization of the traumatic injured spine by means of springs, called spring alloplasty, was introduced into clinical practice by Professor M. Weiss in 1965 and has been applied in the Warsaw Medical Academy Rehabilitation Clinic ( Konstancin ) ever since. The springs here replace the damaged system of posterior ligaments of the spine, restoring its stability and alleviating the front (often damaged) part of the body. This method has been used in surgery on about 350 patients mainly with spinal injury in the thoracic and thoracolumbar levels. Spine stabilization by the method in question usually makes it possible to start an early verticalization and an active rehabilitation. The verticalization of the patient in a specially designed bed is introduced as early as a few days after the accident, and attempts at active verticalization are made in 2-3 weeks time after surgery, thus the rehabilitation process is substantially precipitated and the period of hospital treatment is significantly reduced. The methodology of rehabilitation of the patients in question has been presented and functional effects of the treatment have been discussed in the paper.

Nonrandom Intrafraction Target Motions and General Strategy for Correction of Spine Stereotactic Body Radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ma Lijun, E-mail: lijunma@radonc.ucsf.ed; Sahgal, Arjun; Hossain, Sabbir

2009-11-15

Purpose: To characterize nonrandom intrafraction target motions for spine stereotactic body radiotherapy and to develop a method of correction via image guidance. The dependence of target motions, as well as the effectiveness of the correction strategy for lesions of different locations within the spine, was analyzed. Methods and Materials: Intrafraction target motions for 64 targets in 64 patients treated with a total of 233 fractions were analyzed. Based on the target location, the cases were divided into three groups, i.e., cervical (n = 20 patients), thoracic (n = 20 patients), or lumbar-sacrum (n = 24 patients) lesions. For each case,more » time-lag autocorrelation analysis was performed for each degree of freedom of motion that included both translations (x, y, and z shifts) and rotations (roll, yaw, and pitch). A general correction strategy based on periodic interventions was derived to determine the time interval required between two adjacent interventions, to overcome the patient-specific target motions. Results: Nonrandom target motions were detected for 100% of cases regardless of target locations. Cervical spine targets were found to possess the highest incidence of nonrandom target motion compared with thoracic and lumbar-sacral lesions (p < 0.001). The average time needed to maintain the target motion to within 1 mm of translation or 1 deg. of rotational deviation was 5.5 min, 5.9 min, and 7.1 min for cervical, thoracic, and lumbar-sacrum locations, respectively (at 95% confidence level). Conclusions: A high incidence of nonrandom intrafraction target motions was found for spine stereotactic body radiotherapy treatments. Periodic interventions at approximately every 5 minutes or less were needed to overcome such motions.« less

USING THE SELECTIVE FUNCTIONAL MOVEMENT ASSESSMENT AND REGIONAL INTERDEPENDENCE THEORY TO GUIDE TREATMENT OF AN ATHLETE WITH BACK PAIN: A CASE REPORT.

PubMed

Goshtigian, Gabriella R; Swanson, Brian T

2016-08-01

Despite the multidirectional quality of human movement, common measurement procedures used in physical therapy examination are often uni-planar and lack the ability to assess functional complexities involved in daily activities. Currently, there is no widely accepted, validated standard to assess movement quality. The Selective Functional Movement Assessment (SFMA) is one possible system to objectively assess complex functional movements. The purpose of this case report is to illustrate the application of the SFMA as a guide to the examination, evaluation, and management of a patient with non-specific low back pain (LBP). An adolescent male athlete with LBP was evaluated using the SFMA. It was determined that the patient had mobility limitations remote to the site of pain (thoracic spine and hips) which therapists hypothesized were leading to compensatory hypermobility at the lumbar spine. Guided by the SFMA, initial interventions focused on local (lumbar) symptom management, progressing to remote mobility deficits, and then addressing the local stability deficit. All movement patterns became functional/non-painful except the right upper extremity medial rotation-extension pattern. At discharge, the patient demonstrated increased soft tissue extensibility of hip musculature and joint mobility of the thoracic spine along with normalization of lumbopelvic motor control. Improvements in pain exceeded minimal clinically important differences, from 2-7/10 on a verbal analog scale at initial exam to 0-2/10 at discharge. Developing and progressing a plan of care for an otherwise healthy and active adolescent with non-specific LBP can be challenging. Human movement is a collaborative effort of muscle groups that are interdependent; the use of a movement-based assessment model can help identify weak links affecting overall function. The SFMA helped guide therapists to dysfunctional movements not seen with more conventional examination procedures. Level 4.

Twente spine model: A complete and coherent dataset for musculo-skeletal modeling of the thoracic and cervical regions of the human spine.

PubMed

Bayoglu, Riza; Geeraedts, Leo; Groenen, Karlijn H J; Verdonschot, Nico; Koopman, Bart; Homminga, Jasper

2017-06-14

Musculo-skeletal modeling could play a key role in advancing our understanding of the healthy and pathological spine, but the credibility of such models are strictly dependent on the accuracy of the anatomical data incorporated. In this study, we present a complete and coherent musculo-skeletal dataset for the thoracic and cervical regions of the human spine, obtained through detailed dissection of an embalmed male cadaver. We divided the muscles into a number of muscle-tendon elements, digitized their attachments at the bones, and measured morphological muscle parameters. In total, 225 muscle elements were measured over 39 muscles. For every muscle element, we provide the coordinates of its attachments, fiber length, tendon length, sarcomere length, optimal fiber length, pennation angle, mass, and physiological cross-sectional area together with the skeletal geometry of the cadaver. Results were consistent with similar anatomical studies. Furthermore, we report new data for several muscles such as rotatores, multifidus, levatores costarum, spinalis, semispinalis, subcostales, transversus thoracis, and intercostales muscles. This dataset complements our previous study where we presented a consistent dataset for the lumbar region of the spine (Bayoglu et al., 2017). Therefore, when used together, these datasets enable a complete and coherent dataset for the entire spine. The complete dataset will be used to develop a musculo-skeletal model for the entire human spine to study clinical and ergonomic applications. Copyright © 2017 Elsevier Ltd. All rights reserved.

Achieving a neutral cervical spine position in suspected spinal cord injury in children: analysing the use of a thoracic elevation device for imaging the cervical spine in paediatric patients.

PubMed

Pandie, Zaahid; Shepherd, Mike; Lamont, Tony; Walsh, Mark; Phillips, Mark; Page, Colin

2010-08-01

Paediatric patients with suspected cervical spine injury (CSI) are routinely immobilised on a firm surface using a hard collar, which results in excessive flexion of the cervical spine due to the relatively large size of the occiput. The objective of this study was to determine whether the use of a thoracic elevation device (TED) results in a more neutral cervical spine position and reduces the occurrence of cervical spine hyperflexion. A prospective cohort study was conducted at two Emergency Departments (sites A and B) from January 2006 to May 2007. Children < or =10 years of age with suspected CSI requiring cervical imaging were included. Those at site A received a wedge-shaped TED and those at site B did not. x-Rays from both sites were analysed for flexion, extension or neutrality of the cervical spine as defined by the Cobb angle. A total of 76 patients were identified at site A and site B. There were four exclusions at each site for poor quality images. 51 patients in the site A group were found to be in neutral position (71%), compared to 29 patients in the site B group (43%) (p=0.001). One patient (1%) who had a TED was found to be hyperflexed (>10 degrees), whereas 12 (18%) patients at site B were hyperflexed (p=0.001). The use of a TED appears to produce a greater proportion of neutral cervical spine films in children < or =10 years of age presenting for suspected CSI.

Validation of spinal motion with the spine reposition sense device

PubMed Central

Petersen, Cheryl M; Rundquist, Peter J

2009-01-01

Background A sagittal plane spine reposition sense device (SRSD) has been developed. Two questions were addressed with this study concerning the new SRSD: 1) whether spine movement was occurring with the methodology, and 2) where movement was taking place. Methods Sixty-five subjects performed seven trials of repositioning to a two-thirds full flexion position in sitting with X and Y displacement measurements taken at the T4 and L3 levels. The thoracolumbar angle between the T4 and the L3 level was computed and compared between the positions tested. A two (vertebral level of thoracic and lumbar) by seven (trials) mixed model repeated measures ANOVA indicated whether significant differences were present between the thoracic (T4) and lumbar (L3) angular measurements. Results Calculated thoracolumbar angles between T4 and L3 were significantly different for all positions tested indicating spinal movement was occurring with testing. No interactions were found between the seven trials and the two vertebral levels. No significant findings were found between the seven trials but significant differences were found between the two vertebral levels. Conclusion This study indicated spine motion was taking place with the SRSD methodology and movement was found specific to the lumbar spine. These findings support utilizing the SRSD to evaluate changes in spine reposition sense during future intervention studies dealing with low back pain. PMID:19386126

Fusionless instrumentation systems for congenital scoliosis: expandable spinal rods and vertical expandable prosthetic titanium rib in the management of congenital spine deformities in the growing child.

PubMed

Yazici, Muharrem; Emans, John

2009-08-01

Review of relevant literature including personal opinions. To review the current researches investigating the efficacy of growing rod and thoracic expansion techniques in the treatment of congenital spine deformity of young children, and to highlight the contrasting advantages and limitations in the fusionless treatment of progressive congenital scoliosis. Congenital scoliosis has the potential for severe spinal deformity and thoracic insufficiency syndrome (TIS). Conventional fusion treatments in children tend to shorten the spine further exacerbating trunk shortening and TIS. In the surgical treatment of congenital spinal deformities in young children, while reconstructing the spinal deformity, one should simultaneously pursue preserving the growth potential of the vertebrae, improving the volume, symmetry, and functions of the thorax, and protecting this improvement during the growth. Today, employed in the treatment of spinal deformities of young children, there are 2 deformity reconstruction methods serving these targets: Growing rod technique and vertical expandable prosthetic titanium rib (VEPTR) with or without expansion thoracostomy. Peer-reviewed research articles and major international meeting presentations were reviewed. Methods were compared in terms of advantages and limitations. The growing rod technique is a safe and reliable method in the treatment of congenital spine deformity of young children who present some flexibility in the anomalous segment, or when the congenital anomaly involves a vertebral segment too long for resection, or with compensating curve with structural pattern concomitant to the congenital deformity. Expansion thoracostomy and VEPTR are the appropriate choice for severe congenital spine deformity when a large amount of growth remains. Although ventilator dependence is significantly decreasing, thoracic volume and space available for the lung are increased after expansion thoracostomy and VEPTR. Growing rod technique should be used in patients where the primary problem is at the vertebral column. If the patient has rib fusions and/or TIS has developed, in other words, if the primary problem involves the thoracic cage, expansion thoracostomy and VEPTR should be an appropriate option.

A Computed Tomography-Based Comparison of Abnormal Vertebrae Pedicles Between Dystrophic and Nondystrophic Scoliosis in Neurofibromatosis Type 1.

PubMed

Li, Ying; Luo, Ming; Wang, Wengang; Shen, Mingkui; Xu, Genzhong; Gao, Jianbo; Xia, Lei

2017-10-01

To explore the prevalence and distribution of abnormal vertebral pedicles in scoliosis secondary to neurofibromatosis type 1 (NF1-S) and to compare the abnormal vertebrae pedicles between dystrophic and nondystrophic scoliosis. Using computed tomography images, we carefully measured 2652 vertebral pedicles from 56 patients with NF1-S with dystrophic scoliosis and 22 patients with NF1-S with nondystrophic scoliosis. Pedicle morphology was classified as follows: type A, a cancellous channel of >4 mm; type B, a cancellous channel of 2 to 4 mm; type C, a cancellous channel of <2 mm with an entirely cortical channel of ≥2 mm; type D, a cortical channel of <2 mm; or type E, absent pedicle. Types B, C, D, and E were defined as abnormal. The total prevalence of abnormal vertebral pedicles in patients with NF1-S was as high as 67%, with type B comprising 39%, type C comprising 22%, type D comprising 4%, and type E comprising 2%. A significantly greater rate of abnormal pedicles was found in dystrophic scoliosis compared with nondystrophic scoliosis (70% vs. 59%, P < 0.0001). The upper thoracic spine (87%) is the most concentrated region of abnormal pedicles compared with the lower thoracic (73%) and lumbar spine (34%). There is a significantly high prevalence of abnormal pedicles in patients with NF1-S and an increased rate of abnormal pedicles in dystrophic scoliosis compared with nondystrophic ones. The described pedicle classification system could serve as an objective tool to guide preoperative assessment. Copyright © 2017 Elsevier Inc. All rights reserved.

The Clay Shoveler's Fracture: A Case Report and Review of the Literature.

PubMed

Posthuma de Boer, Jantine; van Wulfften Palthe, Alexander F Y; Stadhouder, Agnita; Bloemers, Frank W

2016-09-01

A clay-shoveler's fracture is a very rarely occurring stress-type avulsion fracture of the lower cervical or upper thoracic spinous processes owing its name to the clay shovelers of past times. Currently, this type of injury is mainly encountered in individuals practicing sports involving rotational movements of the upper spine. We present a case of a man sustaining a clay-shoveler's injury during his work in a horse-riding school. Treatment consisted of a period of rest and analgesics, followed by mobilization as was tolerated. We give a brief historical account of clay shoveler's fractures. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Clay-shoveler's fractures are frequently overlooked due to their rareness; however, they have specific clinical features that should alert an attending physician to set the correct diagnosis. This report describes a typical case of a clay-shoveler's fracture, relates to the historical entity of clay-shoveler's fractures, and summarizes existing literature on this topic. Copyright © 2016 Elsevier Inc. All rights reserved.

Medical devices of the head, neck, and spine.

PubMed

Hunter, Tim B; Yoshino, Mark T; Dzioba, Robert B; Light, Rick A; Berger, William G

2004-01-01

There are many medical devices used for head, neck, and spinal diseases and injuries, and new devices are constantly being introduced. Many of the newest devices are variations on a previous theme. Knowing the specific name of a device is not important. It is important to recognize the presence of a device and to have an understanding of its function as well as to be able to recognize the complications associated with its use. The article discusses the most common and important devices of the head, neck, and spine, including cerebrospinal fluid shunts and the Codman Hakim programmable valve; subdural drainage catheters, subdural electrodes, intracranial electrodes, deep brain stimulators, and cerebellar electrodes; coils, balloons, adhesives, particles, and aneurysm clips; radiation therapy catheters, intracranial balloons for drug installation, and carmustine wafers; hearing aids, cochlear implants, and ossicular reconstruction prostheses; orbital prostheses, intraocular silicone oil, and lacrimal duct stents; anterior and posterior cervical plates, posterior cervical spine wiring, odontoid fracture fixation devices, cervical collars and halo vests; thoracic and lumbar spine implants, anterior and posterior instrumentation for the thoracic and lumbar spine, vertebroplasty, and artificial disks; spinal column stimulators, bone stimulators, intrathecal drug delivery pumps, and sacral stimulators; dental and facial implant devices; gastric and tracheal tubes; vagus nerve stimulators; lumboperitoneal shunts; and temperature- and oxygen-sensing probes. Copyright RSNA, 2004

Investigation of motorcyclist cervical spine trauma using HUMOS model.

PubMed

Sun, Jingchao; Rojas, Alban; Bertrand, Pierre; Petit, Yvan; Kraenzler, Reinhard; Arnoux, Pierre Jean

2012-09-01

With 16 percent of the total road user fatalities, motorcyclists represent the second highest rate of road fatalities in France after car occupants. Regarding road accidents, a large proportion of trauma was on the lower cervical spine. According to different clinical studies, it is postulated that the cervical spine fragility areas are located on the upper and lower cervical spine. In motorcycle crashes, impact conditions occur on the head segment with various orientations and impact directions, leading to a combination of rotations and compression. Hence, motorcyclist vulnerability was investigated considering many impact conditions. Using the human model for safety (HUMOS), a finite element model, this work aims to provide an evaluation of the cervical spine weaknesses based on an evaluation of injury mechanisms. This evaluation consisted of defining 2 injury risk factors (joint injury and bone fracture) using a design of experiment including various velocities, impact directions, and impact orientations. The results confirmed previously reported clinical and epidemiological work on the fragility of the lower cervical spine and the upper cervical spine segments. Joint injuries appeared before bone fractures on both the upper and lower cervical spine. Bone fracture risk was greater on the lower cervical spine than on the upper cervical spine. The compression induced by a high impact angle was identified as an important injury severity factor. It significantly increased the injury incidence for both joint injuries and bone fractures. It also induced a shift in injury location from the lower to the upper cervical spine. The impact velocity exhibited a linear relationship with injury risks and severity. It also shifted the bone fracture risk from the lower to upper spinal segments.

Quantitative Postural Analysis of Children With Congenital Visual Impairment.

PubMed

de Pádua, Michelle; Sauer, Juliana F; João, Silvia M A

2018-01-01

The aim of this study was to compare the postural alignment of children with visual impairment with that of children without visual impairment. The sample studied was 74 children of both sexes ages 5 to 12 years. Of these, 34 had visual impairment and 40 were control children. Digital photos from the standing position were used to analyze posture. Postural variables, such as tilt of the head, shoulder position, scapula position, lateral deviation of the spine, ankle position in the frontal plane and head posture, angle of thoracic kyphosis, angle of lumbar lordosis, pelvis position, and knee position in the frontal and sagittal planes, were measured with the Postural Assessment Software 0.63, version 36 (SAPO, São Paulo, Brazil), with markers placed in predetermined bony landmarks. The main results of this study showed that children with visual impairment have increased head tilt (P < .001), shoulder deviation in frontal plane (P = .004), lateral deviation of the spine (P < .001), changes in scapula position (P = .012), higher thoracic kyphosis (P = .004), and lower lumbar lordosis (P < .001). Visual impairment influences postural alignment. Children with visual impairment had increased head tilt, uneven shoulders, greater lateral deviation of the spine, thoracic kyphosis, lower lumbar lordosis, and more severe valgus deformities on knees. Copyright © 2017. Published by Elsevier Inc.

Giant thoracic schwannoma presenting with abrupt onset of abdominal pain: a case report

PubMed Central

2009-01-01

Introduction Giant intradural extramedullary schwannomas of the thoracic spine are not common. Schwannomas, that is, tumors derived from neoplastic Schwann cells, and neurofibromas represent the most common intradural extramedullary spinal lesions. We report the case of a patient with a giant thoracic schwannoma presenting unusually with acute abdominal pain and with delayed neurological impairment. Case presentation A 26-year-old Hispanic man with no previous medical problems presented with acute periumbilical pain. After extensive work-up including an exploratory laparotomy for appendectomy, magnetic resonance imaging scans of the lumbar and thoracic spine revealed a giant intradural extramedullary thoracic schwannoma within the spinal canal posterior to the T9, T10, and T11 vertebral bodies. Magnetic resonance imaging signal prolongation was noted in the spinal cord both rostral and caudal to the schwannoma. The patient underwent an urgent laminectomy from T8 to L1. After sacrificing the T10 root, the tumor was removed en bloc. Postoperatively, the patient improved significantly gaining antigravity strength in both lower extremities. Conclusion The T10 dermatome is represented by the umbilical region. This referred pain may represent a mechanism by which a giant thoracic schwannoma may present as acute abdominal pain. Acute, intense abdominal pain with delayed neurologic deficit is a rare presentation of a thoracic schwannoma but should be considered as a possible cause of abdominal pain presenting without clear etiology. Although these lesions may be delayed in their diagnosis, early diagnosis and treatment may lead to an improved clinical outcome. PMID:19946504

A Technique to Allow Prone Positioning in the Spine Surgery Patient With Unstable Spine Fracture and Flail Segment Rib Fractures.

PubMed

Pennington, Matthew W; Roche, Anthony M; Bransford, Richard J; Zhang, Fangyi; Dagal, Armagan

2016-07-01

Two patients with unstable thoracic spine and flail segment rib fractures initially failed prone positioning on a Jackson spinal table used for posterior spinal instrumentation and fusion surgery. Both patients experienced rapid hemodynamic collapse. We developed a solution using the anterior portions of a thoracolumbosacral orthosis brace as chest supports to use during prone positioning, allowing both patients to undergo uncomplicated posterior spinal instrumentation and fusion surgeries with greater hemodynamic stability.

Aortic rupture complicating a fracture of an ankylosed thoracic spine. A case report.

PubMed

Savolaine, E R; Ebraheim, N A; Stitgen, S; Jackson, W T

1991-11-01

A 34-year-old man was injured in a motorcycle accident and suffered both aortic rupture and thoracic spinal fracture, complicated by an underlying undetected ankylosing spondylitis. The latter disease can affect the integrity of vascular and spinal structure. Aortography is recommended as a high priority for the patient in an unstable cardiovascular condition requiring a definitive diagnosis. Aortic rupture and thoracic spine fracture may occur from high energy deceleration trauma. Motor vehicle passenger and pedestrian injuries are most commonly involved, although airline accidents and high falls also generate some cases. Mediastinal widening, displacement of esophagus and trachea, apical dissection of blood, and, especially, paravertebral pleural space widening are common to both injuries. Whereas most mediastinal hematomas are nonaortic in origin, a combined injury must be considered because clinical features may also overlap. These include hypotension (hypovolemic or spinal shock), paraplegia, and severe back pain. In light of the high mortality and time constraints associated with aortic rupture, immediate diagnostic resolution is necessary for appropriate management and priority of investigation.

Application of multislice spiral CT for guidance of insertion of thoracic spine pedicle screws: an in vitro study.

PubMed

Wang, Juan; Zhou, Yicheng; Hu, Ning; Wang, Renfa

2006-01-01

To investigate the value of the guidance of three dimensional (3-D) reconstruction of multi-slice spiral CT (MSCT) for the placement of pedicle screws, the 3-D anatomical data of the thoracic pedicles were measured by MSCT in two embalmed human cadaveric thoracic pedicles spines (T1-T10) to guide the insertion of pedicle screws. After pulling the screws out, the pathways were filled with contrast media. The PW, PH, TSA and SSA of developed pathways were measured on the CT images and they were also measured on the real objects by caliper and goniometer. Analysis of variance demonstrated that the difference between the CT scans and real objects had no statistical significance (P > 0.05). Moreover, the difference between pedicle axis and developed pathway also had no statistical significance (P > 0.05). The data obtained from 3-D reconstruction of MSCT demonstrated that individualized standards, are not only accurate but also helpful for the successful placement of pedicle screws.

Vertebral derotation in adolescent idiopathic scoliosis causes hypokyphosis of the thoracic spine

PubMed Central

2012-01-01

Background The purpose of this study was to test the hypothesis that direct vertebral derotation by pedicle screws (PS) causes hypokyphosis of the thoracic spine in adolescent idiopathic scoliosis (AIS) patients, using computer simulation. Methods Twenty AIS patients with Lenke type 1 or 2 who underwent posterior correction surgeries using PS were included in this study. Simulated corrections of each patient’s scoliosis, as determined by the preoperative CT scan data, were performed on segmented 3D models of the whole spine. Two types of simulated extreme correction were performed: 1) complete coronal correction only (C method) and 2) complete coronal correction with complete derotation of vertebral bodies (C + D method). The kyphosis angle (T5-T12) and vertebral rotation angle at the apex were measured before and after the simulated corrections. Results The mean kyphosis angle after the C + D method was significantly smaller than that after the C method (2.7 ± 10.0° vs. 15.0 ± 7.1°, p < 0.01). The mean preoperative apical rotation angle of 15.2 ± 5.5° was completely corrected after the C + D method (0°) and was unchanged after the C method (17.6 ± 4.2°). Conclusions In the 3D simulation study, kyphosis was reduced after complete correction of the coronal and rotational deformity, but it was maintained after the coronal-only correction. These results proved the hypothesis that the vertebral derotation obtained by PS causes hypokyphosis of the thoracic spine. PMID:22691717

Occupant and Crash Characteristics in Thoracic and Lumbar Spine Injuries Resulting From Motor Vehicle Collisions

PubMed Central

Rao, Raj D.; Berry, Chirag; Yoganandan, Narayan; Agarwal, Arnav

2016-01-01

Background context Motor vehicle collisions (MVC) are a leading cause of thoracic and lumbar (T and L) spine injuries. Mechanisms of injury in vehicular crashes that result in thoracic and lumbar fractures and the spectrum of injury in these occupants have not been extensively studied in the literature. Purpose The objective was to investigate the patterns of T and L spine injury following MVC; correlate these patterns with restraint use, crash characteristics and demographic variables; and study the associations of these injuries with general injury morbidity and fatality. Study design/Setting Retrospective study of a prospectively gathered database. Patient sample Six hundred and thirty-one occupants with T and L (T1-L5) spine injuries from 4572 occupants included in the Crash Injury Research and Engineering Network (CIREN) database between 1996 and 2011. Outcome measures No clinical outcome measures were evaluated in this study. Methods The CIREN database includes moderate to severely injured occupants from MVC involving vehicles manufactured recently. Demographic, injury and crash data from each patient was analyzed for correlations between pattern of T and L spine injury, associated extra-spinal injuries and overall injury severity score (ISS), type and use of seat belts, and other crash characteristics. T and L spine injury pattern was categorized using a modified Denis classification, to include extension injuries as a separate entity. Results T and L spine injuries were identified in 631 of 4572 vehicle occupants, of whom 299 sustained major injuries (including 21 extension injuries) and 332 sustained minor injuries. Flexion-distraction injuries were more prevalent in children and young adults, and extension injuries in older adults (mean age 65.7 years). Occupants with extension injuries had a mean BMI of 36.0 and a fatality rate of 23.8%, much higher than the fatality rate for the entire cohort (10.9%). The most frequent extra-spinal injuries (Abbreviated Injury Scale grade 2 or more) associated with T and L spine injuries involved the chest (seen in 65.6% of 631 occupants). In contrast to occupants with major T and L spine injuries, those with minor T and L spine injuries showed a strikingly greater association with pelvic and abdominal injuries. Occupants with minor T and L spine injuries had a higher mean ISS (27.1) than those with major T and L spine injuries (25.6). Among occupants wearing a three-point seat belt, 35.3% sustained T and L spine injuries, while only 11.6% of the unbelted occupants sustained T and L spine injuries. Three-point belted individuals were more likely to sustain burst fractures, while two-point belted occupants sustained flexion-distraction injuries most often, and unbelted occupants had a predilection for fracture-dislocations of the T and L spine. Three-point seat belts were protective against neurologic injury, higher ISS and fatality. Conclusions T and L spine fracture patterns are influenced by age of occupant and type and use of seat belts. Despite a reduction in overall injury severity and mortality, seat belt use is associated with an increased incidence of T and L spine fractures. Minor T and L spine fractures were associated with an increased likelihood of pelvic and abdominal injuries and higher ISS scores, demonstrating their importance in predicting overall injury severity. Extension injuries occurred in older, obese individuals, and were associated with a high fatality rate. Future advancements in automobile safety engineering should address the need to reduce T and L spine injuries in belted occupants. PMID:24486471

Trans-arterial Onyx Embolization of a Functional Thoracic Paraganglioma

PubMed Central

Chacón-Quesada, Tatiana; Maud, Alberto; Ramos-Duran, Luis; Torabi, Alireza; Fitzgerald, Tamara; Akle, Nassim; Cruz Flores, Salvador; Trier, Todd

2015-01-01

Paragangliomas are rare tumors of the endocrine system. They are highly vascular and in some cases hormonally active, making their management challenging. Although there is strong evidence of the safety and effectiveness of preoperative embolization in the management of spinal tumors, only five cases have been reported in the setting of thoracic paragangliomas. We present the case of a 19-year-old man with a large, primary, functional, malignant paraganglioma of the thoracic spine causing a vertebral fracture and spinal cord compression. To our knowledge this is the first report of preoperative trans-arterial balloon augmented Onyx embolization of a thoracic paraganglioma. PMID:25763296

[Devic disease: a rare cause of retrobulbar optic neuritis: a case report].

PubMed

Sempińska-Szewczyk, J; Weglewski, A; Juryńczyk, J; Cybulska, B

2000-01-01

A case of 58-year-old woman with recurrent retrobulbar optic neuritis (ron) and transverse myelitis is presented. The patient was admitted to the opthalmology unit because of acute right retrobulbar optic neuritis. In 1997 she complained of left retrobulbar optic neuritis. One year later transverse myelitis of thoracic spine with spastic paraparesis occurred. MRI examination showed T2 hyperintensive focus in the thoracic spine (Th8-Th9, probably demyelinisation). Nowadays MRI examination of the optic nerves and brain showed demyelinisation focus in the right optic nerve. There was no pathological changes in the brain. The diagnosis of Devic disease was established. Treatment with intravenous methyloprednisolon was administered with slight improvement. The pathology and clinical course of Devic disease are discussed.

Tension Pneumothorax During Surgery for Thoracic Spine Stabilization in Prone Position: A Case Report and Review of Literature.

PubMed

Rankin, Demicha; Mathew, Paul S; Kurnutala, Lakshmi N; Soghomonyan, Suren; Bergese, Sergio D

2014-01-01

The intraoperative progression of a simple or occult pneumothorax into a tension pneumothorax can be a devastating clinical scenario. Routine use of prophylactic thoracostomy prior to anesthesia and initiation of controlled ventilation in patients with simple or occult pneumothorax remains controversial. We report the case of a 75-year-old trauma patient with an insignificant pneumothorax on the right who developed an intraoperative tension pneumothorax on the left side while undergoing thoracic spine stabilization surgery in the prone position. Management of an intraoperative tension pneumothorax requires prompt recognition and treatment; however, the prone position presents an additional challenge of readily accessing the standard anatomic sites for pleural puncture and air drainage.

Giant cell tumor of the spine.

PubMed

Ozaki, Toshifumi; Liljenqvist, Ulf; Halm, Henry; Hillmann, Axel; Gosheger, Georg; Winkelmann, Winfried

2002-08-01

Six patients with giant cell tumor of the spine had surgery between 1981 and 1995. Three lesions were located in the scrum, two lesions were in the thoracic spine, and one lesion was in the lumbar spine. Preoperatively, all patients had local pain and neurologic symptoms. Two patients had cement implanted after curettage or intralesional excision of the sacral tumor; one patient had a local relapse. After the second curettage and cement implantation, the tumor was controlled. One patient with a sacral lesion had marginal excision and spondylodesis; no relapse developed. Two patients with thoracic lesions had planned marginal excision and spondylodesis; the margins finally became intralesional, but no relapse developed. One patient with a lumbar lesion had incomplete removal of the tumor and received postoperative irradiation. At the final followup (median, 69 months), five of six patients were disease-free and one patient died of disease progression. Two of the five surviving patients had pain after standing or neurologic problems. Although some contamination occurred, planning a marginal excision of the lesion seems beneficial for vertebral lesions above the sacrum. Total sacrectomy of a sacral lesion seems to be too invasive when cement implantation can control the lesion.

Spine Topographical Distribution of Skin α-Synuclein Deposits in Idiopathic Parkinson Disease.

PubMed

Donadio, Vincenzo; Incensi, Alex; Rizzo, Giovanni; Scaglione, Cesa; Capellari, Sabina; Fileccia, Enrico; Avoni, Patrizia; Liguori, Rocco

2017-05-01

Phosphorylated α-synuclein (p-syn) in skin nerves mainly in the proximal sites is a promising neurodegenerative biomarker for idiopathic Parkinson disease (IPD). However, the p-syn spine distribution particularly in patients with unilateral motor dysfunctions remains undefined. This study aimed to investigate in IPD p-syn differences between left and right cervical spine sites in patients with prevalent unilateral motor symptoms, and cervical and thoracic spine sites in patients with bilateral motor symptoms. We enrolled 28 IPD patients fulfilling clinical diagnostic criteria associated with abnormal nigro-striatal DatScan and cardiac MIBG: 15 with prevalently unilateral motor symptoms demonstrated by DatScan; 13 with bilateral motor symptoms and DatScan abnormalities. Patients underwent skin biopsy searching for intraneural p-syn deposits: skin samples were taken from C7 paravertebral left and right sites in unilateral patients and from cervical (C7) and thoracic (Th12) paravertebral spine regions in bilateral patients. Unilateral patients displayed 20% of abnormal p-syn deposits in the affected motor site, 60% in both sites and 20% only in the non-affected site. P-syn was found in all patients in C7 but in only 62% of patients in Th12. Our data showed that cervical p-syn deposits displayed a uniform distribution between both sides not following the motor dysfunction in unilateral patients, and skin nerve p-syn deposits demonstrated a spine gradient with the cervical site expressing the highest positivity. © 2017 American Association of Neuropathologists, Inc. All rights reserved.

Thoracic myelopathy with alkaptonuria.

PubMed

Akeda, Koji; Kasai, Yuichi; Kawakita, Eiji; Matsumura, Yoshihiro; Kono, Toshibumi; Murata, Tetsuya; Uchida, Atsumasa

2008-01-15

A case of thoracic myelopathy with alkaptonuria (ochronotic spondyloarthropathy) is presented. To present and review the first reported case of an alkaptonuric patient with concomitant thoracic myelopathy. Alkaptonuria, a rare hereditary metabolic disease, is characterized by accumulation of homogentistic acid, ochronosis, and destruction of connective tissue resulting in degenerative spondylosis and arthritis. Despite the high incidence of intervertebral disc diseases among patients with alkaptonuria, neurologic symptoms caused by spinal disease are rare. Thoracic myelopathy in a patient with alkaptonuria has not been previously reported. The clinical course, radiologic features, pathology, and treatment outcome of an alkaptonuria patient with thoracic myelopathy was documented. Myelopathy of the patient was caused by rupture of a thoracic intervertebral disc. The neurologic symptoms of the patient were markedly improved after surgery. We have reported for the first time, that an alkaptonuria patient showed thoracic myelopathy caused by rupture of a thoracic intervertebral disc. Decompression followed by the instrumented fusion of the thoracic spine was effective for improving the neurologic symptoms.

Epithelioid hemangioma of the spine: Two cases.

PubMed

O'Shea, Bendan M; Kim, Jinsuh

2014-01-01

We report two cases of epithelioid hemangioma (EH) manifested in the thoracic spine with associated clinical, radiographic, and pathological findings. Epithelioid hemangioma is a benign vascular tumor that can involve any bone (including the spine in a subset of patients). Although recognized as a benign tumor by the WHO, it can display locally aggressive features. Within the spine, these features may lead to pain, instability, and/or neurologic dysfunction. The radiographic appearance is most typically that of a lytic, well-defined lesion on plain film or CT. The MRI appearance is typically hypointense on T1WI, hyperintense on T2WI, and avidly enhancing, often with an extraosseous soft-tissue component.

Three-dimensional assessment of scoliosis based on ultrasound data

NASA Astrophysics Data System (ADS)

Zhang, Junhua; Li, Hongjian; Yu, Bo

2015-12-01

In this study, an approach was proposed to assess the 3D scoliotic deformity based on ultrasound data. The 3D spine model was reconstructed by using a freehand 3D ultrasound imaging system. The geometric torsion was then calculated from the reconstructed spine model. A thoracic spine phantom set at a given pose was used in the experiment. The geometric torsion of the spine phantom calculated from the freehand ultrasound imaging system was 0.041 mm-1 which was close to that calculated from the biplanar radiographs (0.025 mm-1). Therefore, ultrasound is a promising technique for the 3D assessment of scoliosis.

Anatomical and morphological spine variation in Gymnocalycium kieslingii subsp. castaneum (Cactaceae).

PubMed

Gebauer, Roman; Řepka, Radomír; Šmudla, Radek; Mamoňová, Miroslava; Ďurkovič, Jaroslav

2016-01-01

Although spine variation within cacti species or populations is assumed to be large, the minimum sample size of different spine anatomical and morphological traits required for species description is less studied. There are studies where only 2 spines were used for taxonomical comparison amnog species. Therefore, the spine structure variation within areoles and individuals of one population of Gymnocalycium kieslingii subsp. castaneum (Ferrari) Slaba was analyzed. Fifteen plants were selected and from each plant one areole from the basal, middle and upper part of the plant body was sampled. A scanning electron microscopy was used for spine surface description and a light microscopy for measurements of spine width, thickness, cross-section area, fiber diameter and fiber cell wall thickness. The spine surface was more visible and damaged less in the upper part of the plant body than in the basal part. Large spine and fiber differences were found between upper and lower parts of the plant body, but also within single areoles. In general, the examined traits in the upper part had by 8-17% higher values than in the lower parts. The variation of spine and fiber traits within areoles was lower than the differences between individuals. The minimum sample size was largely influenced by the studied spine and fiber traits, ranging from 1 to 70 spines. The results provide pioneer information useful in spine sample collection in the field for taxonomical, biomechanical and structural studies. Nevertheless, similar studies should be carried out for other cacti species to make generalizations. The large spine and fiber variation within areoles observed in our study indicates a very complex spine morphogenesis.

Anatomical and morphological spine variation in Gymnocalycium kieslingii subsp. castaneum (Cactaceae)

PubMed Central

Gebauer, Roman; Řepka, Radomír; Šmudla, Radek; Mamoňová, Miroslava; Ďurkovič, Jaroslav

2016-01-01

Abstract Although spine variation within cacti species or populations is assumed to be large, the minimum sample size of different spine anatomical and morphological traits required for species description is less studied. There are studies where only 2 spines were used for taxonomical comparison amnog species. Therefore, the spine structure variation within areoles and individuals of one population of Gymnocalycium kieslingii subsp. castaneum (Ferrari) Slaba was analyzed. Fifteen plants were selected and from each plant one areole from the basal, middle and upper part of the plant body was sampled. A scanning electron microscopy was used for spine surface description and a light microscopy for measurements of spine width, thickness, cross-section area, fiber diameter and fiber cell wall thickness. The spine surface was more visible and damaged less in the upper part of the plant body than in the basal part. Large spine and fiber differences were found between upper and lower parts of the plant body, but also within single areoles. In general, the examined traits in the upper part had by 8–17% higher values than in the lower parts. The variation of spine and fiber traits within areoles was lower than the differences between individuals. The minimum sample size was largely influenced by the studied spine and fiber traits, ranging from 1 to 70 spines. The results provide pioneer information useful in spine sample collection in the field for taxonomical, biomechanical and structural studies. Nevertheless, similar studies should be carried out for other cacti species to make generalizations. The large spine and fiber variation within areoles observed in our study indicates a very complex spine morphogenesis. PMID:27698579

Characterization of the frequency and muscle responses of the lumbar and thoracic spines of seated volunteers during sinusoidal whole body vibration.

PubMed

Baig, Hassam A; Dorman, Daniel B; Bulka, Ben A; Shivers, Bethany L; Chancey, Valeta C; Winkelstein, Beth A

2014-10-01

Whole body vibration has been postulated to contribute to the onset of back pain. However, little is known about the relationship between vibration exposure, the biomechanical response, and the physiological responses of the seated human. The aim of this study was to measure the frequency and corresponding muscle responses of seated male volunteers during whole body vibration exposures along the vertical and anteroposterior directions to define the transmissibility and associated muscle activation responses for relevant whole body vibration exposures. Seated human male volunteers underwent separate whole body vibration exposures in the vertical (Z-direction) and anteroposterior (X-direction) directions using sinusoidal sweeps ranging from 2 to 18 Hz, with a constant amplitude of 0.4 g. For each vibration exposure, the accelerations and displacements of the seat and lumbar and thoracic spines were recorded. In addition, muscle activity in the lumbar and thoracic spines was recorded using electromyography (EMG) and surface electrodes in the lumbar and thoracic region. Transmissibility was determined, and peak transmissibility, displacement, and muscle activity were compared in each of the lumbar and thoracic regions. The peak transmissibility for vertical vibrations occurred at 4 Hz for both the lumbar (1.55 ± 0.34) and thoracic (1.49 ± 0.21) regions. For X-directed seat vibrations, the transmissibility ratio in both spinal regions was highest at 2 Hz but never exceeded a value of 1. The peak muscle response in both spinal regions occurred at frequencies corresponding to the peak transmissibility, regardless of the direction of imposed seat vibration: 4 Hz for the Z-direction and 2-3 Hz for the X-direction. In both vibration directions, spinal displacements occurred primarily in the direction of seat vibration, with little off-axis motion. The occurrence of peak muscle responses at frequencies of peak transmissibility suggests that such frequencies may induce greater muscle activity, leading to muscle fatigue, which could be a contributing mechanism of back pain.

Role of motor-evoked potential monitoring in conjunction with temporary clipping of spinal nerve roots in posterior thoracic spine tumor surgery.

PubMed

Eleraky, Mohammed A; Setzer, Matthias; Papanastassiou, Ioannis D; Baaj, Ali A; Tran, Nam D; Katsares, Kiesha M; Vrionis, Frank D

2010-05-01

The vascular supply of the thoracic spinal cord depends on the thoracolumbar segmental arteries. Because of the small size and ventral course of these arteries in relation to the dorsal root ganglion and ventral root, they cannot be reliably identified during surgery by anatomic or morphologic criteria. Sacrificing them will most likely result in paraplegia. The goal of this study was to evaluate a novel method of intraoperative testing of a nerve root's contribution to the blood supply of the thoracic spinal cord. This is a clinical retrospective study of 49 patients diagnosed with thoracic spine tumors. Temporary nerve root clipping combined with motor-evoked potential (MEP) and somatosensory-evoked potential (SSEP) monitoring was performed; additionally, postoperative clinical evaluation was done and reported in all cases. All cases were monitored by SSEP and MEPs. The nerve root to be sacrificed was temporarily clipped using standard aneurysm clips, and SSEP/MEP were assessed before and after clipping. Four nerve roots were sacrificed in four cases, three nerve roots in eight cases, and two nerve roots in 22 cases. Nerve roots were sacrificed bilaterally in 12 cases. Most patients (47/49) had no changes in MEP/SSEP and had no neurological deficit postoperatively. One case of a spinal sarcoma demonstrated changes in MEP after temporary clipping of the left T11 nerve root. The nerve was not sacrificed, and the patient was neurologically intact after surgery. In another case of a sarcoma, MEPs changed in the lower limbs after ligation of left T9 nerve root. It was felt that it was a global event because of anesthesia. Postoperatively, the patient had complete paraplegia but recovered almost completely after 6 months. Temporary nerve root clipping combined with MEP and SSEP monitoring may enhance the impact of neuromonitoring in the intraoperative management of patients with thoracic spine tumors and favorably influence neurological outcome. Copyright 2010 Elsevier Inc. All rights reserved.

The role of the paravertebral muscles in adolescent idiopathic scoliosis evaluated by temporary paralysis.

PubMed

Wong, Christian; Gosvig, Kasper; Sonne-Holm, Stig

2017-01-01

Muscle imbalance has been suggested as implicated in the pathology of adolescent idiopathic scoliosis (AIS). The specific "pathomechanic" role of the paravertebral muscles as being scoliogenic (inducing scoliosis) or counteracting scoliosis in the initial development and maintenance of this spinal deformity has yet to be clarified in humans. In the present study, we investigated the radiographic changes of temporal paralysis using botulinum toxin A as localized injection therapy (ITB) in the psoas major muscle in AIS patients. Nine patients with AIS were injected one time with ITB using ultrasonic and EMG guidance in the selected spine muscles. Radiographic and clinical examinations were performed before and 6 weeks after the injection. Primary outcome parameters of radiological changes were analyzed using Wilcoxon signed-rank test and binomial test, and secondary outcome parameters of short- and long-term clinical effects were obtained. Significant radiological corrective changes were seen in the frontal plane in the thoracic and lumbar spine as well as significant derotational corrective change in the lumbar spine according to Cobb's angle measurements and to Nash and Moe's classification, respectively. No serious adverse events were detected at follow-up. In conclusion, this study demonstrated that the psoas major muscle do play a role into the pathology in adolescent idiopathic scoliosis by maintaining the curvature of the lumbar spine and thoracic spine. EudraCT number 2008-004584-19.

Bone mineral density at different sites and vertebral fractures in Serbian postmenopausal women.

PubMed

Ilic Stojanovic, O; Vuceljic, M; Lazovic, M; Gajic, M; Radosavljevic, N; Nikolic, D; Andjic, M; Spiroski, D; Vujovic, S

2017-02-01

This randomized study aimed to evaluate the correlation between bone mineral densities (BMD) measured at different sites and the frequency of vertebral fractures in a group of Serbian postmenopausal women. BMD was measured in 130 naïve postmenopausal women by dual X-ray absorptiometry (DXA) at the ultra-distal part of the forearms, at the hip and at the lumbar spine. At each of the measurement sites, the patients were categorized as osteoporotic, or osteopenic, or in the reference range. Vertebral fractures were examined using thoracic and lumbar spine radiography. A T-score at different skeletal sites showed discordance in the site-specific region. Vertebral fractures were found in 58.82% of patients with hip osteopenia, in 45% with forearm osteopenia and in 54.54% with lumbar spine osteoporosis. The study confirmed that the reduction of BMD depends on age and choice of measurement site. The best correlation was obtained in the women with osteopenia at all measurement sites. The discovery of vertebral fractures by lateral thoracic and lumbar spine radiography improves prompt treatment. Reference values of BMD do not exclude vertebral fractures. Of vertebral fractures, 72.5% were asymptomatic and thus spine radiographies are obligatory. Currently discussed is the position of DXA for measuring BMD as a method of detection for patients at risk of fracture.

Spine and Spinal Cord Injuries After Falls From Tree Stands During the Wisconsin Deer Hunting Season.

PubMed

Hamilton, Kimberly; Rocque, Brandon; Brooks, Nathaniel

2017-11-01

Deer hunting is popular in much of the United States. In Wisconsin, use of tree stands for hunting is common. Spine surgeons at a Level 1 Trauma Center observed a high incidence of spine and spinal cord injury due to falls from tree stands while hunting. This study's purpose is to systematically characterize and classify those injuries. We reviewed the University of Wisconsin Hospital and Clinics' trauma database for tree stand-related injuries from 1999 to 2013. We collected and analyzed data pertaining to hunters' demographics, comorbidities, type and mechanism of injury, injury severity, and management. We identified 117 patients evaluated after a tree stand fall. Sixty-five (ages 16-76) suffered spine fractures that occurred at all levels, from occipital condyle to sacrum, with thoracolumbar compression and burst fractures being most common. Fractures occurred in the following locations: cranio-cervical junction (8.7%), cervical spine (7.6%), cervical-thoracic junction (6.5%), thoracic spine (32.6%), thoracolumbar junction (33.7%), and lumbar spine (10.9%). Twenty-one patients (32%) experienced a single spinal fracture; 44 patients (68%) suffered multiple spinal fractures. Twenty-five patients (38%) required surgical fixation; 19 patients experienced loss of neurologic function: 5 complete spinal cord injuries (SCI), 5 incomplete SCI, 2 central cord syndromes, and 8 radiculopathies. Two mortalities, both of cardiopulmonary etiology, were noted-one in a patient without a spine fracture and the other in a patient with a complete spinal cord injury at T4. The majority of spine fractures are treated nonoperatively. However, enough patients require surgical intervention that consultation with a neurosurgical or orthopedic spine surgeon is prudent. It is more common to have multiple spine fractures from a tree stand fall, therefore, it is recommended that if 1 fracture is identified the entire spine be evaluated for additional fractures. For safety, it is recommended that hunters wear and use safety harnesses appropriately. Additionally, keeping the height of the tree stand at 10 feet or less is associated with a lower likelihood of spinal cord injury. Further study is needed to determine additional interventions such as education that might reduce the injury frequency in this population.

Spine deformities in rare congenital syndromes: clinical issues.

PubMed

Campbell, Robert M

2009-08-01

A focused review of the literature with regard to the important system abnormalities of patients with spinal deformities associated with exotic congenital syndromes with additional data from the author's own experience in assessment of patients with rare syndromes treated for thoracic insufficiency syndrome. The objectives of this study are to emphasize important medical considerations that influence the choice of surgical treatment of spinal deformity in patients with exotic congenital syndromes and point out preoperative strategies that reduce treatment morbidity and mortality of these patients. Individual experience is limited in the treatment of spine abnormality in rare exotic syndromes and the medical aspects of these syndromes that may impact spinal treatment are seldom discussed in detail in the orthopedic literature. For a successful outcome in the treatment of spinal deformity in these unique patients, a working knowledge of the unique pitfalls in their medical care is necessary in order to avoid morbidity and mortality during their treatment. The literature was reviewed for 6 exotic congenital syndromes with known or unreported spinal abnormalities and the author's personal 22-years experience of the treatment of thoracic insufficiency syndrome in the relevant congenital syndromes was summarized. Children with Marfan syndrome and spinal deformity may have serious cardiac abnormalities. Spontaneous dissection of the aortic root is a clear danger and patients should be monitored by serial echocardiograms. Prophylactic cardiac surgery may be necessary before spinal surgery is to be performed. Patients with Jeune syndrome have a high rate of proximal cervical stenosis and should undergo screening with cervical spine films at birth. Significant stenosis or instability may require decompression and cervical-occipital fusion. Arthrogryposis may be associated with a severe scoliosis and jaw contracture may make intubation difficult. Larsen syndrome may have early onset scoliosis that is very rigid and requires early intervention. Cervical kyphosis and subluxation may be lethal in these patients and screening radiographs are important. Upper airway abnormalities are an anesthesia concern. Jarcho-Levin syndrome is a thoracic volume depletion deformity due to shortness of the thorax, either a spondylocostal dysostosis variant or spondylothoracic dysplasia. The former has a chaotic congenital scoliosis with varied combination of missing and fused ribs. Although spondylocostal dysostosis has a benign reputation in the literature for respiratory complications, respiratory insufficiency is nevertheless common and 1 death is known from respiratory failure. Spondylothoracic dysplasia seldom has significant scoliosis, but has a mortality rate approaching 50% from respiratory complications due to thoracic insufficiency syndrome. In spite of severe restrictive respiratory disease, adult survivors of spondylothoracic dysplasia appear to do well clinically for unknown reasons. Cerebrocostomandibular syndrome has scoliosis, micrognathia, and thoracic insufficiency syndrome, due to an "implosion" deformity of the thorax from congenital pseudarthrosis of the posterior ribs. For optimal patient care, it is necessary to have a clear understanding of exotic congenital syndromes and how they may impact on both the presentation of spinal deformity and the response to treatment, as well as how they may introduce additional morbidity into standard treatment plans. It is clear that with this understanding that preoperative strategies can be employed to enhance the safety of spinal treatment for these unique children.

The Audible Pop from Thoracic Spine Thrust Manipulation and Its Relation to Short-Term Outcomes in Patients with Neck Pain

PubMed Central

Cleland, Joshua A.; Flynn, Timothy W.; Childs, John D.; Eberhart, Sarah

2007-01-01

Clinicians routinely consider the success of a thrust manipulation technique based on the presence or absence of an audible pop despite the lack of evidence suggesting that this pop is associated with improved outcomes. The purpose of this study was to determine the relationship between the number of audible pops with thoracic spinal manipulation and improvement in pain and function in patients with mechanical neck pain. In this prospective cohort study, 78 patients referred to physical therapy with mechanical neck pain underwent a standardized examination and thoracic spine manipulation treatment protocol. All patients were treated with a total of 6 thrust manipulation techniques directed to the thoracic spine followed by a basic cervical range of motion exercise. The treating clinician recorded the presence or absence of a pop during each manipulation. Outcomes were assessed at a 2–4 day follow-up with an 11-point numeric pain rating (NPRS), the Neck Disability Index, the patient Global Rating of Change (GROC), and measurements of cervical range of motion (CROM). The relationship between the number of pops and change scores for pain, disability, and CROM was first examined using Pearson correlation coefficients. Individuals were then categorized as having received ≤3 or >3 pops. Repeated measures analyses of variance were used to examine whether achievement of >3 pops resulted in improved outcome. Seventy-eight patients with a mean age of 42 (SD 11.3) years participated in the study. Pearson correlation coefficients revealed no significant correlation existed between the number of pops and outcomes with the exception of 3 of the 6 CROM measurements, which were inversely related. There was no significant interaction for group X time for any of the dependent measures (P>0.05). The odds ratio for patients experiencing dramatic improvement was in favor of the group experiencing ≤3 pops but this was not clinically meaningful (1.3: 95% CI 0.46, 3.7). The results of this analysis provide preliminary evidence for the hypothesis that there is no relationship between the number of audible pops during thoracic spine thrust manipulation and clinically meaningful improvements in pain, disability, or CROM in patients with mechanical neck pain. Additionally, a greater number of audible pops experienced was not associated with a dramatic improvement with manipulation treatment. PMID:19066662

Changes in neck pain and active range of motion after a single thoracic spine manipulation in subjects presenting with mechanical neck pain: a case series.

PubMed

Fernández-de-las-Peñas, César; Palomeque-del-Cerro, Luis; Rodríguez-Blanco, Cleofás; Gómez-Conesa, Antonia; Miangolarra-Page, Juan C

2007-05-01

Our aim was to report changes in neck pain at rest, active cervical range of motion, and neck pain at end-range of cervical motion after a single thoracic spine manipulation in a case series of patients with mechanical neck pain. Seven patients with mechanical neck pain (2 men, 5 women), 20 to 33 years old, were included. All patients received a single thoracic manipulation by an experienced manipulative therapist. The outcome measures of these cases series were neck pain at rest, as measured by a numerical pain rating scale; active cervical range of motion; and neck pain at the end of each neck motion (eg, flexion or extension). These outcomes were assessed pre treatment, 5 minutes post manipulation, and 48 hours after the intervention. A repeated-measures analysis was made with parametric tests. Within-group effect sizes were calculated using Cohen d coefficients. A significant (P < .001) decrease, with large within-group effect sizes (d > 1), in neck pain at rest were found after the thoracic spinal manipulation. A trend toward an increase in all cervical motions (flexion, extension, right or left lateral flexion, and right or left rotation) and a trend toward a decrease in neck pain at the end of each cervical motion were also found, although differences did not reach the significance (P > .05). Nevertheless, medium to large within-group effect sizes (0.5 < d < 1) were found between preintervention data and both postintervention assessments in both active range of motion and neck pain at the end of each neck motion. The present results demonstrated a clinically significant reduction in pain at rest in subjects with mechanical neck pain immediately and 48 hours following a thoracic manipulation. Although increases in all tested ranges of motion were obtained, none of them reached statistical significance at either posttreatment point. The same was found for pain at the end of range of motion for all tested ranges, with the exception of pain at the end of forward flexion at 48 hours. More than one mechanism likely explains the effects of thoracic spinal manipulation. Future controlled studies comparing spinal manipulation vs spinal mobilization of the thoracic spine are required.

[Evaluation of the risk of mediastinal or retroperitoneal injuries caused by dorso-lumbar pedicle screws].

PubMed

Hernigou, P; Germany, W

1998-09-01

Within an anatomical and a clinical study, the authors employed computerized tomographic scans to evaluate the risks of anterior surrounding tissues injuries during screw insertion. CT scans of 20 patients suffering from cardiac disease were reviewed retrospectively. Scans through the thoracic and lumbar spine were obtained using 6 mm slice thickness. These examinations were performed with intravenous contrast medium. Measurements of vessel diameters and distance of the soft tissues situated directly anterior to the spine were done. A retrospective study of 61 pedicle screws implanted for spine fractures evaluated the penetration of the anterior vertebral cordex with X rays and CT scans. Computerized tomographic scans of the thoracic and lumbar spine of the 20 patients in the control group confirmed proximity of the posterior mediastinal structures to the anterior vertebral cortex. Many structures of the posterior mediastinum were within five millimeters of the anterior vertebral cortex and thus were at risk: aorta, azygos vein, vena cava, parietal pleura and lungs. The theoretical risk of unrecognized screw penetrations evaluated on geometric shape of the anterior vertebral body is as high as 21 per cent when screw position is only seen with an antero posterior and a lateral X Ray. In the other group, computerized tomographic scans showed that 30 per cent of the implanted screws were outside the boundaries of the anterior thoracic spine. Two orthogonal incidences do not enable determination of whether the extremity of the screw is slightly outside the anterior cortex of the vertebral body. However the geometric shape of the anterior vertebral body enables peroperative definition of a safety zone on two orthogonal incidences. Even if a breach of a few millimeters of the anterior cortical boundaries of the vertebral body may not initially damage the adjacent soft-tissue structures, chronic irritation may result in late damages of these structures. The use of metallic markers and the respect of a safe vertebral zone on X Rays could guide the choice of the appropriate screw length.

Spinal injuries in professional rugby union: a prospective cohort study.

PubMed

Fuller, Colin W; Brooks, John H M; Kemp, Simon P T

2007-01-01

To determine the incidence, severity, nature, and causes of cervical, thoracic, and lumbar spine injuries sustained during competition and training in professional rugby union. A 2 season prospective cohort design. Twelve English Premiership rugby union clubs. Five hundred and forty-six male rugby union players of whom 296 were involved in both seasons. Location, diagnosis, severity (number of days unavailable for training and matches), and cause of injury: incidence of match and training injuries (injuries/1000 player-hours). Player age, body mass, stature, playing position, use of headgear, and activity and period of season. The incidences of spinal injuries were 10.90 (9.43 to 12.60) per 1000 player match-hours and 0.37 (0.29 to 0.47) per 1000 player training-hours. No player sustained a catastrophic spinal injury, but 3 players sustained career-ending injuries. Overall, players were more likely to sustain a cervical injury during matches and a lumbar injury during training. Forwards were significantly more likely to sustain a spinal injury than backs during both matches (P < 0.01) and training (P = 0.02). During matches, injuries to the cervical (average: 13 days; P < 0.01) and lumbar (13 days; P < 0.01) spine were more severe than injuries to the thoracic (5 days) spine; during training, injuries to the lumbar spine (26 days) were more severe than injuries to the cervical (13 days; P = 0.10) or thoracic (12 days; P = 0.06) spine. A total of 4037 days were lost to competition and training through spinal injuries with lumbar disc injuries sustained during training accounting for 926 days (23%) and cervical nerve root injuries sustained during matches for 621 days (15%). During matches, more injuries were caused by tackles (37%), and during training more injuries were caused by weight-training (33%). The results showed that rugby union players were exposed to a high risk of noncatastrophic spinal injury during tackling, scrummaging, and weight-training activities; injury prevention strategies, therefore, should be focused on these activities.

TU-F-12A-02: Quantitative Characterization of Normal Bone Marrow Proliferative Activity with FLT PET/CT

DOE Office of Scientific and Technical Information (OSTI.GOV)

Weisse, N; Jeraj, R

Purpose: [F-18]FLT PET is a tool for assessing health of bone marrow by evaluating its proliferative activity. This study establishes a baseline quantitative characterization of healthy marrow proliferation to aid in diagnosis of hematological disease. Methods: 31 patients (20 male, 11 female, 41–76 years) being treated for solid cancers with no history of hematological disease, osseous metastatic disease, or radiation therapy received pre-treatment FLT PET/CT scans. Total bone marrow was isolated from whole body FLT PET images by manually removing organs and applying a standardize uptake value (SUV) threshold of 1.0. Because adult marrow is concentrated in the axial skeleton,more » quantitative total bone marrow analysis (QTBMA) was used to isolate marrow in the lumbar spine, thoracic spine, sacrum, and pelvis for analysis. SUV mean, SUV max, and SUV CV were used to quantify bone marrow proliferation. Correlations were explored between SUV and patient characteristics including age, weight, height, and BMI using the Spearman coefficient (ρ). Results: The population-averaged whole-skeleton SUV mean, SUV max, and SUV CV were 3.0±0.6, 18.4±5.7, and 0.6±0.1, respectively. Uptake values in the axial skeleton were similar to the whole-skeleton demonstrated by SUV mean in the thoracic spine (3.6±0.6), lumbar spine (3.3±0.5), sacrum (3.0±0.6), and pelvis regions (2.8±0.5). Whole-skeleton SUV max correlated with patient weight (ρ=0.47, p<0.01) and BMI (ρ=0.60, p<0.01), suggesting marrow activity is related to the body's burden. SUV measures in the thoracic spine, lumbar spine, sacrum, and pelvis were negatively correlated with age (ρ:−0.41 to −0.46, p≤0.02). These negative correlations reflect the fact that active marrow in the adult skeleton is localized in the axial skeleton and decreases with age. Conclusions: Normal bone marrow characterizations were determined using FLT PET. These results provide a baseline characterization against which proliferative activity of abnormal marrow can be compared.« less

Differences in male and female spino-pelvic alignment in asymptomatic young adults: a three-dimensional analysis using upright low-dose digital biplanar X-rays.

PubMed

Janssen, Michiel M A; Drevelle, Xavier; Humbert, Ludovic; Skalli, Wafa; Castelein, René M

2009-11-01

A three-dimensional analysis of spino-pelvic alignment in 60 asymptomatic young adult males and females. To analyze the differences in sagittal spino-pelvic alignment in a group of asymptomatic young adult males and females and describe gender specific reference values. Several spinal disorders like idiopathic scoliosis and Scheuermann's disease have a well-known sex-related prevalence ratio. As spino-pelvic alignment plays an important role in spinal biomechanics, it is imperative to analyze possible differences between the male and female spino-pelvic alignment. Furthermore, in spinal fusion surgery, normal sagittal balance should be recreated as closely as possible. An innovative biplanar ultra low-dose radiographic technique was used to obtain three-dimensional reconstructions of the spine (T1-L5), sacrum, and pelvis in a freestanding position of 30 asymptomatic young male and 30 young female adults. Values were calculated for thoracic kyphosis (T4-T12), lumbar lordosis (L1-S1), total and regional lumbopelvic lordosis (PRT12, PRL2, PRL4, and PRL5), sagittal plumb line of T1, T4, and T9 (HAT1, HAT4, and HAT9), T1-L5 sagittal spinal inclination, T9 sagittal offset, and pelvic parameters (pelvic tilt, sacral slope, and pelvic incidence). In addition, vertebral inclination in the sagittal plane of each vertebra was measured. Differences in spino-pelvic alignment between the sexes were analyzed. The female spine was more dorsally inclined (11 degrees vs. 8 degrees ; P = 0.003). High thoracic and thoracolumbar vertebrae were more dorsally inclined in women than in men. Thoracic kyphosis, lumbar lordosis, regional lumbopelvic lordosis, sagittal plumb lines, T9 sagittal offset, and pelvic parameters were not statistically different between the sexes. These results indicate that the female spine is definitely different from the male spine. The spine as whole and individual vertebrae in certain regions of the normal spine is more backwardly inclined in females than in males. Based on our previous research this signifies that these spinal regions are subjected to different biomechanical loading conditions. These vertebral segments are possibly less rotationally stable in females than in males.

Thoracic Insufficiency Syndrome

MedlinePlus

... Patients with this condition can't maintain normal respiration or lung growth. The thorax (spine, rib cage, and sternum) is the engine of respiration. It must have adequate space for the lungs ...

The accuracy and safety of fluoroscopic-guided percutaneous pedicle screws in the thoracic and lumbosacral spine in the Asian population: A CT scan analysis of 1002 screws.

PubMed

Chiu, Chee Kidd; Chan, Chris Yin Wei; Kwan, Mun Keong

2017-01-01

This study investigates the safety and accuracy of percutaneous pedicle screws placed using fluoroscopic guidance in the thoracolumbosacral spine among Asian patients. Computerized tomography scans of 128 patients who had surgery using fluoroscopic-guided percutaneous pedicle screws were selected. Medial, lateral, superior, and inferior screw perforations were classified into grade 0 (no violation), grade 1 (<2 mm perforation), grade 2 (2-4 mm perforation), and grade 3(>4 mm perforation). Anterior perforations were classified into grade 0 (no violation), grade 1 (<4 mm perforation), grade 2 (4-6 mm perforation), and grade 3(>6 mm perforation). Grade 2 and grade 3 perforation were considered as "critical" perforation. In total, 1002 percutaneous pedicle screws from 128 patients were analyzed. The mean age was 52.7 ± 16.6. There were 70 male patients and 58 female patients. The total perforation rate was 11.3% (113) with 8.4% (84) grade 1, 2.6% (26) grade 2, and 0.3% (3) grade 3 perforations. The overall "critical" perforation rate was 2.9% (29 screws) and no complications were noted. The highest perforation rates were at T4 (21.6%), T2 (19.4%), and T6 (19.2%). The total perforation rate of 11.3% with the total "critical" perforation rate of 2.9% (2.6% grade 2 and 0.3% grade 3 perforations). The highest perforation rates were found over the upper to mid-thoracic region. Fluoroscopic-guided percutaneous pedicle screws insertion among Asians has the safety and accuracy comparable to the current reported percutaneous pedicle screws and open pedicle screws techniques.

Investigation of whiplash injuries in the upper cervical spine using a detailed neck model.

PubMed

Fice, Jason B; Cronin, Duane S

2012-04-05

Whiplash injuries continue to have significant societal cost; however, the mechanism and location of whiplash injury is still under investigation. Recently, the upper cervical spine ligaments, particularly the alar ligament, have been identified as a potential whiplash injury location. In this study, a detailed and validated explicit finite element model of a 50th percentile male cervical spine in a seated posture was used to investigate upper cervical spine response and the potential for whiplash injury resulting from vehicle crash scenarios. This model was previously validated at the segment and whole spine levels for both kinematics and soft tissue strains in frontal and rear impact scenarios. The model predicted increasing upper cervical spine ligament strain with increasing impact severity. Considering all upper cervical spine ligaments, the distractions in the apical and alar ligaments were the largest relative to their failure strains, in agreement with the clinical findings. The model predicted the potential for injury to the apical ligament for 15.2 g frontal or 11.7 g rear impacts, and to the alar ligament for a 20.7 g frontal or 14.4 g rear impact based on the ligament distractions. Future studies should consider the effect of initial occupant position on ligament distraction. Copyright © 2012 Elsevier Ltd. All rights reserved.

The Safety of Cardiac and Thoracic Magnetic Resonance Imaging in Patients with Cardiac Implantable Electronic Devices.

PubMed

Dandamudi, Sanjay; Collins, Jeremy D; Carr, James C; Mongkolwat, Pat; Rahsepar, Amir A; Tomson, Todd T; Verma, Nishant; Arora, Rishi; Chicos, Alex B; Kim, Susan S; Lin, Albert C; Passman, Rod S; Knight, Bradley P

2016-12-01

Studies reporting the safety of magnetic resonance imaging (MRI) in patients with a cardiac implantable electronic device (CIED) have mostly excluded examinations with the device in the magnet isocenter. The purpose of this study was to describe the safety of cardiac and thoracic spine MRI in patients with a CIED. The medical records of patients with a CIED who underwent a cardiac or thoracic spine MRI between January 2011 and December 2014 were reviewed. Devices were interrogated before and after imaging with reprogramming to asynchronous pacing in pacemaker-dependent patients. The clinical interpretability of the MRI and peak and average specific absorption rates (SARs, W/kg) achieved were determined. Fifty-eight patients underwent 51 cardiac and 11 thoracic spine MRI exams. Twenty-nine patients had a pacemaker and 29 had an implantable cardioverter defibrillator. Seventeen percent (n = 10) were pacemaker dependent. Fifty-one patients (89%) had non-MRI-conditional devices. There were no clinically significant changes in atrial and ventricular sensing, impedance, and threshold measurements. There were no episodes of device mode changes, arrhythmias, therapies delivered, electrical reset, or battery depletion. One study was prematurely discontinued due to a patient complaint of chest pain of which the etiology was not determined. Across all examinations, the average peak SAR was 2.0 ± 0.85 W/kg with an average SAR of 0.35 ± 0.37 W/kg. Artifact significantly limiting the clinical interpretation of the study was present in 33% of cardiac MRI studies. When a comprehensive CIED magnetic resonance safety protocol is followed, the risk of performing 1.5-T magnetic resonance studies with the device in the magnet isocenter, including in patients who are pacemaker dependent, is low. Copyright © 2016. Published by Elsevier Inc.

Predictors of Intrathoracic Injury after Blunt Torso Trauma in Children Presenting to an Emergency Department as Trauma Activations.

PubMed

McNamara, Caitlin; Mironova, Irina; Lehman, Erik; Olympia, Robert P

2017-06-01

Thoracic injuries are a major cause of death associated with blunt trauma in children. Screening for injury with chest x-ray study, compared with chest computed tomography (CT) scan, has been controversial, weighing the benefits of specificity with the detriment of radiation exposure. To identify predictors of thoracic injury in children presenting as trauma activations to a Level I trauma center after blunt torso trauma, and to compare these predictors with those previously reported in the literature. We performed a retrospective chart review of pediatric patients (<18 years of age) who presented to the Emergency Department of a Level I trauma center between June 2010 and June 2013 as a trauma activation after sustaining a blunt torso trauma and who received diagnostic imaging of the chest as part of their initial evaluation. Data analysis was performed on 166 patients. There were 33 patients (20%) with 45 abnormalities detected on diagnostic imaging of the chest, with the most common abnormalities being lung contusion (36%), pneumothorax (22%), and rib fracture (13%). Statistically significant predictors of abnormal diagnostic imaging of the chest included Glasgow Coma Scale score (GCS) < 15 (27% with abnormality vs. 13% without abnormality), hypoxia (22% vs. 5%), syncope/loss of consciousness (55% vs. 35%), cervical spine tenderness (12% vs. 3%), thoraco-lumbar-sacral spine tenderness (41% vs. 17%), and abdominal/pelvic tenderness (12% vs. 3%). Based on our data, predictors of thoracic injury in children after blunt torso trauma include GCS < 15, hypoxia, syncope/dizziness, cervical spine tenderness, thoraco-lumbar-sacral spine tenderness, and abdominal/pelvic tenderness. Copyright © 2016 Elsevier Inc. All rights reserved.

Thoracolumbar spine fractures in frontal impact crashes.

PubMed

Pintar, Frank A; Yoganandan, Narayan; Maiman, Dennis J; Scarboro, Mark; Rudd, Rodney W

2012-01-01

There is currently no injury assessment for thoracic or lumbar spine fractures in the motor vehicle crash standards throughout the world. Compression-related thoracolumbar fractures are occurring in frontal impacts and yet the mechanism of injury is poorly understood. The objective of this investigation was to characterize these injuries using real world crash data from the US-DOT-NHTSA NASS-CDS and CIREN databases. Thoracic and lumbar AIS vertebral body fracture codes were searched for in the two databases. The NASS database was used to characterize population trends as a function of crash year and vehicle model year. The CIREN database was used to examine a case series in more detail. From the NASS database there were 2000-4000 occupants in frontal impacts with thoracic and lumbar vertebral body fractures per crash year. There was an increasing trend in incidence rate of thoracolumbar fractures in frontal impact crashes as a function of vehicle model year from 1986 to 2008; this was not the case for other crash types. From the CIREN database, the thoracolumbar spine was most commonly fractured at either the T12 or L1 level. Major, burst type fractures occurred predominantly at T12, L1 or L5; wedge fractures were most common at L1. Most CIREN occupants were belted; there were slightly more females involved; they were almost all in bucket seats; impact location occurred approximately half the time on the road and half off the road. The type of object struck also seemed to have some influence on fractured spine level, suggesting that the crash deceleration pulse may be influential in the type of compression vector that migrates up the spinal column. Future biomechanical studies are required to define mechanistically how these fractures are influenced by these many factors.

Capillary Hemangioma of Thoracic Spinal Cord: PET/CT and MR Findings.

PubMed

Shen, Guohua; Su, Minggang; Zhao, Junyi; Liu, Bin; Kuang, Anren

2017-05-01

Capillary hemangiomas are frequently encountered superficially in the cutaneous, subcutaneous, or mucosal tissues during the childhood and early adulthood, but the occurrence of spinal intradural capillary hemangioma is relatively rare. Herein, we report a case with capillary hemangioma of the thoracic spine. MR and PET/CT features of this lesion are presented, and awareness of this entity may help differentiate it from other spinal intradural tumors.

A slouched body posture decreases arm mobility and changes muscle recruitment in the neck and shoulder region.

PubMed

Malmström, Eva-Maj; Olsson, Joakim; Baldetorp, Johan; Fransson, Per-Anders

2015-12-01

Long-term use of unfavorable postures, congenital deformations and degenerative processes associated with aging or disease may generate an increased thoracic curvature resulting in pain and disability. We wanted to examine whether a slouched postural alignment with increased thoracic kyphosis changes the shoulder kinematics and muscle activity in upper trapezius (UT), lower trapezius (LT) and serratus anterior (SA) during arm elevation. The aim was to determine if a slouched posture influences range of motion, muscle activation patterns, maximal muscle activity and the total muscle work required when performing arm elevations. Twelve male subjects (23.3 ± 1.5 years) performed maximum arm elevations in upright and slouched postures. A combined 3D movement and EMG system recorded arm movements and spine curvature simultaneously with EMG activity in the UT, LT and SA. Slouched posture affected the biomechanical conditions by significantly decreasing maximum arm elevation by ~15° (p < 0.001) and decreasing arm movement velocity by ~8 % during movements upwards (p < 0.001) and downwards (p = 0.034). The peak muscle activity increased in all muscles: UT (p = 0.034, +32.3 %), LT (p = 0.001, +48.6 %) and SA (p = 0.007, +20.9 %). The total muscle work increased significantly in the slouched posture during movements upwards: UT (p = 0.003, +36.6 %), LT (p < 0.001, +89.0 %), SA (p = 0.002, +19.4 %) and downwards: UT (p = 0.012, +29.8 %) and LT (p < 0.001, +122.5 %). An increased thoracic kyphosis was found associated with marked increased physical costs when performing arm movements. Hence, patients suffering from neck-shoulder pain and disability should be investigated and treated for defective thoracic curvature issues.

Central neuropathic pain in MS is due to distinct thoracic spinal cord lesions.

PubMed

Okuda, Darin T; Melmed, Kara; Matsuwaki, Takashi; Blomqvist, Anders; Craig, Arthur D Bud

2014-08-01

To determine a neuro-anatomic cause for central neuropathic pain (CNP) observed in multiple sclerosis (MS) patients. Parallel clinical and neuro-anatomical studies were performed. A clinical investigation of consecutively acquired MS patients with and without CNP (i.e. cold allodynia or deep hyperesthesia) within a single MS center was pursued. A multivariate logistic regression model was used to assess the relationship between an upper central thoracic spinal cord focus to central pain complaints. To identify the hypothesized autonomic interneurons with bilateral descending projections to lumbosacral sensory neurons, retrograde single- and double-labeling experiments with CTb and fluorescent tracers were performed in three animal species (i.e. rat, cat, and monkey). Clinical data were available in MS patients with (n = 32; F:23; median age: 34.6 years (interquartile range [IQR]: 27.4-45.5)) and without (n = 30; F:22; median age: 36.6 years [IQR: 31.6-47.1]) CNP. The value of a central focus between T1-T6 in relation to CNP demonstrated a sensitivity of 96.9% (95% confidence interval [CI]: 83.8-99.9) and specificity of 83.3% (95% CI: 65.3-94.4). A significant relationship between CNP and a centrally located focus within the thoracic spine was also observed (odds ratio [OR]: 155.0 [95% CI lower limit: 16.0]; P < 0.0001, two-tailed Fisher exact test). In all animal models, neurons with bilateral descending projections to the lumbosacral superficial dorsal horn were concentrated in the autonomic intermediomedial nucleus surrounding the mid-thoracic central canal. Our observations provide the first evidence for the etiology of CNP. These data may assist with the development of refined symptomatic therapies and allow for insights into unique pain syndromes observed in other demyelinating subtypes.

Spinal alignment in surgical, multisegmental, transpedicular correction of adolescent idiopathic scoliosis

PubMed Central

Nowakowski, Andrzej; Dworak, Lechosław B.; Kubaszewski, Łukasz; Kaczmarczyk, Jacek

2012-01-01

Summary The objective of this study was to discuss the variables influencing alignment mechanisms of the spine, with particular consideration of post-surgical alignment in adolescent idiopathic scoliosis. The analysis is based on information currently available in the literature, and on the authors’ own experience, which includes surgical material from over 2200 cases of idiopathic scoliosis. Over 50% of cases of adolescent idiopathic scoliosis are decompensated before surgical treatment. Spinal alignment is most significantly influenced by the position of the pelvis. Surgical restoration of lumbar lordosis is more important than attempting to restore thoracic kyphosis in the sagittal plane. The sagittal profile has an essential impact on spinal alignment. The same curves in the coronal plane can have various 3-dimensional configurations. Clinical difficulties in the assessment of thoracic kyphosis and lumbar lordosis result from the fact that they undergo constant change with age. Thoracic hypokyphosis diagnosed before surgery is a very frequent symptom of curve progression. The presence of proximal (thoraco-thoracic) and distal (thoraco-lumbar) junctional kyphosis is very important for planning the scope of spondylodesis. The natural tendency of the spine for alignment (compensation) after surgery nowadays occurs more naturally by applying derotational forces through pedicle screws, compared to the distraction devices (eg, Harrington rod) used in the past. PMID:23229319

Spine surgeon's kinematics during discectomy, part II: operating table height and visualization methods, including microscope.

PubMed

Park, Jeong Yoon; Kim, Kyung Hyun; Kuh, Sung Uk; Chin, Dong Kyu; Kim, Keun Su; Cho, Yong Eun

2014-05-01

Surgeon spine angle during surgery was studied ergonomically and the kinematics of the surgeon's spine was related with musculoskeletal fatigue and pain. Spine angles varied depending on operation table height and visualization method, and in a previous paper we showed that the use of a loupe and a table height at the midpoint between the umbilicus and the sternum are optimal for reducing musculoskeletal loading. However, no studies have previously included a microscope as a possible visualization method. The objective of this study is to assess differences in surgeon spine angles depending on operating table height and visualization method, including microscope. We enrolled 18 experienced spine surgeons for this study, who each performed a discectomy using a spine surgery simulator. Three different methods were used to visualize the surgical field (naked eye, loupe, microscope) and three different operating table heights (anterior superior iliac spine, umbilicus, the midpoint between the umbilicus and the sternum) were studied. Whole spine angles were compared for three different views during the discectomy simulation: midline, ipsilateral, and contralateral. A 16-camera optoelectronic motion analysis system was used, and 16 markers were placed from the head to the pelvis. Lumbar lordosis, thoracic kyphosis, cervical lordosis, and occipital angle were compared between the different operating table heights and visualization methods as well as a natural standing position. Whole spine angles differed significantly depending on visualization method. All parameters were closer to natural standing values when discectomy was performed with a microscope, and there were no differences between the naked eye and the loupe. Whole spine angles were also found to differ from the natural standing position depending on operating table height, and became closer to natural standing position values as the operating table height increased, independent of the visualization method. When using a microscope, lumbar lordosis, thoracic kyphosis, and cervical lordosis showed no differences according to table heights above the umbilicus. This study suggests that the use of a microscope and a table height above the umbilicus are optimal for reducing surgeon musculoskeletal fatigue.

Expanding the phenotype of spondylospinal thoracic dysostosis (the Turkel-Chen-Johnson syndrome).

PubMed

Becerra-Solano, Luis E; Chacon, Liliana; Morales-Mata, Dinorah; Ramírez-Dueñas, Maria de Lourdes; García-Ortiz, José E

2015-01-01

Spondylospinal thoracic dysostosis can be considered a type of spondylocostal dysostosis because of the occurrence of vertebral defects (hemivertebrae and vertebral body fusion) and thoracic anomalies (short thorax and pulmonary hypoplasia). This syndrome was described by Johnson et al. (1997) in two siblings with dwarfism, short thorax, curved spine, fusion of the vertebrae and spinal process, multiple pterygium, and arthrogryposis. We describe the case of a 16-year-old Mexican girl with the longest survival recorded (the previous oldest patient was 7 years old) and analyze the natural history and describe some new features of this rare entity.

Symptomatic thoracic spinal cord herniation: case series and technical report.

PubMed

Hawasli, Ammar H; Ray, Wilson Z; Wright, Neill M

2014-09-01

Idiopathic spinal cord herniation (ISCH) is an uncommon condition located predominantly in the thoracic spine and often associated with a remote history of a major traumatic injury. ISCH has an incompletely described presentation and unknown etiology. There is no consensus on the treatment algorithm and surgical technique, and there are few data on clinical outcomes. In this case series and technical report, we describe the atypical myelopathy presentation, remote history of traumatic injury, radiographic progression, treatment, and outcomes of 5 patients treated at Washington University for symptomatic ISCH. A video showing surgical repair is presented. In contrast to classic compressive myelopathy symptomatology, ISCH patients presented with an atypical myelopathy, characterized by asymmetric motor and sensory deficits and early-onset urinary incontinence. Clinical deterioration correlated with progressive spinal cord displacement and herniation observed on yearly spinal imaging in a patient imaged serially because of multiple sclerosis. Finally, compared with compressive myelopathy in the thoracic spine, surgical treatment of ISCH led to rapid improvement despite a long duration of symptoms. Symptomatic ISCH presents with atypical myelopathy and slow temporal progression and can be successfully managed with surgical repair.

Three-Dimensional Mechanical Model of the Human Spine and the Versatility of its Use

NASA Astrophysics Data System (ADS)

Sokol, Milan; Velísková, Petra; Rehák, Ľuboš; Žabka, Martin

2014-03-01

The aim of the work is oriented towards the simulation or modeling of the lumbar and thoracic human spine as a load-bearing 3D system in a computer program (ANSYS). The human spine model includes a determination of the geometry based on X-ray pictures of frontal and lateral projections. For this reason, another computer code, BMPCOORDINATES, was developed as an aid to obtain the most precise and realistic model of the spine. Various positions, deformations, scoliosis, rotation and torsion can be modelled. Once the geometry is done, external loading on different spinal segments is entered; consequently, the response could be analysed. This can contribute a lot to medical practice as a tool for diagnoses, and developing implants or other artificial instruments for fixing the spine.

Test-retest reliability of 3D ultrasound measurements of the thoracic spine.

PubMed

Fölsch, Christian; Schlögel, Stefanie; Lakemeier, Stefan; Wolf, Udo; Timmesfeld, Nina; Skwara, Adrian

2012-05-01

To explore the reliability of the Zebris CMS 20 ultrasound analysis system with pointer application for measuring end-range flexion, end-range extension, and neutral kyphosis angle of the thoracic spine. The study was performed within the School of Physiotherapy in cooperation with the Orthopedic Department at a University Hospital. The thoracic spines of 28 healthy subjects were measured. Measurements for neutral kyphosis angle, end-range flexion, and end-range extension were taken once at each time point. The bone landmarks were palpated by one examiner and marked with a pointer containing 2 transmitters using a frequency of 40 kHz. A third transmitter was fixed to the pelvis, and 3 microphones were used as receiver. The real angle was calculated by the software. Bland-Altman plots with 95% limits of agreement, intraclass correlations (ICC), standard deviations of mean measurements, and standard error of measurements were used for statistical analyses. The test-retest reliability in this study was measured within a 24-hour interval. Statistical parameters were used to judge reliability. The mean kyphosis angle was 44.8° with a standard deviation of 17.3° at the first measurement and a mean of 45.8° with a standard deviation of 16.2° the following day. The ICC was high at 0.95 for the neutral kyphosis angle, and the Bland-Altman 95% limits of agreement were within clinical acceptable margins. The ICC was 0.71 for end-range flexion and 0.34 for end-range extension, whereas the Bland-Altman 95% limits of agreement were wider than with the static measurement of kyphosis. Compared with static measurements, the analysis of motion with 3-dimensional ultrasound showed an increased standard deviation for test-retest measurements. The test-retest reliability of ultrasound measuring of the neutral kyphosis angle of the thoracic spine was demonstrated within 24 hours. Bland-Altman 95% limits of agreement and the standard deviation of differences did not appear to be clinically acceptable for measuring flexion and extension. Copyright © 2012 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Multidrug-resistant, progressive, invasive diffuse spinal aspergillosis: case report and review of the literature.

PubMed

Andaluz, N; Zuccarello, M

2008-06-01

The authors describe a 65-year-old man who, after 7 years of complete remission from lung cancer, was found on routine oncologic follow imaging to have lesions on several vertebral bodies. Open biopsy of the affected thoracic vertebrae and surrounding soft tissue were negative for neoplasia. Bacteriology cultures revealed colonies of aspergillus fumigatus in all bone samples. Unlike most reported cases in which vertebral compromise rarely extends to more than two adjacent vertebrae, our patient had extensive compromise of the thoracic spine. This infection progressed despite treatment with antifungal regimens known to be effective, even in immunocompromised patients. Invasive aspergillosis of the spine is a rare and typically occurred in terminal patients. However, the spectrum of hosts and clinical presentations of invasive aspergillosis are increasing, due in part to better medical treatments that prolong the survival of patients with cancer, severe infections, and organ failure. In reviewing the literature, the authors discuss the currently available therapies for such infections of the spine, and highlight the growing incidence these and other formerly rare infections.

Roentgenographic Evaluation of the Spine in Patients With Osteogenesis Imperfecta.

PubMed

de Lima, Marcos Vaz; de Lima, Fabiana Vaz; Akkari, Miguel; Resende, Vanessa Ribeiro de; Santili, Claudio

2015-11-01

Osteogenesis imperfecta (OI) is a hereditary connective tissue disorder that leads to bone weakness and deformities, especially in the spine, which can lead to poor outcomes.The aim of this study was to find patterns and risk factors in spinal deformities in patients with OI.In a retrospective study, 70 patients with OI were selected. Radiographs of the spine were evaluated. We observed the presence or absence of the following changes: biconcave vertebrae, chest and vertebral deformities, unilateral rib, and thoracolumbar kyphosis. The greater curve was considered the primary one, and the secondary curve considered compensatory.In the study sample, we observed that the patients' ages ranged between 7 and 50 years, with a mean equal to 13 years, and 76% had scoliosis. In 68% of cases the main curve in the thoracic region was observed with the convexity to the right.The following was found in patients with OI: scoliosis, biconcave vertebrae, vertebral and chest deformity, unilateral rib, and thoracolumbar kyphosis. The thoracolumbar kyphosis is highly associated with thoracic hypokyphosis in patients with OI.

Serial elongation derotation flexion (EDF) casting for patients with infantile and juvenile scoliosis.

PubMed

Canavese, Federico; Rousset, Marie; Mansour, Mounira; Samba, Antoine; Dimeglio, Alain

2016-02-01

Infantile and juvenile scoliosis, among different types of spinal deformity, is still a challenge for pediatric orthopedic surgeons. The ideal treatment of infantile and juvenile scoliosis has not yet been identified as both clinicians and surgeons still face multiple challenges, including preservation of the thoracic spine, thoracic cage, lung growth and cardiac function without reducing spinal motion. Elongation, derotation, flexion (EDF) casting technique is a custom-made thoracolumbar cast based on a three dimensional correction concept. This cast offers three-dimensional correction and can control the evolution of the deformity in some cases. Spinal growth can be guided by EDF casting as it can influence the initially curved spine to grow straighter. This article aimed to provide a comprehensive review of how infantile and juvenile scoliosis can affect normal spine and thorax and how these deformities can be treated with serial EDF casting technique. A current literature review is mandatory in order to understand the principles of the serial EDF casting technique and the effectiveness of conservative treatment in young and very young patients.

Association of head trauma with cervical spine injury, spinal cord injury, or both.

PubMed

Iida, H; Tachibana, S; Kitahara, T; Horiike, S; Ohwada, T; Fujii, K

1999-03-01

Links between cervical spine and/or spinal cord injuries and head trauma have not been reported in detail. 188 patients with cervical spine and/or spinal cord injury were divided into two groups, i.e., with upper cervical and mid-lower cervical injury, and compared for head injury. Associated head trauma was investigated in 188 patients with cervical spine and/or spinal cord injuries; 35% had moderate or severe injuries. Brain damage was more frequently observed in patients with upper cervical injury than in those with mid to lower cervical injury. Those patients with upper cervical injury appeared to have an elevated risk of suffering skull base fractures, traumatic subarachnoid hemorrhage, and contusional hemotoma. Approximately one third of patients with cervical spine and/or spinal cord injuries had moderate or severe head injuries. Brain damage was more frequently associated with upper cervical injury. Those patients with upper cervical injury are at greater risk of suffering from skull base fractures and severe intracranial hematomas than those with mid to lower cervical injury.

Surgical Treatment of Congenital Scoliosis Associated With Tethered Cord by Thoracic Spine-shortening Osteotomy Without Cord Detethering.

PubMed

Huang, Jing-Hui; Yang, Wei-Zhou; Shen, Chao; Chang, Michael S; Li, Huan; Luo, Zhuo-Jing; Tao, Hui-Ren

2015-10-15

Retrospective case series. To investigate the safety and efficacy of spine-shortening osteotomy for congenital scoliosis with tethered cord. Conventional surgery for congenital scoliosis associated with tethered cord risks the complications of detethering. Spine-shortening osteotomy holds the potential to correct scoliosis and decrease spinal cord tension simultaneously without an extra detethering procedure, but no data on this issue is available. 21 patients (14 females and 7 males, average age 15.4 yr) underwent spine-shortening osteotomy without detethering. All of the patients had tethered cord. Patients with main curve more than 90° underwent vertebral column resection (VCR), whereas the others had pedicle subtraction osteotomy (PSO) performed. The average postoperative follow-up period was 45.2 months. The mean operation time was 544.5 min with average blood loss of 2769.1 ml. The deformity correction was 61.3% in the coronal plane and 43.9° in the sagittal plane. 10 patients had neurological deficits preoperatively. At the final follow-up, the deficits in 8 (80%) patients were significantly improved, whereas 2 (20%) remained unchanged. At final follow-up, 71.4% (5/7) patients reported improvement in motor function, 100% (3/3) had improved pain scores, and 75% (3/4) reported better sensory function after the spine-shortening osteotomy. Urinary dysfunction and bowel incontinence present preoperatively in 3 patients all recovered by final follow-up. 5 (23.8%) patients incurred complications including temporary neurological deterioration in 1 patient, urinary tract infection in 2 patients, cerebrospinal fluid leakage in 1 patient, and blood loss more than 5000 ml in 1 patient. Spine-shortening osteotomy is a safe and effective procedure for congenital scoliosis associated with tethered cord. Spine-shortening osteotomy at the thoracic apical vertebrae level not only corrects the spine deformity but also simultaneously releases the tension of the tethered cord, resulting in improved neurologic function.

Anaplastic myxopapillary ependymoma in an infant: Case report and literature review.

PubMed

Trivedi, Darshan; Xiong, Zhenggang

2017-05-01

A 7-month-old boy presented with gastrointestinal disturbance, mild neurologic deficit of the left lower extremity and levo-scoliosis of the thoracic spine. Magnetic resonance imaging demonstrated a large intramedullary lesion involving the thoracic spine, from level T1 to T11. Histologic analysis showed a glial tumor with fibrillary processes arranged in radial pattern around mucoid fibrovascular cores with a high proliferative index (focally up to 80%) and prominent vascular endothelial hyperplasia. These findings were consistent with an anaplastic myxopapillary ependymoma. Subtotal resection was performed via a T3-T10 laminoplasty. A ventricular shunt was placed, and the patient subsequently received chemoradiation therapy. To date, this is the second case of a myxopapillary ependymoma with high-grade anaplastic features and the first case in an infant reported in the literature.

Intradural extramedullary hemangiopericytoma of the thoracic spine infiltrating a nerve root: a case report and literature review.

PubMed

Moscovici, Samuel; Ramirez-DeNoriega, Fernando; Fellig, Yakov; Rosenthal, Guy; Cohen, José E; Itshayek, Eyal

2011-11-01

Review the presentation and diagnosis of an intradural extramedullary hemangiopericytoma of the thoracic spine. To present a rare case of intradural, subpial hemangiopericytoma in the thoracic spine, with a brief overview of the literature. Spinal intradural extramedullary hemangiopericytoma is rare entity that radiographically mimics nerve-sheath tumors. These lesions are typically diagnosed at surgery performed due to suspicion of tumor. A 20-year-old man who presented with back pain, leg weakness, and sphincter incontinence. MR imaging demonstrated an intradural extramedullary lesion at the T9-T10 level that was isointense on T1- and T2-weighted images and homogeneously enhancing after administration of gadolinium, with cystic components seen on T2-weighted images. The preoperative diagnosis was meningioma or schwannoma. At surgery, the lesion was bluish and completely subpial, with apparent nerve root invasion. Pathological examination revealed a neoplasm adjacent to a nerve root with possible focal infiltration. Abundant reticulin fibers and widened, branching vascular channels imparting a staghorn appearance were seen. Up to five mitotic figures were counted in one high-power field. On immunostaining, the neoplastic cells were diffusely immunoreactive for CD99 and immunonegative for EMA, CD34, and S-100 protein. The pathological diagnosis was consistent with anaplastic hemangiopericytoma, WHO grade III. This is the ninth report of spinal intradural hemangiopericytoma. The location of the neoplasm supports the hypothesis that hemangiopericytoma may arise from the spinal pial capillaries.

Key-Vertebral Screws Strategy for Main Thoracic Curve Correction in Patients With Adolescent Idiopathic Scoliosis.

PubMed

Li, Jingfeng; Cheung, Kenneth M C; Samartzis, Dino; Ganal-Antonio, Anne K B; Zhu, Xiaodong; Li, Ming; Luk, Keith D K

2016-10-01

The following study was a prospective radiographic and retrospective clinical data assessment of adolescent idiopathic scoliosis (AIS) patients who had undergone a key-vertebral screws strategy (KVSS) at a single institution, with a minimum of 2 years' follow-up. The aim of the study was to introduce the KVSS for the operative treatment of AIS of the main thoracic curve, and to address the role of the fulcrum-bending radiograph (FBR) in predicting the outcome of surgical management by this method. The application of multilevel pedicle screws for the main thoracic curve in AIS patients is popular in an effort to provide spinal stability, enhance fusion outcome, and provide optimal curve correction. However, with the application of pedicle screw also comes a potential risk for soft tissue and neural injury and increased health care costs. It remains unknown whether limited screw placement can provide proper curve correction without compromising patient outcome. A total of 17 consecutive patients with AIS extending to the main thoracic spine, who had undergone posterior fusion and fixation by the KVSS, a procedure in which screws are placed at important strategic points in the spine (ie, bilaterally at the upper and lower end segments of the fusion block, apical vertebra on the convex side, adjacent cephalad, and caudal screw placement on the concave side), at a single institution, with a minimum of 2 year' follow-up, were included. The assessment of preoperative standing posteroanterior and sagittal, FBR, and postoperative standing posteroanterior and sagittal plain radiographs were assessed in all patients. The flexibility of the curve as well as the fulcrum-bending correction index (FBCI) were calculated for all patients. Postoperatively, radiographs were assessed at the immediate (ie, 1 wk) and last follow-up. Clinical assessment entailed evaluation of patient demographics and the presence of any intraoperative or postoperative complications. The mean age at the time of surgery was 15.6 years. The mean follow-up was 39.8 months. The average FBR flexibility was 62.2%. The mean immediate curve correction was 71.2%, which did not differ in comparison with the last follow-up assessment (P>0.05). The mean immediate and last follow-up FBCIs were 119.3% and 112.5%, respectively (P=0.079). A significant negative correlation was found between immediate FBCI to that of the FBR curve flexibility (r=-0.706; P=0.002), which remained similar on the last follow-up (r=-0.681; P=0.003). Sagittal alignment did not significantly change from the immediate to last follow-up (P=0.163) Fusion was achieved in all patients. No instrumentation-related complications were noted. Key-vertebral screws strategy is a safe and cost-effective method for the surgical treatment of the main thoracic curve in AIS patients. Moreover, in the context of this strategy, the FBR may have some predictive utility in the correction of the main thoracic curve in AIS patients.

Ventral C1 Fracture Combined with Congenital Posterior Cleft: What to Do?

PubMed

Gembruch, Oliver; Dammann, Philipp; Schoemberg, Tobias; Ahmadipour, Yahya; Payer, Michael; Sure, Ulrich; Tessitore, Enrico; Özkan, Neriman

2018-01-01

 We present a treatment approach for a rare condition of patients with a ventral C1 fracture and a congenital cleft in the posterior arch (half-ring Jefferson fracture) with an intact transverse atlantal ligament. Our technique aims to achieve stability of the atlanto-occipital and atlantoaxial joints while preserving mobility of the upper cervical spine.  Two male patients, 43 years and 29 years of age, respectively, were admitted to our hospital due to a fracture of the ventral arch of the atlas with no damage of the transverse atlantal ligament. Both men also presented a congenital cleft of the posterior arch. Initial conservative management with a halo-thoracic vest was performed in one case and failed. As a result, surgical treatment was performed in both cases using bilateral C1 mass screws and a transverse connector.  The patients showed no neurologic deficits on follow-up examination 4 weeks after surgery with a full range of head and neck motion. Computed tomography (CT) showed no dislocation of the implanted material with good dorsal alignment and a stable ventral fracture distance. Follow-up CT showed osseous stability in both cases with the beginning of bony ossification of the bone graft.  Isolated instable fractures of the ventral arch of the atlas with a congenital cleft of the posterior arch with no damage of the transverse atlantal ligament can be stabilized using bilateral C1 mass screws and a transverse connector preserving upper cervical spine mobility. Georg Thieme Verlag KG Stuttgart · New York.

[Research on the range of motion measurement system for spine based on LabVIEW image processing technology].

PubMed

Li, Xiaofang; Deng, Linhong; Lu, Hu; He, Bin

2014-08-01

A measurement system based on the image processing technology and developed by LabVIEW was designed to quickly obtain the range of motion (ROM) of spine. NI-Vision module was used to pre-process the original images and calculate the angles of marked needles in order to get ROM data. Six human cadaveric thoracic spine segments T7-T10 were selected to carry out 6 kinds of loads, including left/right lateral bending, flexion, extension, cis/counterclockwise torsion. The system was used to measure the ROM of segment T8-T9 under the loads from 1 Nm to 5 Nm. The experimental results showed that the system is able to measure the ROM of the spine accurately and quickly, which provides a simple and reliable tool for spine biomechanics investigators.

Pain involving the motor system and serum vitamin D concentration in postmenopausal women working in agriculture.

PubMed

Raczkiewicz, Dorota; Owoc, Alfred; Sarecka-Hujar, Beata; Bojar, Iwona

2017-03-22

Since the role of vitamin D is essential in numerous biological processes its deficiency was suggested to be a risk factor for e.g. osteoporosis, musculoskeletal pain and spine pain. The purpose of the study was to analyse whether serum vitamin D concentration is related to pain involving the motor system in Polish postmenopausal women working in agriculture. The study group consisted of 1,751 post-menopausal women, aged 45-65, at least 12 months from the last menstrual period, living in rural areas and working in agriculture. The research method was self-assessment of pain involving the motor system using VAS, laboratory test of serum vitamin D concentration and a medical interview. Statistical methods included generalized linear models, analysis of variance, t test for two means in two independents, χ2 test of stochastic independence. Postmenopausal women working in agriculture and suffering from pain in at least one part of the motor system were younger and lower educated, they also had higher abdominal obesity and lower serum vitamin D, compared to those without pain in any part of the motor system. Decreased serum vitamin D concentration in postmenopausal women working in agriculture is important from the aspect of a higher prevalence of pain in the thoracic spine and more severe pain in the neck spine, but not for severity of pain in the lumbar spine; higher occurrence of pain in both hands or wrists; higher prevalence and more severe pain in at least one knee; and no prevalence or severity of pain in the shoulders and elbows. Serum vitamin D concentration is important for the prevalence and severity of pain in the neck and thoracic spine, knees and hands or wrists, but not for the lumbar spine, shoulders and elbows.

An L-Shaped Incision for an Extensive Thoracic Aortic Aneurysm and Coronary Artery Bypass Using the Left Internal Thoracic Artery.

PubMed

Abe, Tomonobu; Suenaga, Hiroto; Oshima, Hideki; Araki, Yoshimori; Mutsuga, Masato; Fujimoto, Kazuro; Usui, Akihiko

2015-04-01

An L-shaped incision combining an upper half mid-sternotomy and a left antero-lateral thoracotomy at the fourth intercostal space has been proposed by several authors for extensive aneurysms involving the aortic arch and the proximal thoracic descending aorta. This approach usually requires the division of the left internal thoracic artery at its mid position, thus making it unusable for coronary artery bypass. We herein report a modified surgical approach for simultaneous extensive arch and proximal thoracic descending aorta replacement and coronary artery bypass using the left internal thoracic artery combining a left antero-lateral thoracotomy at the sixth intercostal space and upper mid-sternotomy. The visualization of the whole diseased aorta down to the level below the hilum of the left lung was good, and the integrity of the left internal thoracic artery graft was preserved by early heparin administration before sternotomy.

Thoracic pedicle classification determined by inner cortical width of pedicles on computed tomography images: its clinical significance for posterior vertebral column resection to treat rigid and severe spinal deformities-a retrospective review of cases.

PubMed

Zhang, Ying; Xie, Jingming; Wang, Yingsong; Bi, Ni; Zhao, Zhi; Li, Tao

2014-08-13

Posterior vertebral column resection (PVCR) is an effective alternative for treating rigid and severe spinal deformities. Accurate placement of pedicle screws, especially apically, is crucial. As morphologic evaluations of thoracic pedicles have not provided objective criteria, we propose a thoracic pedicle classification for treating rigid and severe spinal deformities. A consecutive series of 56 patients with severe and rigid spinal deformities who underwent PVCR at a single institution were reviewed retrospectively. Altogether, 1098 screws were inserted into thoracic pedicles at T2-T12. Based on the inner cortical width of the thoracic pedicles, the patients were divided into four groups: group 1 (0-1.0 mm), group 2 (1.1-2.0 mm), group 3 (2.1-3.0 mm), group 4 (≥3.1 mm). The proportion of screws accurately inserted in thoracic pedicles for each group was calculated. Statistical analysis was also performed regarding types of thoracic pedicles classified by Lenke et al. (SPINE 35:1836-1842, 2010) using a morphological method. There were statistically significant differences in the rates of screws inserted in thoracic pedicles between the groups (P < 0.008) except groups 3 and 4 (P > 0.008), which were then combined. The accuracies for the three new groups were 35.05%, 65.34%, and 88.32%, respectively, with statistically significant differences between the groups (P < 0.017). Rates of screws inserted in thoracic pedicles classified by Lenke et al. (SPINE 35:1836-1842, 2010) were 82.31%, 83.40%, 80.00%, and 30.28% for types A, B, C, and D, respectively. There was no statistically significant difference (P > 0.008) between these types except between type D and the other three types (P < 0.008). The inner cortical width of thoracic pedicles is the sole factor crucial for accurate placement of thoracic pedicle screws. We propose a computed tomography-based classification of the pedicle's inner cortical width: type I thoracic pedicle: absent channel, inner cortical width of 0-1 mm; type II: presence of a channel of which type IIa has an inner cortical width of 1.1-2.0 mm and type IIb a width of ≥2.1 mm. The proposed classification can help surgeons predict whether screws can be inserted into the thoracic pedicle, thus guiding instrumentation when PVCR is performed.

Growth Patterns of the Neurocentral Synchondrosis (NCS) in Immature Cadaveric Vertebra.

PubMed

Blakemore, Laurel; Schwend, Richard; Akbarnia, Behrooz A; Dumas, Megan; Schmidt, John

2018-03-01

Gross anatomic study of osteological specimens. To evaluate the age of closure for the neurocentral synchondrosis (NCS) in all 3 regions of the spine in children aged 1 to 18 years old. The ossification of the human vertebra begins from a vertebral body ossification center and a pair of neural ossification centers located within the centrum called the NCS. These bipolar cartilaginous centers of growth contribute to the growth of the vertebral body, spinal canal, and posterior elements of the spine. The closure of the synchondroses is dependent upon location of the vertebra and previous studies range from 2 to 16 years of age. Although animal and cadaveric studies have been performed regarding NCS growth and early instrumentation's effect on its development, the effects of NCS growth disturbances are still not completely understood. The vertebrae of 32 children (1 to 18 y old) from the Hamann-Todd Osteological collection were analyzed (no 2 or 9 y old specimens available). Vertebrae studied ranged from C1 to L5. A total of 768 vertebral specimens were photographed on a background grid to allow for measurement calibration. Measurements of the right and left NCS, pedicle width at the NCS, and spinal canal area were taken using Scandium image-analysis software (Olympus Soft Imaging Solutions, Germany). The percentage of the growth plate still open was found by dividing the NCS by the pedicle width and multiplying by 100. Data were analyzed with JMP 11 software (SAS Institute Inc., Cary, NC). The NCS was 100% open in all 3 regions of the spine in the 1- to 3-year age group. The cervical NCS closed first with completion around 5 years of age. The lumbar NCS was nearly fully closed by age 11. Only the thoracic region remained open through age 17 years. The left and right NCS closed simultaneously as there was no statistical difference between them. In all regions of the spine, the NCS appeared to close sooner in males than in females. Spinal canal area increased with age up to 12 years old in the cervical and thoracic spine but did not significantly change after age 3 in the lumbar spine. In conclusion, closure of the NCS differed among the cervical, thoracic, and lumbar spine regions. The NCS reached closure in males before females even though females mature faster and reach skeletal maturity sooner than males. However, it is not determined whether the continued open NCS in females to a later age may be a factor in their increased rate of scoliosis.

Use of Vertical Expandable Prosthetic Titanium Rib (VEPTR) in the Treatment of Congenital Scoliosis Without Fused Ribs.

PubMed

Murphy, Robert F; Moisan, Alice; Kelly, Derek M; Warner, William C; Jones, Tamekia L; Sawyer, Jeffrey R

2016-06-01

Although the vertical expandable prosthetic titanium rib (VEPTR) has been shown to be useful in treating congenital scoliosis (CS) with fused ribs, no studies to date have specifically evaluated the efficacy of VEPTR in the treatment of CS without fused ribs. The purpose of this study was to determine the effectiveness of VEPTR in sagittal/coronal curve correction and spine growth and compare its complication rate to the use of VEPTR in other conditions and to other treatment methods used for CS. A multicenter database was queried for patients with CS without fused ribs treated with VEPTR. Anteroposterior (AP) and lateral radiographs were used to measure parameters at 3 timepoints (preoperative, immediate postoperative, and latest follow-up): coronal Cobb angle, sagittal kyphosis, and thoracic and lumbar spine heights. Clinical data included age, time to follow-up, and complications. Twenty-five patients (13 females, 12 males) were identified. The average age at implantation was 5.7 years, with an average follow-up of 50 months. Several parameters improved from preoperative to latest follow-up: coronal Cobb angle (69 to 54 degrees, P<0.0001), thoracic spine height (T1-T12) in the AP (13.3 to 15.9 cm, P<0.0001) and lateral (14.8 to 17.4 cm, P=0.0024) planes, and lumbar spine height (L1-S1) in the AP (8.8 to 11.4 cm, P<0.0001) and lateral (9.9 to 11.9 cm, P=0.0002) planes. Kyphosis increased over the study period (36 to 41 degrees, P=0.6). Fifteen patients (60%) had 41 complications (average 2.75; range, 1 to 12). Twenty-eight complications (68%) were device-related, and 13 (32%) were disease-related. The most common complications were infection, wound dehiscence, and device migration. Six complications (15%) altered the course of treatment. Thoracic spine height increased 79% of expected growth. VEPTR is an effective treatment for patients with CS without fused ribs, as evidenced by improved radiographic parameters and increased spinal height, with a complication rate which is high but similar to other methods of treatment. Level IV-case series.

Study on Treatment with Respect to Idiopathic Scoliosis

NASA Astrophysics Data System (ADS)

Takeuchi, Kenzen; Azegami, Hideyuki; Murachi, Shunji; Kitoh, Junzoh; Ishida, Yoshito; Kawakami, Noriaki; Makino, Mitsunori

A hypothesis that the thoracic idiopathic scoliosis is buckling phenomenon of the fourth mode induced by the growth of thoracic vertebral bodies was presented in the previous work by the authors using numerical simulations with finite element model of the spine. If the hypothesis is acceptable, sensitivity function with respect to the critical growth of thoracic vertebrae on the maximization problem of buckling load with the fourth buckling mode gives us useful information to improve and develop treatments for the idiopathic scoliosis. The numerical results analyzed by the finite element method demonstrated that the sensitivity function is high at the articular capsules of the intervertebral joints, the intervertebral disks, the costotransverse joints and the constovertebral joints around the apex of the curvature in the case of the thoracic idiopathic scoliosis.

Cadaveric study of movement in the unstable upper cervical spine during emergency management: tracheal intubation and cervical spine immobilisation—a study protocol for a prospective randomised crossover trial

PubMed Central

Popp, Erik; Hüttlin, Petra; Weilbacher, Frank; Münzberg, Matthias; Schneider, Niko; Kreinest, Michael

2017-01-01

Introduction Emergency management of upper cervical spine injuries often requires cervical spine immobilisation and some critical patients also require airway management. The movement of cervical spine created by tracheal intubation and cervical spine immobilisation can potentially exacerbate cervical spinal cord injury. However, the evidence that previous studies have provided remains unclear, due to lack of a direct measurement technique for dural sac's space during dynamic processes. Our study will use myelography method and a wireless human motion tracker to characterise and compare the change of dural sac's space during tracheal intubations and cervical spine immobilisation in the presence of unstable upper cervical spine injury such as atlanto-occipital dislocation or type II odontoid fracture. Methods and analysis Perform laryngoscopy and intubation, video laryngoscope intubation, laryngeal tube insertion, fiberoptic intubation and cervical collar application on cadaveric models of unstable upper cervical spine injury such as atlanto-occipital dislocation or type II odontoid fracture. The change of dural sac's space and the motion of unstable cervical segment are recorded by video fluoroscopy with previously performing myelography, which enables us to directly measure dural sac's space. Simultaneously, the whole cervical spine motion is recorded at a wireless human motion tracker. The maximum dural sac compression and the maximum angulation and distraction of the injured segment are measured by reviewing fluoroscopic and myelography images. Ethics and dissemination This study protocol has been approved by the Ethics Committee of the State Medical Association Rhineland-Palatinate, Mainz, Germany. The results will be published in relevant emergency journals and presented at relevant conferences. Trial registration number DRKS00010499. PMID:28864483

Management of symptomatic vertebral haemangioma in a resource challenged environment.

PubMed

Adeolu, Augustine A; Balogun, James A; Adeleye, Amos O; Adeoye, Peter O; Okolo, Clement A; Ogbole, Godwin I

2010-07-01

Vertebral haemangiomas are benign lesions and often asymptomatic. They are more common in the thoracic spine where they may become symptomatic with varying presentations. We present two teenage girls who presented with progressive, nontraumatic paraparesis with no background history of chronic cough or underlying medical illness. The radiologic investigations were suggestive of vertebral haemangiomas of the thoracic spine. They had surgery: transthoracic approach with corpectomy and fusion with iliac crest autograft. The posterior stabilisation in the first patient was with Rush nails and circlage wire and only circlage wire in the second patient. The first patient's post-operative recovery was complicated by graft extrusion necessitating re-opening thoracotomy and graft replacement. They are, however, both ambulant at discharge and have remained so 13 and 15 months post-surgery. We have presented two cases with rewarding outcomes in the face of 'adaptive' instrumentation due to limited resources.

Symptomatic Thoracic Spinal Cord Herniation: Case Series and Technical Report

PubMed Central

Hawasli, Ammar H.; Ray, Wilson Z.; Wright, Neill M.

2014-01-01

Background and Importance Idiopathic spinal cord herniation (ISCH) is an uncommon condition located predominantly in the thoracic spine and often associated with a remote history of a major traumatic injury. ISCH has an incompletely described presentation and unknown etiology. There is no consensus on treatment algorithm and surgical technique, and there is little data on clinical outcomes. Clinical Presentation In this case series and technical report, we describe the atypical myelopathy presentation, remote history of traumatic injury, radiographic progression, treatment, and outcomes of 5 patients treated at Washington University for symptomatic ISCH. A video showing surgical repair is presented. In contrast to classic compressive myelopathy symptomology, ISCH patients presented with an atypical myelopathy, characterized by asymmetric motor and sensory deficits and early-onset urinary incontinence. Clinical deterioration correlated with progressive spinal cord displacement and herniation observed on yearly spinal imaging in a patient imaged serially due to multiple sclerosis. Finally compared to compressive myelopathy in the thoracic spine, surgical treatment of ISH led to rapid improvement despite long duration of symptoms. Conclusion Symptomatic ISCH presents with atypical myelopathy and slow temporal progression and can be successfully managed with surgical repair. PMID:24871148

Degenerative changes in adolescent spines: a comparison of motocross racers and age-matched controls.

PubMed

Daniels, David J; Luo, T David; Puffer, Ross; McIntosh, Amy L; Larson, A Noelle; Wetjen, Nicholas M; Clarke, Michelle J

2015-03-01

Motocross racing is a popular sport; however, its impact on the growing/developing pediatric spine is unknown. Using a retrospective cohort model, the authors compared the degree of advanced degenerative findings in young motocross racers with findings in age-matched controls. Patients who had been treated for motocross-related injury at the authors' institution between 2000 and 2007 and had been under 18 years of age at the time of injury and had undergone plain radiographic or CT examination of any spinal region were eligible for inclusion. Imaging was reviewed in a blinded fashion by 3 physicians for degenerative findings, including endplate abnormalities, loss of vertebral body height, wedging, and malalignment. Acute pathological segments were excluded. Spine radiographs from age-matched controls were similarly reviewed and the findings were compared. The motocross cohort consisted of 29 riders (mean age 14.7 years; 82% male); the control cohort consisted of 45 adolescents (mean age 14.3 years; 71% male). In the cervical spine, the motocross cohort had 55 abnormalities in 203 segments (average 1.90 abnormalities/patient) compared with 20 abnormalities in 213 segments in the controls (average 0.65/patient) (p = 0.006, Student t-test). In the thoracic spine, the motocross riders had 51 abnormalities in 292 segments (average 2.04 abnormalities/patient) compared with 25 abnormalities in 299 segments in the controls (average 1.00/patient) (p = 0.045). In the lumbar spine, the motocross cohort had 11 abnormalities in 123 segments (average 0.44 abnormalities/patient) compared with 15 abnormalities in 150 segments in the controls (average 0.50/patient) (p = 0.197). Increased degenerative changes in the cervical and thoracic spine were identified in adolescent motocross racers compared with age-matched controls. The long-term consequences of these changes are unknown; however, athletes and parents should be counseled accordingly about participation in motocross activities.

Heavily T2-weighted MR myelography in patients with spontaneous intracranial hypotension: a case-control study.

PubMed

Tsai, P-H; Fuh, J-L; Lirng, J-F; Wang, S-J

2007-08-01

We performed whole-spine heavily T2-weighted magnetic resonance (MR) myelography using a single-shot fast spin-echo pulse sequence in 17 patients (8 M/9 F) with spontaneous intracranial hypotension (SIH) to detect abnormal cerebrospinal fluid (CSF) collections. In addition, a group of age- and sex-matched controls were recruited. Follow-up MR myelography was also done at 3 weeks. MR myelography showed three kinds of abnormal CSF collections in 15 patients with SIH (88%): epidural fluid collection (n = 15, 88%), C1-2 extraspinal collections (n = 6, 35%) and CSF collections along nerve roots in the lower cervical or upper thoracic spines (n = 6, 35%). One patient (6%) showed a meningeal diverticulum. In contrast, none of the controls showed these findings. Overall, MR myelography results helped in early diagnosis of SIH in four (24%) patients whose initial brain MRIs failed to show typical SIH findings. Follow-up MR myelography results were compatible with the clinical changes with kappa statistics of 0.52 and an agreement rate of 76%. Our study showed heavily T2-weighted MR myelography provided a rapid, non-invasive and high yield method to diagnose and follow-up patients with SIH. Whether the CSF collections along the nerve roots represent the ongoing leakage sites warrants further study.

Epidural analgesia does not increase the rate of inpatient falls after major upper abdominal and thoracic surgery: a retrospective case-control study.

PubMed

Elsharydah, Ahmad; Williams, Tiffany M; Rosero, Eric B; Joshi, Girish P

2016-05-01

Postoperative epidural analgesia for major upper abdominal and thoracic surgery can provide significant benefits, including superior analgesia and reduced pulmonary dysfunction. Nevertheless, epidural analgesia may also be associated with decreased muscle strength, sympathetic tone, and proprioception that could possibly contribute to falls. The purpose of this retrospective case-control study was to search a large national database in order to investigate the possible relationship between postoperative epidural analgesia and the rate of inpatient falls. Data from the nationwide inpatient sample for 2007-2011 were queried for adult patients who underwent elective major upper abdominal and thoracic surgery. Multiple International Classification of Diseases, Ninth Revision, Clinical Modification codes for inpatient falls and accidents were combined into one binary variable. Univariate analyses were used for initial statistical analysis. Logistic regression analyses and McNemar's tests were subsequently used to investigate the association of epidural analgesia with inpatient falls in a 1:1 case-control propensity-matched sample after adjustment of patients' demographics, comorbidities, and hospital characteristics. Forty-two thousand six hundred fifty-eight thoracic and 54,974 upper abdominal surgical procedures were identified. The overall incidence of inpatient falls in the thoracic surgery group was 6.54% with an increasing trend over the study period from 4.95% in 2007 to 8.11% in 2011 (P < 0.001). Similarly, the overall incidence of inpatient falls in the upper abdominal surgery group was 5.30% with an increasing trend from 4.55% in 2007 to 6.07% in 2011 (P < 0.001). Postoperative epidural analgesia was not associated with an increased risk for postoperative inpatient falls in the thoracic surgery group (relative risk [RR], 1.18; 95% confidence interval [CI], 0.95 to 1.47; P = 0.144) and in the upper abdominal surgery group (RR, 0.84; 95% CI 0.64 to 1.09; P = 0.220). Inpatient falls compared with non-falls were associated with a longer median (interquartile range) length of hospital stay in both the thoracic surgery group (11 [7-17] days vs 9 [6-16] days, respectively; P < 0.001) and the upper abdominal surgery group (12 [7-20] days vs 10 [6-17] days, respectively; P < 0.001). Our study suggests that postoperative epidural analgesia for patients undergoing major upper abdominal and thoracic surgery is not associated with an increased risk of inpatient falls.

Biomechanical evaluation of a new fixation device for the thoracic spine.

PubMed

Hongo, Michio; Ilharreborde, Brice; Gay, Ralph E; Zhao, Chunfeng; Zhao, Kristin D; Berglund, Lawrence J; Zobitz, Mark; An, Kai-Nan

2009-08-01

The technology used in surgery for spinal deformity has progressed rapidly in recent years. Commonly used fixation techniques may include monofilament wires, sublaminar wires and cables, and pedicle screws. Unfortunately, neurological complications can occur with all of these, compromising the patients' health and quality of life. Recently, an alternative fixation technique using a metal clamp and polyester belt was developed to replace hooks and sublaminar wiring in scoliosis surgery. The goal of this study was to compare the pull-out strength of this new construct with sublaminar wiring, laminar hooks and pedicle screws. Forty thoracic vertebrae from five fresh frozen human thoracic spines (T5-12) were divided into five groups (8 per group), such that BMD values, pedicle diameter, and vertebral levels were equally distributed. They were then potted in polymethylmethacrylate and anchored with metal screws and polyethylene bands. One of five fixation methods was applied to the right side of the vertebra in each group: Pedicle screw, sublaminar belt with clamp, figure-8 belt with clamp, sublaminar wire, or laminar hook. Pull-out strength was then assessed using a custom jig in a servohydraulic tester. The mean failure load of the pedicle screw group was significantly larger than that of the figure-8 clamp (P = 0.001), sublaminar belt (0.0172), and sublaminar wire groups (P = 0.04) with no significant difference in pull-out strength between the latter three constructs. The most common mode of failure was the fracture of the pedicle. BMD was significantly correlated with failure load only in the figure-8 clamp and pedicle screw constructs. Only the pedicle screw had a statistically significant higher failure load than the sublaminar clamp. The sublaminar method of applying the belt and clamp device was superior to the figure-8 method. The sublaminar belt and clamp construct compared favorably to the traditional methods of sublaminar wires and laminar hooks, and should be considered as an alternative fixation device in the thoracic spine.

Biomechanical evaluation of a new fixation device for the thoracic spine

PubMed Central

Hongo, Michio; Ilharreborde, Brice; Zhao, Chunfeng; Zhao, Kristin D.; Berglund, Lawrence J.; Zobitz, Mark; An, Kai-Nan

2009-01-01

The technology used in surgery for spinal deformity has progressed rapidly in recent years. Commonly used fixation techniques may include monofilament wires, sublaminar wires and cables, and pedicle screws. Unfortunately, neurological complications can occur with all of these, compromising the patients’ health and quality of life. Recently, an alternative fixation technique using a metal clamp and polyester belt was developed to replace hooks and sublaminar wiring in scoliosis surgery. The goal of this study was to compare the pull-out strength of this new construct with sublaminar wiring, laminar hooks and pedicle screws. Forty thoracic vertebrae from five fresh frozen human thoracic spines (T5–12) were divided into five groups (8 per group), such that BMD values, pedicle diameter, and vertebral levels were equally distributed. They were then potted in polymethylmethacrylate and anchored with metal screws and polyethylene bands. One of five fixation methods was applied to the right side of the vertebra in each group: Pedicle screw, sublaminar belt with clamp, figure-8 belt with clamp, sublaminar wire, or laminar hook. Pull-out strength was then assessed using a custom jig in a servohydraulic tester. The mean failure load of the pedicle screw group was significantly larger than that of the figure-8 clamp (P = 0.001), sublaminar belt (0.0172), and sublaminar wire groups (P = 0.04) with no significant difference in pull-out strength between the latter three constructs. The most common mode of failure was the fracture of the pedicle. BMD was significantly correlated with failure load only in the figure-8 clamp and pedicle screw constructs. Only the pedicle screw had a statistically significant higher failure load than the sublaminar clamp. The sublaminar method of applying the belt and clamp device was superior to the figure-8 method. The sublaminar belt and clamp construct compared favorably to the traditional methods of sublaminar wires and laminar hooks, and should be considered as an alternative fixation device in the thoracic spine. PMID:19404687

Thoracic spine localization using preoperative placement of fiducial markers and subsequent CT. A technical report.

PubMed

Anaizi, Amjad Nasr; Kalhorn, Christopher; McCullough, Michael; Voyadzis, Jean-Marc; Sandhu, Faheem A

2015-01-01

A retrospective case series evaluating the use of fiducial markers with subsequent computed tomography (CT) or CT myelography for intraoperative localization. To evaluate the safety and utility of preoperative fiducial placement, confirmed with CT myelography, for intraoperative localization of thoracic spinal levels. Thoracic spine surgery is associated with serious complications, not the least of which is the potential for wrong-level surgery. Intraoperative fluoroscopy is often used but can be unreliable due to the patient's body habitus and anatomical variation. Sixteen patients with thoracic spine pathology requiring surgical intervention underwent preoperative fiducial placement at the pedicle of the level of interest in the interventional radiology suite. CT or CT myelogram was then done to evaluate fiducial location relative to the level of pathology. Surgical treatment followed at a later date in all patients. All patients underwent preoperative fiducial placement and CT or CT myelography, which was done on an outpatient basis in 14 of the 16 patients. Intraoperatively, fiducial localization was easily and quickly done with intraoperative fluoroscopy leading to correct localization of spinal level in all cases. All patients had symptomatic improvement following surgery. There were no complications from preoperative localization or operative intervention. Preoperative placement of fiducial markers confirmed with a CT or CT myelogram allows for reliable and fast intraoperative localization of the spinal level of interest with minimal risks and potential complications to the patient. In most cases, a noncontrast CT should be sufficient. This should be an equally reliable means of localization while further decreasing potential for complications. CT myelography should be reserved for pathology that is not evident on noncontrast CT. Accuracy of localization is independent of variations in rib number or vertebral segmentation. The technique is a safe, reliable, and rapid means of localizing spinal level during surgery. Georg Thieme Verlag KG Stuttgart · New York.

Do adolescents with idiopathic scoliosis have body schema disorders? A cross-sectional study.

PubMed

Picelli, Alessandro; Negrini, Stefano; Zenorini, Andrea; Iosa, Marco; Paolucci, Stefano; Smania, Nicola

2016-01-01

To date etiology of adolescent idiopathic scoliosis appears complex and still remains unclear. A distorted body schema has been proposed to be a part of a sequence of pathological events in the development of adolescent idiopathic scoliosis. To investigate the awareness of trunk misalignment in adolescents with idiopathic scoliosis. Information about 44 adolescents with idiopathic scoliosis was collected as follows: age; sex; handedness; family history of scoliosis; back pain; sport practice; shoulder and waist line symmetry; leg length; dorsal kyphosis; back hump; rehabilitation; scoliotic curve; Risser sign. We evaluated awareness of trunk misalignment with a graphic table displaying pictures of progressively increasing scoliotic curves. Patients were asked to indicate which picture corresponded to their perceived own spinal alignment. Patients with thoracolumbar scoliosis overestimated their actual thoracic spine curve. Patients with thoracic-thoracolumbar scoliosis underestimated their actual thoracolumbar spine curve and overestimated their actual lumbar spine curve. Scoliotic curve > 15°, double curve, younger age, back pain, family history of scoliosis and lower Risser score related with a misperception of trunk alignment. Our results support the hypothesis that adolescents with idiopathic scoliosis have an altered corporeal awareness of their trunk alignment.

Dysphagia and hypervitaminosis A: cervical hyperostosis.

PubMed

Wendling, Daniel; Hafsaoui, Chafika; Laurain, Jean-Marie; Runge, Michel; Magy-Bertrand, Nadine; Prati, Clément

2009-07-01

Vertebral hyperostosis typically predominates at the thoracic spine and causes only minor symptoms. Involvement of the cervical spine may cause dysphagia due to pressure on the esophagus. We report three cases of dysphagia revealing cervical hyperostosis. The patients were 3 men aged 54-73 years. Dysphagia was moderate in 2 patients and severe in 1 patient who had lost 4 kg over 6 months. Stiffness of the neck with mild pain was present. One patient reported a neck injury in childhood and another had a brother and father with similar symptoms. Radiographs showed exuberant anterior cervical hyperostosis. Two patients also had hyperostotic changes at the thoracic spine and pelvis. The skin and neurological evaluation were normal. Findings were normal from standard blood tests (C-reactive protein, calcium, and vitamin D). Tests were negative for the HLA-B27 antigen in all 3 patients. Serum vitamin A levels were high, ranging from 894 to 1123 microg/L (normal, 489-720). None of the patients reported taking retinoids or having unusual eating habits. Dysphagia can result from anterior cervical hyperostosis. A role for hypervitaminosis A in the genesis of hyperostosis has long been suspected. In our patients, the absence of vitamin A supplementation suggests an abnormality in vitamin A metabolism.

High level cross of the esophagus with the descending aorta in scoliosis: CT study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Takahashi, Koji; Kikuno, Motoyuki; Hyodoh, Hideki

1996-05-01

The esophagus occasionally crosses the descending aorta at an unusually high level (3-5 cm inferior to the carina) in right-sided scoliosis. The purpose of this study was to analyze the mechanism of this finding. We prospectively evaluated thoracic CT scans in 30 patients with right-sided scoliosis. We assessed the alterations in the positions of the esophagus and the descending aorta by the thoracic deformity. The descending aorta followed the scoliotic curve of the spine in 26 (87%) patients. The esophagus followed the scoliotic curve of the spine in 14 (47%) patients and did not in 16 (53%). The anteroposterior diametermore » of the thorax in the former group was significantly smaller than that in the latter (p < 0.01). High level cross of both structures was identified in 14 (47%) patients, and all of them belonged to the group in which the esophagus did not follow the scoliotic curve of the spine. The unusual high level cross of the esophagus with the descending aorta occasionally seen in scoliosis is due to a difference in the positional alterations of the two structures resulting from the scoliosis. 6 refs., 3 figs.« less

Late onset Pott's paraplegia in patients with upper thoracic sharp kyphosis.

PubMed

Zhang, Zhengfeng

2012-02-01

The purpose of this study was to determine the clinical results of patients with late onset upper thoracic sharp Pott's kyphosis and to predict the prognosis for Pott's paraplegics. The study included five patients who developed late onset upper thoracic (T1-T4) sharp Pott's kyphosis/kyphoscoliosis within a period from 19 to 37 years after the active disease was healed. The kyphosis angle of the patients ranged from 95° to 105°. Among them, three patients suffered onset of paraplegia ranging from 26 to 31 years after spinal tuberculosis was healed. The duration of neurological deterioration before surgery ranged from four to five years. All patients underwent decompressive surgery with an attempt to correct the curve. Neurological status was evaluated using the ASIA impairment classification and the motor score. Postoperatively, kyphosis correction ranged from 20° to 30° for five patients. No neurological deficit occurred in two patients with normal neurological status. Two ASIA D paraplegics remained unchanged after surgery and no further improvement was found at one year follow-up. One ASIA C paralysis deteriorated neurologically to ASIA B after surgery and persisted to a deterioration of neurological status at one year follow-up. Upper thoracic sharp Pott's kyphosis and neurological deficits occur progressively. The neurological recovery or improvement of Pott's paraplegics with upper thoracic severe sharp kyphosis results in poor prognosis after decompressive surgery.

Spine and axial skeleton injuries in the National Football League.

PubMed

Mall, Nathan A; Buchowski, Jacob; Zebala, Lukas; Brophy, Robert H; Wright, Rick W; Matava, Matthew J

2012-08-01

The majority of previous literature focusing on spinal injuries in American football players is centered around catastrophic injuries; however, this may underestimate the true number of these injuries in this athletic cohort. The goals of this study were to (1) report the incidence of spinal and axial skeleton injuries, both minor and severe, in the National Football League (NFL) over an 11-year period; (2) determine the incidence of spinal injury by injury type, anatomic location, player position, mechanism of injury, and type of exposure (practice vs game); and (3) determine the average number of practices and days missed because of injury for each injury type. Descriptive epidemiological study. All documented injuries to the cervical, thoracic, and lumbar spine; pelvis; ribs; and spinal cord were retrospectively analyzed using the NFL's injury surveillance database over a period of 11 seasons from 2000 through 2010. The data were analyzed by the number of injuries per athlete-exposure, the anatomic location and type of injury, player position, mechanism of injury, and number of days missed per injury. A total of 2208 injuries occurred to the spine or axial skeleton over an 11-season interval in the NFL, with a mean loss of 25.7 days per injury. This represented 7% of the total injuries during this time period. Of these 2208 injuries, 987 (44.7%) occurred in the cervical spine. Time missed from play was greatest for thoracic disc herniations (189 days/injury). Other injuries that had a mean time missed greater than 30 days included (in descending order) cervical fracture (120 days/injury), cervical disc degeneration/herniation (85 days/injury), spinal cord injury (77 days/injury), lumbar disc degeneration/herniation (52 days/injury), thoracic fracture (34 days/injury), and thoracic nerve injury (30 days/injury). Offensive linemen were the most likely to suffer a spinal injury, followed by defensive backs, defensive linemen, and linebackers. Blocking and tackling were the 2 most frequent injury mechanisms reported. Spinal and axial skeleton injuries occur frequently in the NFL and can result in significant time missed from practices and games. Tackling and blocking result in the greatest number of injuries, and players performing these activities are the most likely to sustain a spinal injury. The results of this study may be used as an impetus to formulate strategies to prevent spinal injuries in American football players.

Establishment and characterization of an open mini-thoracotomy surgical approach to an ovine thoracic spine fusion model.

PubMed

Yong, Mostyn R N O; Saifzadeh, Siamak; Askin, Geoffrey N; Labrom, Robert D; Hutmacher, Dietmar W; Adam, Clayton J

2014-01-01

A large animal model is required for the assessment of minimally invasive, tissue-engineering-based approaches to thoracic spine fusion, with relevance to deformity correction surgery for human adolescent idiopathic scoliosis. Here, we develop a novel open mini-thoracotomy approach in an ovine model of thoracic interbody fusion that allows the assessment of various fusion constructs, with a focus on novel, tissue-engineering-based interventions. The open mini-thoracotomy surgical approach was developed through a series of mock surgeries, and then applied in a live sheep study. Customized scaffolds were manufactured to conform with intervertebral disc space clearances that were required of the study. Six male Merino sheep aged 4-6 years and weighing 35-45 kg underwent the procedure mentioned earlier and were alloted a survival timeline of 6 months. Each sheep underwent a three-level discectomy (T6/7, T8/9, and T10/11) with a randomly allocated implantation of a different graft substitute at each of the following three levels: (1) polycaprolactone (PCL)-based scaffold plus 0.54 μg recombinant human bone morphogenetic protein-2 (rhBMP-2); (2) PCL-based scaffold alone; or (3) autograft. The sheep were closely monitored postoperatively for signs of pain (i.e., gait abnormalities/teeth gnawing/social isolation). Fusion assessments were conducted postsacrifice using computed tomography and hard-tissue histology. All scientific work was undertaken in accordance with the study protocol that was approved by the Institute's committee on animal research. All six sheep were successfully operated on and reached the allotted survival timeline, thereby demonstrating the feasibility of the surgical procedure and postoperative care. There were no significant complications and during the postoperative period, the animals did not exhibit marked signs of distress according to the previously described assessment criteria. Computed tomographic scanning demonstrated higher fusion grades in the rhBMP-2 plus PCL-based scaffold group in comparison to either PCL-based scaffold alone or autograft. These results were supported by a histological evaluation of the respective groups. This novel open mini-thoracotomy surgical approach to the ovine thoracic spine represents a safe surgical method that can reproducibly form the platform for research into various spine-tissue-engineered constructs and their fusion-promoting properties.

Paediatric cervical spine injures. Nineteen years experience of a single centre.

PubMed

Ribeiro da Silva, Manuel; Linhares, Daniela; Cacho Rodrigues, Pedro; Monteiro, Eurico Lisboa; Santos Carvalho, Manuel; Negrão, Pedro; Pinto, Rui Peixoto; Neves, Nuno

2016-06-01

This observational study aims to describe pediatric C-spine injuries from a level 1 trauma centre through a period of 19 years. Clinical records of pediatric trauma patients admitted to a level 1 trauma centre between 1991 and 2009 were analyzed. Patients were stratified by age into groups A (8 or less) and B (9 to 16), and in lower (C0-C2) and upper (C3-C7) spine injuries. Several variables were studied. Seventy-five cases of C-spine injuries (nine SCIWORA) were identified. Group A included 23 patients and group B 52. In group A, skeletal injuries at the upper C-spine were more common than injuries at the lower C-spine, whereas in group B, injuries of the lower C-spine were more frequent (p = 0.035). Motor vehicle accidents were the main cause of injury (44 %); 25.3 % of patients were surgically treated. Thirty-nine patients presented neurologic deficits, 16 of which improved. The overall mortality rate was 18.7 % and significantly higher in patients with neurological damages (p < 0.001) CONCLUSIONS: This study revealed a low incidence of cervical spine injuries in the paediatric population. As in previous reports younger children mainly sustained injuries at the upper C-spine, higher incidence of spinal injuries, and higher risk of death than older children.

Occupant Kinematics in Laboratory Rollover Tests: ATD Response and Biofidelity.

PubMed

Zhang, Qi; Lessley, David L; Riley, Patrick; Toczyski, Jacek; Lockerby, Jack; Foltz, Patrick; Overby, Brian; Seppi, Jeremy; Crandall, Jeff R; Kerrigan, Jason R

2014-11-01

Rollover crashes are a serious public health problem in United States, with one third of traffic fatalities occurring in crashes where rollover occurred. While it has been shown that occupant kinematics affect the injury risk in rollover crashes, no anthropomorphic test device (ATD) has yet demonstrated kinematic biofidelity in rollover crashes. Therefore, the primary goal of this study was to assess the kinematic response biofidelity of six ATDs (Hybrid III, Hybrid III Pedestrian, Hybrid III with Pedestrian Pelvis, WorldSID, Polar II and THOR) by comparing them to post mortem human surrogate (PMHS) kinematic response targets published concurrently; and the secondary goal was to evaluate and compare the kinematic response differences among these ATDs. Trajectories (head, T1, T4, T10, L1 and sacrum), spinal segment (head-to-T1, T1-to-T4, T4-T10, T10-L1, and L1-to-sacrum) rotations relative to the rollover buck, and spinal segment extension/compression were calculated from the collected kinematics data from an optical motion tracking system. Response differences among the ATDs were observed mainly due to the different lateral bending stiffness of the spine from their varied architecture, while the additional thoracic joint in Polar II and THOR did not seem to provide more flexion/extension compliance than the other ATDs. In addition, the ATD response data were compared to PMHS response corridors developed from similar tests for assessing ATD biofidelity. All of the ATDs, generally, drifted outboard and upward during the tests similar to the PMHS. However, accompanied with this upward and outward motion, the ATD head and upper torso pitched forward (~10 degrees) while the PMHS' head and upper torso pitching rearward (~10 to ~15 degrees), due to the absence of flexion/extension compliance in the ATD spine. The differences in these pitch motions resulted in a difference of 130 mm to 160 mm in the longitudinal position of the head at 195 degrees of roll angle. Finally, substantially less lateral spinal bending was also observed in the ATDs compared to the PMHS. The results of the current study suggests there is greater upper spine flexion/extension, and lateral bending stiffness in all of the ATDs in comparison to the PMHS, and provided information for improvement of ATD biofidelity in future for rollover crashes.

Three-dimensional morphometrics of thoracic vertebrae in Neandertals and the fossil evidence from El Sidrón (Asturias, Northern Spain).

PubMed

Bastir, Markus; García Martínez, Daniel; Rios, Luis; Higuero, Antonio; Barash, Alon; Martelli, Sandra; García Tabernero, Antonio; Estalrrich, Almudena; Huguet, Rosa; de la Rasilla, Marco; Rosas, Antonio

2017-07-01

Well preserved thoracic vertebrae of Neandertals are rare. However, such fossils are important as their three-dimensional (3D) spatial configuration can contribute to the understanding of the size and shape of the thoracic spine and the entire thorax. This is because the vertebral body and transverse processes provide the articulation and attachment sites for the ribs. Dorsal orientation of the transverse processes relative to the vertebral body also rotates the attached ribs in a way that could affect thorax width. Previous research indicates possible evidence for greater dorsal orientation of the transverse processes and small vertebral body heights in Neandertals, but their 3D vertebral structure has not yet been addressed. Here we present 15 new vertebral remains from the El Sidrón Neandertals (Asturias, Northern Spain) and used 3D geometric morphometrics to address the above issues by comparing two particularly well preserved El Sidrón remains (SD-1619, SD-1641) with thoracic vertebrae from other Neandertals and a sample of anatomically modern humans. Centroid sizes of El Sidrón vertebrae are within the human range. Neandertals have larger T1 and probably also T2. The El Sidrón vertebrae are similar in 3D shape to those of other Neandertals, which differ from Homo sapiens particularly in central-lower regions (T6-T10) of the thoracic spine. Differences include more dorsally and cranially oriented transverse processes, less caudally oriented spinous processes, and vertebral bodies that are anteroposteriorly and craniocaudally short. The results fit with current reconstructions of Neandertal thorax morphology. Copyright © 2017 Elsevier Ltd. All rights reserved.

The relationship of forward head posture and rounded shoulders with neck pain in Iranian office workers.

PubMed

Nejati, Parisa; Lotfian, Sara; Moezy, Azar; Moezy, Azar; Nejati, Mina

2014-01-01

Background Office workers spend a long period of time behind a computer during working hours. The relation between the posture of sitting during work with computer and neck pain is still debatable. Even though some researchers claim a significant difference in head posture between patients with neck pain and pain-free participants, the FHP (forward head posture) has not always been associated with neck pain in literature. So, the purpose of this study was to discover the relationship between neck pain and improper posture in the head, cervicothoracic spine and shoulders. This was a cross-sectional study to explore the relationships between neck pains, sagittal postures of cervical and thoracic spine and shoulders among office workers in two positions, straight looking forward and working position. 46 subjects without neck pain and 55 subjects with neck pain were evaluated using a photographic method. Thoracic and cervical postures were measured by the HT (High Thoracic), CV (Craniovertebral) angles respectively. Shoulder's posture was evaluated in the sagittal plane by the acromion protrusion. HT and CV angles were positively correlated with the presence of neck pain only in working position (p< 0.05). In straight looking forward position there was no significant difference between the two groups statistically (p>0.05). The difference of shoulder protrusion between symptomatic and asymptomatic groups was not significant. FHP and thoracic kyphosis were accompanied with neck pain. But shoulder posture was not correlated with neck pain.

Clinical methods to quantify trunk mobility in an elite male surfing population.

PubMed

Furness, James; Climstein, Mike; Sheppard, Jeremy M; Abbott, Allan; Hing, Wayne

2016-05-01

Thoracic mobility in the sagittal and horizontal planes are key requirements in the sport of surfing; however to date the normal values of these movements have not yet been quantified in a surfing population. To develop a reliable method to quantify thoracic mobility in the sagittal plane; to assess the reliability of an existing thoracic rotation method, and quantify thoracic mobility in an elite male surfing population. Clinical Measurement, reliability and comparative study. A total of 30 subjects were used to determine the reliability component. 15 elite surfers were used as part of a comparative analysis with age and gender matched controls. Intraclass correlation coefficient values ranged between 0.95-0.99 (95% CI; 0.89-0.99) for both thoracic methods. The elite surfing group had significantly (p ≤ 0.05) greater rotation than the comparative group (mean rotation 63.57° versus 40.80°, respectively). This study has illustrated reliable methods to assess the thoracic spine in the sagittal plane and thoracic rotation. It has also quantified ROM in a surfing cohort; identifying thoracic rotation as a key movement. This information may provide clinicians, coaches and athletic trainers with imperative information regarding the importance of maintaining adequate thoracic rotation. Copyright © 2015 Elsevier Ltd. All rights reserved.

Spinal postural training: Comparison of the postural and mobility effects of electrotherapy, exercise, biofeedback trainer in addition to postural education in university students.

PubMed

Çelenay, Şeyda Toprak; Kaya, Derya Özer; Özüdoğru, Anıl

2015-01-01

Spinal posture and mobility are significant for protecting spine. The aim was to compare effects of different postural training interventions on spinal posture and mobility. Ninety-six university students (ages: 18–25 years) were allocated into Electrical Stimulation (ES) (n = 24), Exercise (n = 24), Biofeedback Posture Trainer (Backtone) (n = 24), and Postural Education (n = 24, Controls) groups. All the groups got postural education. The interventions were carried out 3 days a week for 8 weeks. Spinal Mouse device (Idiag, Fehraltorf, Switzerland) was used to detect thoracic and lumbar curvatures and mobility (degrees) in standing and sitting positions. Paired Student’s t-test, one-way ANOVA, and pairwise post-hoc tests were used. ES decreased thoracic curvature, the exercise decreased thoracic and lumbar curvature and increased thoracic mobility in standing position between pre-post training (p < 0.05). Exercise and Backtone improved thoracic curvature in sitting (p <0.05). In Exercise Group, thoracic curvature decreased compared to Backtone and Education Groups, and thoracic mobility increased compared to all groups (p < 0.05). The exercise was effective and superior in improving thoracic and lumbar curves, and mobility among university students. ES decreased thoracic curve. Biofeedback posture trainer improved sitting posture. A prospective randomized controlled trial, Level 1.

Fractures of the cervical spine

PubMed Central

Marcon, Raphael Martus; Cristante, Alexandre Fogaça; Teixeira, William Jacobsen; Narasaki, Douglas Kenji; Oliveira, Reginaldo Perilo; de Barros Filho, Tarcísio Eloy Pessoa

2013-01-01

OBJECTIVES: The aim of this study was to review the literature on cervical spine fractures. METHODS: The literature on the diagnosis, classification, and treatment of lower and upper cervical fractures and dislocations was reviewed. RESULTS: Fractures of the cervical spine may be present in polytraumatized patients and should be suspected in patients complaining of neck pain. These fractures are more common in men approximately 30 years of age and are most often caused by automobile accidents. The cervical spine is divided into the upper cervical spine (occiput-C2) and the lower cervical spine (C3-C7), according to anatomical differences. Fractures in the upper cervical spine include fractures of the occipital condyle and the atlas, atlanto-axial dislocations, fractures of the odontoid process, and hangman's fractures in the C2 segment. These fractures are characterized based on specific classifications. In the lower cervical spine, fractures follow the same pattern as in other segments of the spine; currently, the most widely used classification is the SLIC (Subaxial Injury Classification), which predicts the prognosis of an injury based on morphology, the integrity of the disc-ligamentous complex, and the patient's neurological status. It is important to correctly classify the fracture to ensure appropriate treatment. Nerve or spinal cord injuries, pseudarthrosis or malunion, and postoperative infection are the main complications of cervical spine fractures. CONCLUSIONS: Fractures of the cervical spine are potentially serious and devastating if not properly treated. Achieving the correct diagnosis and classification of a lesion is the first step toward identifying the most appropriate treatment, which can be either surgical or conservative. PMID:24270959

Short-Term Effects of Thoracic Spine Manipulation on Shoulder Impingement Syndrome: A Randomized Controlled Trial.

PubMed

Haik, Melina N; Alburquerque-Sendín, Francisco; Camargo, Paula R

2017-08-01

To investigate the short-term effects of thoracic spine manipulation (TSM) on pain, function, scapular kinematics, and scapular muscle activity in individuals with shoulder impingement syndrome. Randomized controlled trial with blinded assessor and patient. Laboratory. Patients with shoulder impingement syndrome (N=61). Participants were randomly allocated to TSM group (n=30) or sham-TSM group (n=31) and attended 2 intervention sessions over a 1-week period. Scapular kinematics and muscle activity were measured at day 1 (baseline, before the first intervention), day 2 preintervention (before second intervention), day 2 postintervention (after the second intervention), and day 3 (follow-up). Shoulder pain and function were assessed by the Disability of the Arm, Shoulder and Hand questionnaire and Western Ontario Rotator Cuff Index at baseline, day 2 preintervention, and follow-up. An assessor blinded to group assignment measured all outcomes. Pain decreased by 0.7 points (95% confidence interval, 1.3-0.1 points) at day 2 preintervention and 0.9 points (95% confidence interval, 1.5-0.3 points) at day 2 postintervention in the TSM group. The Disability of the Arm, Shoulder and Hand questionnaire (P=.01) and Western Ontario Rotator Cuff Index (P=.02) scores improved in both groups. Scapular upward rotation increased during arm lowering (P<.01) at day 2 postintervention (5.3°) and follow-up (3.5°) in the TSM group. Upper trapezius activity increased (P<.05) in the sham-TSM group. Middle trapezius, lower trapezius, and serratus anterior decreased activities in both groups during elevation and lowering of the arm. TSM may increase scapular upward rotation during arm lowering. TSM does not seem to influence activity of the scapular muscles. The results concerning shoulder pain, function, scapular tilt, and internal rotation are not conclusive. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Lumbar interspinous bursitis in active polymyalgia rheumatica.

PubMed

Salvarani, Carlo; Barozzi, Libero; Boiardi, Luigi; Pipitone, Nicolò; Bajocchi, Gian Luigi; Macchioni, Pier Luigi; Catanoso, Mariagrazia; Pazzola, Giulia; Valentino, Massimo; De Luca, Carlo; Hunder, Gene G

2013-01-01

To evaluate the inflammatory involvement of lumbar interspinous bursae in patients with polymyalgia rheumatica (PMR) using magnetic resonance imaging (MRI). Ten consecutive, untreated new patients with PMR and pain in the shoulder and pelvic girdles were investigated. Seven patients with spondyloarthritis (4 with psoriatic spondyloarthrits, one with entheropatic spondyloarthritis, and 2 with ankylosing spondylitis) as well as 2 patients with spinal osteoarthritis and 2 patients with rheumatoid arthritis with lumbar pain served as controls. MRI of lumbar spine was performed in all PMR patients and controls. Nine patients (5 PMR patients and 4 controls) also had MRI of the thoracic spine. MRI evidence of interspinous lumbar bursitis was found in 9/10 patients with PMR and in 5/11 controls. A moderate to marked (grade ≥2 on a semiquantitative 0-3 scale) lumbar bursitis occurred significantly more frequently in patients with PMR than in control patients (60% vs. 9%, p=0.020). In most of the patients and controls lumbar bursitis was found at the L3-L5 interspaces. Only 2 patients had bursitis at a different level (one patient had widespread lumbar bursitis, and one control at L2-L4). No interspinous bursitis was demonstrated by MRI of the thoracic spine in patients and controls. Inflammation of lumbar bursae may be responsible for the low back pain reported by patients with PMR. The prominent inflammatory involvement of bursae including those of the lumbar spine supports the hypothesis that PMR may be a disorder affecting predominantly extra-articular synovial structures.

Assessment of a Learning Strategy among Spine Surgeons.

PubMed

Gotfryd, Alberto Ofenhejm; Corredor, Jose Alfredo; Teixeira, William Jacobsen; Martins, Delio Eulálio; Milano, Jeronimo; Iutaka, Alexandre Sadao

2017-02-01

Pilot test, observational study. To evaluate objectively the knowledge transfer provided by theoretical and practical activities during AOSpine courses for spine surgeons. During two AOSpine principles courses, 62 participants underwent precourse assessment, which consisted of questions about their professional experience, preferences regarding adolescent idiopathic scoliosis (AIS) classification, and classifying the curves by means of the Lenke classification of two AIS clinical cases. Two learning strategies were used during the course. A postcourse questionnaire was applied to reclassify the same deformity cases. Differences in the correct answers of clinical cases between pre- and postcourse were analyzed, revealing the number of participants whose accuracy in classification improved after the course. Analysis showed a decrease in the number of participants with wrong answers in both cases after the course. In the first case, statistically significant differences were observed in both curve pattern (83.3%, p   =  0.005) and lumbar spine modifier (46.6%, p   =  0.049). No statistically significant improvement was seen in the sagittal thoracic modifier (33.3%, p   =  0.309). In the second case, statistical improvement was obtained in curve pattern (27.4%, p   =  0.018). No statistically significant improvement was seen regarding lumbar spine modifier (9.8%, p   =  0.121) and sagittal thoracic modifier (12.9%, p   =  0.081). This pilot test showed objectively that learning strategies used during AOSpine courses improved the participants' knowledge. Teaching strategies must be continually improved to ensure an optimal level of knowledge transfer.

Assessment of a Learning Strategy among Spine Surgeons

PubMed Central

Gotfryd, Alberto Ofenhejm; Teixeira, William Jacobsen; Martins, Delio Eulálio; Milano, Jeronimo; Iutaka, Alexandre Sadao

2017-01-01

Study Design Pilot test, observational study. Objective To evaluate objectively the knowledge transfer provided by theoretical and practical activities during AOSpine courses for spine surgeons. Methods During two AOSpine principles courses, 62 participants underwent precourse assessment, which consisted of questions about their professional experience, preferences regarding adolescent idiopathic scoliosis (AIS) classification, and classifying the curves by means of the Lenke classification of two AIS clinical cases. Two learning strategies were used during the course. A postcourse questionnaire was applied to reclassify the same deformity cases. Differences in the correct answers of clinical cases between pre- and postcourse were analyzed, revealing the number of participants whose accuracy in classification improved after the course. Results Analysis showed a decrease in the number of participants with wrong answers in both cases after the course. In the first case, statistically significant differences were observed in both curve pattern (83.3%, p  =  0.005) and lumbar spine modifier (46.6%, p  =  0.049). No statistically significant improvement was seen in the sagittal thoracic modifier (33.3%, p  =  0.309). In the second case, statistical improvement was obtained in curve pattern (27.4%, p  =  0.018). No statistically significant improvement was seen regarding lumbar spine modifier (9.8%, p  =  0.121) and sagittal thoracic modifier (12.9%, p  =  0.081). Conclusion This pilot test showed objectively that learning strategies used during AOSpine courses improved the participants' knowledge. Teaching strategies must be continually improved to ensure an optimal level of knowledge transfer. PMID:28451507

Solid Variant of an Aneurysmal Bone Cyst of the Thoracic Spine.

PubMed

Mehta, Varshil; Padalkar, Pravin; Kale, Maya; Kathare, Ambadas

2017-05-01

The solid variant of an aneurysmal bone cyst (ABC) has been observed very rarely, especially those involving the spine. In this case report, we present a very unusual tumour of the thoracic spine which was managed by 360˚ decompression via posterior-only approach and stabilization. A 16-year-old boy presented to us with a sudden onset of weakness in both lower limbs leading to paraplegia. He also had a history of back and chest pain over the past one year. A collapse of the T5 vertebrae on plain radiograph was observed. The patient was immediately shifted to the operation theatre with an initial plan of a total en bloc spondylectomy of the T5. However, intraoperatively, histology favored a solid-ABC variant rather than a spindle cell tumour or giant cell tumour. Thus, the initial plan was revised to a 360˚ decompression without resecting the body en bloc via a posterolateral approach. After surgery, complete resolution of his sensory and motor dysfunction was achieved. His chest and back pain also resolved. The diseased vertebral body gradually healed and new bone formation was seen at 18 months postoperatively. This case report concludes that a solid variant of an ABC should be considered as a differential diagnosis for tumours involving the spine. An intraoperative frozen section procedure should be undertaken, especially during emergency situations. Early diagnosis and appropriate surgical management play an important role in the successful management of a solid variant of ABC.

Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial.

PubMed

Dunning, James R; Butts, Raymond; Mourad, Firas; Young, Ian; Fernandez-de-Las Peñas, Cesar; Hagins, Marshall; Stanislawski, Thomas; Donley, Jonathan; Buck, Dustin; Hooks, Todd R; Cleland, Joshua A

2016-02-06

Although commonly utilized interventions, no studies have directly compared the effectiveness of cervical and thoracic manipulation to mobilization and exercise in individuals with cervicogenic headache (CH). The purpose of this study was to compare the effects of manipulation to mobilization and exercise in individuals with CH. One hundred and ten participants (n = 110) with CH were randomized to receive both cervical and thoracic manipulation (n = 58) or mobilization and exercise (n = 52). The primary outcome was headache intensity as measured by the Numeric Pain Rating Scale (NPRS). Secondary outcomes included headache frequency, headache duration, disability as measured by the Neck Disability Index (NDI), medication intake, and the Global Rating of Change (GRC). The treatment period was 4 weeks with follow-up assessment at 1 week, 4 weeks, and 3 months after initial treatment session. The primary aim was examined with a 2-way mixed-model analysis of variance (ANOVA), with treatment group (manipulation versus mobilization and exercise) as the between subjects variable and time (baseline, 1 week, 4 weeks and 3 months) as the within subjects variable. The 2X4 ANOVA demonstrated that individuals with CH who received both cervical and thoracic manipulation experienced significantly greater reductions in headache intensity (p < 0.001) and disability (p < 0.001) than those who received mobilization and exercise at a 3-month follow-up. Individuals in the upper cervical and upper thoracic manipulation group also experienced less frequent headaches and shorter duration of headaches at each follow-up period (p < 0.001 for all). Additionally, patient perceived improvement was significantly greater at 1 and 4-week follow-up periods in favor of the manipulation group (p < 0.001). Six to eight sessions of upper cervical and upper thoracic manipulation were shown to be more effective than mobilization and exercise in patients with CH, and the effects were maintained at 3 months. NCT01580280 April 16, 2012.

Lumbar postures, seat interface pressures and discomfort responses to a novel thoracic support for police officers during prolonged simulated driving exposures.

PubMed

Gruevski, Kristina M; Holmes, Michael W R; Gooyers, Chad E; Dickerson, Clark R; Callaghan, Jack P

2016-01-01

A high prevalence of low back pain has been reported among professional drivers, including mobile police officers. The purpose of this investigation was to develop and evaluate a novel thoracic support designed for mobile police officers. Fourteen participants (7 male, 7 female) attended two 120-min driving simulations using a Crown Victoria Interceptor seat and the same seat equipped with a surface mounted thoracic support. Time-varying spine postures, seat pressures and ratings of discomfort were measured. Averaged discomfort values were low (less than 10 mm of a possible 100 mm) for both seating conditions. The postures in the thoracic support condition were more similar to non-occupational driving without occupational equipment than the Crown Victoria seating condition. The reduction in pressure area at the low back with the thoracic support has the potential to reduce discomfort reporting in officers compared to a standard vehicle package. Copyright © 2015 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Individualized 3D printing navigation template for pedicle screw fixation in upper cervical spine

PubMed Central

Guo, Fei; Dai, Jianhao; Zhang, Junxiang; Ma, Yichuan; Zhu, Guanghui; Shen, Junjie; Niu, Guoqi

2017-01-01

Purpose Pedicle screw fixation in the upper cervical spine is a difficult and high-risk procedure. The screw is difficult to place rapidly and accurately, and can lead to serious injury of spinal cord or vertebral artery. The aim of this study was to design an individualized 3D printing navigation template for pedicle screw fixation in the upper cervical spine. Methods Using CT thin slices data, we employed computer software to design the navigation template for pedicle screw fixation in the upper cervical spine (atlas and axis). The upper cervical spine models and navigation templates were produced by 3D printer with equal proportion, two sets for each case. In one set (Test group), pedicle screws fixation were guided by the navigation template; in the second set (Control group), the screws were fixed under fluoroscopy. According to the degree of pedicle cortex perforation and whether the screw needed to be refitted, the fixation effects were divided into 3 types: Type I, screw is fully located within the vertebral pedicle; Type II, degree of pedicle cortex perforation is <1 mm, but with good internal fixation stability and no need to renovate; Type III, degree of pedicle cortex perforation is >1 mm or with the poor internal fixation stability and in need of renovation. Type I and Type II were acceptable placements; Type III placements were unacceptable. Results A total of 19 upper cervical spine and 19 navigation templates were printed, and 37 pedicle screws were fixed in each group. Type I screw-placements in the test group totaled 32; Type II totaled 3; and Type III totaled 2; with an acceptable rate of 94.60%. Type I screw placements in the control group totaled 23; Type II totaled 3; and Type III totaled 11, with an acceptable rate of 70.27%. The acceptability rate in test group was higher than the rate in control group. The operation time and fluoroscopic frequency for each screw were decreased, compared with control group. Conclusion The individualized 3D printing navigation template for pedicle screw fixation is easy and safe, with a high success rate in the upper cervical spine surgery. PMID:28152039

Individualized 3D printing navigation template for pedicle screw fixation in upper cervical spine.

PubMed

Guo, Fei; Dai, Jianhao; Zhang, Junxiang; Ma, Yichuan; Zhu, Guanghui; Shen, Junjie; Niu, Guoqi

2017-01-01

Pedicle screw fixation in the upper cervical spine is a difficult and high-risk procedure. The screw is difficult to place rapidly and accurately, and can lead to serious injury of spinal cord or vertebral artery. The aim of this study was to design an individualized 3D printing navigation template for pedicle screw fixation in the upper cervical spine. Using CT thin slices data, we employed computer software to design the navigation template for pedicle screw fixation in the upper cervical spine (atlas and axis). The upper cervical spine models and navigation templates were produced by 3D printer with equal proportion, two sets for each case. In one set (Test group), pedicle screws fixation were guided by the navigation template; in the second set (Control group), the screws were fixed under fluoroscopy. According to the degree of pedicle cortex perforation and whether the screw needed to be refitted, the fixation effects were divided into 3 types: Type I, screw is fully located within the vertebral pedicle; Type II, degree of pedicle cortex perforation is <1 mm, but with good internal fixation stability and no need to renovate; Type III, degree of pedicle cortex perforation is >1 mm or with the poor internal fixation stability and in need of renovation. Type I and Type II were acceptable placements; Type III placements were unacceptable. A total of 19 upper cervical spine and 19 navigation templates were printed, and 37 pedicle screws were fixed in each group. Type I screw-placements in the test group totaled 32; Type II totaled 3; and Type III totaled 2; with an acceptable rate of 94.60%. Type I screw placements in the control group totaled 23; Type II totaled 3; and Type III totaled 11, with an acceptable rate of 70.27%. The acceptability rate in test group was higher than the rate in control group. The operation time and fluoroscopic frequency for each screw were decreased, compared with control group. The individualized 3D printing navigation template for pedicle screw fixation is easy and safe, with a high success rate in the upper cervical spine surgery.

Immediate Changes After Manual Therapy in Patients With Persistent, Nonspecific Back Pain: A Randomized Controlled Trial.

PubMed

Espí-López, Gemma Victoria; Ruescas-Nicolau, Maria-Arantzazu; Sanchez-Sanchez, M Luz; Arnal-Gómez, Anna; Balasch-Bernat, Mercè; Marques-Sule, Elena

2018-02-10

Context • Thoracic manipulation decreases pain and disability. However, when such manipulation is contraindicated, the use of other manual techniques based on the regional interdependence of the thoracic spine, upper ribs, and shoulders is an alternative approach. Objective • The study intended to investigate the immediate changes resulting from 3 manual therapy treatments on spinal mobility, flexibility, comfort, and pain perception in patients with persistent, nonspecific back pain as well as changes in their sense of physical well-being and their perception of change after treatment. Design • The study was a randomized, double-blind, controlled trial. Setting • The study took place in the Department of Physiotherapy of the Faculty of Physiotherapy at the University of Valencia (Valencia, Spain). Participants • Participants were 112 individuals from the community-56.6% female, with a mean age of 21.8 ± 0.2 y-who had persistent, nonspecific back pain. Intervention • Participants were randomly assigned to 1 of 3 groups, receiving (1) neurolymphatic therapy (NL group), (2) articulatory spinal manual therapy (AS group), or (3) articulatory costal manual therapy (AC group). Outcome Measures • Cervical mobility, lumbar flexibility, comfort, pain perception, and physical well-being were assessed at baseline and immediately postintervention. Perception of change was evaluated postintervention. Results • Between baseline and postintervention, the AC group showed a significant increase in cervical flexion (P = .010), whereas the NL and AS groups improved in lumbar flexibility, P = .047 and P = .012, respectively. For that period, significant changes were found in lumbar comfort for the AS group (P < .001) and the NL group (P < .026) and in thoracic comfort (P < .001) for the AC group. All groups improved in physical well-being and pain perception (P < .05). Changes in thoracic comfort, lumbar comfort, and physical well-being differed among the groups, with some differences being statistically significant. Conclusions • All treatments improved pain perception and increased physical well-being. The NL and AS treatments were more effective in lumbar flexibility, the AC treatment in cervical flexion and thoracic comfort, and the NL treatment in lumbar comfort.

Thoracic spine CT scan

MedlinePlus

... take this medicine. Find out if the CT machine has a weight limit if you weigh more than 300 pounds (135 kilograms). Too much weight can cause damage to the scanner. You will be asked to remove jewelry and wear a hospital gown during the study.

Autonomic Dysreflexia-Like Syndrome in a T12 Paraplegic During Thoracic Spine Surgery

DTIC Science & Technology

2010-11-01

pheochromocytoma , carcinoid syndrome, or thyroid storm. This presentation differs from autonomic dysreflexia because the spinal cord lesion was well below T6...instability. The differential diagnosis of isolated, abrupt intraopera- tive hypertension includes pheochromocytoma , carcinoid syndrome, thyroid storm

2015 Young Investigator Award Winner: Cervical Nerve Root Displacement and Strain During Upper Limb Neural Tension Testing: Part 2: Role of Foraminal Ligaments in the Cervical Spine.

PubMed

Lohman, Chelsea M; Gilbert, Kerry K; Sobczak, Stéphane; Brismée, Jean-Michel; James, C Roger; Day, Miles; Smith, Michael P; Taylor, LesLee; Dugailly, Pierre-Michel; Pendergrass, Timothy; Sizer, Phillip J

2015-06-01

A cross-sectional cadaveric examination of the mechanical effect of foraminal ligaments on cervical nerve root displacement and strain. To determine the role of foraminal ligaments by examining differences in cervical nerve root displacement and strain during upper limb neural tension testing (ULNTT) before and after selective cutting of foraminal ligaments. Although investigators have determined that lumbar spine foraminal ligaments limit displacement and strain of lumbosacral nerve roots, similar studies have not been conducted to prove that it is true for the cervical region. Because the size, shape, and orientation of cervical spine foraminal ligaments are similar to those in the lumbar spine, it is hypothesized that foraminal ligaments in the cervical spine will function in a similar fashion. Radiolucent markers were implanted into cervical nerve roots C5-C8 of 9 unembalmed cadavers. Posteroanterior fluoroscopic images were captured at resting and upper limb neural tension testing positioning before and after selective cutting of foraminal ligaments. Selective cutting of foraminal ligaments resulted in significant increases in inferolateral displacement (average, 2.94 mm [ligaments intact]-3.87 mm [ligaments cut], P < 0.05) and strain (average, 9.33% [ligaments intact]-16.31% [ligaments cut], P < 0.03) of cervical nerve roots C5-C8 during upper limb neural tension testing. Foraminal ligaments in the cervical spine limited cervical nerve root displacement and strain during upper limb neural tension testing. Foraminal ligaments seem to have a protective role, reducing displacement and strain to cervical nerve roots during tension events. 2.

Steadiness of Spinal Regions during Single-Leg Standing in Older Adults with and without Chronic Low Back Pain

PubMed Central

Kuo, Yi-Liang; Huang, Kuo-Yuan; Chiang, Pei-Tzu; Lee, Pei-Yun; Tsai, Yi-Ju

2015-01-01

The aims of this study were to compare the steadiness index of spinal regions during single-leg standing in older adults with and without chronic low back pain (LBP) and to correlate measurements of steadiness index with the performance of clinical balance tests. Thirteen community-dwelling older adults (aged 55 years or above) with chronic LBP and 13 age- and gender-matched asymptomatic volunteers participated in this study. Data collection was conducted in a university research laboratory. Measurements were steadiness index of spinal regions (trunk, thoracic spine, lumbar spine, and pelvis) during single-leg standing including relative holding time (RHT) and relative standstill time (RST), and clinical balance tests (timed up and go test and 5-repetition sit to stand test). The LBP group had a statistically significantly smaller RHT than the control group, regardless of one leg stance on the painful or non-painful sides. The RSTs on the painful side leg in the LBP group were not statistically significantly different from the average RSTs of both legs in the control group; however, the RSTs on the non-painful side leg in the LBP group were statistically significantly smaller than those in the control group for the trunk, thoracic spine, and lumbar spine. No statistically significant intra-group differences were found in the RHTs and RSTs between the painful and non-painful side legs in the LBP group. Measurements of clinical balance tests also showed insignificant weak to moderate correlations with steadiness index. In conclusion, older adults with chronic LBP demonstrated decreased spinal steadiness not only in the symptomatic lumbar spine but also in the other spinal regions within the kinetic chain of the spine. When treating older adults with chronic LBP, clinicians may also need to examine their balance performance and spinal steadiness during balance challenging tests. PMID:26024534

The Impact of Metastatic Spinal Tumor Location on 30-Day Perioperative Mortality and Morbidity After Surgical Decompression.

PubMed

Hussain, Awais K; Vig, Khushdeep S; Cheung, Zoe B; Phan, Kevin; Lima, Mauricio C; Kim, Jun S; Kaji, Deepak A; Arvind, Varun; Cho, Samuel Kang-Wook

2018-06-01

A retrospective cohort study from 2011 to 2014 was performed using the American College of Surgeons National Surgical Quality Improvement Program database. The purpose of this study was to assess the impact of tumor location in the cervical, thoracic, or lumbosacral spine on 30-day perioperative mortality and morbidity after surgical decompression of metastatic extradural spinal tumors. Operative treatment of metastatic spinal tumors involves extensive procedures that are associated with significant complication rates and healthcare costs. Past studies have examined various risk factors for poor clinical outcomes after surgical decompression procedures for spinal tumors, but few studies have specifically investigated the impact of tumor location on perioperative mortality and morbidity. We identified 2238 patients in the American College of Surgeons National Surgical Quality Improvement Program database who underwent laminectomy for excision of metastatic extradural tumors in the cervical, thoracic, or lumbosacral spine. Baseline patient characteristics were collected from the database. Univariate and multivariate regression analyses were performed to examine the association between spinal tumor location and 30-day perioperative mortality and morbidity. On univariate analysis, cervical spinal tumors were associated with the highest rate of pulmonary complications. Multivariate regression analysis demonstrated that cervical spinal tumors had the highest odds of multiple perioperative complications. However, thoracic spinal tumors were associated with the highest risk of intra- or postoperative blood transfusion. In contrast, patients with metastatic tumors in the lumbosacral spine had lower odds of perioperative mortality, pulmonary complications, and sepsis. Tumor location is an independent risk factor for perioperative mortality and morbidity after surgical decompression of metastatic spinal tumors. The addition of tumor location to existing prognostic scoring systems may help to improve their predictive accuracy. 3.

Relationships among spinal mobility and sagittal alignment of spine and lower extremity to quality of life and risk of falls.

PubMed

Ishikawa, Yoshinori; Miyakoshi, Naohisa; Hongo, Michio; Kasukawa, Yuji; Kudo, Daisuke; Shimada, Yoichi

2017-03-01

Spinal deformities can affect quality of life (QOL) and risk of falling, but no studies have explored the relationships of spinal mobility and sagittal alignment of spine and the lower extremities simultaneously. Purpose of this study is to clarify the relationship of those postural parameters to QOL and risk of falling. The study evaluated 110 subjects (41 men, 69 women; mean age, 73 years). Upright and flexion and extension angles for thoracic kyphosis, lumbar lordosis, and spinal inclination were evaluated with SpinalMouse ® . Total-body inclination and hip and knee flexion angles in upright position were measured from lateral photographs. Subjects were divided into Fallers (n=23, 21%) and Non-fallers (n=87, 79%) based on past history of falls. QOL was assessed using the Short Form 36 Health Survey (SF-36 ® ). Age, total-body inclination, spinal inclination upright and in extension, thoracic kyphosis in flexion, lumbar lordosis upright and in extension, and knee flexion correlated significantly with the SF-36. Multiple regression analysis revealed total-body inclination and knee flexion to have the most significant relationships with the SF-36. SF-36, total-body inclination, spinal inclination in extension, thoracic kyphosis in flexion, lumbar lordosis upright and in extension, and hip and knee flexion angles differed significantly between Fallers and Non-fallers (P<0.05 for all). Multivariate logistic regression analyses revealed lumbar lordosis in extension to be a significant predictor of falling (P=0.038). Forward-stooped posture and knee-flexion deformity could be important indicator of lower QOL. Moreover, limited extension in the lumbar spine could be a useful screening examination for fall prevention in the elderly. Copyright © 2017 Elsevier B.V. All rights reserved.

Evaluation of the hybrid III and Q-series pediatric ATD upper neck loads as compared to pediatric volunteers in low-speed frontal crashes.

PubMed

Seacrist, Thomas; Mathews, Emily A; Balasubramanian, Sriram; Maltese, Matthew R; Arbogast, Kristy B

2013-11-01

Debate exists in the automotive community regarding the validity of the pediatric ATD neck response and corresponding neck loads. Previous research has shown that the pediatric ATDs exhibit hyper-flexion and chin-to-chest contact resulting in overestimations of neck loads and neck injury criteria. Our previous work comparing the kinematics of the Hybrid III and Q-series 6 and 10-year-old ATDs to pediatric volunteers in low-speed frontal sled tests revealed decreased ATD cervical and thoracic spine excursions. These kinematic differences may contribute to the overestimation of upper neck loads by the ATD. The current study compared upper neck loads of the Hybrid III and Q-series 6 and 10-year-old ATDs against size-matched male pediatric volunteers in low-speed frontal sled tests. A 3-D near-infrared target tracking system quantified the position of markers on the ATD and pediatric volunteers (head top, nasion, bilateral external auditory meatus). Shear force (F x ), axial force (F z ), bending moment (M y ), and head angular acceleration ([Formula: see text]) were calculated about the upper neck using standard equations of motion. In general, the ATDs underestimated axial force and overestimated bending moment compared to the human volunteers. The Hybrid III 6, Q6, and Q10 exhibited reduced head angular acceleration and modest increases in upper neck shear compared to the pediatric volunteers. The reduction in axial force and bending moment has important implications for neck injury predictions as both are used when calculating N ij . These analyses provide insight into the biofidelity of the pediatric ATD upper neck loads in low-speed crash environments.

[Flat rate reimbursement system for minimally invasive management of unstable vertebral fractures. An analysis of costs and benefits].

PubMed

Hartwig, E; Schultheiss, M; Bischoff, M

2002-08-01

Some 30% of unstable vertebral fractures of the thoracic and lumbar spine involve a destruction of the ventral column and thus of the supporting structures of the spine. This requires extensive surgical reconstruction procedures, which are carried out using minimally invasive techniques. The disadvantages of the minimally invasive methods are the high cost, the technical equipment and the expenditure of time required in the initial phase for the performance of the surgical procedure. With the structural reform of the health care system in the year 2000, the private-sector regulatory bodies were called upon to introduce a flat-rate compensation system for hospital services according to section 17b of the Hospital Law (KHG). The previous financing system which involved per-diem operating cost rates has thus been abolished. Calculations of individual entities are now required. Considering the case values to date, a contribution margin deficit of EUR 4628.45 has been calculated for our patients with fractures of the thoracic and lumbar spine without neurological defunctionalization symptoms. An economically efficient medical care is thus no longer possible. Consequently, an adjustment of the German relative weights must urgently be demanded in order to guarantee a high-quality medical care of patients.

Relationship between thoracic hypokyphosis, lumbar lordosis and sagittal pelvic parameters in adolescent idiopathic scoliosis.

PubMed

Clément, Jean-Luc; Geoffray, Anne; Yagoubi, Fatima; Chau, Edouard; Solla, Federico; Oborocianu, Ioana; Rampal, Virginie

2013-11-01

Sagittal spine and pelvic alignment of adolescent idiopathic scoliosis (AIS) is poorly described in the literature. It generally reports the sagittal alignment with regard to the type of curve and never correlated to the thoracic kyphosis. The objective of this study is to investigate the relationship between thoracic kyphosis, lumbar lordosis and sagittal pelvic parameters in thoracic AIS. Spinal and pelvic sagittal parameters were evaluated on lateral radiographs of 86 patients with thoracic AIS; patients were separated into hypokyphosis group (n = 42) and normokyphosis group (n = 44). Results were statistically analyzed. The lumbar lordosis was lower in the hypokyphosis group, due to the low proximal lordosis. The thoracic kyphosis was not correlated with any pelvic parameters but with the proximal lordosis. The pelvic incidence was correlated with sacral slope, pelvic tilt, lumbar lordosis and highly correlated with distal lumbar lordosis in the two groups. There was a significant linear regression between thoracic kyphosis and proximal lordosis and between pelvic incidence and distal lordosis. We can consider that the proximal part of the lordosis depends on the thoracic kyphosis and the distal part depends on the pelvic incidence. The hypokyphosis in AIS is independent of the pelvic parameters and could be described as a structural parameter, characteristic of the scoliotic deformity.

Biomechanical evaluation of a simulated T-9 burst fracture of the thoracic spine with an intact rib cage.

PubMed

Perry, Tiffany G; Mageswaran, Prasath; Colbrunn, Robb W; Bonner, Tara F; Francis, Todd; McLain, Robert F

2014-09-01

Classic biomechanical models have used thoracic spines disarticulated from the rib cage, but the biomechanical influence of the rib cage on fracture biomechanics has not been investigated. The well-accepted construct for stabilizing midthoracic fractures is posterior instrumentation 3 levels above and 2 levels below the injury. Short-segment fixation failure in thoracolumbar burst fractures has led to kyphosis and implant failure when anterior column support is lacking. Whether shorter constructs are viable in the midthoracic spine is a point of controversy. The objective of this study was the biomechanical evaluation of a burst fracture at T-9 with an intact rib cage using different fixation constructs for stabilizing the spine. A total of 8 human cadaveric spines (C7-L1) with intact rib cages were used in this study. The range of motion (ROM) between T-8 and T-10 was the outcome measure. A robotic spine testing system was programmed to apply pure moment loads (± 5 Nm) in lateral bending, flexion-extension, and axial rotation to whole thoracic specimens. Intersegmental rotations were measured using an optoelectronic system. Flexibility tests were conducted on intact specimens, then sequentially after surgically induced fracture at T-9, and after each of 4 fixation construct patterns. The 4 construct patterns were sequentially tested in a nondestructive protocol, as follows: 1) 3 above/2 below (3A/2B); 2) 1 above/1 below (1A/1B); 3) 1 above/1 below with vertebral body augmentation (1A/1B w/VA); and 4) vertebral body augmentation with no posterior instrumentation (VA). A repeated-measures ANOVA was used to compare the segmental motion between T-8 and T-10 vertebrae. Mean ROM increased by 86%, 151%, and 31% after fracture in lateral bending, flexion-extension, and axial rotation, respectively. In lateral bending, there was significant reduction compared with intact controls for all 3 instrumented constructs: 3A/2B (-92%, p = 0.0004), 1A/1B (-63%, p = 0.0132), and 1A/1B w/VA (-66%, p = 0.0150). In flexion-extension, only the 3A/2B pattern showed a significant reduction (-90%, p = 0.011). In axial rotation, motion was significantly reduced for the 3 instrumented constructs: 3A/2B (-66%, p = 0.0001), 1A/1B (-53%, p = 0.0001), and 1A/1B w/VA (-51%, p = 0.0002). Between the 4 construct patterns, the 3 instrumented constructs (3A/2B, 1A/1B, and 1A/1B w/VA) showed comparable stability in all 3 motion planes. This study showed no significant difference in the stability of the 3 instrumented constructs tested when the rib cage is intact. Fractures that might appear more grossly unstable when tested in the disarticulated spine may be bolstered by the ribs. This may affect the extent of segmental spinal instrumentation needed to restore stability in some spine injuries. While these initial findings suggest that shorter constructs may adequately stabilize the spine in this fracture model, further study is needed before these results can be extrapolated to clinical application.

Radiology of spinal curvature

DOE Office of Scientific and Technical Information (OSTI.GOV)

De Smet, A.A.

1985-01-01

This book offers the only comprehensive, concise summary of both the clinical and radiologic features of thoracic and lumbar spine deformity. Emphasis is placed on idiopathic scoliosis, which represents 85% of all patients with scoliosis, but less common areas of secondary scoliosis, kyphosis and lordosis are also covered.

[Plain radiographs of the spine: static and relationships between spine and pelvis].

PubMed

Morvan, G; Wybier, M; Mathieu, P; Vuillemin, V; Guerini, H

2008-05-01

Man, with his erect posture, evolves in a world subject to the laws of gravity. His spine reflects these constraints. The morphology and static of human spine and biomechanical relationships between spine and pelvis are in direct relation with bipedia. Owing to this position the pelvis widened and straightened, characteristic sagittal spinal curves appeared and the perispinal muscles were deeply reorganized. Each pelvis is characterized by an important anatomical landmark: the pelvic incidence that reflects the sagittal morphology of the pelvis. Based on this anatomical characteristic, a chain of reactions determines the more efficient equilibrium of the whole body in the sagittal plane in term of energy consumption. Incidence affects the sacral slope, which determines lumbar lordosis, which itself influences pelvic tilt, thoracic kyphosis, and even hip and knee position. All these landmarks can easily be studied on a sagittal radiograph. Knowledge of these functional relationships is essential to understand the origin of low back pain, sagittal imbalance and above all before surgical treatment of spine disorders especially when arthrodesis is considered.

Effective dose reduction in spine radiographic imaging by choosing the less radiation-sensitive side of the body.

PubMed

Ben-Shlomo, Avi; Bartal, Gabriel; Mosseri, Morris; Avraham, Boaz; Leitner, Yosef; Shabat, Shay

2016-04-01

X-ray absorption is highest in the organs and tissues located closest to the radiation source. The photon flux that crosses the body decreases from the entry surface toward the image receptor. The internal organs absorb x-rays and shield each other during irradiation. Therefore, changing the x-ray projection angle relative to the patient for specific spine procedures changes the radiation dose that each organ receives. Every organ has different radiation sensitivity, so irradiation from different sides of the body changes the biological influence and radiation risk potential on the total body, that is the effective dose (ED). The study aimed to determine the less radiation-sensitive sides of the body during lateral and anterior-posterior (AP) or posterior anterior (PA) directions. The study used exposure of patient phantoms and Monte Carlo simulation of the effective doses. Calculations for adults and 10-year-old children were included because the pediatric population has a greater lifetime radiation risk than adults. Pediatric and adult tissue and organ doses and ED from cervical, thoracic, and lumbar x-ray spine examinations were performed from different projections. Standard mathematical phantoms for adults and 10-year-old children, using PCXMC 2.0 software based on Monte Carlo simulations, were used to calculate pediatric and adult tissue and organ doses and ED. The study was not funded. The authors have no conflicts of interest to declare. Spine x-ray exposure from various right (RT) LAT projection angles was associated with lower ED compared with the same left (LT) LAT projections (up to 28% and 27% less for children aged 10 and adults, respectively). The PA spine projections showed up to 64% lower ED for children aged 10 and 65% for adults than AP projections. The AP projection at the thoracic spine causes an excess breast dose of 543.3% and 597.0% for children aged 10 and adults, respectively. Radiation ED in spine procedures can be significantly reduced by performing x-ray exposures through the less radiation-sensitive sides of the body, which are PA in the frontal position and right lateral in the lateral position. Copyright © 2015 Elsevier Inc. All rights reserved.

Evaluation of the value of ENI in radiotherapy for cervical and upper thoracic esophageal cancer: a retrospective analysis.

PubMed

Liu, Mina; Zhao, Kuaile; Chen, Yun; Jiang, Guo-Liang

2014-10-25

A retrospective study to compare the failure patterns and effects of elective nodal irradiation (ENI) or involved field irradiation (IFI) for cervical and upper thoracic esophageal squamous cell carcinoma (SCC) patients. One hundred and sixty nine patients with the cervical and upper thoracic esophageal SCC were analyzed retrospectively; 99 patients (59%) underwent IFI and 70 patients (41%) received ENI. We defined "Out-PTVifi in-PTVeni metastasis" as lymph node metastasis occurring in the cervical prophylactic field of PTVeni thus out of PTVifi. Out-PTVifi in-PTVeni cervical node metastasis occurred in 8% of patients in the IFI group, all within 2 years after treatment. However, it occurred in 10% of patients in the ENI group, and these failures happened gradually since one year after treatments. No difference was found in OS and the incidences of Grade ≥ 3 treatment-related esophageal and lung toxicities between the two groups. ENI for cervical and upper thoracic esophageal SCC patients did not bring longer OS and better long-term control of cervical lymph nodes. Although ENI might delay cervical nodes progression in elective field; it could not decrease the incidence of these failures.

The posterior skeletal thorax: rib-vertebral angle and axial vertebral rotation asymmetries in adolescent idiopathic scoliosis.

PubMed

Burwell, R G; Aujla, R K; Freeman, B J C; Dangerfield, P H; Cole, A A; Kirby, A S; Polak, F J; Pratt, R K; Moulton, A

2008-01-01

The deformity of the ribcage in thoracic adolescent idiopathic scoliosis (AIS) is viewed by most as being secondary to the spinal deformity, though a few consider it primary or involved in curve aggravation. Those who consider it primary ascribe pathogenetic significance to rib-vertebra angle asymmetry. In thoracic AIS, supra-apical rib-vertebra angle differences (RVADs) are reported to be associated with the severity of the Cobb angle. In this paper we attempt to evaluate rib and spinal pathomechanisms in thoracic and thnoracolumbar AIS using spinal radiographs and real-time ultrasound. On the radiographs by costo-vertebral angle asymmetries (rib-vertebral angle differences RVADs, and rib-spinal angle differences RSADs), apical vertebral rotation (AV) and apical vertebral translation (AVT) were measured; and by ultrasound, spine-rib rotation differences (SRRDs) were estimated. RVADs are largest at two and three vertebral levels above the apex where they correlate significantly and positively with Cobb angle and AVT but not AVR. In right thoracic AIS, the cause(s) of the RVA asymmetries is unknown: it may result from trunk muscle imbalance, or from ribs adjusting passively within the constraint of the fourth column of the spine to increasing spinal curvature from whatever cause. Several possible mechanisms may drive axial vertebral rotation including, biplanar spinal asymmetry, relative anterior spinal overgrowth, dorsal shear forces in the presence of normal vertebral axial rotation, asymmetry of rib linear growth, trunk muscle imbalance causing rib-vertebra angle asymmetry weakening the spinal rotation-defending system of bipedal gait, and CNS mechanisms.

Tripolar spinal cord stimulation for the treatment of abdominal pain associated with irritable bowel syndrome.

PubMed

Rana, Maunak V; Knezevic, Nebojsa Nick

2013-01-01

The objective of this case report is to describe the use of transverse tripolar dorsal column stimulation in a patient with a history of irritable bowel syndrome (IBS) associated with abdominal pain resistant to conservative treatments. We report a 36-year-old man who presented to the pain clinic with an eight-year history of IBS (constipation predominant with occasional diarrheal episodes), with "crampy and sharp" abdominal pain. He also had nonradicular thoracic spine pain due to thoracic scoliosis. Both pains were affecting his ability to function as an attorney. Prior conservative therapy, including psychologic treatment, antidepressants, and opioids, was without any benefits. The use of a spinal cord stimulator (SCS) was discussed with the patient. The procedure was performed after Institutional Review Board approval. A tripolar SCS was implanted at the T8 level using one-eight contact and two-four contact percutaneous leads based on paresthesia reproduction of patient's areas of discomfort. This tripolar spinal cord stimulation provided relief of abdominal and thoracic pain, and better management of gastrointestinal symptoms. The patient was followed-up for one year, and his quality of life also was improved via the IBS-Severity Scoring System quality of life tool. The use of the tripolar SCS in this patient provided relief of abdominal and thoracic spine pain, regulated bowel habits, and improved the patient's quality of life. We believe that the use of SCS should be considered as a treatment option in patients with IBS when all conservative treatments failed. © 2012 International Neuromodulation Society.

The True Ponte Osteotomy: By the One Who Developed It.

PubMed

Ponte, Alberto; Orlando, Giuseppe; Siccardi, Gian Luigi

2018-01-01

Technique and applications. To define the anatomy, biomechanics, indications, and surgical technique of the true Ponte osteotomy. The Ponte osteotomy, originally developed for thoracic kyphosis, was the first one to obtain posterior shortening of the thoracic spine, maintaining the anterior column load-sharing capacity. It has become a widely applied technique in various types of spine deformities and a frequent topic of presentations at meetings and in scientific articles. Several of them offer unquestionable evidence of an incorrect execution, with consequently distorted outcomes and erroneous conclusions. A clearing up became essential. Our original experience is based on a series of 240 patients with thoracic hyperkyphosis operated in the years 1969-2015, at first with a standard posterior Harrington technique and then by using the Ponte osteotomy with different instrumentations. A series of 78 of them, operated in the years 1987-1997, who had Ponte osteotomies at every level, is presented. The average preoperative kyphosis has been corrected from 80° (range 61°-102°) to 31° (range 15°-50°) by a substantial posterior shortening. A number of publications use the term Ponte osteotomy loosely for by far incomplete resections and mixing it up with Smith-Petersen's osteotomy. The true Ponte osteotomy is capable of producing marked flexibility in extension, flexion and rotation, justifying its wide use in thoracic deformities, mainly in scoliosis. An exact performance of the osteotomy with adequate bony resections, including the laminae, is an absolute condition to take full advantage of its properties. Level IV, therapeutic study. Copyright © 2017 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

Validation, repeatability and reproducibility of a noninvasive instrument for measuring thoracic and lumbar curvature of the spine in the sagittal plane.

PubMed

Chaise, Fabiana O; Candotti, Cláudia T; Torre, Marcelo L; Furlanetto, Tássia S; Pelinson, Patricia P T; Loss, Jefferson F

2011-01-01

The need for early identification of postural abnormalities without exposing patients to constant radiation has stimulated the development of instruments aiming to measure the spinal curvatures. To verify the validity, repeatability and reproducibility of angular measures of sagittal curvatures of the spine obtained using an adapted arcometer, by comparing them with Cobb angles of the respective curvatures obtained by using X-rays. 52 participants were submitted to two procedures designed to evaluate the thoracic and lumbar curvatures: (1) X-ray examination from which the Cobb angles (CA) of both curvatures were obtained, and (2) measuring the angles with the arcometer (AA). Two evaluators collected the data using the arcometer, with the rods placed at T1, T12, L1 and L5 spinous processes levels in a way as to permit linear measurements which, with aid of trigonometry, supplied the AA. There was a very strong and significant correlation between AA and CA (r=0.94; p<0.01), with no-significant difference (p=0.32), for the thoracic curvature. There was a strong and significant correlation for the lumbar curvature (r=0.71; p<0.01) between AA and CA, with no-significant difference (p=0.30). There is a very strong correlation between intra-evaluator and inter-evaluator AA. It was possible to quantify reliably the thoracic and lumbar curvatures with the arcometer and it can thus be considered valid and reliable and for use in evaluating spinal curvatures in the sagittal plane.

Interrater reliability of the cervicothoracic and shoulder physical examination in patients with a primary complaint of shoulder pain.

PubMed

Burns, Scott A; Cleland, Joshua A; Carpenter, Kristin; Mintken, Paul E

2016-03-01

Examine the interrater reliability of cervicothoracic and shoulder physical examination in patients with a primary complaint of shoulder pain. Single-group repeated-measures design for interrater reliability. Orthopaedic physical therapy clinics. Twenty-one patients with a primary complaint of shoulder pain underwent a standardized examination by a physical therapist (PT). A PT conducted the first examination and one of two additional PTs conducted the 2nd examination. The Cohen κ and weighted κ were used to calculate the interrater reliability of ordinal level data. Intraclass correlation coefficients model 2,1 (ICC2,1) and the 95% confidence intervals were calculated to determine the interrater reliability. The kappa coefficients ranged from -.24 to .83 for the mobility assessment of the glenohumeral, acromioclavicular and sternoclavicular joints. The kappa coefficients ranged from -.20 to .58 for joint mobility assessment of the cervical and thoracic spine. The kappa coefficients ranged from .23 to 1.0 for special tests of the shoulder and cervical spine. The present study reported the reliability of a comprehensive upper quarter physical examination for a group of patients with a primary report of shoulder pain. The reliability varied considerably for the cervical and shoulder examination and was significantly higher for the examination of muscle length and cervical range of motion. Copyright © 2015 Elsevier Ltd. All rights reserved.

Slipping rib syndrome: a place for sonography in the diagnosis of a frequently overlooked cause of abdominal or low thoracic pain.

PubMed

Meuwly, Jean-Yves; Wicky, Stephan; Schnyder, Pierre; Lepori, Domenico

2002-03-01

To describe the sonographic appearance of a poorly recognized cause of low thoracic or upper abdominal pain. Three sonographic descriptions of slipping rib syndrome are presented. The 3 patients had abnormal mobility of a cartilaginous rib, which could slip over an adjacent rib during abdominal muscle contraction. Slipping rib syndrome should be considered in patients with histories of upper abdominal or low thoracic pain of unknown origin. We suggest that high-resolution sonography of the costal margin should be added to abdominal sonography in cases of nonspecific abdominal pain.

Factors affecting survival of patients in the acute phase of upper cervical spine injuries.

PubMed

Morita, Tomonori; Takebayashi, Tsuneo; Irifune, Hideto; Ohnishi, Hirofumi; Hirayama, Suguru; Yamashita, Toshihiko

2017-04-01

In recent years, on the one hand, the mortality rates of upper cervical spine injuries, such as odontoid fractures, were suggested to be not so high, but on the other hand reported to be significantly high. Furthermore, it has not been well documented the relationship between survival rates and various clinical features in those patients during the acute phase of injury because of few reports. This study aimed to evaluate survival rates and acute-phase clinical features of upper cervical spine injuries. We conducted a retrospective review of all patients who were transported to the advanced emergency medical center and underwent computed tomography of the cervical spine at our hospital between January 2006 and December 2015. We excluded the patients who were discovered in a state of cardiopulmonary arrest (CPA) and could not be resuscitated after transportation. Of the 215 consecutive patients with cervical spine injuries, we examined 40 patients (18.6%) diagnosed with upper cervical spine injury (males, 28; females, 12; median age, 58.5 years). Age, sex, mechanism of injury, degree of paralysis, the level of cervical injury, injury severity score (ISS), and incidence of CPA at discovery were evaluated and compared among patients classified into the survival and mortality groups. The survival rate was 77.5% (31/40 patients). In addition, complete paralysis was observed in 32.5% of patients. The median of ISS was 34.0 points, and 14 patients (35.0%) presented with CPA at discovery. Age, the proportion of patients with complete paralysis, a high ISS, and incidence of CPA at discovery were significantly higher in the mortality group (p = 0.038, p = 0.038, p < 0.001, and p < 0.001, respectively). Elderly people were more likely to experience upper cervical spine injuries, and their mortality rate was significantly higher than that in injured younger people. In addition, complete paralysis, high ISS, a state of CPA at discovery, was significantly higher in the mortality group.

Ocean wave electric generators

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rosenberg, H.R.

This patent describes an apparatus for generating electricity from ocean waves. It consists of: 1.) a hollow buoyant duck positioned in the path of waves including a core about the center axis of which the duck rotates, a lower chamber portion having liquid therein and an upper chamber portion having air therein. The air is alternately compressed and expanded by the liquid in the chamber during the rotational motion of the duck caused by waves. A turbine mounted in the upper portion of the duck is driven by the compressed and expanded air. A generator is coupled to the turbinemore » and operated to produce electrical energy and an air bulb; 2.) a spine having a transverse axial shaft anchoring the spine to the ocean floor. The upper portion of the spine engages the duck to maintain the duck in position. The spine has a curved configuration to concentrate and direct wave energy. The spine configuration acts as a scoop to increase the height of wave peaks and as a foil to increase the depth of wave troughs.« less

Analysis of complications and perioperative data after open or percutaneous dorsal instrumentation following traumatic spinal fracture of the thoracic and lumbar spine: a retrospective cohort study including 491 patients.

PubMed

Kreinest, Michael; Rillig, Jan; Grützner, Paul A; Küffer, Maike; Tinelli, Marco; Matschke, Stefan

2017-05-01

The aim of the current study is to analyze perioperative data and complications of open vs. percutaneous dorsal instrumentation after dorsal stabilization in patients suffering from fractures of the thoracic or lumbar spine. In the time period from 01/2007 to 06/2009, open surgical approach was used for dorsal stabilization. The percutaneous surgical approach was used from 05/2009 to 03/2014. In every time period, all types of fractures were treated only by open or by percutaneous approach, respectively, to avoid any selection bias. Retrospectively, epidemiological data, complications and perioperative data were documented and statistically analyzed. A total of 491 patients met the inclusion criteria. Open surgery procedure was carried out on 169 patients, and percutaneous surgery procedure was carried out on 322 patients. Fracture level ranged from T1 to L5, and fractures were classified types A, B, and C. In 91.4% of all patients, no complication occured following dorsal stabilization after traumatic spine fracture during their hospital stay. However, 42 complications related to dorsal stabilization have been documented during the hospital stay. The complication rate was 14.8% if open surgical approach has been used and was significantly reduced to 5.3% using percutaneous surgical approach. Post-operative hospital stay was also reduced significantly using the percutaneous surgical approach. According to the current study, percutaneous dorsal stabilization of the spine could also be safely used in trauma cases and is not restricted to degenerative spinal surgery.

Ischiovertebral dysplasia: a retrospective analysis of 30 consecutive cases pointing out the specifics and risks of the spine management.

PubMed

Aurégan, Jean-Charles; Odent, Thierry; Coyle, Ryan M; Miladi, Lotfi; Wicart, Philippe; Dubousset, Jean; Le Merrer, Martine; Padovani, Jean-Paul; Glorion, Christophe

2014-04-20

A review of clinical publications, current knowledge, and recent developments regarding the etiology of ischiovertebral dysplasia was combined with a clinical review of the condition. To acquaint orthopedic spine surgeons with identification patterns of ischiovertebral dysplasia in order to provide them with guidelines about spine management and which complications to expect. Ischiovertebral dysplasia is a rare skeletal dysplasia that may appear in a sporadic fashion or be inherited with an autosomal dominant inheritance pattern. It is defined by the association of an ischiopubic ramus hypoplasia and a vertebral dysplasia. It leads to a specific spine deformity whose management and complications should be clarified. Thirty consecutive patients from 0 to 31 years of age with ischiovertebral dysplasia were included from 5 centers specialized in congenital spinal deformities. Frontal and sagittal Cobb angles before treatment, natural history of the curves, therapeutic options, and their complications were systematically analyzed. All the patients had a vertebral dysplasia and 28 of them developed a spinal deformity. This deformity was an extremely severe thoracic kyphoscoliosis in 25 cases. The other deformities were a thoracolumbar scoliosis in 1 case and a thoracolumbar kyphosis in 2 cases. The management of the thoracic kyphoscoliosis was always challenging and complications included death by respiratory failure (3 cases) and neurological impairment (9 cases). Recognizing the occurrence of ischioverterbral dysplasia is very important to allow for dedicated treatment. The authors advocate preoperative distraction and circumferential fusion to prevent progression of the curve and to avoid the potentially fatal sequelae associated with this disorder. 4.

The coordinated movement of the spine and pelvis during running.

PubMed

Preece, Stephen J; Mason, Duncan; Bramah, Christopher

2016-02-01

Previous research into running has demonstrated consistent patterns in pelvic, lumbar and thoracic motions between different human runners. However, to date, there has been limited attempt to explain why observed coordination patterns emerge and how they may relate to centre of mass (CoM) motion. In this study, kinematic data were collected from the thorax, lumbar spine, pelvis and lower limbs during over ground running in n=28 participants. These data was subsequently used to develop a theoretical understanding of the coordination of the spine and pelvis in all three body planes during the stance phase of running. In the sagittal plane, there appeared to be an antiphase coordinate pattern which may function to increase femoral inclination at toe off whilst minimising anterior-posterior accelerations of the CoM. In the medio-lateral direction, CoM motion appears to facilitate transition to the contralateral foot. However, an antiphase coordination pattern was also observed, most likely to minimise unnecessary accelerations of the CoM. In the transverse plane, motion of the pelvis was observed to lag slightly behind that of the thorax. However, it is possible that the close coupling between these two segments facilitates the thoracic rotation required to passively drive arm motion. This is the first study to provide a full biomechanical rationale for the coordination of the spine and pelvis during human running. This insight should help clinicians develop an improved understanding of how spinal and pelvic motions may contribute to, or result from, common running injuries. Copyright © 2015 Elsevier B.V. All rights reserved.

Transmission of Insult in Out-of-Position Subjects: III. Thoracic Spine Injury

NASA Astrophysics Data System (ADS)

Shaibani, Saami J.

2004-03-01

In two related papers,[1-2] the behavior of vehicle occupants subjected to low-severity insults was calculated. The same low level of impact was experienced by a train operator in the engine compartment studied here. It is important to recognize that the operator chair is totally different from passenger vehicle seats, which means that results for the latter cannot meaningfully be employed for the former. Instead, the chair design must be examined thoroughly to show that the top of the chair reaches only the mid-point of the operator's back and the line of the chair is rotated to the right of the line of forward travel. The first feature offers no protection against rearward motion of the upper body, and the second compounds this by twisting the body into a non-standard posture. Physics principles once again enabled consequent injury to be diagnosed. 1. Transmission of Insult in Out-of-Position Subjects: I. Shoulder Injury, Bull. Am. Phys. Soc., 47, 544 (2002); 2. ibid: II. Lumbosacral Injury.

Transmission of Insult in Out-of-Position Subjects: I. Shoulder Injury

NASA Astrophysics Data System (ADS)

Shaibani, Saami J.

2002-03-01

The dynamic response of vehicle occupants in impact events is quite well understood when initial boundary conditions have simple values. However, departure from regular seated postures can present considerable analytical challenges in identifying possible causes of injury. Research grounded in physics[1] can facilitate the latter to promote diagnosis, and enhance treatment, for injuries that might not otherwise be recognized. This is confoundingly true in some low-severity impacts, three of which are explored as separate studies because they are so different. The first involves the upper extremity of a passenger who was bent fully forward at the time of impact, and correct use of physics established an unusual injury mechanism when lesser approaches failed. Subsequent papers deal with other parts of the body.[2-3] 1. Proper Treatment of Complex Human Structures, Announcer 27 (4), 100 (1997); 2. Transmission of Insult in Out-of-Position Subjects: II. Lumbosacral Injury, Bull. Am. Phys. Soc. in press (2002); 3. ibid: III. Thoracic Spine Injury.

Fatty replacement of lower paraspinal muscles: normal and neuromuscular disorders

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hader, H.; Gadoth, N.; Heifetz, H.

1983-11-01

The physiologic replacement of the lower paraspinal muscles by fat was evaluated in 157 patients undergoing computed tomography for reasons unrelated to abnormalities of the locomotor system. Five patients with neuromuscular disorders were similarly evaluated. The changes were graded according to severity at three spinal levels: lower thoracic-upper lumbar, midlumbar, and lumbosacral. The results were analyzed in relation to age and gender. It was found that fatty replacement of paraspinal muscles is a normal age-progressive phenomenon most prominent in females. It progresses down the spine, being most advanced in the lumbosacral region. The severest changes in the five patients withmore » neuromuscular disorders (three with poliomyelitis and two with progressive muscular dystrophy) consisted of complete muscle group replacement by fat. In postpoliomyelitis atrophy, the distribution was typically asymmetric and sometimes lacked clinical correlation. In muscular dystrophy, fatty replacement was symmetric, showing relative sparing of the psoas and multifidus muscles. In patients with neuromuscular diseases, computed tomography of muscles may be helpful in planning a better rehabilitation regimen.« less

Variations of cervical lordosis and head alignment after pedicle subtraction osteotomy surgery for sagittal imbalance.

PubMed

Cecchinato, R; Langella, F; Bassani, R; Sansone, V; Lamartina, C; Berjano, P

2014-10-01

The variations of the cervical lordosis after correction of sagittal imbalance have been poorly studied. The aim of our study is to verify whether the cervical lordosis changes after surgery for sagittal imbalance. Thirty-nine patients were included in the study. Cervical, thoracic and lumbar spine, pelvic and lower-limb sagittal parameters were recorded. The cranial alignment was measured by the newly described Cranial Slope. The global cervical kyphosis (preop -43°, postop -31.5°) and the upper (preop -24.1°, postop -20.2°) and lower cervical kyphosis (preop -18.1°, postop -9.2°) were significantly reduced after surgical realignment of the trunk. A positive linear correlation was observed between the changes in T1 slope and the lower cervical lordosis, and between T1 slope and the global cervical alignment. The cervical lordosis is reduced by surgical correction of malalignment of the trunk, suggesting an adaptive role to maintain the head's neutral position.

Lower thoracic spinal cord injury without radiographic abnormality in an amateur rugby player.

PubMed

Smith, Hannah K; Durnford, Andrew J; Sherlala, Khaled; Merriam, William F

2012-10-26

A 37-year-old man, amateur rugby player sustained a hyperextension injury to his lower thoracic spine during a scrum collapse. The patient developed extreme hyperpathia in the T10-12 dermatome, and parasthesia from T12 to S1 in the left lower limb. Medical Research Council grade 5 power was regained rapidly within minutes of the accident, and the hyperpathia resolved within a week. MRI showed contusion of the spinal cord at T10 level but no associated osseoligamentous injury. Six months later, parasthesia and subjective weakness remained in the left lower limb. To our knowledge, this is the first description of a lower thoracic spinal cord injury without radiographic abnormality following an isolated low-energy injury in a skeletally mature patient.

Lower thoracic spinal cord injury without radiographic abnormality in an amateur rugby player

PubMed Central

Smith, Hannah K; Durnford, Andrew J; Sherlala, Khaled; Merriam, William F

2012-01-01

A 37-year-old man, amateur rugby player sustained a hyperextension injury to his lower thoracic spine during a scrum collapse. The patient developed extreme hyperpathia in the T10-12 dermatome, and parasthesia from T12 to S1 in the left lower limb. Medical Research Council grade 5 power was regained rapidly within minutes of the accident, and the hyperpathia resolved within a week. MRI showed contusion of the spinal cord at T10 level but no associated osseoligamentous injury. Six months later, parasthesia and subjective weakness remained in the left lower limb. To our knowledge, this is the first description of a lower thoracic spinal cord injury without radiographic abnormality following an isolated low-energy injury in a skeletally mature patient. PMID:23104628

One-stage posterior approaches for treatment of thoracic spinal infection: Transforaminal and costotransversectomy, compared with anterior approach with posterior instrumentation.

PubMed

Kao, Fu-Cheng; Tsai, Tsung-Ting; Niu, Chi-Chien; Lai, Po-Liang; Chen, Lih-Huei; Chen, Wen-Jer

2017-10-01

Treating thoracic infective spondylodiscitis with anterior surgical approaches carry a relatively high risk of perioperative and postoperative complications. Posterior approaches have been reported to result in lower complication rates than anterior procedures, but more evidence is needed to demonstrate the safety and efficacy of 1-stage posterior approaches for treating infectious thoracic spondylodiscitis.Preoperative and postoperative clinical data, of 18 patients who underwent 2 types of 1-stage posterior procedures, costotransversectomy and transforaminal thoracic interbody debridement and fusion and 7 patients who underwent anterior debridement and reconstruction with posterior instrumentation, were retrospectively assessed.The clinical outcomes of patients treated with 1-stage posterior approaches were generally good, with good infection control, back pain relief, kyphotic angle correction, and either partial or solid union for fusion status. Furthermore, they achieved shorter surgical time, fewer postoperative complications, and shorter hospital stay than the patients underwent anterior debridement with posterior instrumentation.The results suggested that treating thoracic spondylodiscitis with a single-stage posterior approach might prevent postoperative complications and avoid respiratory problems associated with anterior approaches. Single-stage posterior approaches would be recommended for thoracic spine infection, especially for patients with medical comorbidities.

[Feasibility and short-term efficacy of simplified intensity-modulated radiotherapy and concurrent chemotherapy for neck and upper thoracic esophageal carcinoma].

PubMed

Zhu, Wei-Guo; Yu, Chang-Hua; Han, Ji-Hua; Li, Tao; Zhou, Xi-Lei; Tao, Guang-Zhou

2009-12-01

For neck and upper thoracic esophageal carcinoma, three dimensional conformal radiation therapy (3D-CRT) does not necessarily meet all clinical requirements while intensity modulated radiation therapy (IMRT) may take up a lot of labour power and material resources. This study was to explore the feasibility of simplified IMPT(sIMRT) and concurrent chemotherapy for neck and upper thoracic esophageal carcinoma, and to investigate the acute toxicities and short-term efficacy of this treatment modality. sIMRT plans were designed for 30 patients with neck and upper thoracic esophageal carcinoma. Two target volumes were defined: PTV1, which was designed to irradiate to 64 Gy (2.13 Gy x 30 fractions); PTV2, which was given to 54 Gy (1.8 Gy x 30). The sIMRT plan included five equiangular coplanar beams. All patients concurrently received DDP+5-FU regimen with radiotherapy on d1-5 and d29-33. Chemotherapy was repeated for two cycles 28 days after radiotherapy. The treatment was completed for all patients within 6 weeks, and only one patient had Grade 3 acute bronchitis. The complete response (CR) rate was 90.0% (27/30) and the partial response (PR) rate 10.0% (3/30). Overall response was 100% for esophageal lesions and the CR rate 76.5% (13/17). The PR rate was 23.5% (4/17) in lymph node lesions. The major toxicities observed were Grades I-II leukocytopenia. sIMRT can generate desirable dose distribution for neck and upper thoracic esophageal carcinoma, which is similar to sophisticated IMRT but obviously better than 3D-CRT. The short-term efficacy of sIMRT is satisfactory and its acute toxicities are tolerable.

The use of the T1 sagittal angle in predicting overall sagittal balance of the spine.

PubMed

Knott, Patrick T; Mardjetko, Steven M; Techy, Fernando

2010-11-01

A balanced sagittal alignment of the spine has been shown to strongly correlate with less pain, less disability, and greater health status scores. To restore proper sagittal balance, one must assess the position of the occiput relative to the sacrum. The assessment of spinal balance preoperatively can be challenging, whereas predicting postoperative balance is even more difficult. This study was designed to evaluate and quantify multiple factors that influence sagittal balance. Retrospective analysis of existing spinal radiographs. A retrospective review of 52 adult spine patient records was performed. All patients had full-column digital radiographs that showed all the important skeletal landmarks necessary for accurate measurement. The average age of the patient was 53 years. Both genders were equally represented. The radiographs were measured using standard techniques to obtain the following parameters: scoliosis in the coronal plane; lordosis or kyphosis of the cervical, thoracic, and lumbar spine; the T1 sagittal angle (angle between a horizontal line and the superior end plate of T1); the angle of the dens in the sagittal plane; the angle of the dens in relation to the occiput; the sacral slope; the pelvic incidence; the femoral-sacral angle; and finally, the sagittal vertical axis (SVA) measured from both the dens of C2 and from C7. It was found that the SVA when measured from the dens was on average 16 mm farther forward than the SVA measured from C7 (p<.0001). The dens plumb line (SVA(dens)) was then used in the study. An analysis was done to examine the relationship between SVA(dens) and each of the other measurements. The T1 sagittal angle was found to have a moderate positive correlation (r=0.65) with SVA(dens), p<.0001, indicating that the amount of sagittal T1 tilt can be used as a good predictor of overall sagittal balance. When examining the other variables, it was found that cervical lordosis had a weak correlation (r=0.37) with SVA(dens) that was unexpected, given that cervical lordosis determines head position. Thoracic kyphosis also had a weak correlation (r=0.26) with SVA(C1), which was equally surprising. Lumbar lordosis had a slightly higher correlation (r=0.38), p=.006, than the cervical or thoracic spine. A multiple regression was run on the data to examine the relationship that all these independent variables have on SVA(dens). SPSS (SPSS, Inc., Chicago, IL, USA) was used to create a regression equation using the independent variables of T1 sagittal angle, cervical lordosis, thoracic kyphosis, lumbar lordosis, sacral slope, pelvic incidence, and femoral-sacral angle and the dependent variable of SVA(dens). The model had a strong correlation (r=0.80, r(2)=0.64) and was statistically significant (p<.0001). The T1 sagittal angle was the variable that had the strongest correlation with the SVA(dens) Spearman r=0.65, p<.0001, followed by pelvic incidence, p=.002, and lumbar lordosis, p=.006. We also observed that when the T1 tilt was higher than 25°, all patients had at least 10 cm of positive sagittal imbalance. In addition, patients with negative sagittal balance had mostly low T1 tilt values, usually lower than 13°. The other variables were not shown to have a statically significant influence on SVA. This analysis shows that many factors influence the overall sagittal balance of the patient, but it may be the position of the pelvis and lower spine that have a stronger influence than the position of the upper back and neck. Unfortunately, to our knowledge, there are no studies to date that have established a normal sagittal T1 tilt angle. However, our analysis has shown that when the T1 tilt was higher than 25°, all patients had at least 10 cm of positive sagittal imbalance. It also showed that patients with negative sagittal balance had mostly low T1 tilt values, usually below 13° of angulation. The T1 sagittal angle is a measurement that may be very useful in evaluating sagittal balance, as it was the measure that most strongly correlated with SVA(dens). It has its great utility where long films cannot be obtained. Patients whose T1 tilt falls outside the range 13° to 25° should be sent for full-column radiographs for a complete evaluation of their sagittal balance. On the other hand, a T1 tilt within the above range does not guarantee a normal sagittal balance, and further investigation should be performed at the surgeon's discretion. Copyright © 2010 Elsevier Inc. All rights reserved.

Radiofrequency Denervation Improves Health-Related Quality of Life in Patients with Thoracic Zygapophyseal Joint Pain.

PubMed

Hambraeus, Johan; Hambraeus, Kjerstin S; Persson, Jan

2018-05-01

To describe a practical approach for the diagnosis and treatment of thoracic zygapophyseal joint pain and to present preliminary clinical data on the effects of this treatment approach on health-related quality of life. An observational study. Specialist outpatient pain clinic in northern Sweden. Patients with long-term thoracic pain. We describe a method of radiofrequency denervation of thoracic zygapophyseal joints. We compared health-related quality of life between patients who underwent radiofrequency denervation of thoracic zygapophyseal joints and patients who underwent radiofrequency denervation for lumbar and cervical zygapophyseal joint pain. Treatment according to the Spine Intervention Society Guidelines was performed on the lumbar region in 178 patients and in the cervical region in 55 patients. Another 82 patients were treated in the thoracic region with our proposed technique. A survival plot of improvements in health-related quality of life revealed that all three treatments were effective in 65% or more of patients. The improvement in health-related quality of life was maintained for 12 or more months after treatment in 47% to 51% of patients. Our results suggest that radiofrequency denervation of thoracic zygapophyseal joint pain is as effective as radiofrequency denervation, the standard treatment, for lumbar and cervical zygapophyseal joint pain. If these results can be confirmed by other centers, radiofrequency denervation is likely to become more widely available for the treatment of thoracic zygapophyseal joint pain.

Efficacy and safety of posteromedial translation for correction of thoracic curves in adolescent idiopathic scoliosis using a new connection to the spine: the Universal Clamp

PubMed Central

Mazda, Keyvan; Even, Julien; Lefevre, Yan; Fitoussi, Franck; Penneçot, Georges-François

2008-01-01

Correction of adolescent idiopathic scoliosis (AIS) has been reported with various systems. All-screw constructs are currently the most popular, but they have been associated with a significant decrease in thoracic kyphosis, with a potential risk of junctional kyphosis, not observed with hybrid constructs in the literature. In addition, it is important to weigh potential advantages of pedicle screw fixation against risks specific to its use. Because hybrid constructs are associated with a lower risk of complications and better sagittal correction than all-screw constructs, at present we use lumbar pedicle screws combined with a new sublaminar connection to the spine (Universal Clamps) at thoracic levels. The purpose of this study was to determine the efficacy and safety of the Universal Clamp (UC) posteromedial translation technique for correction of AIS. Seventy-five consecutive patients underwent posterior spinal fusion and hybrid instrumentation for progressive AIS. Correction was performed at the thoracic level using posteromedial translation. At the lumbar level, correction was performed using in situ contouring and compression/distractions maneuvers. A minimum 2-year follow-up was required. Medical data and radiographs were prospectively analyzed and compared using a paired t test. The average age at surgery was 15 years and 4 months (±19 months). The average number of levels fused was 12 ± 1.6. The mean follow-up was 30 ± 5 months. The average preoperative Cobb angle of the major curve was 60° ± 20°. The immediate postoperative major curve correction averaged 66 ± 13%. The average loss of correction of the major curve between the early postoperative assessment and latest follow-up was 3.5° ± 1.4°. The mean Cincinnati correction index was 1.7 ± 0.8 postoperatively, and 1.57 ± 1 at last follow up. The mean rotation of the apical vertebra was corrected from 23.3° ± 9° preoperatively to 7.3° ± 5° at last follow up (69% improvement, P < 0.0001). In the sagittal plane, the mean thoracic kyphosis improved from 23.8° ± 14.2° preoperatively to 32.3° ± 7.3° at last follow up. For the 68 patients who had a normokyphotic or a hypokyphotic sagittal modifier, thoracic kyphosis increased from 20.5° ± 9.9° to 31.8° ± 7.4°, corresponding to a mean kyphosis correction of 55% at last follow up. No intraoperative complication occurred and none of the patients developed proximal junctional kyphosis during the follow up. The principal limitation of the UC technique was the rate of proximal posterior prominence (14.6%), leading us to recommend the use of conventional claws at the upper extremity of the construct. The technique was safe, and reduced operative time, radiation exposure, and blood loss. While achieving correction of deformity in the coronal and axial planes equivalent to the best reported results of all-screw or previous hybrid constructs, the UC hybrid technique appears to provide superior correction in the sagittal plane. The excellent outcome in all three planes was maintained at 2 year follow up. PMID:19089466

Progression, incidence, and risk factors for intervertebral disc degeneration in a longitudinal population-based cohort: the Wakayama Spine Study.

PubMed

Teraguchi, M; Yoshimura, N; Hashizume, H; Yamada, H; Oka, H; Minamide, A; Nagata, K; Ishimoto, Y; Kagotani, R; Kawaguchi, H; Tanaka, S; Akune, T; Nakamura, K; Muraki, S; Yoshida, M

2017-07-01

The present study examined the progression, incidence, and risk factors for intervertebral disc degeneration (DD) throughout the lumbar spine using magnetic resonance imaging (MRI) in a large population-based cohort. We followed up 617 subjects for more than 4 years as part of the Wakayama Spine Study. 1) "Progression of DD" in each of the entire, upper (L1/2 to L3/4) and lower (L4/5 and L5/S1) lumbar spine was defined as Pfirrmann grade progression at follow-up in at least one disc in the affected region. 2) "Incidence of DD" in each of these regions was defined if all discs were grade 3 or lower (white disc) at baseline, and at least one disc had progressed to grade 4 or higher (black disc) at follow-up. Logistic regression analyses were used to determine the risk factors for progression and incidence of DD. DD progression and incidence in the entire lumbar spine were 52.0% and 31.6% in men, and 60.4% and 44.7% in women, respectively. Women was associated with DD progression in the upper lumbar spine (odds ratio [OR] = 1.68, 95% confidence interval [CI] = 1.18-2.42). Aging was associated with the incidence of DD in each region (entire: OR = 1.14, CI = 1.06-1.14; upper: OR = 1.10, CI = 1.05-1.15; lower: OR = 1.11, CI = 1.05-1.19). Diabetes mellitus (DM) was associated with the incidence of DD in the upper lumbar spine (OR = 6.83, CI = 1.07-133.7). This 4-year longitudinal study is the first to demonstrate DD progression and incidence in the lumbar spine and their risk factors in a large population-based cohort. Copyright © 2017 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

The association between incentive spirometry performance and pain in postoperative thoracic epidural analgesia.

PubMed

Harris, David J; Hilliard, Paul E; Jewell, Elizabeth S; Brummett, Chad M

2015-01-01

Effective use of postoperative incentive spirometry improves patient outcomes but is limited by pain after thoracic and upper abdominal surgery. Thoracic epidurals are frequently used to provide analgesia and attenuate postoperative pulmonary dysfunction. We hypothesized that, in patients with thoracic epidurals for thoracic and abdominal surgery, high pain scores would be associated with poorer incentive spirometry performance, even when accounting for other variables. Retrospective study of 468 patients who underwent upper abdominal or thoracic surgery using postoperative thoracic epidural analgesia between June 1, 2009, and August 31, 2013, at a single tertiary academic center. The association between incentive spirometry performance and pain was assessed as the primary outcome. Other independent predictors of incentive spirometry performance were also identified. Postoperative incentive spirometry performance was found to be inversely proportional to pain score, which correlated significantly stronger with deep breathing pain compared with pain at rest (-0.33 vs -0.14 on postoperative day 1; -0.23 vs -0.12 on postoperative day 2). Pain with deep breathing was independently associated with poorer incentive spirometry performance in the multivariable linear regression model (P < 0.0001), as was increasing age, female sex, thoracic surgery, and higher American Society of Anesthesiologists (ASA) physical status score. The present study suggests that pain with deep breathing is more indicative of thoracic epidural efficacy than is pain at rest. Furthermore, incentive spirometry performance could be used as another indicator of thoracic epidural efficacy. This may be particularly useful in patients reporting high pain scores postoperatively.

Three new species of Heteromysis (Mysida, Mysidae, Heteromysini) from the Cape Peninsula, South Africa, with first documentation of a mysid-cephalopod association.

PubMed

Wittmann, Karl J; Griffiths, Charles L

2017-01-01

Faunistic studies in sublittoral and littoral marine habitats on the Cape Peninsula, South Africa, have yielded three new species belonging to the genus Heteromysis , subgenus Heteromysis: H. cancelli sp. n. associated with the diogenid hermit crab Cancellus macrothrix Stebbing, 1924, and H. fosteri sp. n. extracted from 'empty' urchin and gastropod shells. The first documented mysid-cephalopod association is reported for H. octopodis sp. n. which was found in dens occupied by Octopus vulgaris Cuvier, 1797, but was also captured from tide pools. The three new species differ from previously known E. Atlantic species, among other characters, by a single spine on the endopods of uropods in combination with large cornea and absence of median sternal processes on thoracic somites. They are also characterized by a white stripe along the dorso-lateral terminal margin of the eyestalks in living specimens. The new species appear quite similar to each other, but are distinguished by different depths of the telson cleft, different distributions of spines on the lateral margins of the telson, different numbers of segments on thoracic endopod 4, and by differently modified setae on the carpus of the third thoracic endopod, as well as on the carpopropodus of the fourth endopod. An updated key to the species of Heteromysis known from the E. Atlantic is given.

Three new species of Heteromysis (Mysida, Mysidae, Heteromysini) from the Cape Peninsula, South Africa, with first documentation of a mysid-cephalopod association

PubMed Central

Wittmann, Karl J.; Griffiths, Charles L.

2017-01-01

Abstract Faunistic studies in sublittoral and littoral marine habitats on the Cape Peninsula, South Africa, have yielded three new species belonging to the genus Heteromysis, subgenus Heteromysis: H. cancelli sp. n. associated with the diogenid hermit crab Cancellus macrothrix Stebbing, 1924, and H. fosteri sp. n. extracted from ‘empty’ urchin and gastropod shells. The first documented mysid-cephalopod association is reported for H. octopodis sp. n. which was found in dens occupied by Octopus vulgaris Cuvier, 1797, but was also captured from tide pools. The three new species differ from previously known E. Atlantic species, among other characters, by a single spine on the endopods of uropods in combination with large cornea and absence of median sternal processes on thoracic somites. They are also characterized by a white stripe along the dorso-lateral terminal margin of the eyestalks in living specimens. The new species appear quite similar to each other, but are distinguished by different depths of the telson cleft, different distributions of spines on the lateral margins of the telson, different numbers of segments on thoracic endopod 4, and by differently modified setae on the carpus of the third thoracic endopod, as well as on the carpopropodus of the fourth endopod. An updated key to the species of Heteromysis known from the E. Atlantic is given. PMID:29089836

The presence of nonthoracic distracting injuries does not affect the initial clinical examination of the cervical spine in evaluable blunt trauma patients: a prospective observational study.

PubMed

Konstantinidis, Agathoklis; Plurad, David; Barmparas, Galinos; Inaba, Kenji; Lam, Lydia; Bukur, Marko; Branco, Bernardino C; Demetriades, Demetrios

2011-09-01

A distracting injury mandates cervical spine (c-spine) imaging in the evaluable blunt trauma patient who demonstrates no pain or tenderness over the c-spine. The purpose of this study was to examine which distracting injuries can negatively affect the sensitivity of the standard clinical examination of the c-spine. This is a prospective observational study conducted at a Level I Trauma Center from January 1, 2008, to December 31, 2009. After institutional review board approval, all evaluable (Glasgow Coma Scale score ≥13) blunt trauma patients older than 16 years sustaining a c-spine injury were enrolled. A distracting injury was defined as any immediately evident bony or soft tissue injury or a complaint of non-c-spine pain whether or not an actual injury was subsequently diagnosed. Information regarding the initial clinical examination and the presence of a distracting injury was collected from the senior resident or attending trauma surgeon involved in the initial management. During the study period, 101 evaluable patients sustained a c-spine injury. Distracting injuries were present in 88 patients (87.1%). The most common was rib fracture (21.6%), followed by lower extremity fracture (20.5%) and upper extremity fracture (12.5%). Only four (4.0%) patients had no pain or tenderness on the initial examination of the c-spine. All four patients had bruising and tenderness to the upper anterior chest. None of these four patients developed neurologic sequelae or required a surgical stabilization or immobilization. C-spine imaging may not be required in the evaluable blunt trauma patient despite distracting injuries in any body regions that do not involve the upper chest. Further definition of distracting injuries is mandated to avoid unnecessary utilization of resources and to reduce the imaging burden associated with the evaluation of the c-spine.

Successful Recovery and Transplantation of 11 Organs Including Face, Bilateral Upper Extremities, and Thoracic and Abdominal Organs From a Single Deceased Organ Donor.

PubMed

Tullius, Stefan G; Pomahac, Bohdan; Kim, Heung Bae; Carty, Matthew J; Talbot, Simon G; Nelson, Helen M; Delmonico, Francis L

2016-10-01

We report on the to date largest recovery of 11 organs from a single deceased donor with the transplantation of face, bilateral upper extremities, heart, 1 lung, liver (split for 2 recipients), kidneys, pancreas, and intestine. Although logistically challenging, this case demonstrates the feasibility and safety of the recovery of multiple thoracic and abdominal organs with multiple vascular composite allotransplants and tissues. Our experience of 8 additional successful multiple vascular composite allotransplants, thoracic, and abdominal organ recoveries suggests that such procedures are readily accomplishable from the same deceased donor.

Thoracic Hemangioma From Rib Presenting as Compressive Paraparesis in a Young Adult: A Treatment Dilemma.

PubMed

Shaik, Ismail; Karapurkar, Anil; Bhojraj, Shekhar; Naggad, Premik

2015-11-01

A case report. To describe the presentation of compressive paraparesis as a result of thoracic rib hemangioma in a young adult and its nonsurgical management. Hemangiomas are rare bone tumors and those arising from rib are rarer. Only about 50 such cases have been reported in literature so far. A 21-year-old male student, presented to us with a 6-week history of progressive weakness in both lower limbs and loss of bowel bladder control. Patient gave history of being operated for left periscapular tumor treated with wide excision and proven with biopsy to be a hemangioendothelioma (benign but locally aggressive hemangioma variant) a year ago. New radiograph of the chest showed an expansile lesion of left fifth rib and magnetic resonance image showed a tumor of left dorsal thoracic wall with AV malformation causing compressive thoracic myelopathy at T5 level vertebrae. We planned for immediate decompression surgery for spine along with excision of tumor with the help of a thoracic surgeon. However, on preoperative digital subtraction angiography, the tumor was found to be highly vascular with high risk of intraoperative bleeding and morbidity. So, the plan was revised and the patient underwent digital subtraction angiography, followed by embolization by an expert interventional neurosurgeon. The patient showed signs of recovery within a week. Lower limb power improved from grade 2 to 3/5 to grade 4 to 4+/5. The patient became ambulatory with single stick at 3-month follow-up; he was a nonwalker to start with. At 2 years plus follow-up, the patient fully recovered and walks without stick. This unique case brings to light the dilemma a spine surgeon sometimes faces. A case that warranted immediate surgical intervention based on clinical findings was treated with interventional fibrin glue embolizations with excellent results. N/A.

Obstructive hydrocephalus as a result of giant cell tumor of the thoracic spine: A case report

PubMed Central

WEI, CHENG-YU; CHEN, SHUO-TSUNG; TAI, HSU-CHIH; WANG, WEN-BING; CHANG, CHI-CHU; WANG, YAO-CHIN; WEI, LI; KUNG, WOON-MAN

2016-01-01

Giant cell tumors (GCTs) are rare bone tumors that account for ~5% of all primary bone tumors. When GCTs occur in the spine, patients usually present with localized pain and neurological symptoms, such as radiating pain or hyperesthesia. In the current report, an unusual case of a GCT of the thoracic spine associated with hydrocephalus is described. A 48-year-old male presented with urinary retention, loss of sensation in the lower limbs and inability to walk. The patient eventually developed hydrocephalus combined with altered consciousness, indicated by an inability to follow simple commands. Magnetic resonance (MR) imaging demonstrated the presence of a soft tissue mass at the T2 level, and biopsy examination of the tissue confirmed that it was a GCT. The patient experienced a sudden loss of consciousness due to an acute episode of obstructive hydrocephalus. A ventriculoperitoneal shunting procedure was performed to treat the hydrocephalus, and the patient regained normal consciousness, although the paraplegia persisted. An MR examination performed 30 months following surgery demonstrated that the tumor size was stable, consistent with the slow growth that is characteristic of GCTs. Diagnosis of GCTs may be challenging, and relies on radiographic and histopathologic findings. Although rare, acute hydrocephalus as a result of GCTs should not be excluded from a differential diagnosis. PMID:26870164

Comparison of athletic training professional preparation to the prevalence of injury occurrence in the collegiate setting

NASA Astrophysics Data System (ADS)

Westerman, Beverly Jean

1999-10-01

This study investigated the relationship between the frequency of injuries that occur to certain body areas in National Collegiate Athletic Association (NCAA) athletes and the percentage of time teaching about the same subject areas in Athletic Training Education Programs (ATEP). Directors of Commission of Accreditation of Allied Health Education Programs (CAAHEP) accredited and National Athletic Trainers' Association (NATA) approved programs were surveyed. Randomly selected ATEP directors were interviewed by telephone to collect information on estimated teaching time, the strengths and weaknesses of their programs, and preferred teaching methods. Data were collected from the NCAA Injury Surveillance System to calculate the frequency of injury. Chi-square 'goodness-of-fit' tests were used to determine if a 'good fit' existed between injury frequency and teaching time in two categories: general body areas (head and face, upper extremity, lower extremity, spine, and abdomen and thorax) and specific body areas (head, face, upper arm and shoulder, elbow and forearm, wrist and hand, hip and pelvis, thigh, knee, lower leg, ankle and foot, cervical spine, thoracic spine, lumbar spine, abdomen, and thorax). Standardized residuals were used to assist in determining the location of statistical significance within the same two categories. The chi-square values calculated for both the general and specific body areas were greater than the critical value set at a significance level of .05 with 4 and 14 degrees of freedom respectively. Therefore, it was found that a 'good fit' does not exist between injury frequency and teaching time. The standardized residuals were calculated for each variable within the categories. One out of five general body areas and 10 out of 15 specific body areas were less than 2.00 in absolute value and were found not to contribute to the high chi-square value. Although the chi-square values showed a lack of fit between injury frequency and teaching time in the general and specific body areas, the standardized residuals indicated a relationship exists between some variables (body areas) within each category. In other words, the percentage of teaching time may correspond with injury frequency in some general and specific body areas. The responses from the program directors indicated they thought their academic programs were spending the appropriate amount of time teaching about the general and specific body areas. However, the percentages of teaching time reported for each of the body areas varied greatly among the responders. Further study is indicated to examine the relationship between teaching time/content and injury frequency.

Posterior Bilateral Intermuscular Approach for Upper Cervical Spine Injuries.

PubMed

Xu, Yong; Xiong, Wei; Han, Sung I I; Fang, Zhong; Li, Feng

2017-08-01

To investigate a novel intermuscular surgical approach for posterior upper cervical spine fixation. Twenty-three healthy volunteers underwent magnetic resonance imaging. By using the magnetic resonance imaging scans in transverse view at the level of lower edge of atlas, the distances from the posterior midline to lateral margin of trapezius, to the medial margin of splenius capitis, and to middle line of semispinalis capitis were recorded. The angle between posterior middle line and the line crossing the lateral margin of trapezius and middle point of ipsilateral pedicles. From October 2009 to May 2013, 12 patients with upper cervical spine injuries were operated via the bilateral intermuscular approach. The time required for surgery, blood loss, and pre- and postoperative visual analogue scale scores were analyzed. The average distance of 0-T was 39.2 ± 7.5 mm, the angle between the approach and posterior middle line was 33.2 ± 8.4°. The surgical time was 78.3 ± 22.5 minutes (45-140 minutes), and the mean intraoperative blood loss was 87.5 ± 44.2 mL (30-200 mL). Preoperative and postoperative visual analogue scale scores were 6.4 ± 0.8 and 1.8 ± 0.7, respectively. The average follow-up time was 19.7 ± 11.5 months (9-48 months). The posterior bilateral intermuscular approach for upper cervical spine injuries is a valid alternative for Hangmans' fractures type I, type II, and type Ia according to Levine and Edwards classification as well as atlantoaxial subluxation caused by upper cervical spine trauma. Copyright © 2017 Elsevier Inc. All rights reserved.

Comparative analysis of low-back loading on chiropractors using various workstation table heights and performing various tasks.

PubMed

Lorme, Kenneth J; Naqvi, Syed A

2003-01-01

There is epidemiologic evidence that chiropractors are a high-risk group for low-back disorders. However, to date there are no known biomechanical studies to determine whether their workstations may be a contributing factor. To investigate whether chiropractors' workstation table height or the tasks they perform make them susceptible to low-back strain. As well as investigating low-back strain, a screening was performed to determine whether chiropractors' upper extremities were at risk for undue strain as workstation table height was varied. Experimental pilot study. A university ergonomic laboratory. An adjustable manipulation table was set at 3 different heights: 465 mm, 665 mm and 845 mm. Each of the 7 volunteer chiropractors were fitted with a triaxial electrogoniometer and were videotaped and photographed for analysis while performing spinal manipulation to the cervical, thoracic, and lumbar spine of a volunteer patient at each workstation table height. Two biomechanical models, one static and one dynamic, were used to record the dependent variables. A screening of various upper extremity variables was also performed with the static model. For the subjects under study, a significant difference was found for the variables maximum sagittal flexion, disk compression force, and ligament strain as table height was varied. For the lumbar and thoracic manipulation tasks, the medium table height (655 mm) was found to create the least low-back strain. For the cervical manipulation task, the high table height (845 mm) was found to be the least straining on the low-back. The low height table (465 mm) was the most straining for all tasks. Upper extremities were not significantly affected by changes to table height. Significant differences were found for the task performed for axial rotational velocity, disk compression force, ligament strain, maximum sagittal flexion, dominant (right) elbow moment, and dominant (right) shoulder moment variables. There was no significant interaction between table height and task performed. Workstation table height was found to have a significant effect on low-back load of subjects under study. The results of this study demonstrate an overall unacceptably high amount of sagittal flexion, ligament strain, and disk compression force on the chiropractor subjects in the tasks performed.

Inclusion of thoracic spine thrust manipulation into an electro-therapy/thermal program for the management of patients with acute mechanical neck pain: a randomized clinical trial.

PubMed

González-Iglesias, Javier; Fernández-de-las-Peñas, Cesar; Cleland, Joshua A; Alburquerque-Sendín, Francisco; Palomeque-del-Cerro, Luis; Méndez-Sánchez, Roberto

2009-06-01

Our aim was to examine the effects of a seated thoracic spine distraction thrust manipulation included in an electrotherapy/thermal program on pain, disability, and cervical range of motion in patients with acute neck pain. This randomized controlled trial included 45 patients (20 males, 25 females) between 23 and 44 years of age presenting with acute neck pain. Patients were randomly divided into 2 groups: an experimental group which received a thoracic manipulation, and a control group which did not receive the manipulative procedure. Both groups received an electrotherapy program consisting of 6 sessions of TENS (frequency 100Hz; 20min), superficial thermo-therapy (15min) and soft tissue massage. The experimental group also received a thoracic manipulation once a week for 3 consecutive weeks. Outcome measures included neck pain (numerical pain rate scale; NPRS), level of disability (Northwick Park Neck Pain Questionnaire; NPQ) and neck mobility. These outcomes were assessed at baseline and 1 week after discharge. A 2-way repeated-measures ANOVA with group as between-subject variable and time as within-subject variable was used. Patients receiving thoracic manipulation experienced greater reductions in both neck pain, with between-group difference of 2.3 (95% CI 2-2.7) points on a 11-NPRS, and perceived disability with between-group differences 8.5 (95% CI 7.2-9.8) points. Further, patients receiving thoracic manipulation experienced greater increases in all cervical motions with between-group differences of 10.6 degrees (95% CI 8.8-12.5 degrees) for flexion; 9.9 degrees (95% CI 8.1-11.7 degrees) for extension; 9.5 degrees (95% CI 7.6-11.4 degrees) for right lateral-flexion; 8 degrees (95% CI 6.2-9.8 degrees) for left lateral-flexion; 9.6 degrees (95% CI 7.7-11.6 degrees) for right rotation; and 8.4 degrees (95% CI 6.5-10.3 degrees) for left rotation. We found that the inclusion of a thoracic manipulation into an electrotherapy/thermal program was effective in reducing neck pain and disability, and in increasing active cervical mobility in patients with acute neck pain.

How does implant distribution affect 3D correction and bone-screw forces in thoracic adolescent idiopathic scoliosis spinal instrumentation?

PubMed

Le Navéaux, Franck; Larson, A Noelle; Labelle, Hubert; Wang, Xiaoyu; Aubin, Carl-Éric

2016-11-01

Optimal implant densities and configurations for thoracic spine instrumentation to treat adolescent idiopathic scoliosis remain unknown. The objective was to computationally assess the biomechanical effects of implant distribution on 3D curve correction and bone-implant forces. 3D patient-specific biomechanical spine models based on a multibody dynamic approach were created for 9 Lenke 1 patients who underwent posterior instrumentation (main thoracic Cobb: 43°-70°). For each case, a factorial design of experiments was used to generate 128 virtual implant configurations representative of existing implant patterns used in clinical practice. All instances except implant configuration were the same for each surgical scenario simulation. Simulation of the 128 implant configurations scenarios (mean implant density=1.32, range: 0.73-2) revealed differences of 2° to 10° in Cobb angle correction, 2° to 7° in thoracic kyphosis and 2° to 7° in apical vertebral rotation. The use of more implants, at the concave side only, was associated with higher Cobb angle correction (r=-0.41 to -0.90). Increased implant density was associated with higher apical vertebral rotation correction for seven cases (r=-0.20 to -0.48). It was also associated with higher bone-screw forces (r=0.22 to 0.64), with an average difference between the least and most constrained instrumentation constructs of 107N per implant at the end of simulated instrumentation. Low-density constructs, with implants mainly placed on the concave side, resulted in similar simulated curve correction as the higher-density patterns. Increasing the number of implants allows for only limited improvement of 3D correction and overconstrains the instrumentation construct, resulting in increased forces on the implants. Copyright © 2016 Elsevier Ltd. All rights reserved.

The treatment of idiopathic scoliosis in adolescents: rotation or in situ bending?

PubMed

Gennari, J M; Tallet, J M; Hornung, H; Bergoin, M

1997-12-01

Rotation alone is not fully efficient in order to correct all types of scoliotic curvatures. We report a series of 30 cases instrumented with the EUROS spine system and analyse reductions obtained with in situ rotation or bending alone or with combined maneuvres. The average age of surgery is 17 years for this series composed of 24 female and 6 male patients. The average follow-up is 2.3 years. The curve patterns are displayed with 6 major thoracic, 5 genuine double major, 4 double major thoracic predominant, 6 double major lumbar predominant and 9 double thoracic curves. Combination of both reduction techniques is advisable and is to be made according to the type of curvature and its reducibility in situ bending is made easier with this system without lockers and by reduced diameter of the rod.

Spine: posture, mobility and pain. A longitudinal study from childhood to adolescence.

PubMed

Widhe, T

2001-04-01

A longitudinal study was undertaken to analyse the development of posture and spinal mobility during growth and its relationship to low back pain and sports activities. A total of 90 children were examined at 5-6 years of age and re-examined at 15-16. Sagittal configuration and mobility were measured using Debrunner's kyphometer. Information about pain and activities was acquired by interview with the parents of the 5- to 6-year-olds and by a questionnaire to the 15- to 16-year-olds. Posture changed significantly during the study period: thoracic kyphosis increased by 6 degrees and lumbar lordosis increased by 6 degrees. The relationship between kyphosis and lordosis was independent of gender at age 5-6, but kyphosis in relation to lordosis was significantly lower in girls among the 15- to 16-year-olds. The total sagittal mobility of the spine decreased significantly during the 10-year study period: in the thoracic spine by as much as 27 degrees and in the lumbar spine by 4 degrees. About one-third of the children at the age of 15-16 years stated that they had occasional low back pain. This complaint was more frequent in those stating they had suffered some type of back injury, but low back pain was not related to gender, regular physical training, posture or spinal mobility. The results of the study showed that kyphosis and lordosis increased and mobility decreased in the 90 children who were examined both at age 5-6 and 15-16 years. The relationship between kyphosis and lordosis decreased in girls but not in boys. Occasional low back pain was reported by 38% of the children at the age of 15-16 years, but back pain was not related to posture, spinal mobility or physical activity.

Radiation dose reduction in thoracic and lumbar spine instrumentation using navigation based on an intraoperative cone beam CT imaging system: a prospective randomized clinical trial.

PubMed

Pireau, Nathalie; Cordemans, Virginie; Banse, Xavier; Irda, Nadia; Lichtherte, Sébastien; Kaminski, Ludovic

2017-11-01

Spine surgery still remains a challenge for every spine surgeon, aware of the potential serious outcomes of misplaced instrumentation. Though many studies have highlighted that using intraoperative cone beam CT imaging and navigation systems provides higher accuracy than conventional freehand methods for placement of pedicle screws in spine surgery, few studies are concerned about how to reduce radiation exposure for patients with the use of such technology. One of the main focuses of this study is based on the ALARA principle (as low as reasonably achievable). A prospective randomized trial was conducted in the hybrid operating room between December 2015 and December 2016, including 50 patients operated on for posterior instrumented thoracic and/or lumbar spinal fusion. Patients were randomized to intraoperative 3D acquisition high-dose (standard dose) or low-dose protocol, and a total of 216 pedicle screws were analyzed in terms of screw position. Two different methods were used to measure ionizing radiation: the total skin dose (derived from the dose-area product) and the radiation dose evaluated by thermoluminescent dosimeters on the surgical field. According to Gertzbein and Heary classifications, low-dose protocol provided a significant higher accuracy of pedicle screw placement than the high-dose protocol (96.1 versus 92%, respectively). Seven screws (3.2%), all implanted with the high-dose protocol, needed to be revised intraoperatively. The use of low-dose acquisition protocols reduced patient exposure by a factor of five. This study emphasizes the paramount importance of using low-dose protocols for intraoperative cone beam CT imaging coupled with the navigation system, as it at least does not affect the accuracy of pedicle screw placement and irradiates drastically less.

Seat belt use to save face: impact on drivers' body region and nature of injury in motor vehicle crashes.

PubMed

Han, Guang-Ming; Newmyer, Ashley; Qu, Ming

2015-01-01

Seat belt use is the single most effective way to save lives and reduce injuries in motor vehicle crashes. However, some case reports described seat belt use as a double-edged sword because some injuries are related to seat belt use in motor vehicle crashes. To comprehensively understand the effects of seat belt use, we systemically investigated the association between seat belt use and injuries based on anatomic body region and type of injury in drivers involved in motor vehicle crashes. The injury information was obtained by linking crash reports with hospital discharge data and categorized by using the diagnosis codes based on the Barell injury diagnosis matrix. A total of 10,479 drivers (≥15 years) in passenger vehicles involved in motor vehicle crashes from 2006 to 2011 were included in this study. Seat belt use significantly reduced the proportions of traumatic brain injury (10.4% non-seat belt; 4.1% seat belt) and other head, face, and neck injury (29.3% non-seat belt; 16.6% seat belt) but increased the proportion of spine: thoracic to coccyx injury (17.9% non-seat belt; 35.5% seat belt). Although the proportion of spine: thoracic to coccyx injury was increased in drivers with seat belt use, the severity of injury was decreased, such as fracture (4.2% with seat belt use; 22.0% without seat belt use). Furthermore, the total medical charges decreased due to the change of injury profiles in drivers with seat belt use from a higher percentage of fractures (average cost for per case $26,352) to a higher percentage of sprains and/or strains ($1,897) with spine: thoracic to coccyx injury. This study provide a comprehensive picture for understanding the protective effect of seat belt use on injuries based on anatomic body region and type of injury in drivers involved in motor vehicle crashes.

Clinical safety of the ProMRI pacemaker system in patients subjected to thoracic spine and cardiac 1.5-T magnetic resonance imaging scanning conditions.

PubMed

Bailey, William M; Mazur, Alexander; McCotter, Craig; Woodard, Pamela K; Rosenthal, Lawrence; Johnson, Whitney; Mela, Theofanie

2016-02-01

Permanent cardiac pacemakers have historically been considered a contraindication to magnetic resonance imaging (MRI). The purpose of the ProMRI Phase B Study, a multicenter, prospective, single-arm, nonrandomized study, was to evaluate the clinical safety of the Biotronik ProMRI pacemaker system in patients undergoing thoracic spine and cardiac MRI. The ProMRI Phase B study enrolled 245 patients with stable baseline pacing indices implanted with an Entovis pacemaker (DR-T or SR-T) and Setrox 53-cm and/or 60-cm lead(s). Device interrogation was performed at enrollment, pre- and post-MRI scan, and 1 and 3 months post-MRI. End-points were (1) freedom from MRI- and pacing system-related serious adverse device effects through 1 month post-MRI; (2) freedom from atrial and ventricular MRI-induced pacing threshold increase (>0.5 V); and (3) freedom from P- and R-wave amplitude attenuation (<50%), or P wave <1.5 mV, or R wave <5.0 mV at 1 month post-MRI. In total, 216 patients completed the MRI and 1-month post-MRI follow-up. One adverse event possibly related to the implanted system and the MRI procedure occurred, resulting in a serious adverse device effect-free rate of 99.6% (220/221; P < .0001. Freedom from atrial and ventricular pacing threshold increase was 100% (194/194, P < .001) and 100% (206/206, P < .001) respectively. Freedom from P- and R-wave amplitude attenuation was 98.2% (167/170, P < .001) and 100% (188/188, P < .001) respectively. The results of the ProMRI Phase B study demonstrate the clinical safety and efficacy of the ProMRI pacemaker system in patients subjected to thoracic spine and cardiac MRI conditions. Copyright © 2016 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

[Optimal lymphadenectomy for thoracic esophageal cancer: three-field or modified two-field lymphadenectomy].

PubMed

Liu, Shuoyan; Wang, Zhen; Wang, Feng

2016-09-25

Differences in operative procedure and knowledge of esophageal cancer exist among surgeons from different countries and regions. There is controversy in the surgical treatment of esophageal cancer, especially in the extent of lymphadenectomy. Until now, results of the three-field lymphadenectomy and two-field lymphadenectomy are mostly reported by retrospective studies from Japan and China. Three-field lymphadenectomy has been initiated in Fujian Provincial Cancer Hospital since 1990s. After evaluating our database, we found that three-field was superior to two-field lymphadenectomy in terms of long-term survival for patients with upper thoracic esophageal cancer, whereas for those with middle or lower thoracic esophageal cancer, the survival benefit of three-field lymphadenectomy was reduced. Therefore, we propose to perform three-field lymphadenectomy for upper thoracic esophageal cancer. In middle or lower thoracic esophageal cancer, we suggest to perform modified two-field lymphadenectomy in most cases, and three-field lymphadenectomy in selective cases. Video-assisted two-field lymphadenectomy is feasible. Based on the national condition of China, we advise to perform thoracic duct removal only in patients with posterior mediastinal or peri-ductus node metastasis to achieve curative effect.

Enhancing the Radiologist-Patient Relationship through Improved Communication: A Quantitative Readability Analysis in Spine Radiology.

PubMed

Hansberry, D R; Donovan, A L; Prabhu, A V; Agarwal, N; Cox, M; Flanders, A E

2017-06-01

More than 75 million Americans have less than adequate health literacy skills according to the National Center for Education Statistics. Readability scores are used as a measure of how well populations read and understand patient education materials. The purpose of this study was to assess the readability of Web sites dedicated to patient education for radiologic spine imaging and interventions. Eleven search terms relevant to radiologic spine imaging were searched on the public Internet, and the top 10 links for each term were collected and analyzed to determine readability scores by using 10 well-validated quantitative readability assessments from patient-centered education Web sites. The search terms included the following: x-ray spine, CT spine, MR imaging spine, lumbar puncture, kyphoplasty, vertebroplasty, discogram, myelogram, cervical spine, thoracic spine, and lumbar spine. Collectively, the 110 articles were written at an 11.3 grade level (grade range, 7.1-16.9). None of the articles were written at the American Medical Association and National Institutes of Health recommended 3rd-to-7th grade reading levels. The vertebroplasty articles were written at a statistically significant ( P < .05) more advanced level than the articles for x-ray spine, CT spine, and MR imaging spine. Increasing use of the Internet to obtain health information has made it imperative that on-line patient education be written for easy comprehension by the average American. However, given the discordance between readability scores of the articles and the American Medical Association and National Institutes of Health recommended guidelines, it is likely that many patients do not fully benefit from these resources. © 2017 by American Journal of Neuroradiology.

Posterior elements disruption with hybrid constructs in AIS patients: is there an impact on proximal junctional kyphosis?

PubMed

Ghailane, S; Pesenti, Sebastien; Peltier, E; Choufani, E; Blondel, B; Jouve, J L

2017-05-01

Proximal junctional kyphosis (PJK) is a frequent proximal adjacent segment disease following spinal fusion in adolescent idiopathic scoliosis (AIS) and its rate has been estimated to 28% in the literature. The etiology is multifactorial, and risk factors associated with PJK are controversial. The aim of this study was to demonstrate that the disruption of muscular and bony tissue above the upper instrumented vertebra (UIV) during surgery does not increase the rate of PJK in patients undergoing posterior fusion for adolescent idiopathic scoliosis. 50 patients with AIS operated between June 2014 and January 2016 were included. Every patient underwent a long posterior spine arthrodesis with a hybrid construct (proximal lamino-laminar claw, thoracic sublaminar bands and lumbar screws). The dissection of posterior elements above the UIV was necessary for the placement of proximal anchors. Radiographic analysis including proximal junctional angle, spino-pelvic parameters (cervical lordosis, thoracic kyphosis TK, lumbar lordosis, pelvic incidence, pelvic tilt, sacral slope) and sagittal vertical axis were collected preoperatively and postoperatively at the last control. The numbers of fused levels, locations of upper instrumented vertebra, locations of lower instrumented vertebra, length of fusion segments were also recorded. Multiple odd ratios and other statistical analysis were performed to evaluate the relation between PJK and the potential risk factors. There were 43 females and 7 males with a mean age of 14.8 years at surgery. PJK occurred in 5 out of 50 cases with an incidence of 10%. The mean follow-up was 18 months. There was no significant difference in gender (OR 1.36, p = 0.8), decrease of TK (OR 1.63, p = 0 0.69), location of UIV (OR 2.25, p = 0.4), LIV (OR 2, p = 0.55), and SVA change (OR 1.63, p = 0.46). The disruption of ligamentous and bony tissue proximal to the UIV during the surgery does not increase the rate of PJK. Level of evidence IV.

Evaluation of spine MRIs in athletes participating in the Rio de Janeiro 2016 Summer Olympic Games.

PubMed

Wasserman, Michael S; Guermazi, Ali; Jarraya, Mohamed; Engbretsen, Lars; AbdelKader, Mohamad; Roemer, Frank W; Hayashi, Daichi; Crema, Michel D; Mian, Asim Z

2018-01-01

In high-level Olympic athletes, many spinal pathologies arise from overuse, while others are the result of acute injury. Our aim is to analyse the epidemiology of spinal pathologies detected on MRI in athletes participating in the 2016 Rio de Janeiro Summer Olympics. In this retrospective study, all spine MRIs performed during the 2016 Rio Games were analysed. Descriptive data from the MRIs were tabulated and analysed for disc degeneration, spinal canal and/or neural foraminal narrowing, and acute/chronic fractures. Data were analysed by sport, continent of origin, age and sex. Of 11 274 athletes participating in the Olympic games, 100 received spine MRI. Fifty-two of the 100 (52%) athletes who received cervical, thoracic and/or lumbar spine MRI showed moderate to severe spinal disease. The highest sport-specific incidence of moderate to severe spine disease was seen in aquatic diving athletes (67%, 3 per 100 divers). Weightlifting had the second highest sport-specific incidence of spine disease (67%, 1.5 per 100 weightlifters). Athletics used the most spine MRIs (31 of 107 MRIs, 29%). European athletes had more spine MRIs than all other continents combined (55 of 107 MRIs, 51%). Athletes over 30 years old had the highest rate of moderate to severe spine disease on MRI (24 of 37 athletes >30 years old, 65%). A high number of the world's premier athletes demonstrated moderate to severe spine disease on MRI during the 2016 Summer Olympics, including moderate/severe degenerative disc changes with varying degrees of disc bulges and herniations.

Evaluation of spine MRIs in athletes participating in the Rio de Janeiro 2016 Summer Olympic Games

PubMed Central

Wasserman, Michael S; Guermazi, Ali; Engbretsen, Lars; AbdelKader, Mohamad; Roemer, Frank W; Hayashi, Daichi; Mian, Asim Z

2018-01-01

Background/aim In high-level Olympic athletes, many spinal pathologies arise from overuse, while others are the result of acute injury. Our aim is to analyse the epidemiology of spinal pathologies detected on MRI in athletes participating in the 2016 Rio de Janeiro Summer Olympics. Methods In this retrospective study, all spine MRIs performed during the 2016 Rio Games were analysed. Descriptive data from the MRIs were tabulated and analysed for disc degeneration, spinal canal and/or neural foraminal narrowing, and acute/chronic fractures. Data were analysed by sport, continent of origin, age and sex. Results Of 11 274 athletes participating in the Olympic games, 100 received spine MRI. Fifty-two of the 100 (52%) athletes who received cervical, thoracic and/or lumbar spine MRI showed moderate to severe spinal disease. The highest sport-specific incidence of moderate to severe spine disease was seen in aquatic diving athletes (67%, 3 per 100 divers). Weightlifting had the second highest sport-specific incidence of spine disease (67%, 1.5 per 100 weightlifters). Athletics used the most spine MRIs (31 of 107 MRIs, 29%). European athletes had more spine MRIs than all other continents combined (55 of 107 MRIs, 51%). Athletes over 30 years old had the highest rate of moderate to severe spine disease on MRI (24 of 37 athletes >30 years old, 65%). Conclusions A high number of the world’s premier athletes demonstrated moderate to severe spine disease on MRI during the 2016 Summer Olympics, including moderate/severe degenerative disc changes with varying degrees of disc bulges and herniations. PMID:29629185

Spinal spindle cell haemangioma: an atypical location.

PubMed

Talan-Hranilović, J; Vucić, M; Sajko, T; Bedek, D; Tomić, K; Lupret, V

2007-03-01

We present a case of the 31-year-old male patient who complained of weakness in both legs and progressed slowly. Neuroimagine of the thoracic spine showed an intraspinal, extradural mass lesion, measuring 5.3 x 1.2 cm at the Th1-Th3 level. Histologically the lesion was a spindle cell haemangioma composed of dilated vascular spaces and a proliferation of bland appearing interspersed spindle cells. Immunohistochemical analysis was diffusely positive for VIM, SMA and focally for CD34. This lesion is uncommon and shows a predilection for distal extremities. Spindle cell haemangioma within the spine has not been previously reported in the literature.

Epithelial-myoepithelial carcinoma metastasis to the thoracic spine.

PubMed

Goodwin, C Rory; Khattab, Mohamed H; Sankey, Eric W; Crane, Genevieve M; McCarthy, Edward F; Sciubba, Daniel M

2016-02-01

Epithelial-myoepithelial carcinoma (EMC) is a very rare salivary gland malignancy accounting for less than 1% of salivary gland tumors, and classically arises from the parotid gland in females. Spinal cord compression caused by EMC metastasized from the parotid gland has only been described once in the literature to our knowledge. We report the first case of a patient with parotid EMC spinal metastasis undergoing a gross total resection with instrumented fusion. This case illustrates that an en bloc resection with a planned transgression through the spinal canal may be a reasonable option for EMC metastasized to the spine. Copyright © 2015 Elsevier Ltd. All rights reserved.

Scheuermann's disease in a juvenile male from the late Roman necropolis of Torrenueva (3rd-4th century CE, Granada, Spain).

PubMed

Viciano, Joan; López-Lázaro, Sandra; Pérez-Fernández, Ángela; Amores-Ampuero, Anabel; D'Anastasio, Ruggero; Jiménez-Triguero, José Miguel

2017-09-01

This study details a severe case of Scheuermann's disease (SD) in a well-preserved skeleton of a juvenile male (designated TOR302), dated to 3rd-4th century CE, from the late Roman necropolis of Torrenueva (Granada, Spain). Individual TOR302 shows an evident kyphotic curve in the thoraco-lumbar spine, which is characterised by: (i) vertebral bodies of thoracic vertebra T2, thoracic segment T4-T9, and thoraco-lumbar segment T12-L2 wedged at >5°; (ii) slight anterior extensions of the epiphyseal ring; (iii) Schmorl's nodes on the superior and/or inferior plates; and (iv) a Cobb angle of 75°, derived from thoracic segments T4-T9. In addition, TOR302 shows other skeletal malformations as the secondary results of abnormal growth, due to altered biomechanical forces imposed by the spinal deformity, including: (i) lateral distortion of the spine that causes a slight secondary scoliotic curve; (ii) pelvic obliquity; and (iii) discrepancy in the length of the limbs. We argue that the secondary skeletal abnormalities allowed the individual to adapt to his spinal deformity meaning he was able to walk without the aid of a stick. Despite SD being a common modern clinical finding, few cases have been reported in ancient skeletal remains. This case therefore represents an important contribution to the palaeopathological literature. Copyright © 2017 Elsevier Inc. All rights reserved.

Influence of lumbar lordosis restoration on thoracic curve and sagittal position in lumbar degenerative kyphosis patients.

PubMed

Jang, Jee-Soo; Lee, Sang-Ho; Min, Jun-Hong; Maeng, Dae Hyeon

2009-02-01

A retrospective study. To determine postsurgical correlations between thoracic and lumbar sagittal curves in lumbar degenerative kyphosis (LDK) and to determine predictability of spontaneous correction of thoracic curve and sacral angle after surgical restoration of lumbar lordosis and fusion. To our knowledge, there are only a limited number of articles about the relationship between thoracic and lumbar curve in sagittal thoracic compensated LDK. Retrospective review of 53 consecutive patients treated with combined anterior and posterior spinal arthrodesis. We included patients with sagittal thoracic compensated LDK caused by sagittal imbalance in this study. Total lumbar lordosis, thoracic kyphosis, sacral slope, and C7 plumb line were measured on the pre- and postoperative whole spine lateral views. Postoperative changes in thoracic kyphosis, sacral slope, and C7 plumb line according to the surgical lumbar lordosis restoration were measured and evaluated. The mean preoperative sagittal imbalance by plumb line was 78.3 mm (+/-76.5); this improved to 13.6 mm (+/-25) after surgery (P < 0.0001). Mean lumbar lordosis was 9.4 degrees (+/-19.2) before surgery and increased to 38.4 degrees (+/-13.1) at follow-up (P < 0.0001). Mean thoracic kyphosis was 1.1 degrees (+/-12.7) before surgery and increased to 17.6 degrees (+/-12.2) at follow-up (P < 0.0001). Significant preoperative correlations existed between kyphosis and lordosis (r = 0.772, P < 0.0001) and between lordosis and sacral slope (r = 0.785, P < 0.0001). Postoperative lumbar lordosis is correlated to thoracic kyphosis increase (r = 0.620, P < 0.0001). Postoperative lumbar lordosis is correlated to sacral slope increase (r = 0.722, P < 0.0001). Reciprocal relationship exists between lumbar lordosis and thoracic kyphosis in sagittal thoracic compensated LDK. Surgical restoration of lumbar lordosis for LDK brings about high level of statistical correlation to thoracic kyphosis improvement. At the same time, the reciprocal relationship is maintained.

49 CFR 572.116 - Instrumentation and test conditions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... probe for lateral thoracic and pelvis impact tests are the same as those specified in § 572.44(a). (b... pelvis is the same as specified in § 572.44(c). (d) Head accelerometer mounting is the same as specified... Impact Tests.” (g) The mountings for the spine, rib and pelvis accelerometers shall have no resonance...

49 CFR 572.116 - Instrumentation and test conditions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... probe for lateral thoracic and pelvis impact tests are the same as those specified in § 572.44(a). (b... pelvis is the same as specified in § 572.44(c). (d) Head accelerometer mounting is the same as specified... Impact Tests.” (g) The mountings for the spine, rib and pelvis accelerometers shall have no resonance...

49 CFR 572.116 - Instrumentation and test conditions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... probe for lateral thoracic and pelvis impact tests are the same as those specified in § 572.44(a). (b... pelvis is the same as specified in § 572.44(c). (d) Head accelerometer mounting is the same as specified... Impact Tests.” (g) The mountings for the spine, rib and pelvis accelerometers shall have no resonance...

49 CFR 572.116 - Instrumentation and test conditions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... probe for lateral thoracic and pelvis impact tests are the same as those specified in § 572.44(a). (b... pelvis is the same as specified in § 572.44(c). (d) Head accelerometer mounting is the same as specified... Impact Tests.” (g) The mountings for the spine, rib and pelvis accelerometers shall have no resonance...

49 CFR 572.116 - Instrumentation and test conditions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... probe for lateral thoracic and pelvis impact tests are the same as those specified in § 572.44(a). (b... pelvis is the same as specified in § 572.44(c). (d) Head accelerometer mounting is the same as specified... Impact Tests.” (g) The mountings for the spine, rib and pelvis accelerometers shall have no resonance...

Development of Predictive Models of Injury for the Lower Extremity, Lumbar, and Thoracic Spine after Discharge from Physical Rehabilitation

DTIC Science & Technology

2015-10-01

prevention titled “Prediction, Prevention, and Preemption: Screening for sports and training injuries. What are the possibilities?” The talk was...the resources and training. The decision was made after MAJ Rhon’s PCS to BAMC, and because the site PI at Madigan there had some pregnancy

Primary osseous hemangiopericytoma in the thoracic spine.

PubMed

Ren, Ke; Zhou, Xing; Wu, SuJia; Sun, Xiaoliang

2014-01-01

Hemangiopericytoma (HPC) is a rare tumor of the central nervous system, most commonly found in the cranial cavity. HPCs in the spine are rare, and very few of them are primary osseous HPC. The aims of this study were to describe a rare case of primary osseous HPC in the thoracic spine and review the literature. A 54-year-old man presented with a 3-month history of back pain. Aneuro logical examination revealed no motor or sensory deficits. Magnetic resonance imaging (MRI) and computed tomography (CT) scan showed a tumor originating from the bone structure of the T10 vertebra with paravertebral extension, and chest CT revealed pulmonary metastases. A laminectomy, face-totomy,and subtotal resection of the tumor was performed with posterior pedicle screw system fixation followed by radiotherapy. The post-operative course was uneventful. His back pain was resolved completely after surgery. The patient survived with tumor during the 18-month follow-up period. Histopathology and immunohistologic findings were consistent with HPC. On immunohistochemistry, the tumor was positive for vimentin and CD34, partially positive for S-100, but negative for EMA, desmin, CD117, and CD1a. A literature review identified eight such cases reported between 1942 and 2013. As a conclusion, clinical manifestations of primary osseous spinal HPCs are different from intraspinal meningeal HPCs. Although showing certain variability, histopathology and immunohistochemical examinations are essential to establish the diagnosis. Surgical resection and radiotherapy are the treatment of choice. *These authors contributed equally to this work.

Comparative Analysis of Body Radiologist to Neuroradiologist Evaluation of the Spine in Trauma Settings.

PubMed

Zhou, Alice L; Bonham, Luke W; Verde, Franco

2018-05-24

CT is routinely performed to evaluate trauma patients. When a radiologist misses an acute finding, there could be serious adverse consequences. In many subspecialty settings, body radiologists and neuroradiologists both interpret the thoracic and lumbar spine. RADPEER has estimated general disagreement rates between radiologists to be 2.9%, but the disagreement rate between neuroradiologists and body radiologists in trauma settings remains unknown. This retrospective case review examined reports from the past 10 years of adult CT scans of the chest, abdomen, and pelvis interpreted by body radiologists, with concurrent thoracic and lumbar spine reconstructions interpreted by neuroradiologists. Reports were scrutinized for disagreement on the presence of acute fractures visible to both radiologists. 1,497 report pairs were analyzed. Of them, 33 pairs (2.2%) disagreed on the presence of an unequivocal acute fracture. In scans where only one miss occurred, the body radiologist and neuroradiologist were attributed with 27 (82%) and 6 (18%) of 32 disagreements, respectively. One scan contained a miss by both the body radiologist and neuroradiologist. Transverse processes were most commonly missed, followed by vertebral body fractures. Misses by body radiologists comprised the majority of disagreements. Neuroradiologists are more sensitive for detecting spinal fractures likely secondary to experience, education, small field of view reconstructed, and more detailed reporting protocols. Additional studies are needed to determine whether emulating neuroradiology practices may help body radiologists detect subtle fractures. Copyright © 2018 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Capillary Hemangioma of the Thoracic Spinal Cord

PubMed Central

Chung, Sung-Kyun; Nam, Taek-Kyun; Park, Seung-Won

2010-01-01

Capillary hemangiomas are common soft tissue tumors on the skin or mucosa of the head and neck in the early childhood, but very rare in the neuraxis. A 47-year-old man presented with one month history of back pain on the lower thoracic area, radiating pain to both legs, and hypesthesia below T7 dermatome. Thoracic spine MRI showed 1×1.3×1.5 cm, well-defined intradural mass at T6-7 disc space level, which showed isointensity to spinal cord on T1, heterogeneous isointensity on T2-weighted images, and homogeneous strong enhancement. The patient underwent T6-7 total laminotomy, complete tumor removal and laminoplasty. Histologically, the mass showed a capsulated nodular lesion composed of capillary-sized vascular channels, which were tightly packed into nodules separated by fibrous septa. These features were consistent with capillary hemangioma. PMID:21082058

Genetics Home Reference: Klippel-Feil syndrome

MedlinePlus

... variations of the upper cervical spine and their importance in preoperative diagnosis. A case report and a ... the necessity for a multidisciplinary approach in patient management. Spine J. 2007 Jan-Feb;7(1):135- ...

A Cervico-Thoraco-Lumbar Multibody Dynamic Model for the Estimation of Joint Loads and Muscle Forces.

PubMed

Khurelbaatar, Tsolmonbaatar; Kim, Kyungsoo; Hyuk Kim, Yoon

2015-11-01

Computational musculoskeletal models have been developed to predict mechanical joint loads on the human spine, such as the forces and moments applied to vertebral and facet joints and the forces that act on ligaments and muscles because of difficulties in the direct measurement of joint loads. However, many whole-spine models lack certain elements. For example, the detailed facet joints in the cervical region or the whole spine region may not be implemented. In this study, a detailed cervico-thoraco-lumbar multibody musculoskeletal model with all major ligaments, separated structures of facet contact and intervertebral disk joints, and the rib cage was developed. The model was validated by comparing the intersegmental rotations, ligament tensile forces, facet joint contact forces, compressive and shear forces on disks, and muscle forces were to those reported in previous experimental and computational studies both by region (cervical, thoracic, or lumbar regions) and for the whole model. The comparisons demonstrated that our whole spine model is consistent with in vitro and in vivo experimental studies and with computational studies. The model developed in this study can be used in further studies to better understand spine structures and injury mechanisms of spinal disorders.

A musculoskeletal model for the lumbar spine.

PubMed

Christophy, Miguel; Faruk Senan, Nur Adila; Lotz, Jeffrey C; O'Reilly, Oliver M

2012-01-01

A new musculoskeletal model for the lumbar spine is described in this paper. This model features a rigid pelvis and sacrum, the five lumbar vertebrae, and a rigid torso consisting of a lumped thoracic spine and ribcage. The motion of the individual lumbar vertebrae was defined as a fraction of the net lumbar movement about the three rotational degrees of freedom: flexion-extension lateral bending, and axial rotation. Additionally, the eight main muscle groups of the lumbar spine were incorporated using 238 muscle fascicles with prescriptions for the parameters in the Hill-type muscle models obtained with the help of an extensive literature survey. The features of the model include the abilities to predict joint reactions, muscle forces, and muscle activation patterns. To illustrate the capabilities of the model and validate its physiological similarity, the model's predictions for the moment arms of the muscles are shown for a range of flexion-extension motions of the lower back. The model uses the OpenSim platform and is freely available on https://www.simtk.org/home/lumbarspine to other spinal researchers interested in analyzing the kinematics of the spine. The model can also be integrated with existing OpenSim models to build more comprehensive models of the human body.

Osteosarcoma of the mobile spine.

PubMed

Zils, K; Bielack, S; Wilhelm, M; Werner, M; Schwarz, R; Windhager, R; Hofmann-Wackersreuther, G; Andus, T; Kager, L; Kuehne, T; Reichardt, P; von Kalle, T

2013-08-01

The aims of this analysis were to investigate features and outcome of high-grade osteosarcomas of the mobile spine. Since 1977, 20 Cooperative Osteosarcoma Study Group patients had a diagnosis of high-grade osteosarcomas of the mobile spine and were included in this retrospective analysis of patient-, tumor- and treatment-related variables and outcome. The median age was 29 years (range 5-58). Most frequent tumor sites were thoracic and lumbar spine. All but three patients had nonmetastatic disease at diagnosis. Treatment included surgery and chemotherapy for all patients, 13 were also irradiated. Eight patients failed to achieve a macroscopically complete surgical remission (five local, one primary metastases, two both), six died, two are alive, both with radiotherapy. Of 12 patients with complete remission at all sites, three had a recurrence (two local, one metastases) and died. The median follow-up of the 11 survivors was 8.7 years (range 3.1-22.3), 5-year overall and event-free survival rates were 60% and 43%. Age <40 years, nonmetastatic disease at diagnosis and complete remission predicted for better overall survival (OS, P < 0.05). Osteosarcomas of the mobile spine are rare. With complete resection (and potentially radiotherapy) and chemotherapy, prognosis may be comparable with that of appendicular osteosarcomas.

Percutaneous tracheostomy in patients with cervical spine fractures--feasible and safe.

PubMed

Ben Nun, Alon; Orlovsky, Michael; Best, Lael Anson

2006-08-01

The aim of this study is to evaluate the short and long-term results of percutaneous tracheostomy in patients with documented cervical spine fracture. Between June 2000 and September 2005, 38 consecutive percutaneous tracheostomy procedures were performed on multi-trauma patients with cervical spine fracture. Modified Griggs technique was employed at the bedside in the general intensive care department. Staff thoracic surgeons and anesthesiologists performed all procedures. Demographics, anatomical conditions, presence of co-morbidities and complication rates were recorded. The average operative time was 10 min (6-15). Two patients had minor complications. One patients had minor bleeding (50 cc) and one had mild cellulitis. Nine patients had severe paraparesis or paraplegia prior to the PCT procedure and 29 were without neurological damage. There was no PCT related neurological deterioration. Twenty-eight patients were discharged from the hospital, 21 were decannulated. The average follow-up period was 18 months (1-48). There was no delayed, procedure related, complication. These results demonstrate that percutaneous tracheostomy is feasible and safe in patients with cervical spine fracture with minimal short and long-term morbidity. We believe that percutaneous tracheostomy is the procedure of choice for patients with cervical spine fracture who need prolonged ventilatory support.

[Influence of occupational factors on the bone and joint functional state in the upper extremities and cervical spine in female workers of clothing manufacture].

PubMed

Druzhinin, V N; Shardakova, É F; Cherniĭ, A N

2014-01-01

The studies using multiple X-ray methods covered influence of complex containing working process and occupational environment factors on locomotory apparatus of upper limbs and cervical spine in female seamers engaged into various productions. Comparative analysis involved results of regular (standard X-ray) and special X-ray methods (stereoroentgenography, high definition roentgenography, roentgen densitometry, roentgenogrammetry) in 370 examinees with early and moderate clinical symptoms of occupationally mediated diseases of the stated areas. X-ray studies of locomotory apparatus of upper limbs and cervical spine in clothing manufacture workers, with special diagnostic methods, enabled to determine incidence and severity of functional and structural changes more reliably than via standard examination. The changes revealed were assigned mostly in "early" and "moderate" categories and matched with occupational peculiarities of the workers examined.

Guide to thoracic imaging.

PubMed

Skinner, Sarah

2015-08-01

Thoracic imaging is commonly ordered in general practice. Guidelines exist for ordering thoracic imaging but few are specific for general practice. This article summarises current indications for imaging the thorax with chest X-ray and computed tomography. A simple frame-work for interpretation of the chest X-ray, suitable for trainees and practitioners providing primary care imaging in rural and remote locations, is presented. Interpretation of thoracic imaging is best done using a systematic approach. Radiological investigation is not warranted in un-complicated upper respiratory tract infections or asthma, minor trauma or acute-on-chronic chest pain.

The Role of Thoracic Medial Branch Blocks in Managing Chronic Mid and Upper Back Pain: A Randomized, Double-Blind, Active-Control Trial with a 2-Year Followup

PubMed Central

Manchikanti, Laxmaiah; Singh, Vijay; Falco, Frank J. E.; Cash, Kimberly A.; Pampati, Vidyasagar; Fellows, Bert

2012-01-01

Study Design. A randomized, double-blind, active-control trial. Objective. To determine the clinical effectiveness of therapeutic thoracic facet joint nerve blocks with or without steroids in managing chronic mid back and upper back pain. Summary of Background Data. The prevalence of thoracic facet joint pain has been established as 34% to 42%. Multiple therapeutic techniques utilized in managing chronic thoracic pain of facet joint origin include medial branch blocks, radiofrequency neurotomy, and intraarticular injections. Methods. This randomized double-blind active controlled trial was performed in 100 patients with 50 patients in each group who received medial branch blocks with local anesthetic alone or local anesthetic and steroids. Outcome measures included the numeric rating scale (NRS), Oswestry Disability Index (ODI), opioid intake, and work status, at baseline, 3, 6, 12, 18, and 24 months. Results. Significant improvement with significant pain relief and functional status improvement of 50% or more were observed in 80% of the patients in Group I and 84% of the patients in Group II at 2-year followup. Conclusions. Therapeutic medial branch blocks of thoracic facets with or without steroids may provide a management option for chronic function-limiting thoracic pain of facet joint origin. PMID:22851967

Buckling and bone modeling as factors in the development of idiopathic scoliosis.

PubMed

Goto, Manabu; Kawakami, Noriaki; Azegami, Hideyuki; Matsuyama, Yukihiro; Takeuchi, Kenzen; Sasaoka, Ryu

2003-02-15

Computational analysis using the finite-element method was used to examine a possible etiology of idiopathic scoliosis. To compare changes in the coronal and the transverse planes of idiopathic thoracic scoliosis with changes produced in a finite-element buckling model, and to investigate the influence of bone modeling on the buckling spine. Although it is now widely accepted that growth is related strongly to the onset and progression of scoliosis, the pathomechanism or etiology of idiopathic scoliosis still is not clear. A previous study showed that a buckling phenomenon caused by anterior spinal overgrowth can produce scoliosis, and that the fourth buckling mode matched the clinical characteristics associated with the thoracic type of idiopathic scoliosis. The fourth buckling mode occurs when the first, second, and third buckling modes are prevented. The spinal finite-element model used in this study consisted of 68,582 elements and 84,603 nodes. The transverse changes seen in the computed tomography images of 41 patients with idiopathic thoracic scoliosis (apex, T8; average Cobb angle, 52.5 degrees) were compared with those produced in the fourth buckling mode. Bone modeling (bone formation and resorption) was simulated as heat deformation caused by changes in temperature. The bone formation and resorption were simulated, respectively, by positive and negative volume changes in proportion to the stress that occurred in the buckling spine. Computed tomography images of scoliosis show that as the scoliosis becomes more severe, the thoracic cage decreases on the convex side of the curve and increases on the concave side. The opposite thoracic cage deformation was obtained in the fourth buckling mode. In patients with scoliosis, the sternum essentially remains in its original position with respect to the vertebrae, but in the linear buckling model, it shifted in the direction of vertebral body rotation. In contrast to clinical data, the incremental deformation resulting from bone formation corrected the original curve, and the thoracic cage distorted. On the other hand, incremental deformation resulting from bone resorption worsened the original curve, and the thoracic cage distorted in a manner similar to that described by the clinical data. This computational investigation suggests that scoliotic changes in the spinal column triggered by the buckling phenomenon are counteracted by bone formation, but worsened by bone resorption. The authors hypothesized that scoliosis progressed with resorption of loaded bone. However, it is unclear whether this hypothesis applies to a living body in practice because of the effects from additional factors.

[Evaluation of upper cervical spine injury (C1-C2) with computed tomography].

PubMed

Siemianowicz, Anna; Baron, Jan; Wawrzynek, Wojciech; Koczy, Bogdan; Kasprowska, Sabina

2006-01-01

Cervical spine injuries are common and essential diagnostic problem. Diagnostic imaging is necessary for proper and effective treatment. Helical computed tomography (CT) and plain radiography are the basic diagnostic methods in cervical spine injuries. The purpose of this work was the comparison of CT examination of the upper cervical spine (CI-C2) with patients' clinical state. Twenty four patients (17 men and 7 women) were introduced into the study. The most common cause of cervical spine injuries were car accidents (48.5%). CT examination was performed in all patients. Six patients (25%) had multilevel injury, localized at C1-C2 level and in the lower part of cervical spine. The main pathology diagnosed by CT in the studied group was rotatory subluxation (66.6%). Eight patients (33.3%), with rotatory subluxation did not present any abnormalities in neurological examination performed immediately after the admission to the hospital. C1 and/or C2 fractures were diagnosed in 11 patients (45.8%), in some cases (in 3 patients - 12.5%) they were accompanied by rotatory subluxations. CT examination is the basic technique of diagnostic imaging in a case of cervical spine injuries. It enables quick, accurate and precise evaluation of bone structures and surrounding soft tissues. CT also enables multiplanar imaging and 3-dimentional imaging.

Spinal cord herniation following cervical meningioma excision: a rare clinical entity and review of literature.

PubMed

Aiyer, Siddharth N; Shetty, Ajoy Prasad; Kanna, Rishi; Maheswaran, Anupama; Rajasekaran, S

2016-05-01

Spinal cord herniation following surgery is an extremely uncommon clinical condition with very few reports in published literature. This condition usually occurs as a spontaneous idiopathic phenomenon often in the thoracic spine or following a scenario of post traumatic spinal cord/nerve root injury. Rarely has it been reported following spinal cord tumor surgery. To document a case of cervical spinal cord herniation as a late onset complication following spinal cord tumor surgery with an atypical presentation of monoparesis. Case report. We describe the clinical presentation, operative procedure, post operative outcome and review of literature of this rare clinical condition. A 57-year-old man presented with right upper limb monoparesis due to a spinal cord herniation 6 years after a cervical intradural meningioma excision. The patients underwent surgery to reduce the herniation and duroplasty with subsequent complete resolution of symptoms. Spinal cord herniation must be considered as differential diagnosis in scenarios of spinal cord tumor excision presenting with late onset neurological deficit. These cases may present as paraparesis, Brown-sequard syndrome and rarely as in our case as monoparesis.

77 FR 70914 - Federal Motor Vehicle Safety Standards; Side Impact Protection

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-28

..., S12.3.2(c), S12.3.3(c) and S12.3.4(l), the `` '' symbols for the discrete arm position settings were... centerline. The shoulder-arm joint allows for discrete arm positions at 0, 45, 90, 135, and 180 degree... thoracic spine centerline. The shoulder-arm joint allows for discrete arm positions at 0, [[Page 70915

Role of a polymorphism in a Hox/Pax-responsive enhancer in the evolution of the vertebrate spine

USGS Publications Warehouse

Guerreiro, Isabel; Nunes, Andreia; Woltering, Joost M.; Casaca, Ana; Nóvoa, Ana; Vinagre, Tânia; Hunter, Margaret E.; Duboule, Denis; Mallo, Moisés

2013-01-01

Patterning of the vertebrate skeleton requires the coordinated activity of Hox genes. In particular, Hox10 proteins are essential to set the transition from thoracic to lumbar vertebrae because of their rib-repressing activity. In snakes, however, the thoracic region extends well into Hox10-expressing areas of the embryo, suggesting that these proteins are unable to block rib formation. Here, we show that this is not a result of the loss of rib-repressing properties by the snake proteins, but rather to a single base pair change in a Hox/Paired box (Pax)-responsive enhancer, which prevents the binding of Hox proteins. This polymorphism is also found in Paenungulata, such as elephants and manatees, which have extended rib cages. In vivo, this modified enhancer failed to respond to Hox10 activity, supporting its role in the extension of rib cages. In contrast, the enhancer could still interact with Hoxb6 and Pax3 to promote rib formation. These results suggest that a polymorphism in the Hox/Pax-responsive enhancer may have played a role in the evolution of the vertebrate spine by differently modulating its response to rib-suppressing and rib-promoting Hox proteins.

Recurrent spontaneous massive hemothorax from intrathoracic extramedullary hematopoiesis resulting in respiratory failure.

PubMed

Chu, Kuo-An; Hsu, Chien-Wei; Lin, Min-Hsi; Lin, Shyh-Jer; Huang, Yi-Luan

2015-03-01

Extramedullary hematopoiesis (EMH) is a compensatory response to many chronic anemic disorders. Intrathoracic EMH, usually presenting as paravertebral masses over the posterior mediastinum, is a rare entity and is usually asymptomatic. Hemothorax is a rare but possibly fatal complication. Local radiation for intrathoracic EMH is considered effective in preventing its recurrence. Here we describe a patient who had had α-thalassemia for many years and developed a spontaneous left-sided hemothorax from EMH. A chest film and a chest computed tomography (CT) scan had showed multiple paravertebral masses over the lower thoracic spine with left-sided pleural effusion. A pathological diagnosis of EMH was made by video-assisted thoracoscopic surgery. The patient had not received preventive local chest radiation. Ten years later, he suffered from a life-threatening hemothorax complicated by acute respiratory failure without traumatic history. A CT scan showed posterior mediastinal masses over the lower thoracic spine with right-sided pleural effusion. Thoracoscopy was performed to remove the blood clot in the pleural space for successful weaning from mechanical ventilation. This is the first case of intrathoracic EMH to have recurrent hemothorax associated with acute respiratory failure. Copyright © 2012. Published by Elsevier B.V.

Practical use of bone scan in patients with an osteoporotic vertebral compression fracture.

PubMed

Jun, Deuk Soo; An, Byoung Keun; Yu, Chang Hun; Hwang, Kyung Hoon; Paik, Je Won

2015-02-01

Rib fractures are one of main causes of chest or flank pain when related to an osteoporotic vertebral compression fracture (OVCF). The authors investigated the incidence and risk factors of rib fracture in 284 patients with OVCF using bone scans and evaluated the feasibility as to whether bone scans could be utilized as a useful screening tool. Hot uptake lesions on ribs were found in 122 cases (43.0%). The factors analyzed were age, sex, number and locations of fractured vertebrae, BMD, and compression rates as determined using initial radiography. However, no statistical significances were found. In 16 cases (5.6%), there were concurrent multiple fractures of both the thoracic and lumbar spines not detected by single site MRI. Sixty cases (21.1%) of OVCF with the a compression rate of less than 15% could not be identified definitely by initial plain radiography, but were confirmed by bone scans. It is concluded that a bone scan has outstanding ability for the screening of rib fractures associated with OVCF. Non-adjacent multiple fractures in both thoracic and lumbar spines and fractures not identified definitely by plain radiography were detected on bone scans, which provided a means for determining management strategies and predicting prognosis.

Pathologic fracture of the thoracic spine in a male master ultra-marathoner due to the combination of a vertebral hemangioma and osteopenia.

PubMed

Knechtle, Beat; Nikolaidis, Pantelis T; Lutz, Bruno; Rosemann, Thomas; Baerlocher, Christian B

2017-01-01

Vertebral hemangiomas are the most common benign vertebral neoplasms and are generally asymptomatic. In the present study, we report the case of a 52-year-old male master ultra-marathoner suffering from a pathologic fracture of the thoracic spine due to a vertebral hemangioma. A further examination in the athlete revealed an accompanying osteopenia, which was most likely due to a deficiency in both vitamin D and testosterone. The treatment of the fracture consisted of percutaneous vertebroplasty. Shortly after the operation the athlete was able to continue running. The most likely reason for the pathologic fracture of the vertebral body was the combination of the vertebral hemangioma and osteopenia. The further treatment consisted of supplementation of both vitamin D and testosterone. Athletes and physicians should be aware that male master ultra-marathoners older than 50 years might suffer from osteopenia, where a deficiency in vitamin D and testosterone could be contributing factors for osteopenia development in general. Copyright © 2017 The Lithuanian University of Health Sciences. Production and hosting by Elsevier Sp. z o.o. All rights reserved.

Treatment of the idiopathic scoliosis with brace and physiotherapy.

PubMed

Hundozi-Hysenaj, Hajrije; Dallku, Iliriana Boshnjaku; Murtezani, Ardiana; Rrecaj, Shkurte

2009-01-01

Scoliosis is a three-dimensional deformation of the spine with a lateral curvature or deviation greater than 10 degrees and associated with vertebral rotation. Many conservative treatments are available for adolescents with idiopathic scoliosis, but the evidence for their effectiveness is still questioned. The objective of this study was to define the effectiveness of braces and individual physiotherapy for the comprehensive treatment of idiopathic scoliosis in adolescents. A retrospective study of 57 children with idiopathic thoracic dextroscoliosis with the magnitude of the thoracic curve between 20 degrees-35 degrees, treated in Orthopedic and Physiatrist Clinic as well as National Ortho-prosthetic Center within University Clinical Center of Kosova in Prishtina, during the period of 2003-2006. Inclusion of kinesitherapy in the comprehensive management of idiopathic scoliosis varied in the improvement of the muscle strength (satisfied and moderate) in almost 80% of the children while the correction of the curve was small in approximately 42.1% of cases. For children with idiopathic scoliosis, who require braces, an exercise program helps chest mobility, muscle strength, proper breathing flexibility in the spine, correct posture and keeps muscles in tone so that the transition period after brace removal is easier.

Gunshot Injury to the Anterior Arch of Atlas

PubMed Central

Park, Jun Hee; Kim, Hyeung Sun; Do, Nam Yong

2012-01-01

Penetrating injuries to the upper cervical spine resulting from gunshots are rare in South Korea due to restrictions of gun use. Moreover, gunshot wounds to the upper cervical spine without neurological deficits occur infrequently because of the anatomic location and surrounding essential structures. We present an uncommon case involving the surgical removal of a bullet located in the anterior arch of first cervical vertebra (C1) via a transoral approach without neurological complications or subsequent mechanical instability. PMID:22639715

The involvement of musculoskeletal system and its influence on postural stability in children and young adults with cystic fibrosis.

PubMed

Kenis-Coskun, Ozge; Karadag-Saygi, Evrim; Bahar-Ozdemir, Yeliz; Gokdemir, Yasemin; Karadag, Bulent; Kayhan, Onder

2017-11-21

Cystic fibrosis (CF) affects the musculoskeletal system via a multifactorial pathway that includes vitamin D deficiency and involvement of respiratory muscles such as intercostals due to recurrent upper and lower respiratory tract infections. Eventual result is the deterioration of musculoskeletal health and posture in CF patients. Postural stability is directly affected by posture and can be compromised in every musculoskeletal problem. The aim of this study is to evaluate musculoskeletal system and postural stability in patients with CF. Patients with CF over six years of age and age and sex-matched control groups were included in the study. Cobb angle and thoracic kyphosis angles were measured on the spine radiographs. Both patients and control group were examined with pediatric gait, arms, legs and spine scale (pGALS). They also were evaluated with a NeuroCom Balance Master for their postural stability. Fifty-one patients with CF and 94 healthy controls participated in the study. In results of the pGALS examination, CF group had significantly more pathological findings than the control group in lower extremity appearance and movement (p = 0.006 and p = 0.01) and spine appearance and movement (p = 0.001 and p = 0.022) domains. The tandem walking speed was significantly higher in controls with a mean of 24.45 ± 7.79 while it was 20.47 ± 6.95 in the CF group (p = 0.03). Various limits of stability parameters also showed significant differences. Medium correlations were found between musculoskeletal examination and postural stability parameters. In patients with CF, a systematic but simple musculoskeletal examination can detect pathologies, which are more frequent than the normal population. These pathologies show a medium correlation with the involvement of postural stability.

Patient-specific Distraction Regimen to Avoid Growth-rod Failure.

PubMed

Agarwal, Aakash; Jayaswal, Arvind; Goel, Vijay K; Agarwal, Anand K

2018-02-15

A finite element study to establish the relationship between patient's curve flexibility (determined using curve correction under gravity) in juvenile idiopathic scoliosis and the required distraction frequency to avoid growth rod fracture, as a function of time. To perform a parametric analysis using a juvenile scoliotic spine model (single mid-thoracic curve with the apex at the eighth thoracic vertebra) and establish the relationship between curve flexibility (determined using curve correction under gravity) and the distraction interval that allows a higher factor of safety for the growth rods. Previous studies have shown that frequent distraction with smaller magnitude of distractions are less likely to result in rod failure. However there has not been any methodology or a chart provided to apply this knowledge on to the individual patients that undergo the treatment. This study aims to fill in that gap. The parametric study was performed by varying the material properties of the disc, hence altering the axial stiffness of the scoliotic spine model. The stresses on the rod were found to increase with increased axial stiffness of the spine, and this resulted in the increase of required optimal frequency to achieve a factor of safety of two for growth rods. A relationship between the percentage correction in Cobb's angle due to gravity alone, and the required distraction interval for limiting the maximum von Mises stress to 255 MPa on the growth rods was established. The distraction interval required to limit the stresses to the selected nominal value reduces with increase in stiffness of the spine. Furthermore, the appropriate distraction interval reduces for each model as the spine becomes stiffer with time (autofusion). This points to the fact the optimal distraction frequency is a time-dependent variable that must be achieved to keep the maximum von Mises stress under the specified factor of safety. The current study demonstrates the possibility of translating fundamental information from finite element modeling to the clinical arena, for mitigating the occurrence of growth rod fracture, that is, establishing a relationship between optimal distraction interval and curve flexibility (determined using curve correction under gravity). N/A.

The History of Sympathetic Surgery.

PubMed

Hashmonai, Moshe

2016-11-01

At present, primary hyperhidrosis is the main indication for sympathectomy. For upper thoracic sympathetic ablation, excision of the second thoracic ganglion alone or with the first and/or third ganglia was the standard during the open surgery era. With the advent of thoracoscopy, modifications related to the level, extent, and type of ablation were proposed to attenuate compensatory hyperhidrosis. The ideal operation for sympathetic denervation of the face and upper limbs remain to be defined. Controlled double-blind studies with quantitave measurements of sweat production are required. Copyright © 2016 Elsevier Inc. All rights reserved.

Infection rate after transoral approach for the upper cervical spine.

PubMed

Shousha, Mootaz; Mosafer, Azim; Boehm, Heinrich

2014-09-01

A retrospective review of prospectively collected databases of 139 consecutive patients who underwent transoral surgery for lesions of the upper cervical spine. To analyze the incidence and risk factors of local infection after transoral surgery for the craniocervical junction in a single institution and to compare the findings with the literature. One of the primary risks associated with transoral approach for lesions in the upper cervical spine is postoperative surgical wound infection. From April 1994 to December 2012, 139 consecutive transoral surgical procedures were performed at a single referral center. The mean age at presentation was 53.6 years (range: 5-87 yr), and more than half of the patients were males (58.3%). The majority of cases were experiencing rheumatic diseases (43.9%), whereas tumor destruction was the indication for surgery in 23.7% of the cases. A total of 23% had fracture of the upper cervical spine and primary infection was found in 7 patients (5%). The mean follow-up period was 4.5 years. Infection of the pharyngeal wound occurred in 5 patients (3.6%), solely in the rheumatic and tumor groups. The presentation was mostly in the first 4 months. A single patient with cage reconstruction after giant cell tumor C2 presented with a late infection 5 years postoperatively. Debridement and primary closure was possible in 2 patients, whereas flap coverage of the pharyngeal wall was necessary in 3 patients. The presence of implant did not have a statistically significant effect on the occurrence of infection. However, infection in the presence of titanium cage mostly necessitated flap coverage of the pharyngeal wall after removal of the cage. The transoral route has proved to be an invaluable method of approaching pathological lesions in the upper cervical spine. The infection rate in this work was 3.6%. Patients with rheumatic diseases and patients presenting with tumors were more susceptible to postoperative surgical wound infection. 4.

Can standard anterior Smith-Robinson supramanubrial approach be utilized for approach down to T2 or T3?

PubMed

Singhatanadgige, Weerasak; Zebala, Lukas P; Luksanapruksa, Panya; Daniel Riew, K

2017-09-01

The aim of this study was to determine a plain radiographic criterion for determining the feasibility of using the standard anterior Smith-Robinson supramanubrial approach for anterior surgery down to T2 or T3. The surgical database (2002-2014) was searched to identify patients with anterior cervical surgery to T2 or T3. A method to determine whether a standard anterior Smith-Robinson approach can be used to operate on the upper thoracic levels was evaluated. The surgeon chose the surgical approach preoperatively using a lateral radiograph by determining if a line from the intended skin incision to the lower instrumented level (LIV) passed above the top of the manubrium. If so, a standard Smith-Robinson approach was selected. Another spine surgeon then analyzed all patients who had anterior thoracic fusion to T2 or below. The lateral radiographs were retrospectively reviewed. A total of 44 patients who underwent anterior surgery down to T2 or T3 vertebrae were identified. T2 was the LIV in 39 patients. T3 was the LIV in five patients. No surgery was abandoned or converted to a difference approach after making the standard Smith-Robinson approach. To increase visualization, T1 corpectomy was necessary in 4 of 39 patients when T2 was the LIV. T2 corpectomy was necessary in 2 of 5 patients when T3 was the LIV. If a line from the intended skin incision to the LIV passes over the top of the manubrium, a standard Smith-Robinson approach without sternotomy can be successfully used.

Dumbbell-Shaped Epidural Capillary Hemangioma Presenting as a Lung Mass: Case Report and Review of the Literature.

PubMed

García-Pallero, María A; Torres, Cristina V; García-Navarrete, Eduardo; Gordillo, Carlos; Delgado, Juan; Penanes, Juan R; García-Campos, María T; Sola, R G

2015-07-15

A case report and literature review. We present the fourth case of a spinal epidural capillary hemangioma with a dumbbell-shaped appearance in the magnetic resonance image reported in the literature and the second presented as a lung mass. Hemangiomas are congenital vascular malformations that pathologists frequently consider to be hamartomatous malformations. Hemangiomas of the spine are usually lesions of the vertebral bodies, but they can sit in other locations such as the intramedullary or epidural space. Purely epidural hemangiomas are rare and most of them are of cavernous type. We present a 67-year-old female with a thoracic dumbbell-shaped capillary hemangioma with both foraminal and intrathoracic extensions, whose presentation was pleural effusion associated with mediastinal mass suggestive of pulmonary neoplasia. Surgical treatment consisted of total removal en bloc of the lesion. Microscopic evaluation showed a fibrofatty tissue with a proliferation of vascular structures that were generally of a small size, with areas of myxoid appearance. To date, there have been 8 epidural capillary hemangiomas of the thoracic and lumbar spine reported in the literature, and only 3 of them were dumbbell-shaped with extraforaminal extension. It is important to consider the diagnosis of hemangiomas in the differential diagnosis of epidural lesions with dumbbell-shaped appearance in the magnetic resonance image, especially at the thoracic level. It is a benign and potentially curable disease and the most appropriate surgical treatment is en bloc resection of the entire lesion. They are usually presented as a progressive myelopathy, so early treatment may prevent permanent neurological deficits. 5.

A Modified Microsurgical Endoscopic-Assisted Transpedicular Corpectomy of the Thoracic Spine Based on Virtual 3-Dimensional Planning.

PubMed

Archavlis, Eleftherios; Schwandt, Eike; Kosterhon, Michael; Gutenberg, Angelika; Ulrich, Peter; Nimer, Amr; Giese, Alf; Kantelhardt, Sven Rainer

2016-07-01

The main difficulties of transpedicular corpectomies are lack of space for vertebral body replacement in the neighborhood of critical structures, the necessity for sacrifice of nerve roots in the thoracic spine. and the extent of hemorrhage due to venous epidural bleeding. We present a modified technique of transpedicular corpectomy by using an endoscopic-assisted microsurgical technique performed through a single posterior approach. A 3-dimensional (3D) preoperative reconstruction could be helpful in the planning for this complex anatomic region. Surface and volume 3D reconstruction were performed by Amira or the Dextroscope. The clinical experience of this study includes 7 cases, 2 with an unstable burst fracture and 5 with metastatic destructive vertebral body disease, all with significant retropulsion and obstruction of the spinal canal. We performed a comparison with a conventional cohort of transpedicular thoracic corpectomies. Qualitative parameters of the 3D virtual reality planning included degree of bone removal and distance from critical structures such as myelon and implant diameter. Parameters were met in each case, with demonstration of optimal positioning of the implant without neurological complications. In all patients, the endoscope was a significant help in identifying the origins of active bleeding, residual tumor, extent of bone removal, facilitating cage insertion in a minimally invasive way, and helping to avoid root sacrifice on both sides. Microsurgical endoscopic-assisted transpedicular corpectomy may prove valuable in enhancing the safety of corpectomy in destructive vertebral body disease. The 3D virtual anatomic model greatly facilitated the preoperative planning. Copyright © 2016 Elsevier Inc. All rights reserved.

Clinical assessment of the efficacy of SpineCor brace in the correction of postural deformities in the course of idiopathic scoliosis.

PubMed

Plewka, Barbara; Sibiński, Marcin; Synder, Marek; Witoński, Dariusz; Kołodziejczyk-Klimek, Katarzyna; Plewka, Michał

2013-03-26

The objective of the study was to perform a clinical, comparative assessment of the degree of postural deformities before and after the treatment of idiopathic scoliosis in patients treated with SpineCor brace compared to the control group. A group of 90 children with idiopathic scoliosis (including 74 girls) at the average age of 12.2 was subject to prospective observation. Average pre-treatment Cobb angle was 24.9° in the thoracic spine and 25.8° in the lumbar spine. The group actively treated with the SpineCor brace consisted of 45 children, while the control group consisted of the remaining 45 children with the natural course of the disease. Both groups did not differ significantly in terms of age, gender, height, body weight, Risser sign of skeletal maturity and baseline clinical and radiological parameters of scoliosis. Significant reduction of rib hump was observed upon 2-year SpineCor brace treatment (P=0.04) compared to the group treated by physiotherapy only (P=0.91). Similarly, improvement in lumbar prominence was observed in the actively treated group (P=0.009), with a trend towards worse results in the control group (P=0.07) In the group treated with the SpineCor brace, significant reduction in pectoral and hamstring muscle contractures as well as reduction in shoulder asymmetry and reduction in anterior and posterior vertical deviation were observed. Treatment using the SpineCor dynamic brace leads to a clinical improvement in posture, particularly to reduction in rib hump, lumbar prominence and muscular contractures.

Gunshot wounds to the spine in adolescents.

PubMed

Aryan, Henry E; Amar, Arun P; Ozgur, Burak M; Levy, Michael L

2005-10-01

The incidence of spinal instability after penetrating gunshot wounds to the spine in adolescents is unknown. We describe our experience over a 15-year period. Hospital records were reviewed retrospectively. After injury and emergency care, patients were transferred to a rehabilitation facility. Examinations were completed using the American Spinal Injury Association and Frankel scales on admission, discharge, and 6 and 12 months after injury. Severity of injury was described by: 1) degree of neurological damage, 2) degree of preserved neurological function, and 3) presence of instability. Sixty patients were identified with a mean age 15.6 years (+/- 2.7 yr). Twelve patients had cervical, 31 thoracic, and 17 lumbosacral injuries. No operative treatments were used in their care. Thirty-four patients had complete neurological deficits. Mean acute hospitalization was 21.1 days (+/- 22.8 d), and mean rehabilitation stay was 86.3 days (+/- 48.9 d), for a total hospitalization of 107.4 days (+/- 65.9 d). At 1 year, 19 patients were ambulatory and 53 were autonomous. Despite the presence of bony involvement in all, no evidence of spinal instability was noted on follow-up dynamic imaging. Even in two patients with apparent two-column disruption, no instability was noted. At 1-year follow-up, significant (nonfunctional) improvement was noted in the neurological examination (P < 0.0001). Improvements were most notable in those patients with cervical injuries, followed by thoracic and lumbar injuries. After penetrating gunshot wounds to the spine, patients at 1-year follow-up examinations have evidence of significant, but nonfunctional, improvement. No evidence of spinal instability was noted in this study, and no surgical intervention was required.

Sagittal plane analysis of the spine and pelvis in degenerative lumbar scoliosis.

PubMed

Han, Fei; Weishi, Li; Zhuoran, Sun; Qingwei, Ma; Zhongqiang, Chen

2017-01-01

Previous studies have reported the normative values of pelvic sagittal parameters, but no study has analyzed the sagittal spino-pelvic alignment in degenerative lumbar scoliosis (DLS) and its role in the pathogenesis. Retrospective analysis was applied to 104 patients with DLS, together with 100 cases of asymptomatic young adults as a control group and another control group consisting of 145 cases with cervical spondylosis. The coronal and sagittal parameters were measured on the anteroposterior and lateral radiograph of the whole spine in the DLS group as well as in the two control groups. Statistical analysis showed that the DLS group had a higher pelvic incidence (PI) value (50.5° ± 10.2°), than the normal control group (with PI 47.2° ± 8.8°) and the cervical spondylosis group (46.9° ± 9.1°). In DLS group, there were 38 cases (36.5%) complicated with degenerative lumbar spondylolisthesis, who had higher PI values than patients without it. Besides, the lumbar lordosis (LL) and sacral slope (SS) of DLS group were lower; the scoliosis Cobb's angle was correlated with pelvic tilt (PT); thoracic kyphosis was correlated with LL, SS, and PT; and LL was correlated with other sagittal parameters. Patients with DLS may have a higher PI, which may impact the pathogenesis of DLS. A high PI value is probably associated with the high prevalence of degenerative lumbar spondylolisthesis among DLS patients. In DLS patients, the lumbar spine maintains the ability of regulating the sagittal balance, and the regulation depends more on thoracic curve.

Variation in the insertion of the latissimus dorsi & its clinical importance.

PubMed

Bhatt, C R; Prajapati, B; Patil, D S; Patel, V D; Singh, Binodkumar G P; Mehta, C D

2013-01-01

The latissimus dorsi is the larger, flat, dorso-lateral muscle on the trunk, posterior to the arm, and partly covered by the trapezius on its median dorsal region. Origin of the latissimus dorsi is from spinous processes of thoracic T7-T12, thoracolumbar fascia, iliac crest and inferior 3 or 4 ribs, inferior angle of scapula and insertion on floor of intertubercular groove of the humerus. We have studied 50 cadavers in the different medical colleges in which we found 2% case of anterior and posterior slip of the muscle fibers with their extension up to the pectoralis major and teres major respectively. Usually, latissimus dorsi involve in extension, adduction, transverse extension also known as horizontal abduction, flexion from an extended position, and internal rotation of the shoulder joint. It also has a synergistic role in extension and lateral flexion of the lumbar spine. The latissimus dorsi may be used for the tendon graft surgeries. Tight latissimus dorsi has been shown to be one cause of chronic shoulder pain and chronic back pain. Because the latissimus dorsi connects the spine to the humerus, tightness in this muscle can manifest as either sub-optimal glenohumeral joint function (which leads to chronic shoulder pain) or tendinitis in the tendinous fasciae connecting the latissimus dorsi to the thoracic and lumbar spine. Latissimus dorsi used for pedicle transplant rotator cuff repair reconstruction of breast, face, scalp and cranium defect. The extra slip of the latissimus dorsi may puzzle any transplant operations. We as anatomist discuss the clinical implication of the extra slip of latissimus dorsi.

Variation in the insertion of the latissimus dorsi & its clinical importance

PubMed Central

Bhatt, C.R.; Prajapati, B.; Patil, D.S.; Patel, V.D.; Singh, Binodkumar G.P.; Mehta, C.D.

2013-01-01

The latissimus dorsi is the larger, flat, dorso-lateral muscle on the trunk, posterior to the arm, and partly covered by the trapezius on its median dorsal region. Origin of the latissimus dorsi is from spinous processes of thoracic T7–T12, thoracolumbar fascia, iliac crest and inferior 3 or 4 ribs, inferior angle of scapula and insertion on floor of intertubercular groove of the humerus. We have studied 50 cadavers in the different medical colleges in which we found 2% case of anterior and posterior slip of the muscle fibers with their extension up to the pectoralis major and teres major respectively. Usually, latissimus dorsi involve in extension, adduction, transverse extension also known as horizontal abduction, flexion from an extended position, and internal rotation of the shoulder joint. It also has a synergistic role in extension and lateral flexion of the lumbar spine. The latissimus dorsi may be used for the tendon graft surgeries. Tight latissimus dorsi has been shown to be one cause of chronic shoulder pain and chronic back pain. Because the latissimus dorsi connects the spine to the humerus, tightness in this muscle can manifest as either sub-optimal glenohumeral joint function (which leads to chronic shoulder pain) or tendinitis in the tendinous fasciae connecting the latissimus dorsi to the thoracic and lumbar spine. Latissimus dorsi used for pedicle transplant rotator cuff repair reconstruction of breast, face, scalp and cranium defect. The extra slip of the latissimus dorsi may puzzle any transplant operations. We as anatomist discuss the clinical implication of the extra slip of latissimus dorsi. PMID:24403744

Epidemiology and recent trends of geriatric fractures presenting to the emergency department for United States population from year 2004-2014.

PubMed

Baidwan, N K; Naranje, S M

2017-01-01

Fractures in geriatric age group (over 65 years of age) are an important public health issue and frequent causes of emergency room visits. The purpose of this descriptive epidemiological study was to present the epidemiology of geriatric fractures and their trends in the USA using National Electronic Injury Surveillance System (NEISS) database from year 2004-2014. National Electronic Injury Surveillance System (NEISS) Database was queried for all fracture injuries from 2004 to 2014 for ages 65 years and above. The proportions of fractures based on NEISS national estimates were calculated and their trends using linear regression over last 11 years were studied. Lower trunk (pelvis, hip and lower spine) fractures were the most common (34% for year 2014) type of fractures in this age group. Upper trunk (upper spine, clavicle and ribs) fractures were the second most common type of fractures (13% for year 2014). Other body parts commonly fractured involved the upper arm and wrist with an average of 7% fractures in both during the study period. About 5% of geriatric fractures pertained to shoulder and upper leg. Although less common, there was also about 2% increase in fractures to face and neck in 2014 as compared to about 3.2% and 1% respectively in 2004. Fractures to other body parts were less common with no major variations during the study period. Overall, lower trunk (hip, pelvic and lower spine) fractures were the most common geriatric fractures followed by upper trunk (upper spine, clavicle and rib) fractures. We suggest that there were decreasing trends for incidence of lower trunk, wrist and upper body fractures over the last 11 years (2004-2014). Approximately half of the geriatric fractures presenting to Emergency Department needed hospitalizations. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Uneventful upper cervical manipulation in the presence of a damaged vertebral artery.

PubMed

Michaud, Thomas C

2002-09-01

To discuss a case in which a patient with a previously injured vertebral artery underwent manipulation in the upper cervical spine without alteration of her symptom pattern. The literature concerning the relative safety of specific upper cervical manipulative techniques is reviewed. A 42-year-old woman had a 3-week history of unilateral suboccipital pain that she related to a sudden twisting of her head and neck that occurred while she was putting sheets of drywall on top of her car. Subsequent examination by a neurologist 2 weeks later was unremarkable, and a tension-type headache was diagnosed. Approximately 10 days later (3 weeks after injury), a single high-velocity upper-cervical manipulation (incorporating slight rotation and full lateral flexion) was performed with no change in her symptom pattern. Two weeks after that, the patient had development of a lateral medullary syndrome (also known as Wallenberg syndrome) after she briefly extended and rotated her upper cervical spine while painting a ceiling. The patient was treated with anticoagulant therapy, and the lateral medullary infarct healed without incident. The spinocerebellar and subtle motor symptoms also resolved, but the ipsilateral suboccipital headache and the loss of temperature sensation associated with the spinothalamic tract lesion were still present 9 months later. This case report demonstrates that vigorous manipulation of the upper cervical spine is possible without injuring an already damaged vertebral artery. It is suggested that the line of drive used during the single manipulation, almost pure lateral flexion with slight rotation, was responsible for the apparent innocuous response. Guidelines for the evaluation and management of vertebral artery dissection are reviewed. Because it is currently impossible to identify patients at risk of having a dissected vertebral artery with standard in-office examination procedures, rotational manipulation of the upper cervical spine should be abandoned by all practitioners, and schools should remove such techniques from their curriculums.

Anterior debridement may not be necessary in the treatment of tuberculous spondylitis of the thoracic and lumbar spine in adults: a retrospective study.

PubMed

Wang, S-T; Ma, H-L; Lin, C-P; Chou, P-H; Liu, C-L; Yu, W-K; Chang, M-C

2016-06-01

Many aspects of the surgical treatment of patients with tuberculosis (TB) of the spine, including the use of instrumentation and the types of graft, remain controversial. Our aim was to report the outcome of a single-stage posterior procedure, with or without posterior decompression, in this group of patients. Between 2001 and 2010, 51 patients with a mean age of 62.5 years (39 to 86) underwent long posterior instrumentation and short posterior or posterolateral fusion for TB of the thoracic and lumbar spines, followed by anti-TB chemotherapy for 12 months. No anterior debridement of the necrotic tissue was undertaken. Posterior decompression with laminectomy was carried out for the 30 patients with a neurological deficit. The mean kyphotic angle improved from 26.1° (- 1.8° to 62°) to 15.2° (-25° to 51°) immediately after the operation. At a mean follow-up of 68.8 months (30 to 144) the mean kyphotic angle was 16.9° (-22° to 54°), with a mean loss of correction of 1.6° (0° to 10°). There was a mean improvement in neurological status of 1.2 Frankel grades in those with a neurological deficit. Bony union was achieved in all patients, without recurrent infection. Long posterior instrumentation with short posterior or posterolateral fusion is effective in the treatment of TB spine. It controls infection, corrects the kyphosis, and maintains correction and neurological improvement over time. With effective anti-TB chemotherapy, a posterior only procedure without debridement of anterior lesion is effective in the treatment of TB spondylitis, and an anterior procedure can be reserved for those patients who have not improved after posterior surgery. Cite this article: Bone Joint J 2016;98-B:834-9. ©2016 The British Editorial Society of Bone & Joint Surgery.

Prevalence of diffuse idiopathic skeletal hyperostosis (DISH) of the whole spine and its association with lumbar spondylosis and knee osteoarthritis: the ROAD study.

PubMed

Kagotani, Ryohei; Yoshida, Munehito; Muraki, Shigeyuki; Oka, Hiroyuki; Hashizume, Hiroshi; Yamada, Hiroshi; Enyo, Yoshio; Nagata, Keiji; Ishimoto, Yuyu; Teraguchi, Masatoshi; Tanaka, Sakae; Nakamura, Kozo; Kawaguchi, Hiroshi; Akune, Toru; Yoshimura, Noriko

2015-03-01

We aimed to assess the prevalence of diffuse idiopathic skeletal hyperostosis (DISH) and its association with lumbar spondylosis (LS) and knee osteoarthritis (KOA) using a population-based cohort study entitled Research on Osteoarthritis/osteoporosis Against Disability (ROAD). In the baseline ROAD study, which was performed between 2005 and 2007, 1,690 participants in mountainous and coastal areas underwent anthropometric measurements and radiographic examinations of the whole spine (cervical, thoracic, and lumbar) and both knees. They also completed an interviewer-administered questionnaire. Presence of DISH was diagnosed according to Resnick criteria, and LS and KOA were defined as Kellgren-Lawrence (KL) grade ≥3. Among the 1,690 participants, whole-spine radiographs of 1,647 individuals (97.5%; 573 men, 1,074 women; mean age, 65.3 years) were evaluated. Prevalence of DISH was 10.8% (men 22.0%, women 4.8%), and was significantly higher in older participants (presence of DISH 72.3 years, absence of DISH 64.4 years) and mainly distributed at the thoracic spine (88.7%). Logistic regression analysis revealed that presence of DISH was significantly associated with older age [+1 year, odds ratio (OR): 1.06, 95% confidence interval (CI): 1.03-1.14], male sex (OR: 5.55, 95% CI: 3.57-8.63), higher body mass index (+1 kg/m(2), OR: 1.08, 95% CI: 1.02-1.14), presence of LS (KL2 vs KL0: 1, OR: 5.50, 95% CI: 2.81-10.8) (KL ≥3 vs KL0: 1, OR: 4.09, 95% CI: 2.08-8.03), and presence of KOA (KL ≥3 vs KL0: 1, OR: 1.89, 95% CI: 1.14-3.10) after adjusting for smoking, alcohol consumption, and residential area (mountainous vs coastal). This cross-sectional population-based study clarified the prevalence of DISH in general inhabitants and its significant association with LS and severe KOA.

The association between type of spine fracture and the mechanism of trauma: A useful tool for identifying mechanism of trauma on legal medicine field.

PubMed

Aghakhani, Kamran; Kordrostami, Roya; Memarian, Azadeh; Asl, Nahid Dadashzadeh; Zavareh, Fatemeh Noorian

2018-05-01

Determining the association between mechanism of trauma, and the type of spine column fracture is a useful approach for exactly describing spine injury on forensic medicine field. We aimed to determine mechanism of trauma based on distribution of the transition of spinal column fractures. This cross-sectional survey was performed on 117 consecutive patients with the history of spinal trauma who were admitted to emergency ward of Rasoul-e-Akram Hospital in Tehran, Iran from April 2015 to March 2016. The baseline characteristics were collected by reviewing the hospital recorded files. With respect to mechanism of fracture, 63.2% of fractures were caused by falling, 30.8% by collisions with motor vehicles, and others caused by the violence. Regarding site of fracture, lumbosacral was affected in 47.9%, thoracic in 29.9%, and cervical in 13.7%. Regarding type of fracture, burst fracture was the most common type (71.8%) followed by compressive fracture (14.5%). The site of fracture was specifically associated with the mechanism of injury; the most common injuries induced by falling from height were found in lumbosacral and cervical sites, and the most frequent injuries by traffic accidents were found in thoracic site; also the injuries following violence were observed more in lumbar vertebrae. The burst fractures were more revealed in the patients affected by falling from height and by traffic accidents, and both burst and compressive fractures were more observed with the same result in the patients injured with violence (p = 0.003). The type of spine fracture due to trauma is closely associated with the mechanism of trauma that can be helpful in legal medicine to identify the mechanism of trauma in affected patients. Copyright © 2018. Published by Elsevier Ltd.

Why do some intervertebral discs degenerate, when others (in the same spine) do not?

PubMed

Adams, Michael A; Lama, Polly; Zehra, Uruj; Dolan, Patricia

2015-03-01

This review suggests why some discs degenerate rather than age normally. Intervertebral discs are avascular pads of fibrocartilage that allow movement between vertebral bodies. Human discs have a low cell density and a limited ability to adapt to mechanical demands. With increasing age, the matrix becomes yellowed, fibrous, and brittle, but if disc structure remains intact, there is little impairment in function, and minimal ingrowth of blood vessels or nerves. Approximately half of old lumbar discs degenerate in the sense of becoming physically disrupted. The posterior annulus and lower lumbar discs are most affected, presumably because they are most heavily loaded. Age and genetic inheritance can weaken discs to such an extent that they are physically disrupted during everyday activities. Damage to the endplate or annulus typically decompresses the nucleus, concentrates stress within the annulus, and allows ingrowth of nerves and blood vessels. Matrix disruption progresses by mechanical and biological means. The site of initial damage leads to two disc degeneration "phenotypes": endplate-driven degeneration is common in the upper lumbar and thoracic spine, and annulus-driven degeneration is common at L4-S1. Discogenic back pain can be initiated by tissue disruption, and amplified by inflammation and infection. Healing is possible in the outer annulus only, where cell density is highest. We conclude that some discs degenerate because they are disrupted by excessive mechanical loading. This can occur without trauma if tissues are weakened by age and genetic inheritance. Moderate mechanical loading, in contrast, strengthens all spinal tissues, including discs. © 2014 Wiley Periodicals, Inc.

Surgical treatment of double thoracic adolescent idiopathic scoliosis with a rigid proximal thoracic curve.

PubMed

Sudo, Hideki; Abe, Yuichiro; Abumi, Kuniyoshi; Iwasaki, Norimasa; Ito, Manabu

2016-02-01

There is limited consensus on the optimal surgical strategy for double thoracic adolescent idiopathic scoliosis (AIS). Recent studies have reported that pedicle screw constructs to maximize scoliosis correction cause further thoracic spine lordosis. The objective of this study was to apply a new surgical technique for double thoracic AIS with rigid proximal thoracic (PT) curves and assess its clinical outcomes. Twenty one consecutive patients with Lenke 2 AIS and a rigid PT curve (Cobb angle ≥30º on side-bending radiographs, flexibility ≤30 %) treated with the simultaneous double-rod rotation technique (SDRRT) were included. In this technique, a temporary rod is placed at the concave side of the PT curve. Then, distraction force is applied to correct the PT curve, which reforms a sigmoid double thoracic curve into an approximate single thoracic curve. As a result, the PT curve is typically converted from an apex left to an apex right curve before applying the correction rod for PT and main thoracic curve. All patients were followed for at least 2 years (average 2.7 years). The average main thoracic and PT Cobb angle correction rate at the final follow-up was 74.7 and 58.0 %, respectively. The average preoperative T5-T12 thoracic kyphosis was 9.3°, which improved significantly to 19.0° (p < 0.0001) at the final follow-up. Although 71 % patients had preoperative level shoulders or a positive radiographic shoulder height, all patients had mildly imbalanced or balanced shoulders at the final follow-up. The average preoperative main thoracic apical vertebral rotation angle of 20.7° improved significantly after surgery to 16.4° (p = 0.0046), while the average preoperative total SRS questionnaire score of 3.7 improved significantly to 4.4 (p = 0.0012) at the final follow-up. Radiographic findings and patient outcomes were satisfactory. Thoracic kyphosis can be maintained or improved, while coronal and axial deformities can be corrected using SDRRT for Lenke 2 AIS with a rigid PT curve.

Multiple cervical hemivertebra resection and staged thoracic pedicle subtraction osteotomy in the treatment of complicated congenital scoliosis.

PubMed

Zhuang, Qianyu; Zhang, Jianguo; Wang, Shengru; Guo, Jianwei; Qiu, Guixing

2016-05-01

To present our experience of staged correction with multiple cervical hemivertebra resection and thoracic pedicle subtraction osteotomy (PSO) treating a rare and complicated congenital scoliosis. A 14-year-old male presented with progressive torticollis and spine deformity. The malformation developed since birth, and back pain after long-time sitting or exercise arose since 6 months before, which was unsuccessfully treated by physiotherapy. X-ray showed a right cervical curve of 60° and a left compensatory thoracic curve of 90°. Three-dimensional computed tomography (3-D CT) scan revealed three semi-segmented hemivertebrae (C4, C5 and C6) on the right side. Based on our staged strategy, the three consecutive cervical hemivertebrae, as the major pathology causing the deformity, were firstly resected by the combined posterior and anterior approach. Six months later, T6 PSO osteotomy was used to correct the structural compensatory thoracic curve. The cervical curve was reduced to 23° while the thoracic curve to 60° after the first-stage surgery, and the thoracic curve was further reduced to 30° after the second-stage surgery. The radiograph at 5-year follow-up showed that both the coronal and sagittal balance were well restored and stabilized, with the occipital tilt reduced from 12° to 0°. Our strategy may provide an option for similar cases with multiple consecutive cervical hemivertebrae and a large structural compensatory thoracic curve, which proved to achieve excellent correction in both the coronal and sagittal planes with acceptable neurologic risk.

Possibility Study of Scale Invariant Feature Transform (SIFT) Algorithm Application to Spine Magnetic Resonance Imaging

PubMed Central

Lee, Dong-Hoon; Lee, Do-Wan; Han, Bong-Soo

2016-01-01

The purpose of this study is an application of scale invariant feature transform (SIFT) algorithm to stitch the cervical-thoracic-lumbar (C-T-L) spine magnetic resonance (MR) images to provide a view of the entire spine in a single image. All MR images were acquired with fast spin echo (FSE) pulse sequence using two MR scanners (1.5 T and 3.0 T). The stitching procedures for each part of spine MR image were performed and implemented on a graphic user interface (GUI) configuration. Moreover, the stitching process is performed in two categories; manual point-to-point (mPTP) selection that performed by user specified corresponding matching points, and automated point-to-point (aPTP) selection that performed by SIFT algorithm. The stitched images using SIFT algorithm showed fine registered results and quantitatively acquired values also indicated little errors compared with commercially mounted stitching algorithm in MRI systems. Our study presented a preliminary validation of the SIFT algorithm application to MRI spine images, and the results indicated that the proposed approach can be performed well for the improvement of diagnosis. We believe that our approach can be helpful for the clinical application and extension of other medical imaging modalities for image stitching. PMID:27064404

Conversion coefficients for determining organ doses in paediatric spine radiography.

PubMed

Seidenbusch, Michael; Schneider, Karl

2014-04-01

Knowledge of organ and effective doses achieved during paediatric x-ray examinations is an important prerequisite for assessment of radiation burden to the patient. Conversion coefficients for reconstruction of organ and effective doses from entrance doses for segmental spine radiographs of 0-, 1-, 5-, 10-, 15- and 30-year-old patients are provided regarding the Guidelines of Good Radiographic Technique of the European Commission. Using the personal computer program PCXMC developed by the Finnish Centre for Radiation and Nuclear Safety (Säteilyturvakeskus STUK), conversion coefficients for conventional segmental spine radiographs were calculated performing Monte Carlo simulations in mathematical hermaphrodite phantom models describing patients of different ages. The clinical variation of beam collimation was taken into consideration by defining optimal and suboptimal radiation field settings. Conversion coefficients for the reconstruction of organ doses in about 40 organs and tissues from measured entrance doses during cervical, thoracic and lumbar spine radiographs of 0-, 1-, 5-, 10-, 15- and 30-year-old patients were calculated for the standard sagittal and lateral beam projections and the standard focus detector distance of 115 cm. The conversion coefficients presented may be used for organ dose assessments from entrance doses measured during spine radiographs of patients of all age groups and all field settings within the optimal and suboptimal standard field settings.

Clearing the Cervical Spine in a War Zone: What Other Injuries Matter?

PubMed

Drew, Jennifer; Chou, Victoria B; Miller, Catriona; Borg, Bryson; Ingalls, Nichole; Shackelford, Stacy

2015-07-01

Cervical spine clearance requires clinicians to assess the reliability of physical examination based on a patient's mental status and distracting injuries. Distracting injuries have never been clearly defined in military casualties. Retrospective review was conducted of patients entered into Department of Defense Trauma Registry January 2008 to August 2013, identifying blunt trauma patients with cervical spine injury and Glasgow Coma Score ≥ 14. Physical examination and radiology results were abstracted from medical records and injury diagnoses were obtained from Department of Defense Trauma Registry. Groups were compared, p-value of < 0.05 was considered significant. A total of 149 patients met study criteria; 20 patients (13%) had a negative clinical examination of the cervical spine. Coexisting injuries identified in patients with negative physical examination included injuries in proximity to the neck (head, thoracic spine, chest, or humerus) in 17 (85%) patients. In 3 patients (15%), coexisting injuries were not in proximity to the neck and included pelvic, femur, and tibia fractures. All patients without coexisting injury (n = 37) had a positive physical examination. Physical examination of multitrauma casualties with neck injury may be unreliable when distracting injuries are present. When no distracting injuries were present, the physical examination was accurate in all patients. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

Manubriosternal dislocation with spinal fracture: A rare cause for delayed haemothorax.

PubMed

Kothari, Manish; Saini, Pramod; Shethna, Sunny; Dalvie, Samir

2015-01-01

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.

[Surgical treatment of thoracic disc herniation].

PubMed

Hrabálek, L; Kalita, O; Langová, K

2010-08-01

The aim of this study was to compare the efficiency of different surgical approaches to thoracic disc herniation, and to show the role of segmental fusion and selection of an appropriate microsurgical decompression technique for the successful outcome of surgery. A group of 27 patients, 10 men and 17 women, between 31 and 70 years (average age, 49.33 years) were included in this prospective study. They underwent surgery for thoracic degeneration disc disease in the period from June 1994 to August 2008. In all patients, the severity of myelopathy was assessed using the grading Frankel system and JOA score, axial and radicular pain intensity was evaluated with VAS and ODI rating systems. The diagnosis was established on the basis of thoracic spine radiography, thoracic spine MRI and a CT scan of the segment. A total of 30 thoracic segments, in the range of Th4/Th5 to Th12/L1, were indicated for surgery. Localisation of the hernia was medial at 19 segments, mediolateral at three and lateral at eight segments. Soft disc herniation was found in 17 cases and hard disc protrusion at the remaining 13 segments. Surgery for significant myelopathy was carried out in 23 patients and for pain in four patients. According to the surgical procedure used, the patients were allocated to two groups: group A comprised 10 patients treated without disc replacement through a laminectomy or a costotransversectomy exposure, and group B consisted of 17 patients undergo- ing intersomatic fusion via a thoracotomy. Clinical and radiographic examinations were made at regular intervals for at least 1 year of follow-up. The results of clinical assessment, including JOA scores, JOA Recovery Rate, VAS scores at rest and after exercise and ODI, were statistically analysed for each group and compared. There was a statistically significant difference in JOA evaluation of myelopathy between the groups in group A, the mean JOA score declined from 7.9 to 7.0, i.e., -0.9 point, while in group B it increased from 6.71 to 9.12, i.e., +2.41 points. The mean JOA Recovery Rate did not reach a plus value in group A, while in group B it improved by 55 %. JOA Recovery Rate: Of the seven patients in group A evaluated for myelopathy, a fair result was in one, unchanged in two and worse in four patients. Of the 16 patients evaluated for myelopathy in group B, the results were excellent in four, good in six, fair in four and unchanged in two patients. Frankel grade function: In group A, one patient improved by one grade, two remained unchanged, two deteriorated by one grade and two by two grades. In group B, five patients improved by one grade, two patients by two grades and two patients by three grades. Eight patients remained unchanged and no patient deteriorated. The post-operative pain intensity, as assessed by the mean VAS score, was lower at rest and after exercise in both groups; the score was better in group B, but the difference was not statistically significant. The ODI was evaluated only in group B its mean value improved from 41.4% to 26.1%, i.e., by 15.3%. Between 7 to 15 % of the patients have asymptomatic thoracic disc herniation, while symptomatic herniation is very rare and accounts for only 0.25 % to 0.57 % of herniated discs in the whole spine. Severe or progressive myelopathy is a clear indication for surgical intervention in thoracic disc herniation, but the role of surgery in pain control is controversial. There are five approaches for thoracic disc herniation. Transpleural anterolateral thoracotomy has an advantage over the other methods because it permits the treatment of all types of herniation, whether localised centrally, laterally or contralaterally, i.e., soft, calcified or sequestered intradural disc herniation. The results of treatment will depend on the outcome of surgical spinal cord decompression and the degree of spinal stabilisation achieved. The surgical procedure via thoracotomy with intersomatic fusion resulted in a statistically more significant improvement of myelopathy than the posterior approach without disc replacement, and it provided greater pain relief. The authors recommend to treat thoracic disc herniation by discectomy via a thoracotomy and by intersomatic fusion.

Kinematics of the thoracic T10-T11 motion segment: locus of instantaneous axes of rotation in flexion and extension.

PubMed

Qiu, Tian-Xia; Teo, Ee-Chon; Lee, Kim-Kheng; Ng, Hong-Wan; Yang, Kai

2004-04-01

The purpose of this study was to determine the locations and loci of instantaneous axes of rotation (IARs) of the T10-T11 motion segment in flexion and extension. An anatomically accurate three-dimensional model of thoracic T10-T11 functional spinal unit (FSU) was developed and validated against published experimental data under flexion, extension, lateral bending, and axial rotation loading configurations. The validated model was exercised under six load configurations that produced motions only in the sagittal plane to characterize the loci of IARs for flexion and extension. The IARs for both flexion and extension under these six load types were directly below the geometric center of the moving vertebra, and all the loci of IARs were tracked superoanteriorly for flexion and inferoposteriorly for extension with rotation. These findings may offer an insight to better understanding of the kinematics of the human thoracic spine and provide clinically relevant information for the evaluation of spinal stability and implant device functionality.

Abnormalities of the axial and proximal appendicular skeleton in adults with Laron syndrome (growth hormone insensitivity).

PubMed

Kornreich, L; Konen, O; Schwarz, M; Siegel, Y; Horev, G; Hershkovitz, I; Laron, Z

2008-02-01

To investigate abnormalities in the skeleton (with the exclusion of the skull, cervical spine, hands and feet) in patients with Laron syndrome, who have an inborn growth hormone resistance and congenital insulin-like growth factor-1 (IGF-1) deficiency. The study group was composed of 15 untreated patients with Laron syndrome (seven male and eight female) aged 21-68 years. Plain films of the axial and appendicular skeleton were evaluated retrospectively for abnormalities in structure and shape. The cortical width of the long bones was evaluated qualitatively and quantitatively (in the upper humerus and mid-femur), and the cortical index was calculated and compared with published references. Measurements were taken of the mid-anteroposterior and cranio-caudal diameters of the vertebral body and spinous process at L3, the interpedicular distance at L1 and L5, and the sacral slope. Thoracic and lumbar osteophytes were graded on a 5-point scale. Values were compared with a control group of 20 healthy persons matched for age. The skeleton appeared small in all patients. No signs of osteopenia were visible. The cortex of the long bones appeared thick in the upper limbs in 11 patients and in the lower limbs in four. Compared with the reference values, the cortical width was thicker than average in the humerus and thinner in the femur. The vertebral diameters at L3 and the interpedicular distances at L1 and L5 were significantly smaller in the patients than in the control subjects (P<0.001); however, at L5 the canal was wider, relative to the vertebral body. The study group had a higher rate of anterior osteophytes in the lumbar spine than the controls had, and their osteophytes were also significantly larger. In the six patients for whom radiographs of the upper extremity in its entirety were available on one film, the ulna appeared to be rotated. In one 22-year-old man, multiple epiphyses were still open. Congenital IGF-1 deficiency leads to skeletal abnormalities characterized by small bones, narrow spinal canal, and delayed bone age. The limitation in elbow distensibility common to patients with Laron syndrome may be related to a marked retroversion of the humeral head.

Mammalian spinal biomechanics: postural support in seated macaques.

PubMed

Gal, Julianna

2002-06-01

The aim of this study was to investigate whether the ligamentous lumbar vertebral column of a macaque could potentially provide passive mechanical support to the weight of the head, upper body and forelimbs during upright sitting. The seated flexed curvature of the lumbar spine of Macaca sylvana was estimated from a photograph and was partitioned equally among the lumbar-lumbar intervertebral joints. This flexed curvature was compared with the hyper-extended profile of the unloaded excised ligamentous spine of a related species (Macaca fascicularis) and used to calculate changes in intervertebral angle from the unloaded excised state to the loaded in vivo state. Changes in intervertebral angle were then used to calculate the net flexion moment required to bend the spine from the unloaded curvature to the seated curvature. The moment arm of the ventrally displaced weight of the head, upper body and forelimbs was estimated and used to calculate a corresponding net force. It was found that this force corresponded to approximately 18 % of the total body weight of the 2.34 kg sample animal. This compares with a likely fractional body weight of approximately 30-40 % for the head, upper body and forelimbs of these primates. Therefore, approximately half of the ventral flexion moment associated with the combined weight of the head, upper body and forelimbs during sitting in these animals may be supported by the passive mechanical properties associated with the ligamentous lumbar spine. This represents a potential means of relieving muscular effort and saving metabolic energy.

Progressive Spinal Kyphosis in the Aging Population.

PubMed

Ailon, Tamir; Shaffrey, Christopher I; Lenke, Lawrence G; Harrop, James S; Smith, Justin S

2015-10-01

Thoracic kyphosis tends to increase with age. Hyperkyphosis is defined as excessive curvature of the thoracic spine and may be associated with adverse health effects. Hyperkyphosis in isolation or as a component of degenerative kyphoscoliosis has important implications for the surgical management of adult spinal deformity. Our objective was to review the literature on the epidemiology, etiology, natural history, management, and outcomes of thoracic hyperkyphosis. We performed a narrative review of literature on thoracic hyperkyphosis and its implications for adult spinal deformity surgery. Hyperkyphosis has a prevalence of 20% to 40% and is more common in the geriatric population. The cause is multifactorial and involves an interaction between degenerative changes, vertebral compression fractures, muscular weakness, and altered biomechanics. It may be associated with adverse health consequences including impaired physical function, pain and disability, impaired pulmonary function, and increased mortality. Nonoperative management may slow the progression of kyphosis and improve function. Surgery is rarely performed for isolated hyperkyphosis in the elderly due to the associated risk, but is an option when kyphosis occurs in the context of significant deformity. In this scenario, increased thoracic kyphosis influences selection of fusion levels and overall surgical planning. Kyphosis is common in older individuals and is associated with adverse health effects and increased mortality. Current evidence suggests a role for nonoperative therapies in reducing kyphosis and delaying its progression. Isolated hyperkyphosis in the elderly is rarely treated surgically; however, increased thoracic kyphosis as a component of global spinal deformity has important implications for patient selection and operative planning.

Acute effects of single and multiple level thoracic manipulations on chronic mechanical neck pain: a randomized controlled trial

PubMed Central

Puntumetakul, Rungthip; Suvarnnato, Thavatchai; Werasirirat, Phurichaya; Uthaikhup, Sureeporn; Yamauchi, Junichiro; Boucaut, Rose

2015-01-01

Background Thoracic spine manipulation has become a popular alternative to local cervical manipulative therapy for mechanical neck pain. This study investigated the acute effects of single-level and multiple-level thoracic manipulations on chronic mechanical neck pain (CMNP). Methods Forty-eight patients with CMNP were randomly allocated to single-level thoracic manipulation (STM) at T6–T7 or multiple-level thoracic manipulation (MTM), or to a control group (prone lying). Cervical range of motion (CROM), visual analog scale (VAS), and the Thai version of the Neck Disability Index (NDI-TH) scores were measured at baseline, and at 24-hour and at 1-week follow-up. Results At 24-hour and 1-week follow-up, neck disability and pain levels were significantly (P<0.05) improved in the STM and MTM groups compared with the control group. CROM in flexion and left lateral flexion were increased significantly (P<0.05) in the STM group when compared with the control group at 1-week follow-up. The CROM in right rotation was increased significantly after MTM compared to the control group (P<0.05) at 24-hour follow-up. There were no statistically significant differences in neck disability, pain level at rest, and CROM between the STM and MTM groups. Conclusion These results suggest that both single-level and multiple-level thoracic manipulation improve neck disability, pain levels, and CROM at 24-hour and 1-week follow-up in patients with CMNP. PMID:25624764

A note on the trilobite genus Dixiphopyge

USGS Publications Warehouse

Brezinski, D.K.

1997-01-01

Recovery of the first nearly complete thoracopygon of the trilobite genus Dixiphopyge Brezinski from the Chouteau Formation of central Missouri aids in evaluating the paleoecology and taxonomic affinities of this genus. Dixiphopyge is an isopygous trilobite, suboval in outline, and possessing nine thoracic segments. At the apex of each axial ring is a hollow tubercle that may represent the base of a short spine. Dixiphopyge inhabited muddy biostrome environments. In an enrolled position Dixiphopyge is interpreted to have looked somewhat like a porcupine with its spines radiating outward, presumably to inhibit its consumption by predators. Previous subfamily assignment of Dixiphopyge in the Otarioninae with Cyphaspis and Namuropyge may have been incorrect, because the latter two genera possess broad preglabellar fields and are micropygous.

Delayed post-traumatic capillary haemangioma of the spine.

PubMed

Shilton, Hamish; Goldschlager, Tony; Kelman, Anthony; Xenos, Chris

2011-11-01

Capillary haemangiomas are well-circumscribed aggregates of closely packed, thin-walled capillaries separated by connective tissue stroma. In subcutaneous tissue they are termed pyogenic granuloma and commonly follow trauma. They rarely occur in the spine. We present a 43-year-old woman with a 6-week history of thoracic myelopathy and back pain on a background of T7 and T8 vertebral compression fractures from a motor vehicle accident 10 years previously. MRI demonstrated a posteriorly based extradural homogeneously enhancing mass at this level. The lesion was resected and diagnosed histopathologically as a capillary haemangioma. The patient's symptoms resolved and she made an uneventful recovery. The literature is reviewed and the possible pathogenesis is discussed. Copyright © 2011 Elsevier Ltd. All rights reserved.

Airway obstruction due to tracheomalacia caused by innominate artery compression and a kyphotic cervical spine.

PubMed

Liu, Chia-Hsin; Huang, Wen-Sheng; Wang, Hong-Hau; Wu, Chin-Pyng; Chian, Chih-Feng; Perng, Wann-Cherng; Tsai, Chen-Liang

2015-02-01

Tracheomalacia can cause variable degrees of intrathoracic airway obstruction and is an easily overlooked cause of respiratory distress in adults. Here, we report a case of acute respiratory failure in which subglottic stenosis was accidentally identified during endotracheal intubation. Subsequent bronchoscopy and computed tomography of the thorax and neck revealed tracheal compression with tracheomalacia caused by a tortuous innominate artery and a kyphotic cervical spine. The patient underwent rigid bronchoscopy with metal stent implantation, and her symptoms were alleviated. These findings outline the importance of precise diagnosis and interventions for preventing recurrent life-threatening respiratory failure in such cases. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Management of an ingested fish bone in the lung using video-assist thoracic surgery: a case report.

PubMed

Tan, Sichuang; Tan, Sipin; Peng, Muyun; Yu, Fenglei

2015-06-01

We report a case of lung abscess caused by an ingested fish bone that was successfully treated by minimally invasive surgery. Although cases of ingested foreign body abscess are well reported, lung abscess caused by ingested fish bone is extremely rare. To date, less than 10 similar cases have been reported in the literature. To the best of our knowledge, the case presented in this case report is the first report of this kind that was successfully treated by video-assist thoracic surgery (VATS). A 47-year-old man was admitted to department of thoracic surgery with the complaint of continues dry cough and fever. The patient accidentally swallowed a long sharp-blade-shaped fish bone 20 days before, which perforated the upper thoracic esophagus on the right and embedded in the right upper lobe.The diagnosis was verified by computed tomography scan and a video-assist thoracic surgery procedure was successfully performed to treat the patient. The patient survived the esophageal perforation fortunately without involvement of great vessel injury and probable mediastinitis. This report may provide additional experience on lung abscess caused by ingested fish bones. However, it is also important to educate the public of the risks of trying to force an ingested object down into the stomach.

Activity of thoracic and lumbar epaxial extensors during postural responses in the cat

NASA Technical Reports Server (NTRS)

Macpherson, J. M.; Fung, J.; Peterson, B. W. (Principal Investigator)

1998-01-01

This study examined the role of trunk extensor muscles in the thoracic and lumbar regions during postural adjustments in the freely standing cat. The epaxial extensor muscles participate in the rapid postural responses evoked by horizontal translation of the support surface. The muscles segregate into two regional groups separated by a short transition zone, according to the spatial pattern of the electromyographic (EMG) responses. The upper thoracic muscles (T5-9) respond best to posteriorly directed translations, whereas the lumbar muscles (T13 to L7) respond best to anterior translations. The transition group muscles (T10-12) respond to almost all translations. Muscles group according to vertebral level rather than muscle species. The upper thoracic muscles change little in their response with changes in stance distance (fore-hindpaw separation) and may act to stabilize the intervertebral angles of the thoracic curvature. Activity in the lumbar muscles increases along with upward rotation of the pelvis (iliac crest) as stance distance decreases. Lumbar muscles appear to stabilize the pelvis with respect to the lumbar vertebrae (L7-sacral joint). The transition zone muscles display a change in spatial tuning with stance distance, responding to many directions of translation at short distances and focusing to respond best to contralateral translations at the long stance distance.

Extrication collars can result in abnormal separation between vertebrae in the presence of a dissociative injury.

PubMed

Ben-Galim, Peleg; Dreiangel, Niv; Mattox, Kenneth L; Reitman, Charles A; Kalantar, S Babak; Hipp, John A

2010-08-01

Cervical collars are applied to millions of trauma victims with the intent of protecting against secondary spine injuries. Adverse clinical outcomes during the management of trauma patients led to the hypothesis that extrication collars may be harmful in some cases. The literature provides indirect support for this observation. The purpose of this study was to directly evaluate cervical biomechanics after application of a cervical collar in the presence of severe neck injury. Cranial-caudal displacements in the upper cervical spine were measured in cadavers from images taken before and after application of collars following creation of an unstable upper cervical spine injury. In the presence of severe injury, collar application resulted in 7.3 mm +/- 4.0 mm of separation between C1 and C2 in a cadaver model. In general, collars had the effect of pushing the head away from the shoulders. This study was consistent with previous evidence that extrication collars can result in abnormal distraction within the upper cervical spine in the presence of a severe injury. These observations support the need to prioritize additional research to better understand the risks and benefits of cervical stabilization methods and to determine whether improved stabilization methods can help to avoid potentially harmful displacements between vertebrae.

Unicameral bone cyst in the spinous process of a thoracic vertebra.

PubMed

Tsirikos, Athanasios I; Bowen, J Richard

2002-10-01

Unicameral bone cysts affecting the spine are extremely rare and tend to be misdiagnosed. We report on a 17-year-old female patient who presented with a 2-year history of persistent low back pain. The radiographic evaluation and bone scan failed to reveal a pathologic process. Magnetic resonance of the painful area and subsequent computed tomography scan showed a well-circumscribed osteolytic lesion originating from the spinous process and extending into both laminae of T9 vertebra. Aneurysmal bone cyst or osteoblastoma was considered to be the most probable diagnosis. The patient underwent excisional biopsy of the tumor. The intraoperative findings were suggestive of solitary bone cyst, a diagnosis that was confirmed histologically. Because the tumor had not invaded the articular facets, no posterolateral spine fusion was required. The patient had an unremarkable postoperative clinical course. Her symptoms resolved and she returned to her previous level of physical activities. Unicameral bone cysts, although uncommon, should be included in the differential diagnosis of an osteolytic lesion involving the spine.

Serial elongation-derotation-flexion casting for children with early-onset scoliosis.

PubMed

Canavese, Federico; Samba, Antoine; Dimeglio, Alain; Mansour, Mounira; Rousset, Marie

2015-12-18

Various early-onset spinal deformities, particularly infantile and juvenile scoliosis (JS), still pose challenges to pediatric orthopedic surgeons. The ideal treatment of these deformities has yet to emerge, as both clinicians and surgeons still face multiple challenges including preservation of thoracic motion, spine and cage, and protection of cardiac and lung growth and function. Elongation-derotation-flexion (EDF) casting is a technique that uses a custom-made thoracolumbar cast based on a three-dimensional correction concept. EDF can control progression of the deformity and - in some cases-coax the initially-curved spine to grow straighter by acting simultaneously in the frontal, sagittal and coronal planes. Here we provide a comprehensive review of how infantile and JS can affect normal spine and thorax and how serial EDF casting can be used to manage these spinal deformities. A fresh review of the literature helps fully understand the principles of the serial EDF casting technique and the effectiveness of conservative treatment in patients with early-onset spinal deformities, particularly infantile and juvenile scolisois.

Serial elongation-derotation-flexion casting for children with early-onset scoliosis

PubMed Central

Canavese, Federico; Samba, Antoine; Dimeglio, Alain; Mansour, Mounira; Rousset, Marie

2015-01-01

Various early-onset spinal deformities, particularly infantile and juvenile scoliosis (JS), still pose challenges to pediatric orthopedic surgeons. The ideal treatment of these deformities has yet to emerge, as both clinicians and surgeons still face multiple challenges including preservation of thoracic motion, spine and cage, and protection of cardiac and lung growth and function. Elongation-derotation-flexion (EDF) casting is a technique that uses a custom-made thoracolumbar cast based on a three-dimensional correction concept. EDF can control progression of the deformity and - in some cases-coax the initially-curved spine to grow straighter by acting simultaneously in the frontal, sagittal and coronal planes. Here we provide a comprehensive review of how infantile and JS can affect normal spine and thorax and how serial EDF casting can be used to manage these spinal deformities. A fresh review of the literature helps fully understand the principles of the serial EDF casting technique and the effectiveness of conservative treatment in patients with early-onset spinal deformities, particularly infantile and juvenile scolisois. PMID:26716089

A kinematic analysis of the spine during rugby scrummaging on natural and synthetic turfs.

PubMed

Swaminathan, Ramesh; Williams, Jonathan M; Jones, Michael D; Theobald, Peter S

2016-01-01

Artificial surfaces are now an established alternative to grass (natural) surfaces in rugby union. Little is known, however, about their potential to reduce injury. This study characterises the spinal kinematics of rugby union hookers during scrummaging on third-generation synthetic (3G) and natural pitches. The spine was sectioned into five segments, with inertial sensors providing three-dimensional kinematic data sampled at 40 Hz/sensor. Twenty-two adult, male community club and university-level hookers were recruited. An equal number were analysed whilst scrummaging on natural or synthetic turf. Players scrummaging on synthetic turf demonstrated less angular velocity in the lower thoracic spine for right and left lateral bending and right rotation. The general reduction in the range of motion and velocities, extrapolated over a prolonged playing career, may mean that the synthetic turf could result in fewer degenerative injuries. It should be noted, however, that this conclusion considers only the scrummaging scenario.

A kinematic analysis of the spine during rugby scrummaging on natural and synthetic turfs

PubMed Central

Swaminathan, Ramesh; Williams, Jonathan M.; Jones, Michael D.; Theobald, Peter S.

2016-01-01

ABSTRACT Artificial surfaces are now an established alternative to grass (natural) surfaces in rugby union. Little is known, however, about their potential to reduce injury. This study characterises the spinal kinematics of rugby union hookers during scrummaging on third-generation synthetic (3G) and natural pitches. The spine was sectioned into five segments, with inertial sensors providing three-dimensional kinematic data sampled at 40 Hz/sensor. Twenty-two adult, male community club and university-level hookers were recruited. An equal number were analysed whilst scrummaging on natural or synthetic turf. Players scrummaging on synthetic turf demonstrated less angular velocity in the lower thoracic spine for right and left lateral bending and right rotation. The general reduction in the range of motion and velocities, extrapolated over a prolonged playing career, may mean that the synthetic turf could result in fewer degenerative injuries. It should be noted, however, that this conclusion considers only the scrummaging scenario. PMID:26375051

Utility of cervical spinal and abdominal computed tomography in diagnosing occult pneumothorax in patients with blunt trauma: Computed tomographic imaging protocol matters.

PubMed

Akoglu, Haldun; Akoglu, Ebru Unal; Evman, Serdar; Akoglu, Tayfun; Denizbasi, Arzu; Guneysel, Ozlem; Onur, Ozge; Onur, Ender

2012-10-01

Small pneumothoraces (PXs), which are not initially recognized with a chest x-ray film and diagnosed by a thoracic computed tomography (CT), are described as occult PX (OCPX). The objective of this study was to evaluate cervival spine (C-spine) and abdominal CT (ACT) for diagnosing OCPX and overt PX (OVPX). All patients with blunt trauma who presented consecutively to the emergency department during a 26-months period were included. Among all the chest CTs (CCTs) (6,155 patients) conducted during that period, 254 scans were confirmed to have a true PX. The findings in their C-spine CT and ACT were compared with the findings in CCTs. Among these patients, 254 had a diagnosis of PX confirmed with CCT. OCPXs were identified on the chest computed tomographic scan of 128 patients (70.3%), whereas OVPXs were evident in 54 patients (29.7%). Computed tomographic imaging of the C-spine was performed in 74% of patients with OCPX and 66.7% of patients with OVPX trauma. Only 45 (35.2%) cases of OCPX and 42 (77.8%) cases of OVPX were detected by C-spine CT. ACT was performed in almost all patients, and 121 (95.3%) of 127 of these correctly identified an existing OCPX. Sensitivity of C-spine CT and ACT was 35.1% and 96.5%, respectively; specificity was 100% and 100%, respectively. Almost all OCPXs, regardless of intrathoracic location, could be detected by ACT or by combining C-spine and abdominal computed tomographic screening for patients. If the junction of the first and second vertebra is used as the caudad extent, C-spine CT does not have sufficient power to diagnose more than a third of the cases. Diagnostic study, level III.

Effort Thrombosis Presenting as Pulmonary Embolism in a Professional Baseball Pitcher

PubMed Central

Bushnell, Brandon D.; Anz, Adam W.; Dugger, Keith; Sakryd, Gary A.; Noonan, Thomas J.

2009-01-01

Context: Effort thrombosis, or Paget-Schroetter’s syndrome, is a rare subset of thoracic outlet syndrome in which deep venous thrombosis of the upper extremity occurs as the result of repetitive overhead motion. It is occasionally associated with pulmonary embolism. This case of effort thrombosis and pulmonary embolus was in a 25-year-old major league professional baseball pitcher, in which the only presenting complaints involved dizziness and shortness of breath without complaints involving the upper extremity—usually, a hallmark of most cases of this condition. The patient successfully returned to play for 5 subsequent seasons at the major league level after multimodal treatment that included surgery for thoracic outlet syndrome. Objective: Though rare, effort thrombosis should be included in the differential diagnosis of throwing athletes with traditional extremity-focused symptoms and in cases involving pulmonary or thoracic complaints. Rapid diagnosis is a critical component of successful treatment. PMID:23015912

Cervical and thoracic spine injury from interactions with vehicle roofs in pure rollover crashes.

PubMed

Bambach, M R; Grzebieta, R H; McIntosh, A S; Mattos, G A

2013-01-01

Around one third of serious injuries sustained by belted, non-ejected occupants in pure rollover crashes occur to the spine. Dynamic rollover crash test methodologies have been established in Australia and the United States, with the aims of understanding injury potential in rollovers and establishing the basis of an occupant rollover protection crashworthiness test protocol that could be adopted by consumer new car assessment programmes and government regulators internationally. However, for any proposed test protocol to be effective in reducing the high trauma burden resulting from rollover crashes, appropriate anthropomorphic devices that replicate real-world injury mechanisms and biomechanical loads are required. To date, consensus regarding the combination of anthropomorphic device and neck injury criteria for rollover crash tests has not been reached. The aim of the present study is to provide new information pertaining to the nature and mechanisms of spine injury in pure rollover crashes, and to assist in the assessment of spine injury potential in rollover crash tests. Real-world spine injury cases that resulted from pure rollover crashes in the United States between 2000 and 2009 are identified, and compared with cadaver experiments under vertical load by other authors. The analysis is restricted to contained, restrained occupants that were injured from contact with the vehicle roof structure during a pure rollover, and the role of roof intrusion in creating potential for spine injury is assessed. Recommendations for assessing the potential for spine injury in rollover occupant protection crash test protocols are made. Copyright © 2012 Elsevier Ltd. All rights reserved.

Program Evaluation of Outcomes Based Orthotic and Prosthetic Education

DTIC Science & Technology

2006-12-01

Rheumatoid Arthritis; synovial joints ; tendon sheaths. b. Osteoarthritis; weight bearing joints ; loading areas. c. Osteoporosis; cancellous bone...flexion. 32. The desirable length of a thumb post is: a. to the thumb IP joint . b. proximal to the IP joint . c. to the nail bed. d. just...assist hyperextension of the thoracic spine. b. eliminate motion. c. prevent lumbar flexion. d. reduce axial load on lumbar vertebrae. 44

Comparison of posture among adolescent male volleyball players and non-athletes

PubMed Central

2014-01-01

Due to high training loads and frequently repeated unilateral exercises, several types of sports training can have an impact on the process of posture development in young athletes. The objective of the study was to assess and compare the postures of adolescent male volleyball players and their non-training peers. The study group comprised 104 volleyball players while the control group consisted of 114 non-training individuals aged 14-16 years. Body posture was assessed by the Moiré method. The volleyball players were significantly taller, and had greater body weight and fat-free mass. The analysis of posture relative to symmetry in the frontal and transverse planes did not show any significant differences between the volleyball players and non-athletes. Postural asymmetries were observed in both the volleyball players and the control participants. Lumbar lordosis was significantly less defined in the volleyball players compared to non-training individuals while no difference was observed in thoracic kyphosis. All athletes demonstrated a loss of lumbar lordosis and an increase in thoracic kyphosis. Significant differences in anteroposterior curvature of the spine between the volleyball players and the non-athletes might be associated with both training and body height. Considering the asymmetric spine overloads which frequently occur in sports training, meticulous posture assessment in young athletes seems well justified. PMID:25729154

[Rehabilitation after Traumatic Fracture of Thoracic and Lumbar Spine].

PubMed

Bork, Hartmut; Simmel, Stefan; Böhle, Eckhardt; Ernst, Ulrich; Fischer, Klaus; Fromm, Bernd; Glaesener, Jean-Jacques; Greitemann, Bernhard; Krause, P; Panning, S; Pullwitt, V; Schmidt, J; Veihelmann, Andreas; Vogt, Lutz

2018-05-18

On the basis of the S2-k guideline "Rehabilitation after traumatic fractures of the thoracic und lumbar spine without neurologic disorder", this article gives an overview of target-oriented rehabilitation of patients with minor fractures or those with column stability and unstable spinal fractures which are stabilised by surgery. To obtain early social and job related reintegration, outpatient or inpatient rehabilitation has to start immediately after treatment in hospital. Rehabilitation must be orientated towards the biopsychosocial model of ICF and has to be adapted for the patient. The overall goal of rehabilitation is functional restoration of patient health to enable participation in society, life and job. Individual goals may change during rehabilitation, because of differential progress in therapy. Pain management must be orientated towards individual requirements and mental health has to be tested early, especially in polytrauma patients. Disorders have to be treated by psychotherapy, because psychic stress supports chronification of pain. Generally early exercise and physiotherapy are recommended in the guideline, with patient education for health-seeking behavior. Otherwise an orthesis device is not really necessary for treatment of a stable fracture. To improve the outcome of rehabilitation aftercare, treatment has to be arranged during rehabilitation, especially for employed patients. Georg Thieme Verlag KG Stuttgart · New York.

Malignant pheochromocytoma with multiple vertebral metastases causing acute incomplete paralysis during pregnancy: Literature review with one case report.

PubMed

Liu, Shuzhong; Song, An; Zhou, Xi; Kong, Xiangyi; Li, William A; Wang, Yipeng; Liu, Yong

2017-11-01

We present a rare case of malignant pheochromocytoma with thoracic metastases during pregnancy that presented with symptoms of myelopathy and was treated with circumferential decompression, stabilization, and radiation. The management of this unique case is not well documented. The clinical manifestations, imaging results, pathological characteristics, treatment and prognosis of the case were analyzed. A 26-year-old pregnant woman with a history of paroxysmal hypertension during the second trimester presented with lower extremity weakness, numbness, urinary incontinence, and back pain. Imaging studies revealed a right adrenal pheochromocytoma, multiple metastases at T8, T11, T12, and the pelvis girdle causing significant multilevel cord compression and significant osteolytic lesions at T11 and T12. We believe this is the first reported case of metastatic pheochromocytoma of the thoracic spine presenting with symptoms of myelopathy during pregnancy. A healthy neonate was delivered by emergency caesarean section at 34 weeks. Subsequently, the patient underwent a circumferential spinal cord decompression and a stabilization procedure. The patient's neurological deficits improved significantly after the surgery, and the postoperative period was uneventful at the 6-month follow-up visit. This article emphasizes that metastatic pheochromocytoma of the spine, although rare, should be part of the differential when a patient presents with elevated blood pressure, weakness, and urinary incontinence.

Prevalence of and factors associated with musculoskeletal symptoms in the spine attributed to computer use in undergraduate students.

PubMed

Kanchanomai, Siriluck; Janwantanakul, Prawit; Pensri, Praneet; Jiamjarasrangsi, Wiroj

2012-01-01

This study aimed to investigate the 3-month prevalence of musculoskeletal symptoms at the spine attributed to computer use and to identify biopsychosocial factors associated with the prevalence in undergraduate students. Undergraduate students who studied at a public university in Thailand. A cross-sectional survey was conducted with a self-administered questionnaire delivered to 3,545 students. A total of 2,511 students (73.7%) returned the questionnaires. Cervical symptoms (22.3%) were the most frequently reported, followed by thoracic (11%) and lumbar symptoms (10.7%). Females, daily computer use greater than three hours and too-high keyboard's position were significantly associated with a high prevalence of cervical symptoms. A significant association was found between higher undergraduate year of the study and too-high keyboard's position and a high prevalence of thoracic symptoms. Higher undergraduate year of the study and daily computer use greater than three hours were significantly related to a high prevalence of lumbar symptoms. Better-than-normal mental health status was associated with a low prevalence of lumbar symptoms. Spinal symptoms are common among undergraduate students. Various factors were identified to be associated with high prevalence of spinal symptoms. Further research investigating the causal relation between these factors and musculoskeletal symptoms should be conducted.

Oncogenous osteomalacia and myopericytoma of the thoracic spine: a case report.

PubMed

Brunschweiler, Benoit; Guedj, Nathalie; Lenoir, Thibault; Faillot, Thierry; Rillardon, Ludovic; Guigui, Pierre

2009-11-01

A case report. To illustrate a rare case of oncogenous osteomalacia caused by a spinal thoracic myopericytoma. Osteomalacia related to a tumor is well known. The cause of the disorder is usually a highly vascularized, benign tumor of mesenchymal origin. Location of the tumor in the spine is very rare. Removal of the tumor is followed by resolution of osteomalacia. Diagnosis of oseomalacia was established on the presence of cardinal clinical, biologic, and radiologic features of osteomalacia. Localization of the tumor at T5 and T6 levels was obtained by magnetic resonance imaging. Surgical treatment consisted in a circumferential correction-fusion with hemivertebrectomy of T5 and T6 and tumor removal. Tumor removal was rapidly followed by disappearance of the clinical symptoms of osteomalacia, and by correction of hypophosphatemia. At 2-years follow-up, no recurrence of the tumor was detectable on imaging studies-the correction fusion remained stable. Histologically, the tumor was classified as a myopericytoma. There was no relapse of the clinical features of osteomalacia. However, secondary recurrence of the biologic markers due to an incomplete tumor removal was disclosed. Removal of the tumor was followed by healing of the clinical features of osteomalacia, demonstrating the causal connection between the myopericytoma and the osteopathy.

Lumbar vertebral haemangioma causing pathological fracture, epidural haemorrhage, and cord compression: a case report and review of literature.

PubMed

Vinay, S; Khan, S K; Braybrooke, J R

2011-01-01

Vertebral haemangiomas are recognized to be one of the commonest benign tumours of the vertebral column, occurring mostly in the thoracic spine. The vast majority of these are asymptomatic. Infrequently, these can turn symptomatic and cause neurological deficit (cord compression) through any of four reported mechanisms: (1) epidural extension; (2) expansion of the involved vertebra(e) causing spinal canal stenosis; (3) spontaneous epidural haemorrhage; (4) pathological burst fracture. Thoracic haemangiomas have been reported to be more likely to produce cord compression than lumbar haemangiomas. A forty-nine year old male with acute onset spinal cord compression from a pathological fracture in a first lumbar vertebral haemangioma. An MRI delineated the haemangioma and extent of bleeding that caused the cord compression. These were confirmed during surgery and the haematoma was evacuated. The spine was instrumented from T12 to L2, and a cement vertebroplasty was performed intra-operatively. Written consent for publication was obtained from the patient. The junctional location of the first lumbar vertebra, and the structural weakness from normal bone being replaced by the haemangioma, probably caused it to fracture under axial loading. This pathological fracture caused bleeding from the vascularized bone, resulting in cord compression.

Lumbar vertebral haemangioma causing pathological fracture, epidural haemorrhage, and cord compression: a case report and review of literature

PubMed Central

Vinay, S; Khan, SK; Braybrooke, JR

2011-01-01

Context Vertebral haemangiomas are recognized to be one of the commonest benign tumours of the vertebral column, occurring mostly in the thoracic spine. The vast majority of these are asymptomatic. Infrequently, these can turn symptomatic and cause neurological deficit (cord compression) through any of four reported mechanisms: (1) epidural extension; (2) expansion of the involved vertebra(e) causing spinal canal stenosis; (3) spontaneous epidural haemorrhage; (4) pathological burst fracture. Thoracic haemangiomas have been reported to be more likely to produce cord compression than lumbar haemangiomas. Findings A forty-nine year old male with acute onset spinal cord compression from a pathological fracture in a first lumbar vertebral haemangioma. An MRI delineated the haemangioma and extent of bleeding that caused the cord compression. These were confirmed during surgery and the haematoma was evacuated. The spine was instrumented from T12 to L2, and a cement vertebroplasty was performed intra-operatively. Written consent for publication was obtained from the patient. Clinical Relevance The junctional location of the first lumbar vertebra, and the structural weakness from normal bone being replaced by the haemangioma, probably caused it to fracture under axial loading. This pathological fracture caused bleeding from the vascularized bone, resulting in cord compression. PMID:21756575

Road Cycling and Mountain Biking Produces Adaptations on the Spine and Hamstring Extensibility.

PubMed

Muyor, J M; Zabala, M

2016-01-01

The purposes of this study were as follows: 1) to analyse the influence of training in road cycling or cross-country mountain biking on sagittal spinal curvatures, pelvic tilt and trunk inclination in cyclists of both cycling modalities; 2) to evaluate the specific spinal posture and pelvic tilt adopted on the road bicycle and cross-country mountain bike; and 3) to compare the spinal sagittal capacity of flexion and pelvic tilt mobility as well as hamstring muscle extensibility among road cyclists, cross-country mountain bikers and non-cyclists. Thirty matched road cyclists, 30 mountain bikers and 30 non-cyclists participated in this study. The road cyclists showed significantly greater thoracic kyphosis and trunk inclination than did the mountain bikers and non-cyclists in a standing posture. On the bicycle, the road bicycling posture was characterised by greater lumbar flexion and more significant anterior pelvic tilt and trunk inclination compared with the mountain biking posture. The thoracic spine was more flexed in mountain biking than in road cycling. Road cyclists had significantly greater hamstring muscle extensibility in the active knee extension test, and showed greater anterior pelvic tilt and trunk inclination capacity in the sit-and-reach test, compared with mountain bikers and non-cyclists. © Georg Thieme Verlag KG Stuttgart · New York.

Four-year follow-up of pregnancy-associated osteoporosis: a case report.

PubMed

Takahashi, Naoto; Arai, Itaru; Kayama, Satoru; Ichiji, Kenji; Fukuda, Hironari; Handa, Jun-Ichi; Konno, Shin-Ichi

2014-01-01

A 22-year-old woman presented with complaints of severe pain in a wide region of the thoracolumbar spine. She developed severe pain in the thoracolumbar spine region 2 months after her first delivery and was referred 1 month later. A lateral thoracic X-ray showed depressed degenerative vertebrae (T7, T9). One month after the initial examination, thoracic sagittal magnetic resonance imaging showed low intensity areas on T1-weighted imaging and iso-high intensity areas on T2-weighted imaging at T5, 7, 8, 9 and 11. Bone mineral density measured by ultrasound was low (%YAM 76%). The bone metabolic markers were high, suggesting accelerated osteoclast activity. These findings prompted a diagnosis of pregnancy-associated osteoporosis. She was asked to stop breastfeeding and to wear a lumbar brace, and treatment with nutritional calcium, activated vitamin D3, and risedronate sodium was started. Her low back pain almost disappeared after treatment. Bone metabolic markers showed normalization 8 months after the initial examination. Risedronate sodium was stopped 2 years and 2 months after the initial examination. Teriparatide treatment was started because her bone mineral density remained low; however, the osteoblast marker P1NP was not increased 5 months after the start of teriparatide treatment.

Cobb Angle Reduction in a Nearly Skeletally Mature Adolescent (Risser 4) After Pattern-Specific Scoliosis Rehabilitation (PSSR)

PubMed Central

Moramarco, Marc; Moramarco, Kathryn; Fadzan, Maja

2017-01-01

Introduction: It has long been said that exercise-based rehabilitation for scoliosis is ineffective, however, these reports studied general exercises. This case report is a prospective one-year follow-up of a nearly skeletally mature adolescent female (Risser 4) with idiopathic scoliosis treated with Pattern-Specific-Scoliosis Rehabilitation (PSSR). Methods: The 15-year old patient recommended for surgery (initial Cobb angle of 45°) completed a 16-hour scoliosis-specific back school (according to Schroth Best Practice®), over the course of five weeks. She continued with her program at home, and followed up with the lead author after 6 months and 1 year. Results: The patient achieved a 13° reduction in her primary thoracic Cobb angle. Postural improvement and reduction in trunk rotation (ATR) was also achieved (-4° in the thoracic spine, and -5° in the lumbar spine). Conclusion: Pattern-specific scoliosis rehabilitation (PSSR) works to reduce the asymmetrical load caused by scoliosis. PSSR is effective in stabilizing Cobb angle, and can, in some cases, reduce Cobb angle in adolescents. Patients recommended for surgery may be candidates for conservative treatment. This case suggests that the practice of discontinuing conservative treatment at Risser stage 4 should be re-evaluated. PMID:29399225

Bone edema of the whole vertebral body: an unusual case of spondyloarthritis.

PubMed

Ortolan, Augusta; Lazzarin, Paolo; Lorenzin, Mariagrazia; Rampin, Lucia; Ramonda, Roberta

2017-01-01

Spondyloarthritis (SpA) is usually characterized by early inflammatory involvement of the sacroiliac joints (SI), which constitutes one of the most important classification criteria according to the SpondyloArthritis International Society (ASAS). These criteria do not include inflammatory spine lesions which can be detected on MRI, although spine involvement is very common in axial SpA. This is because spine MRI lesion often retrieved in SpA are not very specific, and can be found in many other diseases such as malignancy and osteoarthritis. Here we present the case of a 33-year old woman who presented a worsening low back pain, with a thoracic spine MRI showing bone marrow edema (BME) of the whole T8 vertebral body. Owing to this peculiar presentation, together with the unresponsiveness of the pain to nonsteroidal anti inflammatory drugs (NSAIDs) and a slight increase of the biomarker CA19-9, a malignancy was suspected. Therefore, the patient underwent bone scintigraphy, Single positron emission computed tomography (SPET/TC), positron emission tomography and repeated MRI without reaching a diagnosis. Finally, when SI joints MRI was performed, BME of the SI joints emerged: this was fundamental to formulate the diagnosis of axSpA.

3D printing-assisted preoperative plan of pedicle screw placement for middle-upper thoracic trauma: a cohort study.

PubMed

Xu, Wei; Zhang, Xuming; Ke, Tie; Cai, Hongru; Gao, Xiang

2017-08-11

This study aimed to evaluate the application of 3D printing in assisting preoperative plan of pedicle screw placement for treating middle-upper thoracic trauma. A preoperative plan was implemented in seven patients suffering from middle-upper thoracic (T3-T7) trauma between March 2013 and February 2016. In the 3D printing models, entry points of 56 pedicle screws (Magerl method) and 4 important parameters of the pedicle screws were measured, including optimal diameter (ϕ, mm), length (L, mm), inclined angle (α), head-tilting angle (+β), and tail-tilting angle (-β). In the surgery, bare-hands fixation of pedicle screws was performed using 3D printing models and the measured parameters as guidance. A total of seven patients were enrolled, including five men and two women, with the age of 21-62 years (mean age of 37.7 years). The position of the pedicle screw was evaluated postoperatively using a computerized tomography scan. Totally, 56 pedicle screws were placed, including 33 pieces of level 0, 18 pieces of level 1, 4 pieces of level 2 (pierced lateral wall), and 1 piece of level 3 (pierced lateral wall, no adverse consequences), with a fine rate of 91.0%. 3D printing technique is an intuitive and effective assistive technology to pedicle screw fixation for treating middle-upper thoracic vertebrae, which improve the accuracy of bare-hands screw placement and reduce empirical errors. The trial was approved by the Ethics Committee of the Fujian Provincial Hospital. It was registered on March 1st, 2013, and the registration number was K2013-03-001.

Management of thoracolumbar spine trauma: An overview

PubMed Central

Rajasekaran, S; Kanna, Rishi Mugesh; Shetty, Ajoy Prasad

2015-01-01

Thoracolumbar spine fractures are common injuries that can result in significant disability, deformity and neurological deficit. Controversies exist regarding the appropriate radiological investigations, the indications for surgical management and the timing, approach and type of surgery. This review provides an overview of the epidemiology, biomechanical principles, radiological and clinical evaluation, classification and management principles. Literature review of all relevant articles published in PubMed covering thoracolumbar spine fractures with or without neurologic deficit was performed. The search terms used were thoracolumbar, thoracic, lumbar, fracture, trauma and management. All relevant articles and abstracts covering thoracolumbar spine fractures with and without neurologic deficit were reviewed. Biomechanically the thoracolumbar spine is predisposed to a higher incidence of spinal injuries. Computed tomography provides adequate bony detail for assessing spinal stability while magnetic resonance imaging shows injuries to soft tissues (posterior ligamentous complex [PLC]) and neurological structures. Different classification systems exist and the most recent is the AO spine knowledge forum classification of thoracolumbar trauma. Treatment includes both nonoperative and operative methods and selected based on the degree of bony injury, neurological involvement, presence of associated injuries and the integrity of the PLC. Significant advances in imaging have helped in the better understanding of thoracolumbar fractures, including information on canal morphology and injury to soft tissue structures. The ideal classification that is simple, comprehensive and guides management is still elusive. Involvement of three columns, progressive neurological deficit, significant kyphosis and canal compromise with neurological deficit are accepted indications for surgical stabilization through anterior, posterior or combined approaches. PMID:25593358

The effectiveness of noninvasive interventions for musculoskeletal thoracic spine and chest wall pain: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) collaboration.

PubMed

Southerst, Danielle; Marchand, Andrée-Anne; Côté, Pierre; Shearer, Heather M; Wong, Jessica J; Varatharajan, Sharanya; Randhawa, Kristi; Sutton, Deborah; Yu, Hainan; Gross, Douglas P; Jacobs, Craig; Goldgrub, Rachel; Stupar, Maja; Mior, Silvano; Carroll, Linda J; Taylor-Vaisey, Anne

2015-09-01

The purpose of this study was to critically appraise and synthesize evidence on the effectiveness of noninvasive interventions, excluding pharmacological treatments, for musculoskeletal thoracic pain. Randomized controlled trials (RCTs), cohort studies, and case-control studies evaluating the effectiveness of noninvasive interventions were eligible. We searched MEDLINE, EMBASE, PsycINFO, and the Cochrane Central Register of Controlled Trials accessed through Ovid Technologies, Inc, and CINAHL Plus with Full Text accessed through EBSCOhost from 1990 to 2015. Our search strategies combined controlled vocabulary relevant to each database (eg, MeSH for MEDLINE) and text words relevant to our research question and the inclusion criteria. Random pairs of independent reviewers screened studies for relevance and critically appraised relevant studies using the Scottish Intercollegiate Guidelines Network criteria. Studies with a low risk of bias were synthesized following best evidence synthesis principles. We screened 6988 articles and critically appraised 2 studies. Both studies had a low risk of bias and were included in our synthesis. One RCT compared thoracic spinal manipulation, needle acupuncture, and placebo electrotherapy for recent thoracic spine pain. There were statistically significant but clinically nonimportant short-term reductions in pain favoring manipulation. There were no differences between acupuncture and placebo electrotherapy. Another RCT compared a multimodal program of care and a session of education for recent musculoskeletal chest wall pain. The multimodal care resulted in statistically significant but clinically nonimportant short-term reductions in pain over education. However, participants receiving multimodal care were more likely to report important improvements in chest pain. Quality evidence on the management of musculoskeletal thoracic pain is sparse. The current evidence suggests that compared to placebo, spinal manipulation is associated with a small and clinically nonimportant reduction in pain intensity and that acupuncture leads to similar outcomes as placebo. Furthermore, a multimodal program of care (ie, manual therapy, soft tissue therapy, exercises, heat/ice, and advice) and a single education session lead to similar pain reduction for recent-onset musculoskeletal chest wall pain. However, patients who receive multimodal care are more likely to report pain improvements. Copyright © 2015 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

Hybrid constructs for tridimensional correction of the thoracic spine in adolescent idiopathic scoliosis: a comparative analysis of universal clamps versus hooks.

PubMed

Ilharreborde, Brice; Even, Julien; Lefevre, Yan; Fitoussi, Franck; Presedo, Ana; Penneçot, Georges-François; Mazda, Keyvan

2010-02-01

Retrospective study of prospectively collected data. Compare Universal Clamps (UCs) and hooks for the thoracic correction of adolescent idiopathic scoliosis (AIS). In scoliosis surgery, sagittal correction is as important as frontal correction due to the risk of junctional kyphosis. Compared to all-screw constructs, hybrid constructs with lumbar pedicle screws and thoracic hooks or sublaminar wires have been shown to achieve similar coronal correction while providing superior postoperative thoracic kyphosis. The authors used a novel sublaminar thoracic implant, the UC with improvements over sublaminar wires. Hybrid constructs using thoracic UCs were compared to those with thoracic hooks. This series involved 150 patients treated for AIS with hybrid constructs. A total of 75 consecutive patients operated from 2001 to 2003, who had thoracic hooks with in situ contouring, distraction, and compression (Group 1), were compared to 75 consecutive patients operated from 2004 to 2006, who had thoracic UCs with posteromedial translation (Group 2). All had intraoperative somatosensory/motor-evoked potential monitoring and at least 2-years follow-up. Except for follow-up (longer in Group 1), the 2 groups were similar before surgery. The UCs achieved better thoracic coronal correction (P < 0.001), Cincinnati index (P < 0.001), kyphosis (P = 0.02), and apical rotation (P < 0.001). In normokyphotic or hypokyphotic patients, the UC corrected thoracic kyphosis by 11.2 degrees (55%) versus 0.4 degrees (2%) achieved by hooks (P < 0.0001). These differences were stable at last follow-up. There were no intraoperative complications or changes in somatosensory/motor-evoked potentials. UC reduced operative time by 20% (60 minutes; P < 0.001) and blood loss by 23% (250 mL; P < 0.001). Although both of these hybrid constructs efficaciously corrected the coronal and axial deformities in AIS, the results of the UC technique were superior to those achieved with hooks in all 3 planes, especially the sagittal plane. Moreover, the UC technique is straightforward and safe, reducing both operative duration and blood loss.

A biomechanical analysis of sublaminar and subtransverse process fixation using metal wires and polyethylene cables.

PubMed

Fujita, Masaru; Diab, Mohammad; Xu, Zheng; Puttlitz, Christian M

2006-09-01

An in vitro biomechanical calf thoracic spine study. To evaluate the biomechanical stability of sublaminar and subtransverse process fixation using stainless steel wires and ultra-high molecular weight polyethylene (UHMWPE) cables. It is commonly held that transverse process fixation provides less stability than sublaminar fixation. To our knowledge, this is the first biomechanical study to compare the stability afforded by sublaminar fixation and subtransverse process fixation using metal wire and UHMWPE cable before and after cyclic loading. There were 6 fresh-frozen calf thoracic spines (T4-T9) used to determine the sublaminar fixation stiffness and subtransverse process fixation stiffness in each group. Double strands of 18-gauge stainless steel wire, 3 and 5 mm-width UHMWPE cable (Nesplon; Alfresa, Inc., Osaka, Japan) were applied to each spine. Cyclic pure flexion-extension moment loading (2 Nm, 0.5 Hz, 5000 cycles) was applied after the initial stability was analyzed by measuring the range of motion. Statistical analyses were used to delineate differences between the various experimental groups. Subtransverse process wiring was more stable than sublaminar wiring after cyclic loading in flexion-extension (P < 0.05). There were no significant differences between each group in lateral bending and axial rotation after cyclic loading. Sublaminar stainless steel wiring was more stable than sublaminar 3 and 5-mm cable before and after cyclic loading in axial rotation (P < 0.01). Acute subtransverse process fixation using 3-mm cable was less stable after cyclic loading in axial rotation (P < 0.05). All other groups did not produce statistically significant differences. Subtransverse process fixation provides at least as much stability as sublaminar fixation. A 5-mm UHMWPE cable and stainless steel wire result in equivalent sublaminar and subtransverse process stability.

Solid variant of aneurysmal bone cyst of the thoracic spine: a case report

PubMed Central

2011-01-01

Introduction The solid variant of aneurysmal bone cyst is rare, and only 13 cases involving the spine have been reported to date, including seven in the thoracic vertebrae. The diagnosis is difficult to secure radiographically before biopsy or surgery. Case report An 18-year-old Hispanic man presented to our facility with a one-year history of left chest pain without any significant neurological deficits. An MRI scan demonstrated a 6 cm diameter enhancing multi-cystic mass centered at the T6 vertebral body with involvement of the left proximal sixth rib and extension into the pleural cavity; the spinal cord was severely compressed with evidence of abnormal T2 signal changes. Our patient was taken to the operating room for a total spondylectomy of T6 with resection of the left sixth rib from a single-stage posterior-only approach. The vertebral column was reconstructed in a 360° manner with an expandable titanium cage and pedicle screw fixation. Histologically, the resected specimen showed predominant solid fibroblastic proliferation, with minor foci of reactive osteoid formation, an area of osteoclastic-like giant cells, and cyst-like areas filled with erythrocytes and focal hemorrhage, consistent with a predominantly solid variant of aneurysmal bone cyst. At 16 months after surgery, our patient remains neurologically intact with resolution of his chest and back pain. Conclusions Because of its rarity, location, and radical treatment approach, we considered this case worthy of reporting. The solid variant of aneurysmal bone cyst is difficult to diagnose radiologically before biopsy or surgery, and we hope to remind other physicians that it should be included in the differential diagnosis of any lytic expansile destructive lesion of the spine. PMID:21718507

The effect of a corrective functional exercise program on postural thoracic kyphosis in teenagers: a randomized controlled trial.

PubMed

Feng, Qiang; Wang, Mei; Zhang, Yanfeng; Zhou, Yu

2018-01-01

To investigate the effects of a corrective functional exercise program on postural thoracic kyphosis in teenagers in China. A single-blind randomized controlled trial including students with a thoracic kyphosis angle (TKA) >40° measured using the SpinalMouse. China Institute of Sport Science and three middle schools in Beijing, China. A total of 181 subjects were included in this trial; of these, 164 subjects were included in the analyses (intervention group, n = 81; control group, n = 83). The intervention group received a functional exercise program designed to correct postural thoracic kyphosis, and the control group received an exercise program designed in accordance with the state-regulated curriculum. The primary outcome variable was TKA. Secondary outcome variables were lumbar lordosis angle (LLA), sacral angle (SA), and incline angle (INA) measured in the upright position; thoracic, lumbar, and sacral spine range of motion (ROM) and INA ROM (change in center of gravity) measured in the forward bending and extended positions; and changes in TKA, LLA, SA, and INA measured during the Matthiass test. There were significant differences in pretest and posttest TKA in both groups (intervention group: pretest 47.09 ± 5.45, posttest 38.31 ± 9.18, P < 0.0001; control group: pretest 47.47 ± 6.06, posttest 43.59 ± 7.49, P < 0.0001). After adjustment for gender and pretest values, there were significant differences in posttest TKA, change in SA, and thoracic ROM in the intervention group compared to the control group ( P < 0.05). The corrective functional exercise program designed for this study improved exaggerated thoracic kyphosis in teenagers.

The top view for analysis of scoliosis progression

DOE Office of Scientific and Technical Information (OSTI.GOV)

De Smet, A.A.; Tarlton, M.A.; Cook, L.T.

1983-05-01

Using computerized spinal analysis, a new top view was developed that displays the spine as if the observer were above and looking down on the patient. Serial top views were obtained of 12 patients with idiopathic scoliosis. In five patients with clinically stable curves, the top views showed no change. One patient with an enlaring rib hump was seen on the top view to have progressive kyphosis but stable scoliosis. Six patients with progressive scoliosis all demonstrated collapse of the thoracic curve in the anteroposterior direction. Five of these six patients had associated lumbar curves. Three lumbar curves demonstrated collapsemore » in the anteroposterior direction similar to the collapse of the thoracic curves, and the other two curves appeared elongated in the anteroposterior direction.« less

Associations between body mass index, lean and fat body mass and bone mineral density in middle-aged Australians: The Busselton Healthy Ageing Study.

PubMed

Zhu, Kun; Hunter, Michael; James, Alan; Lim, Ee Mun; Walsh, John P

2015-05-01

Low BMI is a risk factor for osteoporosis, but it is not clear if relationships between BMI, lean mass (LM), fat mass (FM) and BMD are consistent across different levels of BMI. We studied 1929 Caucasian participants (1014 females) aged 45-66years in the Busselton Healthy Ageing Study in Western Australia. Body composition and BMD of total body, lumbar spine, total hip and femoral neck were measured using DXA. From generalized additive models, the positive relationships between BMI and BMD were weaker at high BMI, particularly at the spine and in males. In the entire cohort, adjusting for relevant covariates, LM and FM were significant predictors of all BMD measures in both genders. In men, analysis by tertiles of BMI showed that LM and FM (in kg) were positively associated with BMD (in mg/cm(2)) in tertile 1 except for LM and spine BMD (LM β: 5.18-6.80, FM β: 3.38-9.24, all P<0.05), but not in the middle or upper tertiles (LM β: -3.12-3.07, FM β: -4.75-1.82, P>0.05). In women, LM was positively associated with BMD in each tertile of BMI, except for spine BMD in the upper tertile, with regression coefficients lower in the upper tertile (β: 5.16-9.95, 5.76-9.56 and 2.80-5.78, respectively, all P<0.05). FM was positively associated with total body, spine and total hip BMD in women in BMI tertile 1 (β: 2.86-6.68, P<0.05); these associations were weaker or absent in the middle and upper tertiles. In conclusion, in middle-aged adults the positive relationships between lean or fat mass with BMD among those with higher BMI are absent in males and weaker in females. Copyright © 2015 Elsevier Inc. All rights reserved.

[Aging at work and musculoskeletal disorders].

PubMed

Occhipinti, E; Colombini, D

2000-01-01

By means of a critical review of the international literature and of their own published experiences, the Authors discuss the influence of the "age" factor on work related musculoskeletal disorders of the spine and upper limbs. Regarding the spine, the lumbosacral spine in particular, there is evidence (both in relation to pathways and from epidemiological data) of the influence of age in determining a progressive increase in the occurrence of spondyloarthropathy with clear radiological signs. For upper limb disorders the influence of the "age" factor is still under debate and in any case does not seem of great importance. As far prevention is concerned for elderly workers subject to fixed postures and repetitive movements of the upper limbs it seems sufficient, to adopt the general measures used for the whole working population. However, specific measures should be adopted for elderly workers exposed to manual material handling (MMH). These consist in using reference values for the recommended weight that are lower than those adopted for younger workers (aged 18-45 years) and in implementing specific programs of active health surveillance.

Influence of standing or seated pelvis on dummy responses in rear impacts.

PubMed

Viano, David C; Parenteau, Chantal S; Burnett, Roger

2012-03-01

There is a question whether the standing or seated pelvis should be used in Hybrid III dummy evaluations of seats and belt restraint systems in severe rear impacts. This study compares the standing and seated Hybrid III pelvis in matched rear sled tests. Sixteen sled tests were found at 10, 16 and 24 km/h rear delta V in Ford's archives where matched tests were run with the standing and seated pelvis in a belted Hybrid III dummy. Two new tests were conducted at 40 km/h rear delta V to extend the severity range. The head, chest and pelvis were instrumented with triaxial accelerometers and the upper and lower neck, thoracic spine and lumbar spine had transducers measuring triaxial loads and moments. Belt Loads were measured. High-speed video recorded different views of the dummy motion. Dummy kinematics and biomechanical responses were compared for all of the data with the two different Hybrid III pelvic designs. In the 40 km/h sled tests, the dummy motion and excursion were essentially similar with the standing and seated pelvis. The similarities included the lap belt interaction with the pelvis and the leg movement upward flexing the hip joint. Overall, similar biomechanic and kinematic responses were found, including the pelvic acceleration, spinal forces and moments. For the lower speed tests at 10, 16 and 24 km/h, the motion sequence was also similar with the two different pelvises, including the upward movement of the legs as the seat was loaded and rebound kinematics. The biomechanical responses were similar. The seated pelvis involves only a small portion of the upper leg molded into the vinyl skin of the pelvis and does not limit leg rotation at the hip joint. Furthermore, lap belt loads were minimal during the rearward movement of the dummy. The matched testing showed no significant difference in occupant kinematics or biomechanical responses between the standing and seated pelvis in rear sled tests. The Hybrid III dummy with the seated pelvis is suitable for FMVSS 301 and other testing of seats and belt restraint systems in severe rear impacts. Copyright © 2011 Elsevier Ltd. All rights reserved.

Is estimated bullet trajectory a reliable predictor of severe injury? Case report of a thoraco-abdominal gunshot with a protracted trajectory managed nonoperatively.

PubMed

Khan, Muhammad Sohaib; Khan, Bilal Masood; Naz, Sumbul; Pirzada, Muhammad Taqi

2013-02-15

Operative management of all gunshot's traumas carries a high rate of unwarranted interventions that are known to cause serious complications. Selective nonoperative management is thus being increasingly practiced which has reduced these avoidable interventions. Physical examination and computed tomography scans are most sensitive in assessing need of laparotomy. Assessment of internal injuries on the basis of an estimated bullet trajectory is often practiced but has seldom been studied. We report a case of conservative management of a thoraco abdominal gun shot patient where an estimated bullet trajectory was indicative of serious injuries. To the best of our knowledge this is the first report of a thoraco abdominal gunshot that, despite of a protracted trajectory, had no sequelae and was thus managed nonoperatively. A 30 year old male patient having height of 180 cm and weight of 70 kg (Body Mass Index 21.6) presented with complaint of a penetrating injury at left side of upper torso. The patient had no symptoms or obvious bleeding and was vitally stable. On examination a 1 cm × 1 cm entry wound at the left 3rd intercostal space in the mid clavicular line was identified. The chest and abdomen were otherwise unremarkable on examination. The chest radiograph displayed clear lung fields. The abdominal radiographs displayed a bullet in the upper left quadrant of the abdomen lateral to the spine. The bullets estimated trajectory from 3rd intercostal space and its lodgment in the abdomen lateral to the spine indicated severe visceral injury. The computed tomography scan showed that the bullet was lodged postero-medially to the left kidney. All thoracic, intra peritoneal and retroperitoneal visceral structures were identified to be normal. The patient remained clinically and vitally stable, hence was managed nonoperatively being discharged after 48 h of observation. From this case we conclude that decision for managing gun shot patients should be based on objective clinical and diagnostic findings. We recommend further investigation of the predictability of estimated trajectory for visceral injuries and consequent operative intervention as we found it to be misleading in this case.

Is estimated bullet trajectory a reliable predictor of severe injury? Case report of a thoraco-abdominal gunshot with a protracted trajectory managed nonoperatively

PubMed Central

2013-01-01

Background Operative management of all gunshot’s traumas carries a high rate of unwarranted interventions that are known to cause serious complications. Selective nonoperative management is thus being increasingly practiced which has reduced these avoidable interventions. Physical examination and computed tomography scans are most sensitive in assessing need of laparotomy. Assessment of internal injuries on the basis of an estimated bullet trajectory is often practiced but has seldom been studied. We report a case of conservative management of a thoraco abdominal gun shot patient where an estimated bullet trajectory was indicative of serious injuries. To the best of our knowledge this is the first report of a thoraco abdominal gunshot that, despite of a protracted trajectory, had no sequelae and was thus managed nonoperatively. Case presentation A 30 year old male patient having height of 180 cm and weight of 70 kg (Body Mass Index 21.6) presented with complaint of a penetrating injury at left side of upper torso. The patient had no symptoms or obvious bleeding and was vitally stable. On examination a 1 cm × 1 cm entry wound at the left 3rd intercostal space in the mid clavicular line was identified. The chest and abdomen were otherwise unremarkable on examination. The chest radiograph displayed clear lung fields. The abdominal radiographs displayed a bullet in the upper left quadrant of the abdomen lateral to the spine. The bullets estimated trajectory from 3rd intercostal space and its lodgment in the abdomen lateral to the spine indicated severe visceral injury. The computed tomography scan showed that the bullet was lodged postero-medially to the left kidney. All thoracic, intra peritoneal and retroperitoneal visceral structures were identified to be normal. The patient remained clinically and vitally stable, hence was managed nonoperatively being discharged after 48 h of observation. Conclusion From this case we conclude that decision for managing gun shot patients should be based on objective clinical and diagnostic findings. We recommend further investigation of the predictability of estimated trajectory for visceral injuries and consequent operative intervention as we found it to be misleading in this case. PMID:23414905

Comparison of Biodynamic Responses in Standing and Seated Human Bodies

NASA Astrophysics Data System (ADS)

MATSUMOTO, Y.; GRIFFIN, M. J.

2000-12-01

The dynamic responses of the human body in a standing position and in a sitting position have been compared. The apparent mass and transmissibilities to the head, six locations along the spine, and the pelvis were measured with eight male subjects exposed to vertical whole-body vibration. In both postures, the principal resonance in the apparent mass occurred in the range 5-6 Hz, with slightly higher frequencies and lower apparent mass in the standing posture. There was greater transmission of vertical vibration to the pelvis and the lower spine and greater relative motion within the lower spine in the standing posture than in the sitting posture at the principal resonance and at higher frequencies. Transmissibilities from the supporting surface (floor or seat) to the thoracic region had similar magnitudes for both standing and sitting subjects. The lumbar spine has less lordosis and may be more compressed and less flexible in the sitting posture than in the standing posture. This may have reduced the relative motions between lumbar vertebrae and both the supporting vibrating surface and the other vertebrae in the sitting posture. The characteristics of the vibration transmitted to the pelvis may have differed in the two postures due to different transmission paths. Increased forward rotation of the pelvis in the standing posture may have caused the differences in responses of the pelvis and the lower spine that were observed between the two postures.

Clinical, morphologic, and morphometric features of cranial thoracic spinal stenosis in large and giant breed dogs.

PubMed

Johnson, Philippa; De Risio, Luisa; Sparkes, Andrew; McConnell, Fraser; Holloway, Andrew

2012-01-01

The clinical, morphologic, and morphometric features of cranial thoracic spinal stenosis were investigated in large and giant breed dogs. Seventy-nine magnetic resonance imaging studies of the cranial thoracic spine were assessed. Twenty-six were retrieved retrospectively and 53 were acquired prospectively using the same inclusion criteria. Images were evaluated using a modified compression scale as: no osseous stenosis (grade 0), osseous stenosis without spinal cord compression (grade 1), and osseous stenosis with spinal cord compression (grade 2). Morphometric analysis was performed and compared to the subjective grading system. Grades 1 and 2 cranial thoracic spinal stenosis were identified on 24 imaging studies in 23 dogs. Sixteen of 23 dogs had a conformation typified by Molosser breeds and 21/23 were male. The most common sites of stenosis were T2-3 and T3-4. The articular process joints were enlarged with abnormal oblique orientation. Stenosis was dorsolateral, lateralized, or dorsoventral. Concurrent osseous cervical spondylomyelopathy was recognized in six dogs and other neurologic disease in five dogs. Cranial thoracic spinal stenosis was the only finding in 12 dogs. In 9 of these 12 dogs (all grade 2) neurolocalization was to the T3-L3 spinal segment. The median age of these dogs was 9.5 months. In the remaining three dogs neurologic signs were not present. Stenosis ratios were of limited benefit in detecting stenotic sites. Grade 2 cranial thoracic spinal stenosis causing direct spinal cord compression may lead to neurologic signs, however milder stenosis (grade 1) is likely to be subclinical or incidental. © 2012 Veterinary Radiology & Ultrasound.

Outcomes of Corpectomy in Patients with Metastatic Cancer.

PubMed

Guzik, Grzegorz

2017-01-26

The objective of surgical management of spinal metastases is to reduce pain and improve the patient's quality of life. The operation should restore spinal stability and decompress neural structures. One surgical technique is corpectomy followed by vertebral body reconstruction and stabilisation of the spine. The procedure may be performed in patients in overall good health and a good survival prognosis. The aim of this paper is to present the outcomes of surgical management of spinal metastases in patients who underwent corpectomy followed by vertebral body reconstruction and stabilisation of the spine. The aim of the study was achieved by analysing medical histories of 124 patients with spinal metastases treated in the Oncological Orthopaedics Department in Brzozów in the period 2010-2015. The majority of patients in the group were women, who represented 64% of all the subjects. The average age was 63 years for women and 67 for men. The metastases were most frequently produced by breast cancer (36%) and myeloma (22%). A total of 87% of the group were diagnosed with pathologic fractures and 92% had spinal instability. Stenosis of the spinal canal was found in 78% of the patients. The surgeries were performed in 18 persons with metastases to the cervical spine, 69 patients with metastases to the thoracic spine and 37 participants with metastases to the lumbar spine. Single-level corpectomies were performed in 83 patients and multilevel corpectomies in 41 persons. Parameters analysed comprised overall health condition, neurological function (the Frankel Grade) and performance status (the Karnofsky score) of the patients. A VAS was used to assess the intensity of pain. The course of the operation and complications were also analysed. Following the surgeries, the average VAS pain score decreased from 7.2 to 3.8. Performance improved from a Karnofsky score of 50.26 to 68.65. Neurological function improved in 21 out of 34 patients with pareses. The average duration of the surgery was 67 minutes for the cervical spine, 123 minutes for the thoracic spine and 112 minutes for the lumbar spine. The loss of blood was strongest for lumbar spine surgeries, amounting on average to 580 ml. 62% of patients required transfusion ofblood substitutes after the operation. The average hospitalisation time was 14 days, with a minimum and maximum duration of 7 and 24 days, respectively. The most common complication was damage to the endplate of the vertebra adjacent to the prosthesis (11%). Two patients developed complete and irreversible paralysis of lower limbs. 1. Corpectomy followed by vertebral body reconstruction should be used in patients with a good prognosis. 2. Therapeutic outcomes are good. The surgery produced a considerable reduction in pain and improvement in performance in the majority of patients. 3. Complications are not frequent. The most common complication is intrusion of the implant into the endplate of the adjacent vertebrae. 4. A high survival rate at one year after the surgery, exceeding 90% of the patients, is evidence of effectiveness of the treatment and appropriate qualification of patients for the operation.

Chest wall resection for multifocal osseous haemangioma.

PubMed

Weinandt, Marthe; Legras, Antoine; Mordant, Pierre; Le Pimpec Barthes, Françoise

2016-02-01

Intraosseous haemangioma is a rare and benign primary tumour of the bone. We report the case of a 76-year old woman who presented the exceptional condition of multifocal cavernous haemangiomas involving the spine and the ribs, requiring spinal and chest wall resections to confirm the diagnosis and treat the symptoms. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Etiology and use of the "hanging drop" technique: a review.

PubMed

Todorov, Ludmil; VadeBoncouer, Timothy

2014-01-01

Background. The hanging drop (HD) technique presumably relies on the presence of subatmospheric epidural pressure. It is not clear whether this negative pressure is intrinsic or an artifact and how it is affected by body position. There are few data to indicate how often HD is currently being used. Methods. We identified studies that measured subatmospheric pressures and looked at the effect of the sitting position. We also looked at the technique used for cervical and thoracic epidural anesthesia in the last 10 years. Results. Intrinsic subatmospheric pressures were measured in the thoracic and cervical spine. Three trials studied the effect of body position, indicating a higher incidence of subatmospheric pressures when sitting. The results show lower epidural pressure (-10.7 mmHg) with the sitting position. 28.8% of trials of cervical and thoracic epidural anesthesia that documented the technique used, utilized the HD technique. When adjusting for possible bias, the rate of HD use can be as low as 11.7%. Conclusions. Intrinsic negative pressure might be present in the cervical and thoracic epidural space. This effect is more pronounced when sitting. This position might be preferable when using HD. Future studies are needed to compare it with the loss of resistance technique.

Etiology and Use of the “Hanging Drop” Technique: A Review

PubMed Central

Todorov, Ludmil; VadeBoncouer, Timothy

2014-01-01

Background. The hanging drop (HD) technique presumably relies on the presence of subatmospheric epidural pressure. It is not clear whether this negative pressure is intrinsic or an artifact and how it is affected by body position. There are few data to indicate how often HD is currently being used. Methods. We identified studies that measured subatmospheric pressures and looked at the effect of the sitting position. We also looked at the technique used for cervical and thoracic epidural anesthesia in the last 10 years. Results. Intrinsic subatmospheric pressures were measured in the thoracic and cervical spine. Three trials studied the effect of body position, indicating a higher incidence of subatmospheric pressures when sitting. The results show lower epidural pressure (−10.7 mmHg) with the sitting position. 28.8% of trials of cervical and thoracic epidural anesthesia that documented the technique used, utilized the HD technique. When adjusting for possible bias, the rate of HD use can be as low as 11.7%. Conclusions. Intrinsic negative pressure might be present in the cervical and thoracic epidural space. This effect is more pronounced when sitting. This position might be preferable when using HD. Future studies are needed to compare it with the loss of resistance technique. PMID:24839558

Pure Spinal Epidural Cavernous Hemangioma with Intralesional Hemorrhage: A Rare Cause of Thoracic Myelopathy

PubMed Central

Jang, Donghwan; Kim, Choonghyo; Lee, Seung Jin; Ryu, Young-Joon

2014-01-01

Although cavernous hemangiomas occur frequently in the intracranial structures, they are rare in the spine. Most of spinal hemangiomas are vertebral origin and "pure" epidural hemangiomas not originating from the vertebral bone are very rare. Our spinal hemangioma case is extremely rare because of its "pure" epidural involvement and intralesional hemorrhage. A 64-year-old man presented with progressive paraparesis from two months ago. His motor weakness was rated as grade 4/5 in bilateral lower extremities. He also complained of decreased sensation below the T4 sensory dermatome, which continuously progressed to the higher dermatome level. Magnetic resonance imaging demonstrated thoracic spinal tumor at T3-T4 level. The tumor was located epidural space compressing thoracic spinal cord ventrally. The tumor was not involved with the thoracic vertebral bone. We performed T3-5 laminectomy and removed the tumor completely. The tumor was not infiltrating into intradural space or vertebral bone. The histopathologic study confirmed the epidural tumor as cavernous hemangioma. Postoperatively, his weakness improved gradually. Four months later, his paraparesis recovered completely. Here, we present a case of pure spinal epidural cavernous hemangioma, which has intralesional hemorrhage. We believe cavernous hemangioma should be included in the differential diagnosis of the spinal epidural tumors. PMID:25110490

Spinal Cord Injury After Extremity Surgery in Children With Thoracic Kyphosis.

PubMed

Pruszczynski, Blazej; Mackenzie, William G; Rogers, Kenneth; White, Klane K

2015-10-01

Spinal cord injury is a rare complication after lower extremity surgery in children with skeletal dysplasia and thoracic kyphosis. We encountered two patients who had this complication, from among 51 (39 from Nemours/Alfred I. duPont Hospital for Children and 12 from Seattle Children's Hospital) who underwent lower extremity surgery during an 8.5-year period (June 2004 to December 2012). Because spinal cord injury is a devastating complication likely not known to most physicians treating patients with skeletal dysplasias, we sought to examine factors that may contribute to this rare complication. We performed a retrospective review of two patients with skeletal dysplasia who had paraplegia develop after extremity surgery. Outcome measures included operative time, vital signs, and postsurgery recovery of neurologic deficit. MR images were reviewed. Two patients were found-an 8.5-year-old boy with spondyloepiphyseal dysplasia congenita with a 76°-thoracic kyphosis apex at T4 and a 6.5-year-old boy with mucopolysaccharidosis type 1-H with an 80°-thoracic kyphosis apex at T2. Bilateral proximal femoral osteotomies or bilateral innominate and proximal femoral osteotomies had been performed. The spinal cord injuries occurred at the apex of the kyphosis as determined by clinical examination and MRI assessment. In both patients, the mean arterial blood pressure decreased below 50 mm Hg and might be a factor in the etiology of the paralysis. The first patient recovered motor function in 5 months; the second had no recovery. Paraplegia is extremely rare after nonspine operations. Many factors contribute to the risk for a spinal cord event: low mean arterial pressure, duration of the surgery, position on the operating table, the kyphotic spine deformity, or unappreciated vascular disease. Motor-evoked potentials and somatosensory-evoked potentials together potentially provide high sensitivity and specificity for predicting a postoperative neurologic deficit. Based on our two patients with skeletal dysplasia and a literature review of patients with hyperkyphosis undergoing extremity surgery, the surgeon must be aware of the risk of spinal cord injury. Careful preoperative assessment possibly including MRI of the spine is recommended. Mean arterial pressure should be maintained at a safe level; neuromonitoring should be considered.

Structural and material changes in the aging thorax and their role in crash protection for older occupants.

PubMed

Kent, Richard; Lee, Sang-Hyun; Darvish, Kurosh; Wang, Stewart; Poster, Craig S; Lange, Aaron W; Brede, Chris; Lange, David; Matsuoka, Fumio

2005-11-01

The human body undergoes a variety of changes as it ages through adulthood. These include both morphological (structural) changes (e.g., increased thoracic kyphosis) and material changes (e.g., osteoporosis). The purpose of this study is to evaluate structural changes that occur in the aging bony thorax and to assess the importance of these changes relative to the well-established material changes. The study involved two primary components. First, full-thorax computed tomography (CT) scans of 161 patients, age 18 to 89 years, were analyzed to quantify the angle of the ribs in the sagittal plane. A significant association between the angle of the ribs and age was identified, with the ribs becoming more perpendicular to the spine as age increased (0.08 degrees/year, p=0.012). Next, a finite element model of the thorax was used to evaluate the importance of this rib angle change relative to other factors associated with aging. A three-factor, two-level factorial design was used to assess the relative importance of rib cage morphology ("young" and "old" rib angle), thickness of the cortical shell (thick = "young" and thin = "old"), and the bone material properties ("young" and "old") on the force-deflection response and injury tolerance of the thorax. The simulations showed that the structural and material changes played approximately equal roles in modulating the force-deflection response of the thorax. Changing the rib angle to be more perpendicular to the spine increased the effective thoracic stiffness, while the "old" material properties and the thin cortical shell decreased the effective stiffness. The offsetting effects of these traits resulted in similar effective thoracic stiffness for the "elderly" and baseline thoracic models, which is consistent with cadaver data available in the literature. All three effects tended to decrease chest deflection tolerance for rib fractures, though the material changes dominated (a four- to six-fold increase in elements eliminated using a maximum strain criterion). The primary conclusion, therefore, is that an older person's thorax, relative to a younger, does not necessarily deform more in response to an applied force. The tolerable sternal deflection level is, however, much less.

Automated Detection, Localization, and Classification of Traumatic Vertebral Body Fractures in the Thoracic and Lumbar Spine at CT

PubMed Central

Burns, Joseph E.; Yao, Jianhua; Muñoz, Hector

2016-01-01

Purpose To design and validate a fully automated computer system for the detection and anatomic localization of traumatic thoracic and lumbar vertebral body fractures at computed tomography (CT). Materials and Methods This retrospective study was HIPAA compliant. Institutional review board approval was obtained, and informed consent was waived. CT examinations in 104 patients (mean age, 34.4 years; range, 14–88 years; 32 women, 72 men), consisting of 94 examinations with positive findings for fractures (59 with vertebral body fractures) and 10 control examinations (without vertebral fractures), were performed. There were 141 thoracic and lumbar vertebral body fractures in the case set. The locations of fractures were marked and classified by a radiologist according to Denis column involvement. The CT data set was divided into training and testing subsets (37 and 67 subsets, respectively) for analysis by means of prototype software for fully automated spinal segmentation and fracture detection. Free-response receiver operating characteristic analysis was performed. Results Training set sensitivity for detection and localization of fractures within each vertebra was 0.82 (28 of 34 findings; 95% confidence interval [CI]: 0.68, 0.90), with a false-positive rate of 2.5 findings per patient. The sensitivity for fracture localization to the correct vertebra was 0.88 (23 of 26 findings; 95% CI: 0.72, 0.96), with a false-positive rate of 1.3. Testing set sensitivity for the detection and localization of fractures within each vertebra was 0.81 (87 of 107 findings; 95% CI: 0.75, 0.87), with a false-positive rate of 2.7. The sensitivity for fracture localization to the correct vertebra was 0.92 (55 of 60 findings; 95% CI: 0.79, 0.94), with a false-positive rate of 1.6. The most common cause of false-positive findings was nutrient foramina (106 of 272 findings [39%]). Conclusion The fully automated computer system detects and anatomically localizes vertebral body fractures in the thoracic and lumbar spine on CT images with a high sensitivity and a low false-positive rate. © RSNA, 2015 Online supplemental material is available for this article. PMID:26172532

Timing, severity of deficits, and clinical improvement after surgery for spinal dural arteriovenous fistulas.

PubMed

Safaee, Michael M; Clark, Aaron J; Burkhardt, Jan-Karl; Winkler, Ethan A; Lawton, Michael T

2018-04-20

OBJECTIVE Spinal dural arteriovenous fistulas (dAVFs) are rare vascular abnormalities caused by arteriovenous shunting. They often form at the dural root sleeve between a radicular feeding artery and draining medullary vein causing venous congestion and edema, decreased perfusion, and ischemia of the spinal cord. Treatment consists of either surgical ligation of the draining vein or selective embolization via an endovascular approach. There is a paucity of data on which modality provides more durable and effective outcomes. METHODS The authors performed a retrospective review of a prospectively maintained database by the senior author to assess clinical outcomes in patients undergoing surgical treatment of spinal dAVFs. Preoperative and postoperative motor and Aminoff-Logue Scale (ALS) scores were collected. RESULTS A total of 41 patients with 44 spinal dAVFs were identified, with a mean patient age of 64 years. The mean symptom duration was 14 months, with weakness (82%), urinary symptoms (47%), and sensory symptoms (29%) at presentation. The fistula locations were as follows: 30 thoracic, 9 lumbar, 3 sacral, and 2 cervical. Five patients had normal motor and ALS scores at presentation. Among the remaining 36 patients with motor deficits or abnormal gait and micturition at presentation, 78% experienced an improvement while the remaining 22% continued to be stable. There was a trend toward improved outcomes in patients with shorter symptom duration; mean symptom duration among patients with clinical improvement was 13 months compared with 22 months among those without improvement. Additionally, rates of improvement were higher for lower thoracic and lumbosacral dAVFs (85% and 83%) compared with those in the upper thoracic spine (57%). No patient developed recurrent fistulas or worsening neurological deficits. CONCLUSIONS Surgery is associated with excellent outcomes in the treatment of spinal dAVFs. Early diagnosis and treatment are critical, with a trend toward improved outcomes. No patient in this study had fistula recurrence or worsening of symptoms. Among patients with abnormal motor or ALS scores, 78% improved after surgery. Therapeutic embolization is an option for some lesions, but for cases with unfavorable anatomy where embolization is not feasible, surgery is a safe option associated with high success.

Safety of thoracic pedicle screw application using the funnel technique in Asians: a cadaveric evaluation.

PubMed

Chan, Chris Yin Wei; Kwan, Mun Keong; Saw, Lim Beng

2010-01-01

The objective of this cadaveric study is to determine the safety and outcome of thoracic pedicle screw placement in Asians using the funnel technique. Pedicle screws have superior biomechanical as well as clinical data when compared to other methods of instrumentation. However, misplacement in the thoracic spine can result in major neurological implications. There is great variability of the thoracic pedicle morphometry between the Western and the Asian population. The feasibility of thoracic pedicle screw insertion in Asians has not been fully elucidated yet. A pre-insertion radiograph was performed and surgeons were blinded to the morphometry of the thoracic pedicles. 240 pedicle screws were inserted in ten Asian cadavers from T1 to T12 using the funnel technique. 5.0 mm screws were used from T1 to T6 while 6.0 mm screws were used from T7 to T12. Perforations were detected by direct visualization via a wide laminectomy. The narrowest pedicles are found between T3 and T6. T5 pedicle width is smallest measuring 4.1 +/- 1.3 mm. There were 24 (10.0%) Grade 1 perforations and only 1 (0.4%) Grade 2 perforation. Grade 2 or worse perforation is considered significant perforation which would threaten the neural structures. There were twice as many lateral and inferior perforations compared to medial perforations. 48.0% of the perforations occurred at T1, T2 and T3 pedicles. Pedicle fracture occurred in 10.4% of pedicles. Intra-operatively, the absence of funnel was found in 24.5% of pedicles. In conclusion, thoracic pedicle screws using 5.0 mm at T1-T6 and 6.0 mm at T7-T12 can be inserted safely in Asian cadavers using the funnel technique despite having smaller thoracic pedicle morphometry.

The incidence of noncontiguous spinal fractures and other traumatic injuries associated with cervical spine fractures: a 10-year experience at an academic medical center.

PubMed

Miller, Christopher P; Brubacher, Jacob W; Biswas, Debdut; Lawrence, Brandon D; Whang, Peter G; Grauer, Jonathan N

2011-09-01

Retrospective medical record review. The purpose of this study was to describe the incidence of other injuries that commonly occur in conjunction with cervical spine fractures and dislocations. Cervical spine fractures are often associated with other significant traumatic conditions, which may also require prompt diagnosis and management. However, the relative incidences of the injuries that occur in conjunction with various cervical spine fractures have not been well documented. The radiographic reports of all patients who underwent CT scans of the cervical spine at a single level 1 trauma center over a 10-year period were reviewed. The medical records of individuals with acute, nonpenetrating fractures of the cervical spine were further assessed for any associated traumatic pathology including noncontiguous spine injuries and those affecting other organ systems (i.e., head and neck, intrathoracic, intra-abdominal/pelvic, and nonspinal orthopedic disorders). A total of 13,896 CT scans of the cervical spine were performed during this 10-year period of which 492 revealed acute fractures and/or dislocations. Of these subjects, 60% had sustained at least one additional injury. Overall, 57% were noted to have extraspinal injuries (34% head and neck, 17% intrathoracic, 10% intra-abdominal/pelvic, and 30% nonspinal orthopedic conditions) and noncontiguous spinal trauma was present in 19% of these cases (8% cervical injuries, 8% thoracic, and 6% lumbar). In general, the rates of associated injuries observed with occipital condyle and C7 fractures were significantly higher than those recorded for other cervical segments. For patients with a known history of cervical spine trauma, the frequencies of associated injuries were similar across all levels of the cervical spine with the exception of the injuries to the craniocervical junctions. In practice, this means that injuries to the cervical spine can likely be grouped together when considering other possible associated injuries. Further elucidation of these injury patterns will likely be useful for facilitating the expedient evaluation and proper management of these individuals.

Age-related changes in thoracic skeletal geometry of elderly females.

PubMed

Holcombe, Sven A; Wang, Stewart C; Grotberg, James B

2017-05-29

Both females and the elderly have been identified as vulnerable populations with increased injury and mortality risk in multiple crash scenarios. Particularly in frontal impacts, older females show higher risk to the chest and thorax than their younger or male counterparts. Thoracic geometry plays a role in this increase, and this study aims to quantify key parts of that geometry in a way that can directly inform human body models that incorporate the concept of person age. Computed tomography scans from 2 female subject groups aged 20-35 and 65-99 were selected from the International Center for Automotive Medicine scan database representing young and old female populations. A model of thoracic skeletal anatomy was built for each subject from independent parametric models of the spine, ribs, and sternum, along with further parametric models of those components' spatial relationships. Parameter values between the 2 groups are directly compared, and average parameter values within each group are used to generate statistically average skeletal geometry for young and old females. In addition to the anatomic measures explicitly used in the parameterization scheme, key measures of rib cage depth and spine curvature are taken from both the underlying subject pool and from the resultant representative geometries. Statistically significant differences were seen between the young and old groups' spine and rib anatomic components, with no significant differences in local sternal geometry found. Vertebral segments in older females had higher angles relative to their inferior neighbors, providing a quantification of the kyphotic curvature known to be associated with age. Ribs in older females had greater end-to-end span, greater aspect ratio, and reduced out-of-plane deviation, producing an elongated and overall flatter curvature that leads to distal rib ends extending further anteriorly in older individuals. Combined differences in spine curvature and rib geometry led to an 18-mm difference in anterior placement of the sternum between young and old subjects. This study provides new geometric data regarding the variability in anthropometry of adult females with age and has utility in advancing the veracity of current human body models. A simplified scaffold representation of underlying 3-dimensional bones within the thorax is presented, and the reported young and old female parameter sets can be used to characterize the anatomic differences expected with age and to both validate and drive morphing algorithms for aged human body models. The modular approach taken allows model parameters to hold inherent and intuitive meaning, offering advantages over more generalized methods such as principal component analysis. Geometry can be assessed on a component level or a whole thorax level, and the parametric representation of thorax shape allows direct comparisons between the current study and other individuals or human body models.

Effect of thoracic mobilization on respiratory parameters in chronic non-specific low back pain: A randomized controlled trial.

PubMed

Babina, R; Mohanty, P P; Pattnaik, M

2016-02-19

Altered respiratory function has been found to be associated with back pain. Limited chest excursion in subjects with chronic low back pain (CLBP) may be due to co-contraction or bracing of erector spinae and abdominal muscles; their flexed spinal posture; and/or their compromised spinal stability resulting from dysfunctional transversus abdominis. To check for the effects of thoracic mobilization on respiratory parameters in subjects with chronic non-specific low back pain. Sixty-two subjects (excluding 11 dropouts) with CLBP of age group 30-60 were randomly allocated to two groups. Both groups received individualized treatment for low back pain (LBP) and HEP (home exercise program) regime of breathing exercises. In addition, group 1 received Maitland's Central postero-anterior vertebral pressure for thoracic spine (T1-T8). Total treatment duration was 10 sessions in 2 weeks (5 sessions/week). Results showed significant improvement in respiratory parameters viz. Forced Vital Capacity (FVC), Sustained Maximal Inspiratory Pressure (SMIP) and Chest Wall Expansion (CWE) and Oswestry Disability Index (ODI) in both groups (p< 0.05) at end of 2 weeks of intervention. However, improvement was significantly more in group 1 (p < 0.05) receiving additional thoracic mobilization. Subjects with non-specific chronic low back pain with or without radiation to lower limbs when treated with thoracic central PA mobilization, in addition to LBP specific treatment and breathing exercises, show an improvement in respiratory parameters and reduction in disability.

Preliminary experience with SpineEOS, a new software for 3D planning in AIS surgery.

PubMed

Ferrero, Emmanuelle; Mazda, Keyvan; Simon, Anne-Laure; Ilharreborde, Brice

2018-04-24

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. 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. 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). 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. These slides can be retrieved under Electronic Supplementary Material.

Peripheral nervous system injury after high-dose single-fraction image-guided stereotactic radiosurgery for spine tumors.

PubMed

Stubblefield, Michael D; Ibanez, Katarzyna; Riedel, Elyn R; Barzilai, Ori; Laufer, Ilya; Lis, Eric; Yamada, Yoshiya; Bilsky, Mark H

2017-03-01

OBJECTIVE The object of this study was to determine the percentage of high-dose (1800-2600 cGy) single-fraction stereotactic radiosurgery (SF-SRS) treatments to the spine that result in peripheral nervous system (PNS) injury. METHODS All patients treated with SF-SRS for primary or metastatic spine tumors between January 2004 and May 2013 and referred to the Rehabilitation Medicine Service for evaluation and treatment of neuromuscular, musculoskeletal, or functional impairments or pain were retrospectively identified. RESULTS Five hundred fifty-seven SF-SRS treatments in 447 patients resulted in 14 PNS injuries in 13 patients. All injures resulted from SF-SRS delivered to the cervical or lumbosacral spine at 2400 cGy. The overall percentage of SF-SRS treatments resulting in PNS injury was 2.5%, increasing to 4.5% when the thoracic spine was excluded from analysis. The median time to symptom onset following SF-SRS was 10 months (range 4-32 months). The plexus (cervical, brachial, and/or lumbosacral) was affected clinically and/or electrophysiologically in 12 (86%) of 14 cases, the nerve root in 2 (14%) of 14, and both in 6 (43%) of 14 cases. All patients experienced pain and most (93%) developed weakness. Peripheral nervous system injuries were CTCAE Grade 1 in 14% of cases, 2 in 64%, and 3 in 21%. No dose relationship between SF-SRS dose and PNS injury was detected. CONCLUSIONS Single-fraction SRS to the spine can result in PNS injury with major implications for function and quality of life.

Age dependence of the normal/abnormal difference of bone mineral density in osteoporotic women.

PubMed

Bagur, A; Vega, E; Mautalen, C

1994-09-01

Bone mineral density (BMD) is the major factor in bone strength and in the risk of suffering osteoporotic fractures. The aim of this study was to examine the normal/abnormal difference for antero-posterior (AP) spine, lateral spine, proximal femur and total body BMD to assess if age influences discrimination at three different decades between 50 and 80 years of age. The BMD was determined in 61 control women and 60 osteoporotic women (at least one vertebral wedge fracture readily visible in the lateral X-rays of the thoracic or lumbar spine). Measurements were made by DEXA with a total body scanner. The BMD of the whole group of osteoporotic women was markedly lower than that of age-matched controls at all skeletal areas (P < 0.001) except at the arms where the difference was smaller (P < 0.02). The Z-score (the difference between osteoporotic patients and age-matched control divided by the intrapopulation S.D.) was similar (approximately -1.7) over the AP spine, femoral neck, Ward's triangle, total body and legs. It was significantly lower at the arms (-0.8, P < 0.001), lateral spine (-1.4, P < 0.01) and trochanter (-1.3, P < 0.001) compared with the Z-score of the AP spine. The analysis of the results by decades of age disclosed that the higher Z-score on the 6th and 7th decades corresponded to the AP lumbar spine (approximately -2.0). A high descrimination was also observed for the femoral neck, Ward's triangle and legs while the Z-score of the lateral lumbar spine, total body, trochanter and arms were significantly lower than that of the AP lumbar spine. However on the 8th decade the Z-score of the AP lumbar spine diminished to -1.2 and was only significantly higher than the Z-score of the arms (P < 0.01). The study showed that, in women 50-60 years of age--the period where the majority of studies are made for prevention of osteoporosis, none of the other skeletal areas were superior to the AP spine in discrimination for spinal osteoporosis. Proximal femur and legs densitometry gave lower but not significantly different Z-score than the AP spine, while the remaining areas were significantly inferior to AP spine in separating osteoporotic and normal women.

Malignant pheochromocytoma with multiple vertebral metastases causing acute incomplete paralysis during pregnancy

PubMed Central

Liu, Shuzhong; Song, An; Zhou, Xi; Kong, Xiangyi; Li, William A.; Wang, Yipeng; Liu, Yong

2017-01-01

Abstract Rationale: We present a rare case of malignant pheochromocytoma with thoracic metastases during pregnancy that presented with symptoms of myelopathy and was treated with circumferential decompression, stabilization, and radiation. The management of this unique case is not well documented. The clinical manifestations, imaging results, pathological characteristics, treatment and prognosis of the case were analyzed. Patient concerns: A 26-year-old pregnant woman with a history of paroxysmal hypertension during the second trimester presented with lower extremity weakness, numbness, urinary incontinence, and back pain. Imaging studies revealed a right adrenal pheochromocytoma, multiple metastases at T8, T11, T12, and the pelvis girdle causing significant multilevel cord compression and significant osteolytic lesions at T11 and T12. Diagnoses: We believe this is the first reported case of metastatic pheochromocytoma of the thoracic spine presenting with symptoms of myelopathy during pregnancy. Interventions: A healthy neonate was delivered by emergency caesarean section at 34 weeks. Subsequently, the patient underwent a circumferential spinal cord decompression and a stabilization procedure. Outcomes: The patient's neurological deficits improved significantly after the surgery, and the postoperative period was uneventful at the 6-month follow-up visit. Lessons: This article emphasizes that metastatic pheochromocytoma of the spine, although rare, should be part of the differential when a patient presents with elevated blood pressure, weakness, and urinary incontinence. PMID:29095319

[The future of bedside chest radiography: Comparative study of mobile flat-panels and needle-image plate storage phosphor systems].

PubMed

Bremicker, K; Gosch, D; Kahn, T; Borte, G

2015-11-01

Chest radiography is the most common diagnostic modality in intensive care units with new mobile flat-panels gaining more attention and availability in addition to the already used storage phosphor plates. Comparison of the image quality of mobile flat-panels and needle-image plate storage phosphor system in terms of bedside chest radiography. Retrospective analysis of 84 bedside chest radiographs of 42 intensive care patients (20 women, 22 men, average age: 65 years). All images were acquired during daily routine. For each patient, two images were analyzed, one from each system mentioned above. Two blinded radiologists evaluated the image quality based on ten criteria (e.g., diaphragm, heart contour, tracheal bifurcation, thoracic spine, lung structure, consolidations, foreign material, and overall impression) using a 5-point visibility scale (1 = excellent, 5 = not usable). There was no significant difference between the image quality of the two systems (p < 0.05). Overall some anatomical structures such as the diaphragm, heart, pulmonary consolidations and foreign material were considered of higher diagnostic quality compared to others, e.g., tracheal bifurcation and thoracic spine. Mobile flat-panels achieve an image quality which is as good as those of needle-image plate storage phosphor systems. In addition, they allow immediate evaluation of the image quality but in return are much more expensive in terms of purchase and maintenance.

Technical Aspects on the Use of Ultrasonic Bone Shaver in Spine Surgery: Experience in 307 Patients

PubMed Central

Hazer, Derya Burcu; Yaşar, Barış; Rosberg, Hans-Eric; Akbaş, Aytaç

2016-01-01

Aim. We discuss technical points, the safety, and efficacy of ultrasonic bone shaver in various spinal surgeries within our own series. Methods. Between June 2010 and January 2014, 307 patients with various spinal diseases were operated on with the use of an ultrasonic bone curette with microhook shaver (UBShaver). Patients' data were recorded and analyzed retrospectively. The technique for the use of the device is described for each spine surgery procedure. Results. Among the 307 patients, 33 (10.7%) cases had cervical disorder, 17 (5.5%) thoracic disorder, 3 (0.9%) foramen magnum disorder, and 254 (82.7%) lumbar disorders. Various surgical techniques were performed either assisted or alone by UBShaver. The duration of the operations and the need for blood replacement were relatively low. The one-year follow-up with Neck Disability Index (NDI) and Oswestry Disability Index (ODI) scores were improved. We had 5 cases of dural tears (1.6%) in patients with lumbar spinal disease. No neurological deficit was found in any patients. Conclusion. We recommend this device as an assistant tool in various spine surgeries and as a primary tool in foraminotomies. It is a safe device in spine surgery with very low complication rate. PMID:27195299

Fluorescent marker for the detection of crop and upper gastrointestinal leakage in poultry processing plants.

PubMed

Byrd, J A; Hargis, B M; Corrier, D E; Brewer, R L; Caldwell, D J; Bailey, R H; McReynolds, J L; Herron, K L; Stanker, L H

2002-01-01

Previous published research has identified the crop as a source of Salmonella and Campylobacter contamination for broiler carcasses and reported that broiler crops are 86 times more likely to rupture than ceca during commercial processing. Presently, we evaluated leakage of crop and upper gastrointestinal contents from broilers using a fluorescent marker at commercial processing plants. Broilers were orally gavaged with a fluorescent marker paste (corn meal-fluorescein dye-agar) within 30 min of live hang. Carcasses were collected at several points during processing and were examined for upper gastrointestinal leakage using long-wavelength black light. This survey indicated that 67% of the total broiler carcasses were positive for the marker at the rehang station following head and shank removal. Crops were mechanically removed from 61% of the carcasses prior to the cropper, and visual online examination indicated leakage of crop contents following crop removal by the pack puller. Examination of the carcasses prior to the cropper detected the marker in the following regions: neck (50.5% positive), thoracic inlet (69.7% positive), thoracic cavity (35.4% positive), and abdominal cavity (34.3% positive). Immediately prior to chill immersion, 53.2% of the carcasses contained some degree of visually identifiable marker contamination, as follows: neck (41.5% positive), thoracic inlet (45.2% positive), thoracic cavity (26.2% positive), and abdominal cavity (30.2% positive). These results suggest that this fluorescent marker technique may serve as a useful tool for rapid identification of potential changes, which could reduce the incidence of crop rupture and contamination of carcasses at processing.

Complications Related to the Recombinant Human Bone Morphogenetic Protein 2 Use in Posterior Cervical Fusion.

PubMed

Takahashi, Shinji; Buser, Zorica; Cohen, Jeremiah R; Roe, Allison; Myhre, Sue L; Meisel, Hans-Joerg; Brodke, Darrel S; Yoon, S Tim; Park, Jong-Beom; Wang, Jeffrey C; Youssef, Jim A

2017-11-01

A retrospective cohort study. To compare the complications between posterior cervical fusions with and without recombinant human bone morphogenetic protein 2 (rhBMP2). Use of rhBMP2 in anterior cervical spinal fusion procedures can lead to potential complications such as neck edema, resulting in airway complications or neurological compression. However, there are no data on the complications associated with the "off-label" use of rhBMP2 in upper and lower posterior cervical fusion approaches. Patients from the PearlDiver database who had a posterior cervical fusion between 2005 and 2011 were identified. We evaluated complications within 90 days after fusion and data was divided in 2 groups: (1) posterior cervical fusion including upper cervical spine O-C2 (upper group) and (2) posterior cervical fusion including lower cervical spine C3-C7 (lower group). Complications were divided into: any complication, neck-related complications, wound-related complications, and other complications. Of the 352 patients in the upper group, 73 patients (20.7%) received rhBMP2, and 279 patients (79.3%) did not. Likewise, in the lower group of 2372 patients, 378 patients (15.9%) had surgery with rhBMP2 and 1994 patients (84.1%) without. In the upper group, complications were observed in 7 patients (9.6%) with and 34 patients (12%) without rhBMP2. In the lower group, complications were observed in 42 patients (11%) with and 276 patients (14%) without rhBMP2. Furthermore, in the lower group the wound-related complications were significantly higher in the rhBMP2 group (23 patients, 6.1%) compared with the non-rhBMP2 group (75 patients, 3.8%). Our data showed that the use of rhBMP2 does not increase the risk of complications in upper cervical spine fusion procedures. However, in the lower cervical spine, rhBMP2 may elevate the risk of wound-related complications. Overall, there were no major complications associated with the use of rhBMP2 for posterior cervical fusion approaches. Level III.

Overhead spine arch analysis of dairy cows from three-dimensional video

NASA Astrophysics Data System (ADS)

Abdul Jabbar, K.; Hansen, M. F.; Smith, M. L.; Smith, L. N.

2017-02-01

We present a spine arch analysis method in dairy cows using overhead 3D video data. This method is aimed for early stage lameness detection. That is important in order to allow early treatment; and thus, reduce the animal suffering and minimize the high forecasted financial losses, caused by lameness. Our physical data collection setup is non-intrusive, covert and designed to allow full automation; therefore, it could be implemented on a large scale or daily basis with high accuracy. We track the animal's spine using shape index and curvedness measure from the 3D surface as she walks freely under the 3D camera. Our spinal analysis focuses on the thoracic vertebrae region, where we found most of the arching caused by lameness. A cubic polynomial is fitted to analyze the arch and estimate the locomotion soundness. We have found more accurate results by eliminating the regular neck/head movements' effect from the arch. Using 22-cow data set, we are able to achieve an early stage lameness detection accuracy of 95.4%.

Effects of the sitting position on the body posture of children aged 11 to 13 years.

PubMed

Drza-Grabiec, Justyna; Snela, Sławomir; Rykała, Justyna; Podgórska, Justyna; Rachwal, Maciej

2015-01-01

Nowadays, children spend increasingly more time in a seated position, both at school during class and at home in front of a computer or television. The aim of this study was to compare selected parameters describing body posture and scoliosis among children in sitting and standing positions. It was an observational, cross-sectional study involving 91 primary school children aged 11-13 years. The children's backs were photographed in standing and sitting positions. The values of selected parameters were calculated using photogrammetric examination based on the Moire projection phenomenon. The results show significant statistical differences for the parameters defining the anteroposterior curves of the spine. The sitting position resulted in a decreased angle of inclination of the thoracolumbar spine, reduced depths of thoracic kyphosis and lumbar lordosis, and pelvic asymmetry. Maintaining a sitting position for a long time results in advanced asymmetries of the trunk and scoliosis, and causes a decrease in lumbar lordosis and kyphosis of a child's entire spine. Therefore, we advocate the introduction of posture education programs for schoolchildren.

Craniocervical hyperpneumatization with concurrent pneumorrhachis, pneumomediastinum, and subcutaneous emphysema in a weightlifter.

PubMed

Germino, Jessica C; Medverd, Jonathan R; Nguyen, Vicky T; Favinger, Jennifer L; Marder, Carrie P

2013-10-01

Acquired hyperpneumatization of the skull base and upper cervical vertebrae is extremely rare and is thought to occur in patients who habitually perform the Valsalva maneuver or engage in repetitive positive pressure activities such as scuba diving or free diving. Craniocervical hyperpneumatization has been reported to cause intracranial and extracranial pneumatoceles but is not generally considered as a cause of pneumorrhachis (air in the spinal canal). Pneumorrhachis is relatively rare, and usually occurs in a localized form, either in the cervical spine secondary to skull base fractures or in the thoracic spine secondary to pneumomediastinum or pneumothorax. Here, we report a case of extensive pneumorrhachis extending from the skull base to the thoracolumbar junction in association with marked axio-atlanto-occipital hyperpneumatization and pneumomediastinum. This unique constellation of findings likely resulted from complications of the Valsalva maneuver during strenuous exercise. To present a unique case of axio-atlanto-occipital hyperpneumatization with concurrent marked cervicothoracic pneumorrhachis, subcutaneous emphysema, and pneumomediastinum and to provide a review of the relevant literature, pathophysiology, and treatment strategies related to hyperpneumatization and pneumorrhachis. A unique case report from an urban medical center. A single case. Imaging findings and clinical history. Imaging data from a picture archiving and communication system and clinical data from an electronic medical record system were analyzed. A 58-year-old previously healthy man presented with 3 to 4 weeks of neck pain, shoulder pain, and intermittent hand and finger numbness that developed after weightlifting. On physical examination, he had mild hyperreflexia and decreased pinprick sensation within the T5-T8 dermatomes. Initial radiographic and computed tomography (CT) studies demonstrated extensive craniocervical hyperpneumatization involving the occipital bone, clivus, and C1 and C2 vertebral bodies. There was also pneumorrhachis extending throughout the entire cervical and thoracic spine, which caused moderate dural compression. Pneumomediastinum and subcutaneous emphysema were present. Maxillofacial CT showed dehiscent bone involving the dens, atlas, and occipital bone, with adjacent soft-tissue gas and pneumorrhachis. He was managed conservatively and advised to stop performing the Valsalva maneuver during weightlifting. His symptoms resolved, and follow-up imaging showed complete resolution of pneumorrhachis and partial reversal of hyperpneumatization. Craniocervical hyperpneumatization is a rare complication of the Valsalva maneuver. Most reported cases have involved only the skull base, or the skull base and C1, and many have been further complicated by microfractures leading to pneumocephalus or extracranial pneumatoceles. We present a unique case of extensive craniocervical hyperpneumatization that extended to the level of C2 and was complicated by microfractures causing severe pneumorrhachis. Concurrent pneumomediastinum in this case may have been an independent complication of the Valsalva maneuver, which could have contributed to pneumorrhachis. Alternatively, pneumomediastinum may have been caused by migration of gas through the neural foramen from the epidural space, driven by positive pressure generated by the one-way valve effect of the Eustachian tube during periods of exertion. Copyright © 2013 Elsevier Inc. All rights reserved.

Mobile C-arm cone-beam CT for guidance of spine surgery: Image quality, radiation dose, and integration with interventional guidance

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schafer, S.; Nithiananthan, S.; Mirota, D. J.

Purpose: A flat-panel detector based mobile isocentric C-arm for cone-beam CT (CBCT) has been developed to allow intraoperative 3D imaging with sub-millimeter spatial resolution and soft-tissue visibility. Image quality and radiation dose were evaluated in spinal surgery, commonly relying on lower-performance image intensifier based mobile C-arms. Scan protocols were developed for task-specific imaging at minimum dose, in-room exposure was evaluated, and integration of the imaging system with a surgical guidance system was demonstrated in preclinical studies of minimally invasive spine surgery. Methods: Radiation dose was assessed as a function of kilovolt (peak) (80-120 kVp) and milliampere second using thoracic andmore » lumbar spine dosimetry phantoms. In-room radiation exposure was measured throughout the operating room for various CBCT scan protocols. Image quality was assessed using tissue-equivalent inserts in chest and abdomen phantoms to evaluate bone and soft-tissue contrast-to-noise ratio as a function of dose, and task-specific protocols (i.e., visualization of bone or soft-tissues) were defined. Results were applied in preclinical studies using a cadaveric torso simulating minimally invasive, transpedicular surgery. Results: Task-specific CBCT protocols identified include: thoracic bone visualization (100 kVp; 60 mAs; 1.8 mGy); lumbar bone visualization (100 kVp; 130 mAs; 3.2 mGy); thoracic soft-tissue visualization (100 kVp; 230 mAs; 4.3 mGy); and lumbar soft-tissue visualization (120 kVp; 460 mAs; 10.6 mGy) - each at (0.3 x 0.3 x 0.9 mm{sup 3}) voxel size. Alternative lower-dose, lower-resolution soft-tissue visualization protocols were identified (100 kVp; 230 mAs; 5.1 mGy) for the lumbar region at (0.3 x 0.3 x 1.5 mm{sup 3}) voxel size. Half-scan orbit of the C-arm (x-ray tube traversing under the table) was dosimetrically advantageous (prepatient attenuation) with a nonuniform dose distribution ({approx}2 x higher at the entrance side than at isocenter, and {approx}3-4 lower at the exit side). The in-room dose (microsievert) per unit scan dose (milligray) ranged from {approx}21 {mu}Sv/mGy on average at tableside to {approx}0.1 {mu}Sv/mGy at 2.0 m distance to isocenter. All protocols involve surgical staff stepping behind a shield wall for each CBCT scan, therefore imparting {approx}zero dose to staff. Protocol implementation in preclinical cadaveric studies demonstrate integration of the C-arm with a navigation system for spine surgery guidance-specifically, minimally invasive vertebroplasty in which the system provided accurate guidance and visualization of needle placement and bone cement distribution. Cumulative dose including multiple intraoperative scans was {approx}11.5 mGy for CBCT-guided thoracic vertebroplasty and {approx}23.2 mGy for lumbar vertebroplasty, with dose to staff at tableside reduced to {approx}1 min of fluoroscopy time ({approx}40-60 {mu}Sv), compared to 5-11 min for the conventional approach. Conclusions: Intraoperative CBCT using a high-performance mobile C-arm prototype demonstrates image quality suitable to guidance of spine surgery, with task-specific protocols providing an important basis for minimizing radiation dose, while maintaining image quality sufficient for surgical guidance. Images demonstrate a significant advance in spatial resolution and soft-tissue visibility, and CBCT guidance offers the potential to reduce fluoroscopy reliance, reducing cumulative dose to patient and staff. Integration with a surgical guidance system demonstrates precise tracking and visualization in up-to-date images (alleviating reliance on preoperative images only), including detection of errors or suboptimal surgical outcomes in the operating room.« less

Mid- to long-term outcomes of posterior decompression with instrumented fusion for thoracic ossification of the posterior longitudinal ligament.

PubMed

Koda, Masao; Furuya, Takeo; Okawa, Akihiko; Inada, Taigo; Kamiya, Koshiro; Ota, Mitsutoshi; Maki, Satoshi; Takahashi, Kazuhisa; Yamazaki, Masashi; Aramomi, Masaaki; Ikeda, Osamu; Mannoji, Chikato

2016-05-01

Posterior decompression with instrumented fusion (PDF) surgery has been previously reported as a relatively safe surgical procedure for any type of thoracic ossification of the longitudinal ligament (OPLL). However, mid- to long-term outcomes are still unclear. The aim of the present study was to elucidate the mid- to long-term clinical outcome of PDF surgery for thoracic OPLL patients. The present study included 20 patients who had undergone PDF for thoracic OPLL and were followed for at least 5years. Increment change and recovery rate of the Japanese Orthopaedic Association (JOA) score were assessed. Revision surgery during the follow-up period was also recorded. Average JOA scores were 3.5 preoperatively and 7.1 at final follow-up. The average improvement in JOA score was 3.8 points and the average recovery rate was 47.0%. The JOA score showed gradual increase after surgery, and took 9months to reach peak recovery. As for neurological complications, two patients suffered postoperative paralysis, but both recovered without intervention. Six revision surgeries in four patients were related to OPLL. Additional anterior thoracic decompression for remaining ossification at the same level of PDF surgery was performed in one patient. Decompression surgery for deterioration of symptoms of pre-existing cervical OPLL was performed in three patients. One patient had undergone lumbar and cervical PDF surgery for de novo ossification foci of the lumbar and cervical spine. PDF surgery for thoracic OPLL is thus considered a relatively safe and stable surgical procedure considering the mid- to long-term outcomes. Copyright © 2015 Elsevier Ltd. All rights reserved.

Flexion-rotation manoeuvre increases dimension of the acoustic target window for paramedian thoracic epidural access.

PubMed

Ramsay, N; Walker, J; Tang, R; Vaghadia, H; Sawka, A

2014-03-01

The posterior longitudinal ligament (PLL) has been found to be a reliable measure of the acoustic target window for lumbar spinal anaesthesia and a predictive tool for difficult spinals. Currently, there is limited information on the PLL in the thoracic spine and its potential use for optimizing the acoustic target window during thoracic epidural placement. This study examined the effects of changes in body position on the length of the PLL as a measure of the acoustic target window for paramedian thoracic epidural access. We performed thoracic ultrasonography on 30 adult volunteers to measure the length of the PLL at the T9/10 interspace, in five different positions: P1, neutral; P2, thoracic and lumbar flexion; P3, as in position 2 with dorsal table tilt to 10°; P4, as in position 2 with 45° rightward shoulder rotation; and P5, as in position 2 with 45° leftward shoulder rotation. The mean (sd) PLL length increased significantly from 9.9 (3.9) mm in P1 to 11.7 (3.4) mm in P2, 12.9 (3.1) mm in P3, and 13.8 (4.0) mm in P4 (P<0.01, <0.01, and <0.01, respectively). The mean PLL length in P3 and P4 was also significantly longer compared with P2 (P<0.01 and 0.01, respectively). In volunteers, flexion with 10° dorsal table tilt and flexion with right rotation significantly increased the length of the ipsilateral PLL, compared with the standard flexed sitting position, as visualized by paramedian ultrasonography at the level of T9/10.

Reversal of childhood idiopathic scoliosis in an adult, without surgery: a case report and literature review

PubMed Central

2009-01-01

Background Some patients with mild or moderate thoracic scoliosis (Cobb angle <50-60 degrees) suffer disproportionate impairment of pulmonary function associated with deformities in the sagittal plane and reduced flexibility of the spine and chest cage. Long-term improvement in the clinical signs and symptoms of childhood onset scoliosis in an adult, without surgical intervention, has not been documented previously. Case presentation A diagnosis of thoracic scoliosis (Cobb angle 45 degrees) with pectus excavatum and thoracic hypokyphosis in a female patient (DOB 9/17/52) was made in June 1964. Immediate spinal fusion was strongly recommended, but the patient elected a daily home exercise program taught during a 6-week period of training by a physical therapist. This regime was carried out through 1992, with daily aerobic exercise added in 1974. The Cobb angle of the primary thoracic curvature remained unchanged. Ongoing clinical symptoms included dyspnea at rest and recurrent respiratory infections. A period of multimodal treatment with clinical monitoring and treatment by an osteopathic physician was initiated when the patient was 40 years old. This included deep tissue massage (1992-1996); outpatient psychological therapy (1992-1993); a daily home exercise program focused on mobilization of the chest wall (1992-2005); and manipulative medicine (1994-1995, 1999-2000). Progressive improvement in chest wall excursion, increased thoracic kyphosis, and resolution of long-standing respiratory symptoms occurred concomitant with a >10 degree decrease in Cobb angle magnitude of the primary thoracic curvature. Conclusion This report documents improved chest wall function and resolution of respiratory symptoms in response to nonsurgical approaches in an adult female, diagnosed at age eleven years with idiopathic scoliosis. PMID:20003501

Unstable upper and middle thoracic fractures. Preliminary experience with a posterior transpedicular correction-fixation technique.

PubMed

Payer, M

2005-06-01

A number of conservative and operative approaches have been described for the treatment of unstable traumatic upper and middle thoracic fractures. The advantage of surgical correction and fixation/fusion lies in its potential to restore sagittal and coronal alignment, thereby indirectly decompressing the spinal cord. A consecutive series of 8 patients with unstable traumatic upper and middle thoracic fractures is reviewed. In all patients, polyaxial pedicle screws were inserted bilaterally into the two levels above and below the fracture. Rods that were less contoured ("undercontoured") than the regional hyperkyphosis at the injured level, were anchored to the caudal four screws. The cranial four screws, with the vertebrae to which they were inserted, were then progressively pulled posteriorly onto the undercontoured rods with rod reducers, thus correcting the hyperkyphosis and anterolisthesis. The mean follow-up was 15 months. The mean regional kyphosis was 23 degrees preoperatively, 17 degrees postoperatively and 18 degrees at follow-up. The mean anterolisthesis was 8 mm preoperatively, 1 mm postoperatively and 1 mm at follow-up. No hardware failure occurred. Five patients with complete spinal cord injury at presentation made no neurological recovery, two patients with incomplete spinal cord injury initially (ASIA B), recovered substantially (to ASIA D), and the patients who were neurologically intact at presentation remained so.

Changes in pressure pain sensitivity in latent myofascial trigger points in the upper trapezius muscle after a cervical spine manipulation in pain-free subjects.

PubMed

Ruiz-Sáez, Mariana; Fernández-de-las-Peñas, César; Blanco, Cleofás Rodríguez; Martínez-Segura, Raquel; García-León, Rafael

2007-10-01

This study analyzed the immediate effects on pressure pain threshold (PPT) in latent myofascial trigger points (MTrPs) in the upper trapezius muscle of a single cervical spine manipulation directed at the C3 through C4 level. Seventy-two volunteers (27 men and 46 women; mean age, 31 years; SD, 10 years) participated in this study. Subjects underwent a screening process to establish both the presence of MTrPs in the upper trapezius muscle as described by Simons et al (Myofascial pain and dysfunction: the trigger point manual, vol 2. 3rd ed. Baltimore: Williams & Wilkins, 1999. p. 23-34) and the presence of intervertebral joint dysfunction at the C3 through C4 level by the lateral gliding test for the cervical spine. Subjects were divided randomly into 2 groups: manipulative group, which received a cervical spine manipulation directed at the C3 through C4 level, and a placebo group, which received a sham manual procedure. The outcome measure was the PPT on the MTrP in the upper trapezius muscle ipsilateral to the side of the joint dysfunction, which was assessed pretreatment and 1, 5, and 10 minutes posttreatment by an assessor blinded to the treatment allocation of the subject. The analysis of variance showed a significant effect for time (F = 5.157; P = .02) but not for side (F = 0.234; P = .63). Furthermore, an interaction between group and time was also found (F = 37.240; P < .001). The experimental group showed a trend toward an increase in PPT levels after the manipulative procedure, whereas the control group showed a trend toward a decrease in PPT. Positive within-group effect sizes ranging from medium to small were found in the manipulative group (0.1

Tuberculous spondylitis in Haji Adam Malik hospital, Medan

NASA Astrophysics Data System (ADS)

Dharmajaya, R.

2018-03-01

Ankylosing tuberculosis is an infection caused by Mycobacterium tuberculosis in one or more components of the vertebrae; it is Pott disease or tuberculous spondylitis. It might become a potential cause of morbidity, including neurological deficits and permanent deformity of the spine. Management of TB Spondylitis, in general, is chemotherapy with antituberculosis drugs (ATG), immobilization, and spine surgical interventions. A retrospective study was conducted to analyze the patients of TB Spondylitis who had undergone surgery at Haji Adam Malik hospital from June 2015 to June 2017. The most common location is thoracal (10%), lumbal (3%), and thoracolumbal junction (3%). Decompression laminectomy with fusion (18%) is the most suitable option for surgical management. The majority, pre- operation ASIA scale is D (8%), and post operation is E (8%). It means that surgical plays an important role in themanagement of tuberculous spondylitis.

Paraplegia in a thalassaemic patient with short stature.

PubMed

Campisi, Saveria; Mangiagli, Antonino; De Sanctis, Vincenzo; Giovannini, Michela

2011-03-01

Extramedullary hematopoiesis (EMH) is a normal compensatory reaction that occurs in almost all chronic hemolytic anemia, especially in transfusion independent thalassemia intermedia, and can involve many organs or tissues, including the epidural space leading to spinal cord compression syndrome. We present a case of EMH in a 29 year old woman with thalassemia major, regularly transfused since the time of diagnosis (age 21 months), who presented with sudden muscle weakness, difficulty walking and maintaining the upright position. Magnetic Resonance Imaging (MRI) of the thoracic spine showed spinal cord compression secondary to extramedullary hematopoiesis in the spinal canal, leading to early therapy. The neurosurgical treatment (decompressive laminectomy D3-D6) in our patient brought a significant and rapid recovery. The next two MRI of the spine (after 6 and 18 months) were both negative for recurrence.

Associations between orthopaedic disturbances and unilateral crossbite in children with asymmetry of the upper cervical spine.

PubMed

Korbmacher, Heike; Koch, L; Eggers-Stroeder, G; Kahl-Nieke, B

2007-02-01

The objective of the present study was to detect possible associations between unilateral crossbite and orthopaedic disturbances in children with asymmetry of the upper cervical spine. Fifty-five children aged 3-10 years (22 girls and 33 boys) with a unilateral crossbite and 55 gender- and age-matched children with a symmetric occlusion but no crossbite, who served as the control group, were selected from an orthopaedic cohort of 240 patients. In all children, asymmetry of the upper cervical region was confirmed by radiographs and palpation. The following orthopaedic aspects were investigated: oblique shoulder and pelvis, scoliosis, functional leg length difference, and laxity of ligaments of the foot. The differences between the groups were analysed by means of an unpaired t-test. An increased occurrence of orthopaedic parameters in the frontal plane was observed in children with a unilateral malocclusion. A unilateral crossbite was not necessarily combined with a pathological orthopaedic variable, but statistically, children with a unilateral malocclusion showed more often an oblique shoulder (P = 0.004), scoliosis (P = 0.04), an oblique pelvis (P = 0.007), and a functional leg length difference (P = 0.002) than children with symmetry. The results suggest that a unilateral crossbite in children with asymmetry of the upper cervical spine is associated with orthopaedic disturbances. There is no evidence of a causal link.

Axial and appendicular body proportions for evaluation of limb and trunk asymmetry.

PubMed

Weinberg, Douglas S; Liu, Raymond W; Li, Samuel Q; Sanders, James O; Cooperman, Daniel R

2017-04-01

Background and purpose - When children with irregular body proportions or asymmetric limbs present, it may be unclear where the pathology is located. An improved understanding of the clinical ratio between upper extremity, lower extremity, and spine length may help elucidate whether there is disproportion between the trunk and limbs, and whether there is a reduction deficit of the shorter limb rather than hypertrophy of the longer limb. Patients and methods - We used the Brush Foundation study of child growth and development, which was a prospective, longitudinal study of healthy children between the 1930s and the 1950s, and we collected serial clinical measurements for 290 children at 3,326 visits. Children ranged from 2 to 20 years of age during the study period. Linear and quadratic regression were used to construct nomographs and 95% prediction intervals for anthropometric body proportions. Results - The maximum anterior superior iliac spine height to sitting height ratio occurred at 12.4 years in females and at 14.17 years in males. Overall, the ratio of arm length to sitting height was 0.76 (SD 0.06), the ratio of arm length to anterior superior iliac spine height was 0.76 (SD 0.03), and the ratio of anterior superior iliac spine height to sitting height was 0.98 (SD 0.13). When comparing ratios between arm length, anterior superior iliac spine height, and sitting height, the smallest variance between appendicular proportions was found in the arm length to anterior superior iliac spine height ratio. Interpretation - We recommend comparisons between total arm length and anterior superior iliac spine height to distinguish limb reduction deficits from hemi-hypertrophy, with sitting height being used only if combined upper and lower extremity discrepancy is noted.

Axial and appendicular body proportions for evaluation of limb and trunk asymmetry

PubMed Central

Weinberg, Douglas S; Liu, Raymond W; Li, Samuel Q; Sanders, James O; Cooperman, Daniel R

2017-01-01

Background and purpose When children with irregular body proportions or asymmetric limbs present, it may be unclear where the pathology is located. An improved understanding of the clinical ratio between upper extremity, lower extremity, and spine length may help elucidate whether there is disproportion between the trunk and limbs, and whether there is a reduction deficit of the shorter limb rather than hypertrophy of the longer limb. Patients and methods We used the Brush Foundation study of child growth and development, which was a prospective, longitudinal study of healthy children between the 1930s and the 1950s, and we collected serial clinical measurements for 290 children at 3,326 visits. Children ranged from 2 to 20 years of age during the study period. Linear and quadratic regression were used to construct nomographs and 95% prediction intervals for anthropometric body proportions. Results The maximum anterior superior iliac spine height to sitting height ratio occurred at 12.4 years in females and at 14.17 years in males. Overall, the ratio of arm length to sitting height was 0.76 (SD 0.06), the ratio of arm length to anterior superior iliac spine height was 0.76 (SD 0.03), and the ratio of anterior superior iliac spine height to sitting height was 0.98 (SD 0.13). When comparing ratios between arm length, anterior superior iliac spine height, and sitting height, the smallest variance between appendicular proportions was found in the arm length to anterior superior iliac spine height ratio. Interpretation We recommend comparisons between total arm length and anterior superior iliac spine height to distinguish limb reduction deficits from hemi-hypertrophy, with sitting height being used only if combined upper and lower extremity discrepancy is noted. PMID:27998211

Metallic artefact reduction with monoenergetic dual-energy CT: systematic ex vivo evaluation of posterior spinal fusion implants from various vendors and different spine levels.

PubMed

Guggenberger, R; Winklhofer, S; Osterhoff, G; Wanner, G A; Fortunati, M; Andreisek, G; Alkadhi, H; Stolzmann, P

2012-11-01

To evaluate optimal monoenergetic dual-energy computed tomography (DECT) settings for artefact reduction of posterior spinal fusion implants of various vendors and spine levels. Posterior spinal fusion implants of five vendors for cervical, thoracic and lumbar spine were examined ex vivo with single-energy (SE) CT (120 kVp) and DECT (140/100 kVp). Extrapolated monoenergetic DECT images at 64, 69, 88, 105 keV and individually adjusted monoenergy for optimised image quality (OPTkeV) were generated. Two independent radiologists assessed quantitative and qualitative image parameters for each device and spine level. Inter-reader agreements of quantitative and qualitative parameters were high (ICC = 0.81-1.00, κ = 0.54-0.77). HU values of spinal fusion implants were significantly different among vendors (P < 0.001), spine levels (P < 0.01) and among SECT, monoenergetic DECT of 64, 69, 88, 105 keV and OPTkeV (P < 0.01). Image quality was significantly (P < 0.001) different between datasets and improved with higher monoenergies of DECT compared with SECT (V = 0.58, P < 0.001). Artefacts decreased significantly (V = 0.51, P < 0.001) at higher monoenergies. OPTkeV values ranged from 123-141 keV. OPTkeV according to vendor and spine level are presented herein. Monoenergetic DECT provides significantly better image quality and less metallic artefacts from implants than SECT. Use of individual keV values for vendor and spine level is recommended. • Artefacts pose problems for CT following posterior spinal fusion implants. • CT images are interpreted better with monoenergetic extrapolation using dual-energy (DE) CT. • DECT extrapolation improves image quality and reduces metallic artefacts over SECT. • There were considerable differences in monoenergy values among vendors and spine levels. • Use of individualised monoenergy values is indicated for different metallic hardware devices.

Comparison of Cervical Spine Anatomy in Calves, Pigs and Humans.

PubMed

Sheng, Sun-Ren; Xu, Hua-Zi; Wang, Yong-Li; Zhu, Qing-An; Mao, Fang-Min; Lin, Yan; Wang, Xiang-Yang

2016-01-01

Animals are commonly used to model the human spine for in vitro and in vivo experiments. Many studies have investigated similarities and differences between animals and humans in the lumbar and thoracic vertebrae. However, a quantitative anatomic comparison of calf, pig, and human cervical spines has not been reported. To compare fundamental structural similarities and differences in vertebral bodies from the cervical spines of commonly used experimental animal models and humans. Anatomical morphometric analysis was performed on cervical vertebra specimens harvested from humans and two common large animals (i.e., calves and pigs). Multiple morphometric parameters were directly measured from cervical spine specimens of twelve pigs, twelve calves and twelve human adult cadavers. The following anatomical parameters were measured: vertebral body width (VBW), vertebral body depth (VBD), vertebral body height (VBH), spinal canal width (SCW), spinal canal depth (SCD), pedicle width (PW), pedicle depth (PD), pedicle inclination (PI), dens width (DW), dens depth (DD), total vertebral width (TVW), and total vertebral depth (TVD). The atlantoaxial (C1-2) joint in pigs is similar to that in humans and could serve as a human substitute. The pig cervical spine is highly similar to the human cervical spine, except for two large transverse processes in the anterior regions ofC4-C6. The width and depth of the calf odontoid process were larger than those in humans. VBW and VBD of calf cervical vertebrae were larger than those in humans, but the spinal canal was smaller. Calf C7 was relatively similar to human C7, thus, it may be a good substitute. Pig cervical vertebrae were more suitable human substitutions than calf cervical vertebrae, especially with respect to C1, C2, and C7. The biomechanical properties of nerve vascular anatomy and various segment functions in pig and calf cervical vertebrae must be considered when selecting an animal model for research on the spine.

An exceptionally preserved armored dinosaur reveals the morphology and allometry of osteoderms and their horny epidermal coverings.

PubMed

Brown, Caleb M

2017-01-01

Although the evolution and function of "exaggerated" bony projections in ornithischian dinosaurs has been subject to significant debate recently, our understanding of the structure and morphology of their epidermal keratinized coverings is greatly limited. The holotype of Borealopelta , a new nodosaurid ankylosaur, preserves osteoderms and extensive epidermal structures (dark organic residues), in anatomic position across the entire precaudal length. Contrasting previous specimens, organic epiosteodermal scales, often in the form of horn-like (keratinous) sheaths, cap and exaggerate nearly all osteoderms, allowing for morphometric and allometric analyses of both the bony osteoderms and their horny sheaths. A total of 172 osteoderms were quantified, with osteoderm spine length and height being positively allometric with respect to basal length and width. Despite tight correlations between the different measures amongst all other osteoderms, the large parascapular spines represent consistent outliers. Thickness and relative contribution of the keratinized epiosteodermal scales/sheaths varies greatly by region, ranging from 2% to 6% for posterior thoracics, to ∼25% (1.3×) for the parascapular spines-similar to horn sheaths in some bovid analogues. Relative to the bony cores, the horny portions of the spines are strongly positively allometric (slope = 2.3, CI = 1.8-2.8). Strong allometric scaling, species-specific morphology, and significant keratinous extension of the cervicoscapular spines is consistent with elaboration under socio-sexual selection. This marks the first allometric analysis of ornithischian soft tissues.

Dosimetric comparison between step-shoot intensity-modulated radiotherapy and volumetric-modulated arc therapy for upper thoracic and cervical esophageal carcinoma.

PubMed

Gao, Min; Li, Qilin; Ning, Zhonghua; Gu, Wendong; Huang, Jin; Mu, Jinming; Pei, Honglei

2016-01-01

To compare and analyze the dosimetric characteristics of volumetric modulated arc therapy (VMAT) vs step-shoot intensity-modulated radiation therapy (sIMRT) for upper thoracic and cervical esophageal carcinoma. Single-arc VMAT (VMAT1), dual-arc VMAT (VMAT2), and 7-field sIMRT plans were designed for 30 patients with upper thoracic or cervical esophageal carcinoma. Planning target volume (PTV) was prescribed to 50.4Gy in 28 fractions, and PTV1 was prescribed to 60Gy in 28 fractions. The parameters evaluated included dose homogeneity and conformality, dose to organs at risk (OARs), and delivery efficiency. (1) In comparison to sIMRT, VMAT provided a systematic improvement in PTV1 coverage. The homogeneity index of VMAT1 was better than that of VMAT2. There were no significant differences among sIMRT, VMAT1, and VMAT2 in PTV coverage. (2) VMAT1 and VMAT2 reduced the maximum dose of spinal cord as compared with sIMRT (p < 0.05). The rest dose-volume characteristics of OARs were similar. (3) Monitor units of VMAT2 and VMAT1 were more than sIMRT. However, the treatment time of VMAT1, VMAT2, and sIMRT was (2.0 ± 0.2), (2.8 ± 0.3), and (9.8 ± 0.8) minutes, respectively. VMAT1 was the fastest, and the difference was statistically significant. In the treatment of upper thoracic and cervical esophageal carcinoma by the AXESSE linac, compared with 7-field sIMRT, VMAT showed better PTV1 coverage and superior spinal cord sparing. Single-arc VMAT had similar target volume coverage and the sparing of OAR to dual-arc VMAT, with shortest treatment time and highest treatment efficiency in the 3 kinds of plans. Copyright © 2016 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

Study for reducing lung dose of upper thoracic esophageal cancer radiotherapy by auto-planning: volumetric-modulated arc therapy vs intensity-modulated radiation therapy.

PubMed

Chen, Hua; Wang, Hao; Gu, Hengle; Shao, Yan; Cai, Xuwei; Fu, Xiaolong; Xu, Zhiyong

2017-10-27

This study aimed to investigate the dosimetric differences and lung sparing between volumetric-modulated arc therapy (VMAT) and intensity-modulated radiation therapy (IMRT) in the treatment of upper thoracic esophageal cancer with T3N0M0 for preoperative radiotherapy by auto-planning (AP). Sixteen patient cases diagnosed with upper thoracic esophageal cancer T3N0M0 for preoperative radiotherapy were retrospectively studied, and 3 plans were generated for each patient: full arc VMAT AP plan with double arcs, partial arc VMAT AP plan with 6 partial arcs, and conventional IMRT AP plan. A simultaneous integrated boost with 2 levels was planned in all patients. Target coverage, organ at risk sparing, treatment parameters including monitor units and treatment time (TT) were evaluated. Wilcoxon signed-rank test was used to check for significant differences (p < 0.05) between datasets. VMAT plans (pVMAT and fVMAT) significantly reduced total lung volume treated above 20 Gy (V 20 ), 25 Gy (V 25 ), 30 Gy (V 30 ), 35 Gy (V 35 ), 40 Gy (V 40 ), and without increasing the value of V 10 , V 13 , and V 15 . For V 5 of total lung value, pVMAT was similar to aIMRT, and it was better than fVMAT. Both pVMAT and fVMAT improved the target dose coverage and significantly decreased maximum dose for the spinal cord, monitor unit, and TT. No significant difference was observed with respect to V 10 and V 15 of body. VMAT AP plan was a good option for treating upper thoracic esophageal cancer with T3N0M0, especially partial arc VMAT AP plan. It had the potential to effectively reduce lung dose in a shorter TT and with superior target coverage and dose homogeneity. Copyright © 2017 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

Dosimetric comparison between step-shoot intensity-modulated radiotherapy and volumetric-modulated arc therapy for upper thoracic and cervical esophageal carcinoma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gao, Min; Li, Qilin; Ning, Zhonghua

2016-07-01

To compare and analyze the dosimetric characteristics of volumetric modulated arc therapy (VMAT) vs step-shoot intensity-modulated radiation therapy (sIMRT) for upper thoracic and cervical esophageal carcinoma. Single-arc VMAT (VMAT1), dual-arc VMAT (VMAT2), and 7-field sIMRT plans were designed for 30 patients with upper thoracic or cervical esophageal carcinoma. Planning target volume (PTV) was prescribed to 50.4 Gy in 28 fractions, and PTV1 was prescribed to 60 Gy in 28 fractions. The parameters evaluated included dose homogeneity and conformality, dose to organs at risk (OARs), and delivery efficiency. (1) In comparison to sIMRT, VMAT provided a systematic improvement in PTV1 coverage.more » The homogeneity index of VMAT1 was better than that of VMAT2. There were no significant differences among sIMRT, VMAT1, and VMAT2 in PTV coverage. (2) VMAT1 and VMAT2 reduced the maximum dose of spinal cord as compared with sIMRT (p < 0.05). The rest dose-volume characteristics of OARs were similar. (3) Monitor units of VMAT2 and VMAT1 were more than sIMRT. However, the treatment time of VMAT1, VMAT2, and sIMRT was (2.0 ± 0.2), (2.8 ± 0.3), and (9.8 ± 0.8) minutes, respectively. VMAT1 was the fastest, and the difference was statistically significant. In the treatment of upper thoracic and cervical esophageal carcinoma by the AXESSE linac, compared with 7-field sIMRT, VMAT showed better PTV1 coverage and superior spinal cord sparing. Single-arc VMAT had similar target volume coverage and the sparing of OAR to dual-arc VMAT, with shortest treatment time and highest treatment efficiency in the 3 kinds of plans.« less

Classification and Management of Pediatric Subaxial Cervical Spine Injuries.

PubMed

Madura, Casey J; Johnston, James M

2017-01-01

Appropriate management of subaxial spine injury in children requires an appreciation for the differences in anatomy, biomechanics, injury patterns, and treatment options compared with adult patients. Increased flexibility, weak neck muscles, and cranial disproportion predispose younger children to upper cervical injuries and spinal cord injury without radiographic abnormality. A majority of subaxial cervical spine injuries can be treated nonoperatively. Surgical instrumentation options for children have significantly increased in recent years. Future studies of outcomes for children with subaxial cervical spine injury should focus on injury classification and standardized outcome measures to ensure continued improvement in quality of care for this patient population. Copyright © 2016 Elsevier Inc. All rights reserved.

Characteristics of Cervical Spine Injury in Pediatric Patients With Facial Fractures.

PubMed

Halsey, Jordan N; Hoppe, Ian C; Marano, Andrew A; Kordahi, Anthony M; Lee, Edward S; Granick, Mark S

2016-01-01

Cervical spine injury may present with pediatric patients having sustained fractures of the craniofacial skeleton. Management considerations of the cervical spine often take priority to the fractures of the facial skeleton. The goal of this study was to examine this subset of patients with a focus on initial presentation and need for intervention. A retrospective review from 2000 to 2012 of all facial fractures in patients ≤ 18 years at a level 1 trauma center was performed. Patient demographics, location of fractures, and the presence of a cervical spine injury were collected. During this time period, 285 patients met inclusion criteria. Ten patients were found to have a cervical spine injury. Fractures of the zygoma and orbit were significantly associated with a cervical spine injury. Patients with a cervical spine injury had a Glasgow Coma Scale of 11.2 compared with 13.8 in those without (P < 0.05). C1 was injured in 4 patients, C2 in 2 patients, and C3 to C7 in 4 patients. A surgical airway was required in 1 patient, and 6 were intubated in the trauma bay. Fractures of the mandible were significantly associated with injury to C2. Le Fort fractures and palate fractures approached significance with injury to C1. Only 1 patient had neurologic impairment at presentation, manifested as upper extremity parasthesias, and underwent decompression and fusion in the operating room. Those patients admitted (90%) were all admitted for reasons other than management of the cervical spine injury. The majority of patients (70%) were treated with collar immobilization. One patient expired. No patients had a neurologic deficit at the time of discharge. In this study only 1 cervical spine injury necessitated intervention, with an eventual full recovery. Cervical spine injuries presenting with fractures of the facial skeleton appear to be relatively benign in this series; however, care must be taken to identify all such injuries to avoid exacerbation during maneuvers commonly used for facial fracture treatment. Special caution should be used when examining patients with a depressed Glasgow Coma Scale or in those with upper midface fractures.

Developmental spinal canal stenosis and somatotype.

PubMed Central

Nightingale, S

1989-01-01

The hypothesis that somatotype and cervical spine developmental canal stenosis may be associated has been investigated by anthropometry and measurement of lateral projection cervical spine radiographs. A significant association of canal size with somatotype has been found such that those with developmentally narrow canals are more likely to have relatively shorter long-bones, particularly in the upper arm, and longer trunks. Images PMID:2769282

A case of myositis ossificans in the upper cervical spine of a young child.

PubMed

Findlay, Iain; Lakkireddi, Prabhat Reddy; Gangone, Ravinder; Marsh, Gavin

2010-12-01

Case report. We present a case of myositis ossificans (MO) of the upper cervical spine in a young child. The literature is reviewed with the classification, etiology, and treatment of MO discussed. Calcification of joint capsule, muscle, cartilage, and ligaments is a well-known phenomenon and is known as myositis ossificans. It is very rarely seen in the head and neck, with no reports of MO of the soft tissues surrounding the first 2 cervical vertebrae. An 8-year-old boy presented with severe neck pain after a fall. He had had a similar neck injury 4 years before, but made a full recovery. Radiographs showed a large ossified lesion between the posterior elements of C1 and C2. After further imaging, a diagnosis of MO was made. The child was treated with simple analgesia and observation. With no evidence of neurologic compromise and minimal symptoms, there was no indication for surgical intervention. Although rare, MO should be suspected as one of the possible causes of persistent pain following cervical spine injury in children. We would advise a low threshold for cervical spine imaging in the child presenting with persistent neck pain and stiffness, even years after injury.

Playing-related disabling musculoskeletal disorders in young and adult classical piano students.

PubMed

Bruno, S; Lorusso, A; L'Abbate, N

2008-07-01

To determine the prevalence of instrument-related musculoskeletal problems in classical piano students and investigate piano-specific risk factors. A specially developed four parts questionnaire was administered to classical piano students of two Apulian conservatories, in southern Italy. A cross-sectional design was used. Prevalences of playing related musculoskeletal disorders (MSDs) were calculated and cases were compared with non-cases. A total of 195 out of the 224 piano students responded (87%). Among 195 responders, 75 (38.4%) were considered affected according to the pre-established criteria. Disabling MSDs showed similar prevalence rates for neck (29.3%), thoracic spine (21.3%) and upper limbs (from 20.0 to 30.4%) in the affected group. Univariate analyses showed statistical differences concerning mean age, number of hours per week spent playing, more than 60 min of continuative playing without breaks, lack of sport practice and acceptability of "No pain, no gain" criterion in students with music-related pain compared with pianists not affected. Statistical correlation was found only between upper limbs diseases in pianists and hand sizes. No correlation with the model of piano played was found in the affected group. The multivariate analyses performed by logistic regression confirmed the independent correlation of the risk factors age, lack of sport practice and acceptability of "No pain, no gain" criterion. Our study showed MSDs to be a common problem among classical piano students. With variance in several studies reported, older students appeared to be more frequently affected by disabling MSDs and no difference in the prevalence rate of the disorders was found in females.

Thoracic Idiopathic Scoliosis Severity Is Highly Correlated with 3D Measures of Thoracic Kyphosis.

PubMed

Sullivan, T Barrett; Reighard, Fredrick G; Osborn, Emily J; Parvaresh, Kevin C; Newton, Peter O

2017-06-07

Loss of thoracic kyphosis has been associated with thoracic idiopathic scoliosis. Modern 3-dimensional (3D) imaging systems allow more accurate characterization of the scoliotic deformity than traditional radiographs. In this study, we utilized 3D calculations to characterize the association between increasing scoliosis severity and changes in the sagittal and axial planes. Patients evaluated in a scoliosis clinic and determined to have either a normal spine or idiopathic scoliosis were included in the analysis. All underwent upright, biplanar radiography with 3D reconstructions. Two-dimensional (2D) measurements of the magnitude of the thoracic major curve and the thoracic kyphosis were recorded. Image processing and MATLAB analysis were utilized to produce a 3D calculation of thoracic kyphosis and apical vertebral axial rotation. Regression analysis was performed to determine the correlation of 2D kyphosis, 3D kyphosis, and apical axial rotation with the magnitude of the thoracic major curve. The 442 patients for whom 2D and 3D data were collected had a main thoracic curve magnitude ranging from 1° to 118°. Linear regression analysis of the 2D and 3D T5-T12 kyphosis versus main thoracic curve magnitude yielded significant models (p < 0.05). The 2D model had a minimally negative slope (-0.07), a small R value (0.02), and a poor correlation coefficient (-0.14). In contrast, the 3D model had a strongly negative slope (-0.54), a high R value (0.56), and a strong correlation coefficient (-0.75). Curve magnitude also had a strong correlation with loss of 3D T1-T12 kyphosis and increasing apical axial rotation. Segmentally calculated 3D thoracic kyphosis had a strongly negative correlation with the magnitude of the main thoracic curve. With near uniformity, 3D thoracic kyphosis progressively decreased as scoliosis magnitude increased, at a rate of more than half the increase in the main thoracic curve magnitude. Analysis confirmed a surprisingly strong correlation between scoliosis severity and loss of 3D kyphosis that was absent in the 2D analysis. A similarly strong correlation between curve magnitude and apical axial rotation was evident. These findings lend further credence to the concept that scoliosis progresses in the coronal, sagittal, and axial planes simultaneously. The findings of this study suggest that 3D assessment is critical for adequate characterization of the multiplanar deformity of idiopathic scoliosis and deformity in the sagittal plane is linked to deformity in the coronal plane. Increasing severity of coronal plane curvature is associated with a progressive loss of thoracic kyphosis that should be anticipated so that the appropriate intraoperative techniques for correction of idiopathic scoliosis can be applied in all 3 planes.

An unusual presentation of pediatric osteoblastoma in a patient with Klippel-Trenaunay-Weber syndrome: case report.

PubMed

Wallace, Scott A; Ignacio, Romeo C; Klugh, Arnett; Gates, Gregory; Henry, Marion C W

2015-06-01

Osteoblastoma is an uncommon primary bone tumor that usually presents as a painful lesion in a long bone or in the spine. Osteoblastoma has been reported only twice in the literature in conjunction with systemic fibromatosis. The authors report the case of an 8-year-old girl with suspected Klippel-Trenaunay-Weber syndrome, a rare syndrome of systemic fibromatosis, who presented with a painless thoracic rib lesion that was found to be an osteoblastoma.

Development of Predictive Models of Injury for the Lower Extremity, Lumbar, and Thoracic Spine after Discharge from Physical Rehabilitation

DTIC Science & Technology

2016-10-01

prediction models will vary by age and sex . Hypothesis 3: A multi-factorial prediction model that accurately predicts risk of new and recurring injuries...members for injury risk after they have been cleared to return to duty from an injury is of great importance. The purpose of this project is to determine ...It turns out that many patients are not formally discharged from rehabilitation. Many of them “ self -discharge” and just stop coming back, either

A 20-Year Prospective Longitudinal Study of Degeneration of the Cervical Spine in a Volunteer Cohort Assessed Using MRI: Follow-up of a Cross-Sectional Study.

PubMed

Daimon, Kenshi; Fujiwara, Hirokazu; Nishiwaki, Yuji; Okada, Eijiro; Nojiri, Kenya; Watanabe, Masahiko; Katoh, Hiroyuki; Shimizu, Kentaro; Ishihama, Hiroko; Fujita, Nobuyuki; Tsuji, Takashi; Nakamura, Masaya; Matsumoto, Morio; Watanabe, Kota

2018-05-16

Few studies have addressed in detail long-term degenerative changes in the cervical spine. In this study, we evaluated the progression of degenerative changes of the cervical spine that occurred over a 20-year period in an originally healthy cohort. We also sought to clarify the relationship between the progression of cervical degenerative changes and the development of clinical symptoms. For this prospective follow-up investigation, we recruited 193 subjects from an original cohort of 497 participants who had undergone magnetic resonance imaging (MRI) of the cervical spine between 1993 and 1996. The subjects were asked about the presence or absence of cervical spine-related symptoms. Degenerative changes of the cervical spine were assessed on MRI using an original numerical grading system. The relationship between the progression of degenerative changes and the onset of clinical symptoms was evaluated by logistic regression analysis. Degeneration in the cervical spine was found to have progressed in 95% of the subjects during the 20-year period. The finding of a decrease in signal intensity of the intervertebral disc progressed in a relatively high proportion of the subjects in all age groups and occurred with similar frequency (around 60%) at all intervertebral disc levels. The rate of progression of other structural failures on MRI increased with age and was highest at C5-C6. The progression of foraminal stenosis was associated with the onset of upper-limb pain (odds ratio, 4.71 [95% confidence interval, 1.02 to 21.7]). A progression of degenerative changes in the cervical spine on MRI over the 20-year period was detected in nearly all subjects. There was no relationship between the progression of degeneration on MRI and the development of clinical symptoms, with the exception of an association found between foraminal stenosis and upper-limb pain. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Poland syndrome with bilateral features: case description with review of the literature.

PubMed

Baban, Anwar; Torre, Michele; Bianca, Sebastiano; Buluggiu, Anna; Rossello, Mario Igor; Calevo, Maria Grazia; Valle, Maura; Ravazzolo, Roberto; Jasonni, Vincenzo; Lerone, Margherita

2009-07-01

Poland syndrome (PS) has been described as unilateral pectoral muscle deficiency variably associated with ipsilateral thoracic and upper limb anomalies. Bilateral hypoplasia/aplasia of the pectoralis muscle and upper limb defects in association with variable thoracic muscles, chest wall deformities and lower limb defects have been infrequently reported in the literature. We report on a 3(1/2)-year-old girl with clinical features consisting in bilateral asymmetric pectoral muscle defects (complete agenesis on the left side and agenesis of the sternocostal head on the right side), nipple hypoplasia, left rib defect, and right hand symbrachydactyly. In this study, we reviewed the bilateral features present in our patient and those described in the literature. Hypotheses explaining bilateral features in PS are reviewed.

Vertebral hemangiomas in the thoracic spine of multiple sclerosis patients are connected with fewer demyelinating lesions at the same level. Possible impact on pathophysiology and clinical course.

PubMed

Anagnostouli, Maria; Katsavos, Serafeim; Kyrozis, Andreas; Gontika, Maria; Voumvourakis, Konstantinos I; Kapaki, Elisabeth

2016-08-01

Mechanisms of angiogenesis regulate multiple sclerosis (MS) lesions' evolution, displaying both neuroprotective and harmful effects. Factors traditionally considered as purely angiogenic, like vascular endothelial growth factor (VEGF), exert complex heterogenous actions on both neural and vascular malformation-derived tissues. Aim of this retrospective study was to examine, for the first time, potential associations between the presence of common vascular malformations, like vertebral hemangiomas (VHs), and several clinico-radiological MS parameters. 236 MS patients who were followed in our Outpatient Clinic were recruited in this study. Outcome measures concerned demographics, disease-derived variables, and MS-lesions' distribution in VHs - positive and negative patients. All data were collected retrospectively. Potential correlations were assessed with univariate statistical analyses (p = 0.05), followed by multivariate regression models, for purposes of confounder-effects elimination. VH presence showed significant negative correlations with presence of MS lesions in the thoracic (p = 0.005 for thoracic VHs), but not the cervical cord. Trends towards negative associations of VH presence with subtentorial MS lesions and positive family history for MS were also observed. Our observations suggest that VH presence may reduce the risk of thoracic demyelinating lesions in MS patients. They could be explained as part of a multifaceted angiogenic process, concomitantly enhancing neural repair and abnormal hemangioma vascularization.

[Poland'syndrome and hand's malformations: about a clinic series of 37 patients].

PubMed

Foucras, L; Grolleau, J L; Chavoin, J P

2005-04-01

Poland's syndrome is a rare malformation which associates thoracic anomalies and anomalies of homolateral upper end. We wish to know the frequency of hand's malformations in this syndrome in our clinical experience. We have revised 37 patients who were seen initially for a thoracomammary anomaly. This clinical series from plastic surgery service of Toulouse has been revised to know the importance of hand's malformations. Hand's malformations in Poland's syndrome are rare in your study, they touch only 12% patients. We find only 4 malformations in 33 patients, four were lost. They were only females, we find three brachymesophalangies and a major form. Hand's malformations in Poland's syndrome are less frequent than classically. There is no parallelism between gravity of thoracic malformation and that one of upper end. In this series, we find only one case with syndactyly; originally, Poland's syndrome was named < Poland's syndactyly >. Finally, we think that we can talk about Poland's syndrome without anomaly of homolateral upper end, the major element is musculary agenesia of sternocostal pectoralis major. The search of homolateral upper end has to be systematic in front of suspicious of Poland's syndrome.

Inertial Measurement Unit-Assisted Implantation of Pedicle Screws in Combination With an Intraoperative 3-Dimensional/2-Dimensional Visualization of the Spine.

PubMed

Jost, Gregory F; Walti, Jonas; Mariani, Luigi; Schaeren, Stefan; Cattin, Philippe

2018-05-30

Inertial measurement units (IMUs) are microelectromechanical systems used to track orientation and motion. To use instruments mounted with IMUs in combination with a 3- and 2-dimensional (3D/2D) rendering of the computed-tomography scan (CT) to guide implantation of pedicle screws. Pedicle screws were implanted from T1 to S1 in 2 human cadavers. A software application enabled the surgeon to select the starting points and trajectories on a 3D/2D image of the spine, then locate these starting points on the exposed spine and apply the IMU-mounted instruments to reproduce the trajectories. The position of the screws was evaluated on the postoperative CT scan. A total of 72 pedicle screws were implanted. Thirty-seven (77%) of the thoracic screws were within the pedicle (Heary I), 7 (15%) showed a lateral breach of the pedicle, and 4 (8%) violated the anterior or lateral vertebral body (Heary III). In the lumbar spine and S1, 21 screws (88%) were within the pedicle (Gertzbein 0), 2 (8%) screws had a pedicle wall breach < 2 mm (Gertzbein 1), and 1 > 2 to < 4 mm (Gertzbein 2). In the second cadaver, the position was compared to the intraoperatively shown virtual position. The median offset was 3°(mean 3° ± 2°, variance 5, range 0°-9°) in the sagittal plane and 3° (mean 4° ± 3°, variance 9, range 0°-12°) in the axial plane. IMU-assisted implantation of pedicle screws combined with an intraoperative 3D/2D visualization of the spine enabled the surgeon to precisely implant pedicle screws on the exposed spine.

Cervical spine alignment in the youth football athlete: recommendations for emergency transportation.

PubMed

Treme, Gehron; Diduch, David R; Hart, Jennifer; Romness, Mark J; Kwon, Michael S; Hart, Joseph M

2008-08-01

Substantial literature exists regarding recommendations for the on-field treatment and subsequent transportation of adult collision-sport athletes with a suspected injury to the cervical spine. To develop an evidence-based recommendation for transportation of suspected spine-injured youth football players. Descriptive laboratory study. Three lateral radiographs were obtained in supine to include the occiput to the cervical thoracic junction from 31 youth football players (8-14 years). Each child was imaged while wearing helmet and shoulder pads, without equipment, and with shoulder pads only. Two independent observers measured cervical spine angulation as Cobb angle from C1 to C7 and subaxial angulation from C2 to C7. We calculated intraclass correlation coefficients for intraobserver reliability analysis and compared Cobb and C2 to C7 angles between equipment conditions with t tests. Interobserver analysis showed excellent reliability among measurements. Cobb and subaxial angle measurements indicated significantly greater cervical lordosis while children wore shoulder pads only, compared with the other 2 conditions (no equipment and helmet and shoulder pads) (P .05). Equipment removal for the youth football athlete with suspected cervical spine injury should abide by the "all or none" policy that has been widely accepted for adult athletes. Helmet and shoulder pads should be left in place during emergency transport of the suspected spine-injured youth athlete. Despite differences in head to torso size ratios between youth and adult players, helmet removal alone is not recommended for either during emergency transportation.

Restrained Differential Growth: The Initiating Event of Adolescent Idiopathic Scoliosis?

PubMed

Crijns, Tom Joris; Stadhouder, Agnita; Smit, Theodoor Henri

2017-06-15

An experimental model study and a short review of literature. The purpose of this study was to explore a new hypothesis suggesting that the curvatures seen in adolescent idiopathic scoliosis (AIS) originate from restrained differential growth between the vertebral column and the surrounding musculo-ligamentary structures. Despite decades of research, there is no generally accepted theory on the physical origin of the severe spinal deformations seen in AIS. The prevailing theories tend to focus on left-right asymmetry, rotational instability, or the sagittal spinal profile in idiopathic scoliosis. We test our hypothesis with a physical model of the spine that simulates growth, counteracted by ligaments and muscles, modeled by tethers and springs. Growth of the spine is further restrained by an anterior band representing the thorax, the linea alba, and abdominal musculature. We also explore literature in search of molecular mechanisms that may induce differential growth. Differential growth in the restrained spine model first induces hypokyphosis and mild lateral bending of the thoracic spine, but then suddenly escalates into a scoliotic deformity, consistent with clinical observations of AIS. The band simulating the ventral structures of the body had a pivotal effect on sagittal curvature and the initiation of lateral bending and rotation. In literature, several molecular mechanisms were found that may explain the occurrence of differential growth between the spine and the musculo-ligamentary structures. While AIS is a three-dimensional deformation of the spine, it appears that restrained differential growth in the sagittal plane can result in lateral bending and rotation without a pre-existing left-right asymmetry. This supports the concept that AIS may result from a growth imbalance rather than a local anatomical defect. N/A.

How the spine differs in standing and in sitting-important considerations for correction of spinal deformity.

PubMed

Hey, Hwee Weng Dennis; Teo, Alex Quok An; Tan, Kimberly-Anne; Ng, Li Wen Nathaniel; Lau, Leok-Lim; Liu, Ka-Po Gabriel; Wong, Hee-Kit

2017-06-01

The current prevailing school of thought in spinal deformity surgery is to restore sagittal balance with reference to the alignment of the spine when the patient is standing. This strategy, however, likely accounts for increased rates of proximal junctional failure. The purpose of this study was to investigate the differences between the spine in standing and sitting positions as these may elucidate reasons for deformity correction failure. A prospective, comparative study of 58 healthy patients presenting to a tertiary hospital over a 6-month period was carried out. All patients presenting with a less than 3-month history of first episode lower back pain were included. Patients who had radicular symptoms, red flag symptoms, previous spine surgery, or visible spinal deformity during forward bending test were excluded. Pregnant patients were also excluded. Radiographic measurements including sagittal vertical axis (SVA), lumbar lordosis (LL), thoracolumbar angle (TL), thoracic kyphosis (TK), cervical lordosis (CL), pelvic incidence (PI), and pelvic tilt (PT) were collected. The sagittal apex and end vertebrae of all radiographs were also recorded. Basic demographic data (age, gender, and ethnicity) was recorded. Lateral standing and sitting radiographs were obtained using EOS technology. Statistical analysis was performed to compare standing and sitting parameters using chi-square tests for categorical variables and paired t tests for continuous variables. Taking the standing position as the reference point, forward displacement of the SVA occurred during sitting by a mean of 6.39±3.87 cm (p<.001). This was accompanied by a reduction of LL and TK by a mean of 24.63±12.70° (p<.001) and 8.56±7.21°(p<.001), respectively. The TL became more lordotic by a mean of 3.25±7.30° (p<.001). The CL only reached borderline significance (p=.047) for increased lordosis by a mean of 3.45±12.92°. The PT also increased by 50% (p<.001). Despite relatively constant end vertebrae, the apex vertebra moved inferiorly for the thoracic curve (p<.006) and superiorly for the lumbar curve (p<.001) by approximately one vertebral level each. Sagittal spinal alignment changes significantly between standing and sitting positions. Understanding these differences is crucial to avoid overcorrection of LL, which may occur if deformity correction is based solely on the spine's standing sagittal profile. Copyright © 2016 Elsevier Inc. All rights reserved.

Comparison between cranial thoracic intervertebral disc herniations in German Shepherd dogs and other large breed dogs.

PubMed

Gaitero, Luis; Nykamp, Stephanie; Daniel, Rob; Monteith, Gabrielle

2013-01-01

Cranial thoracic intervertebral disc herniations have been reported to be rare in dogs due to the presence of the intercapital ligament, however some studies have proposed they may not be uncommon in German Shepherd dogs. The purpose of this retrospective study was to compare cranial thoracic intervertebral disc herniations in German Shepherd dogs and other large breed dogs (control group). Medical records at the Ontario Veterinary College were searched for German Shepherd dogs and other large breed dogs that had magnetic resonance imaging studies including the T1-T9 region. For each dog and each disc space from T1-T9, three variables (compression, disc degeneration, and herniation) were recorded and graded based on review of sagittal T2-weighted images. Twenty-three German Shepherd dogs and 47 other large breed dogs met inclusion criteria. The German Shepherd dog group had higher scores than the control group for compression (P = 0.0099) and herniation (P < 0.001), but not disc degeneration (P = 0.97). In the German Shepherd dog group, intervertebral discs T2-T3 and T4-T5 had an increased risk for compression and T3-T4 had an increased risk for compression and herniation. Findings from this study indicated that German Shepherd dogs may be more likely than other large breed dogs to have spinal cord compression due to cranial thoracic disc herniations. Imaging of the cranial thoracic spine, including T2-T3, is recommended for German Shepherd dogs with T3-L3 neurological signs. © 2012 Veterinary Radiology & Ultrasound.

Occupant thorax response variations due to arm position and restraint systems in side impact crash scenarios.

PubMed

Gierczycka, Donata; Cronin, Duane S

2017-09-01

Recent epidemiological studies have identified that thoracic side airbags may vary in efficacy to reduce injury severity in side impact crash scenarios, while previous experimental and epidemiological studies have presented contrasting results. This study aimed to quantify the variations in occupant response in side impact conditions using a human body computational model integrated with a full vehicle model. The model was analyzed for a Moving Deformable Barrier side impact at 61km/h to assess two pre-crash arm positions, the incorporation of a seatbelt, and a thorax air bag on thorax response. The occupant response was evaluated using chest compression, the viscous criterion and thoracic spinal curvature. The arm position accounted for largest changes in the thorax response (106%) compared to the presence of the airbag and seatbelt systems (75%). It was also noted that the results were dependant on the method and location of thorax response measurement and this should be investigated further. Assessment using lateral displacement of the thoracic spine correlated positively with chest compression and Viscous Criterion, with the benefit of evaluating whole thorax response and provides a useful metric to compare occupant response for different side impact safety systems. The thoracic side airbag was found to increase the chest compression for the driving arm position (+70%), and reduced the injury metrics for the vertical arm position (-17%). This study demonstrated the importance of occupant arm position on variability in thoracic response, and provides insight for future design and optimization of side impact safety systems. Copyright © 2017 Elsevier Ltd. All rights reserved.

Combined microwave ablation and minimally invasive open decompression for the management of thoracic metastasis in breast cancer.

PubMed

Liu, Bin; Yuan, Zhenchao; Wei, Chang Yuan

2018-01-01

The incidence rate of thoracic metastasis from breast cancer is increasing. Microwave ablation is one type of clinical therapy used to treat metastatic spine disease, although it can cause protein denaturation and immediate cell death, and coagulative necrosis can occur. Minimally invasive open decompression is associated with lower rates of surgical complications in comparison to traditional open surgery. Therefore, it is an alternative therapeutic option for spinal metastases. This study aimed to assess the efficacy of microwave ablation with minimally invasive open decompression in the management of breast cancer patients with thoracic metastasis. This single-institution retrospective study investigated 23 cases of thoracic metastasis from breast cancer treated with combined microwave ablation and minimally invasive open decompression. Patients that presented with indications for surgery underwent surgical treatment. Data were collected for pain scores, the Frankel Grade classification system for acute spinal injury, the Karnofsky performance status (KPS) scale and complications due to treatment. Of the 23 patients included in this study, all were successfully treated with microwave ablation and minimal invasive open decompression using our metrics. Of those, 18 patients (78.3%) showed improvement in their KPS results while 5 (21.7%) had alleviation of KPS. All 23 patients showed improvement in their Frankel Grade, suggesting improved neurological function following surgery. Most of the patients reported pain relief. Postoperative complications occurred in 4 patients. Microwave ablation combined with minimally invasive open decompression therapy for breast cancer patients with thoracic metastatic tumors is an alternative treatment that maintains or improves functional outcome in comparison to open surgery.

A novel spinal kinematic analysis using X-ray imaging and vicon motion analysis: a case study.

PubMed

Noh, Dong K; Lee, Nam G; You, Joshua H

2014-01-01

This study highlights a novel spinal kinematic analysis method and the feasibility of X-ray imaging measurements to accurately assess thoracic spine motion. The advanced X-ray Nash-Moe method and analysis were used to compute the segmental range of motion in thoracic vertebra pedicles in vivo. This Nash-Moe X-ray imaging method was compared with a standardized method using the Vicon 3-dimensional motion capture system. Linear regression analysis showed an excellent and significant correlation between the two methods (R2 = 0.99, p < 0.05), suggesting that the analysis of spinal segmental range of motion using X-ray imaging measurements was accurate and comparable to the conventional 3-dimensional motion analysis system. Clinically, this novel finding is compelling evidence demonstrating that measurements with X-ray imaging are useful to accurately decipher pathological spinal alignment and movement impairments in idiopathic scoliosis (IS).

Two-Stage Surgical Management of Multilevel Symptomatic Thoracic Haemangioma Using Ethanol and Iliac Crest Bone Graft

PubMed Central

Brahmajoshyula, Venkatramana; Mayi, Shivanand; Teegala, Suman

2014-01-01

This article presents a 56-year-old obese female who presented with back pain and progressive weakness in her lower limbs for three months. She was bed-ridden for one week before reporting to our hospital. Plain radiographs showed vertical striations in multiple vertebrae classical of haemangioma. Magnetic resonance imaging (MRI) spine revealed multiple thoracic and lumbar vertebral haemangiomas. Extra osseous extension of haemangioma at T12 was causing spinal cord compression. Two-stage surgery was performed with absolute alcohol (ethanol) injection followed by pedicle screw fixation and decompression with tricortical iliac crest bone graft into the vertebral body. Postoperatively rapid neurological improvement was seen. After three weeks, she could walk independently. One year later, computed tomography showed complete incorporation of bone graft and maintained vertebral body height. MRI showed complete resolution of the cord edema at T12. These findings indicated diminished vascularity of the tumor. PMID:25187869

The thoracic paraspinal shadow: normal appearances.

PubMed

Lien, H H; Kolbenstvedt, A

1982-01-01

The width of the right and left thoracic paraspinal shadows were measured at all levels in 200 presumably normal individuals. The paraspinal shadow could be identified in nearly all cases on the left side and in approximately one-third on the right. The range of variation was greater on the left side than one the right. The left paraspinal shadow was wider at the upper levels and in individuals above 40 years of age.

Health-related quality of life in children with thoracic insufficiency syndrome.

PubMed

Vitale, Michael G; Matsumoto, Hiroko; Roye, David P; Gomez, Jaime A; Betz, Randal R; Emans, John B; Skaggs, David L; Smith, John T; Song, Kit M; Campbell, Robert M

2008-03-01

The traditional techniques to treat thoracic insufficiency syndrome (TIS) are not able to stabilize or improve chest wall size or pulmonary function while allowing spine growth. To this end, vertical expandable prosthetic titanium rib (VEPTR) was specifically designed to treat TIS by allowing growth of the thoracic cavity and control/correction of spine deformity. The purpose of this study was to determine quality of life (QOL) of children with TIS and its impact on their parents before and after implantation of the VEPTR and also compare these results to those of healthy children. As part of the original multicenter evaluation of the VEPTR, a Child Health Questionnaire (CHQ) was collected preoperatively on 45 patients who were subsequently treated with expansion thoracoplasty using the VEPTR. The average age was 8.2 +/- 2.6 years, and the parent form of the CHQ was filled out by the primary caretaker. Patients were divided into 3 diagnostic categories: rib fusion (n = 15), hypoplastic thorax syndromes (n = 17), and progressive spinal deformity (n = 13). There were significant differences between the study patients and healthy children in physical domains. Compared with parents of healthy children, parents of children with TIS experienced more limitations on their time and emotional lives due to their children's health problems. There were no significant differences in CHQ before and after the surgery except for a significant decrease in the self-esteem among a subgroup of patients with hypoplastic thorax syndromes. There were no significant differences in postoperative QOL between patients who had VEPTR-related complications and patients who did not have the complications. The children with TIS had lower physical scores and higher caregiver burden scores than healthy children. However, the scores in psychosocial domains were similar to those in healthy children. Our study demonstrated that QOL of children and burden of care in their parents remained the same after VEPTR instrumentation. Children's QOL seemed to be not affected by whether they had VEPTR-related complications or not.

The six degrees of freedom motion of the human head, spine, and pelvis in a frontal impact.

PubMed

Lopez-Valdes, F J; Riley, P O; Lessley, D J; Arbogast, K B; Seacrist, T; Balasubramanian, S; Maltese, M; Kent, R

2014-01-01

The goal of this study is to characterize the in situ 6-degree-of-freedom kinematics of the head, 3 vertebrae (T1, T8, and L2), and the pelvis in a 40 km/h frontal impact. Three postmortem human surrogates (PMHS) were exposed to a deceleration of 15 g over 125 ms and the motion of selected anatomical structures (head, T1, T8, L2, and pelvis) was tracked at 1000 Hz using an optoelectric stereophotogrammetric system. Displacements of the analyzed structures are reported in the sagittal and the transverse planes. Rotations of the structures are described using the finite helical axis of the motion. Anterior displacements were 530.5 ± 39.4 mm (head), 434.7 ± 20.0 mm (T1), 353.3 ± 29.6 mm (T8), 219.9 ± 19.3 mm (L2), and 78.9 ± 22.1 mm (pelvis). The ratio between peak anterior and lateral displacement was up to 19 percent (T1) and 26 percent (head). Magnitudes of the rotation of the head (69.9 ± 1.5°), lumbar (66.5 ± 9.1°), and pelvis (63.8 ± 11.8°) were greater than that of the thoracic vertebrae (T1: 49.1 ± 7.8°; T8: 47.7 ± 6.3°). Thoracic vertebrae exhibited a complex rotation behavior caused by the asymmetric loading of the shoulder belt. Rotation of the lumbar vertebra and pelvis occurred primarily within the sagittal plane (flexion). Despite the predominance of the sagittal motion of the occupant in a pure (12 o'clock) frontal impact, the asymmetry of belt loading induced other relevant displacements and rotations of the head and thoracic spine. Attempts to model occupant kinematics in a frontal impact should consider these results to biofidelically describe the interaction of the torso with the belt.

‘Serpent in the spine’: a case of giant spinal ependymoma of cervicothoracic spine

PubMed Central

Arrifin, Arlizan; Kaliaperumal, Chandrasekaran; Keohane, Catherine; O'Sullivan, Michael

2012-01-01

We describe a case of giant spinal ependymoma of cervicothoracic spine in a 30-year-old lady who presented with progressive spastic paraparesis and significant combined upper and lower motor neuron signs in her lower limbs over a 1-year period. She also had upper limb small muscle wasting with absent reflexes and diminished sensation. She was wheel chair bound with involvement of sphincters. Neuroimaging revealed a uniformly enhancing intramedullary lesion from C2–T3 level with associated syringomyelia. She underwent a complete excision of this World Health Organisation (WHO) II cellular ependymoma, resulting in significant clinical outcome and improvement in bladder and bowel function. PMID:22739334

Surgical Removal of Circumferentially Leaked Polymethyl Methacrylate in the Epidural Space of the Thoracic Spine after Percutaneous Vertebroplasty

PubMed Central

Kita, Kenichiro; Takata, Yoichiro; Higashino, Kosaku; Yamashita, Kazuta; Tezuka, Fumitake; Sakai, Toshinori; Nagamachi, Akihiro; Sairyo, Koichi

2017-01-01

Background  The major complication of percutaneous vertebroplasty (PVP) using polymethyl methacrylate (PMMA) is epidural leakage of PMMA that damages the spinal cord. Methods  This is a case report. Result  A 77-year-old man presented to our institution with a 6-month history of muscle weakness and an intolerable burning sensation of both lower limbs after PVP with PMMA for thoracic compression fracture at T7 at another hospital. His past medical history was significant for hypertension. He had no history of smoking and alcohol. Computed tomography revealed massive leakage of PMMA into the T6 and T7 spinal canal circumferentially surrounding the spinal cord that caused marked encroachment of the thecal sac. Magnetic resonance images revealed cord compression and intramedullary signal change from T6 to T7 level. After we verified that the leaked PMMA could be easily detached from the dura mater in the cadaveric lumbar spine, surgical decompression and removal of epidural PMMA was performed. The leaked PMMA was carefully thinned down with a high-speed diamond burr. Eight pieces of PMMA were detached from the dura mater easily without causing a dural tear. No neurologic deterioration was observed in the postoperative period. The burning sensation resolved, but the muscle weakness remained unchanged. One and a half years postoperatively, the muscle weakness has improved to ⅘ on the manual muscle strength test, but he could not walk without an aid because of spasticity. Conclusion  This report demonstrates the catastrophic epidural extrusion of PMMA following PVP. Extravasated PMMA can be removed through a working space created by means of laminectomy and subtraction of the affected pedicle. Spine surgeons should recognize the possible neurologic complications of PVP and be prepared to treat them using suitable approaches. PMID:28825011

Biomechanical Evaluation of a Growth-Friendly Rod Construct

PubMed Central

Galvis, Sarah; Arnold, Josh; Mannen, Erin; Wong, Benjamin; Sis, Hadley; Cadel, Eileen; Anderson, John; Anderson, Dennis; Arnold, Paul; Friis, Elizabeth

2017-01-01

Background Distraction type rods mechanically stabilize the thorax and improve lung growth and function by applying distraction forces at the rib, spine, pelvis, or a combination of locations. However, the amount of stability the rods provide and the amount the thorax needs is unknown. Methods Five freshly frozen and thawed cadaveric thoracic spine specimens were tested lateral bending, flexion/extension, and axial rotation in displacement control (1°/sec) to a load limit of ± 5 Nm for five cycles after which a growth-friendly unilateral rod was placed in a simulated rib-to-lumbar attachment along the right side. The specimens were tested again the same modes of bending. From the seven Optotrak Orthopedic Research Pin markers (Northern Digital Inc., Waterloo, ON, Canada) inserted into the top potting to denote T1, and the right pedicles at T2, T4, T5, T8, T9, and T11 and the Standard Needle Tip Pressure Transducers (Gaeltech, Isle of Skye, Scotland) inserted into the T4/T5 and T8/T9 discs, motion, stiffness, and pressure data were calculated. Parameters from the third cycle of the intact case and the construct case were compared using two-tailed paired t-tests with 0.05 as the level of significance. Results With the construct attached, the T1–T4 segment showed a 30% increase in NZS during extension (p = 0.001); the T8–T12 segment experienced a 63% reduction in the in-plane ROM during flexion (p = 0.04); and the T8/T9 spinal motion unit had a significant decrease of 24% in EZS during left axial rotation (p = 0.04). Conclusions It’s clear the device as tested here does not produce large biomechanical changes, but the balance between providing desired changes while preventing complications remains difficult. Clinical Relevance Investigating the biomechanical effect growth-friendly rods have on the thoracic spine could lead to better understanding of treatment outcomes, both positive and negative. PMID:28038688