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Medicine › Surgery

Spinal Fractures and Fixation Techniques

Works Count: 72464

Description

This cluster of papers encompasses advancements in spine surgery techniques and technologies, including vertebroplasty, pedicle screw fixation, kyphoplasty, and robotic-assisted surgery. It explores topics such as spinal fractures, cervical spine injury, osteoporotic compression fractures, and the biomechanics of spine surgery. The use of navigation techniques and percutaneous vertebroplasty are also prominent themes in this cluster.

Keywords

Vertebroplasty; Pedicle Screw Fixation; Kyphoplasty; Spinal Fractures; Cervical Spine Injury; Osteoporotic Compression Fractures; Robotic-assisted Surgery; Biomechanics; Navigation Techniques; Percutaneous Vertebroplasty

Atlanto-axial rotatory fixation. (Fixed rotatory subluxation of the atlanto-axial joint)

1977-01-01
Fielding Jw , RJ Hawkins
In seventeen cases of irreducible atlanto-axial rotatory subluxation (here called fixation), the striking features were the delay in diagnosis and the persistent clinical and roentgenographic deformities. All patients had torticollis … In seventeen cases of irreducible atlanto-axial rotatory subluxation (here called fixation), the striking features were the delay in diagnosis and the persistent clinical and roentgenographic deformities. All patients had torticollis and restricted, often painful neck motion, and seven young patients with long-standing deformity had flattening on one side of the face. The diagnosis was suggested by the plain roentgenograms and tomograms and confirmed by persistence of the deformity as demonstrated by cineroentgenography. Treatment included skull traction, followed by atlanto-axial arthrodesis if necessary. Of the thirteen patients treated by atlanto-axial arthrodesis, eleven had good results, one had a fair result, and one had not been followed for long enough to determine the result. Of the remaining four patients, one treated conservatively had not been followed for long enough to evaluate the result, two declined surgery, and one died while in traction as the result of cord transection produced by further rotation of the atlas on the axis despite the traction.

Early failure of short-segment pedicle instrumentation for thoracolumbar fractures. A preliminary report.

1993-02-01
Robert F. McLain , E. Sparling , D R Benson
The results after treatment of fifty-two lumbar and thoracolumbar fractures with Cotrel-Dubousset instrumentation were reviewed as part of an ongoing study. Nineteen patients (average duration of follow-up, fifteen months) had … The results after treatment of fifty-two lumbar and thoracolumbar fractures with Cotrel-Dubousset instrumentation were reviewed as part of an ongoing study. Nineteen patients (average duration of follow-up, fifteen months) had been managed with short-segment pedicle-screw instrumentation. This preliminary report outlines the complications and pitfalls identified during the initial healing phase in this subgroup of patients. There were no neurological or vascular injuries due to placement of the pedicle screws, but ten patients had some form of failure of the fixation during the early period of healing. Failure of the fixation was manifested in three ways: progressive kyphosis secondary to the bending of screws (six patients), kyphosis secondary to osseous collapse or vertebral translation without bending of the hardware (three patients), and segmental kyphosis after a caudad screw in the lumbar construct broke (one patient, who had had a combined instrumentation for multiple fractures). Untreated anterior instability, and pre-stressing of the screws when the rods were contoured in situ, resulted in a high rate of failure. The high rate of failure of the hardware associated with this fixation construct suggests that posterior screw fixation alone may not be adequate when Cotrel-Dubousset instrumentation is used for short-segment lumbar arthrodeses. Bent screws or measurable kyphosis did not always herald a clinical failure, but patients who had progressive kyphosis of more than 10 degrees had substantially more pain than did those who had little or no progression. The results reported here are preliminary, and speculation as to the importance of these findings and as to the long-term outcome in these patients would be premature.(ABSTRACT TRUNCATED AT 250 WORDS)

PERCUTANEOUS VERTEBROPLASTY WITH POLYMETHYLMETHACRYLATE

1998-05-01
Hervé Deramond , C. Depriester , P Galibert +1 more

Mechanical behavior of the human lumbar and lumbosacral spine as shown by three-dimensional load-displacement curves.

1994-03-01
Manohar M. Panjabi , Thomas R. Oxland , I. Yamamoto +1 more
The lumbar region is a frequent site of spinal disorders, including low-back pain, and of spinal trauma. Clinical studies have established that abnormal intervertebral motions occur in some patients who … The lumbar region is a frequent site of spinal disorders, including low-back pain, and of spinal trauma. Clinical studies have established that abnormal intervertebral motions occur in some patients who have low-back pain. A knowledge of normal spinal movements, with all of the inherent complexities, is needed as a baseline. The present study documents the complete three-dimensional elastic physical properties of each lumbar intervertebral level from the level between the first and second lumbar vertebrae through the level between the fifth lumbar and first sacral vertebrae. Nine whole fresh-frozen human cadaveric lumbar-spine specimens were used. Pure moments of flexion-extension, bilateral axial torque, and bilateral lateral bending were applied, and three-dimensional intervertebral motions were determined with use of stereophotogrammetry. The motions were presented in the form of a set of six load-displacement curves, quantitating intervertebral rotations and translations. The curves were found to be non-linear, and the motions were coupled. The ranges of motion were found to compare favorably with reported values from in vivo studies.

Plate and screw fixation for atlanto-axial subluxation

1994-03-01
Atul Goel , V. Laheri

A Mechanistic Classification of Closed, Indirect Fractures and Dislocations of the Lower Cervical Spine

1982-01-01
Ben L. Allen , Ron L. Ferguson , Thomas R. Lehmann +1 more
Closed, indirect fractures and dislocations of the lower cervical spine occur in families or groups within which there is a spectrum of anatomic damage to a cervical motion segment. This … Closed, indirect fractures and dislocations of the lower cervical spine occur in families or groups within which there is a spectrum of anatomic damage to a cervical motion segment. This study of 165 cases demonstrates the various spectra of injury, called phylogenies, and develops a classification based on the mechanism of injury. The common groups are compressive flexion, vertical compression, distractive flexion, compressive extension, distractive extension, and lateral flexion. The probability of an associated neurologic lesion relates directly to the type and severity of cervical spine injury. With use of the classification, it is possible to formulate a rational treatment plan for injuries to the cervical spine.

Spinal Instability as Defined by the Three-column Spine Concept in Acute Spinal Trauma

1984-10-01
Francis Denis
This article is a presentation of the concept of the three-column spine. The concept evolved from a retrospective review of 412 thoracolumbar spine injuries and observations on spinal instability. The … This article is a presentation of the concept of the three-column spine. The concept evolved from a retrospective review of 412 thoracolumbar spine injuries and observations on spinal instability. The posterior column consists of what Holdsworth described as the posterior ligamentous complex. The middle column includes the posterior longitudinal ligament, posterior annulus fibrosus, and posterior wall of the vertebral body. The anterior column consists of the anterior vertebral body, anterior annulus fibrosus, and anterior longitudinal ligament. Major spinal injuries are classified into four different categories, all definable in terms of the degree of involvement of each of the three columns. Each type is defined also in terms of its pathomechanics, roentgenograms, and computerized axial tomograms, as well as in terms of its particular stability. The compression fracture is basically stress failure of the anterior column with an intact middle column. The burst fracture indicates failure under compression of both the anterior and middle columns. The seat-belt-type spinal fracture is the result of failure of the posterior and middle columns under tension with an intact anterior hinge. In fracture-dislocations, the structure of all three columns fails from forces acting to various degrees from one or another direction.

Free Hand Pedicle Screw Placement in the Thoracic Spine: Is it Safe?

2004-01-29
Yongjung J. Kim , Lawrence G. Lenke , Keith H. Bridwell +2 more
A retrospective study.To evaluate the safety of a free hand technique of pedicle screw placement in the thoracic spine at a single institution over a 10-year experience.Thoracic pedicle screw fixation … A retrospective study.To evaluate the safety of a free hand technique of pedicle screw placement in the thoracic spine at a single institution over a 10-year experience.Thoracic pedicle screw fixation techniques are still controversial for thoracic deformities because of possible complications including neurologic.Three hundred ninety-four consecutive patients who underwent posterior stabilization utilizing 3204 transpedicular thoracic screws by 2 surgeons from 1992 to 2002 were analyzed. The mean age was 27 + 10 years (range 5 + 3-87 + 0 years) at the time of surgery. Etiologic diagnoses were: scoliosis in 273, kyphosis in 53, other spinal disease in 68. Pedicle screws were inserted using a free hand technique similar to that used in the lumbar spine in which anatomic landmarks and specific entry sites were used to guide the surgeon. A 2-mm tip pedicle probe was carefully advanced free hand down the pedicle into the body. Careful palpation of all bony borders (floor and four pedicle walls) was performed before and after tapping. Next, the screw was placed, followed by neurophysiologic (screw stimulation with rectus abdominus muscle recording) and radiographic (anteroposterior and lateral) confirmation. An independent spine surgeon using medical records and roentgenograms taken during treatment and follow-up reviewed all the patients.The number of the screws inserted at each level were as follows (total n = 3204): T1, n = 13; T2, n = 60; T3, n = 192; T4, n = 275; T5, n = 279; T6, n = 240; T7, n = 230; T8, n = 253; T9, n = 259; T10, n = 341; T11, n = 488; T12, n = 572. Five hundred seventy-seven screws inserted into the deformed thoracic spine were randomly evaluated by thoracic computed tomography scan to assess for screw position. Thirty-six screws (6.2%) were inserted with moderate cortical perforation, which meant the central line of the pedicle screw was out of the outer cortex of the pedicle wall and included 10 screws (1.7%) that violated the medial wall. There were no screws (out of the entire study group of 3204) with any neurologic, vascular, or visceral complications with up to 10 years follow-up.The free hand technique of thoracic pedicle screw placement performed in a step-wise, consistent, and compulsive manner is an accurate, reliable, and safe method of insertion to treat a variety of spinal disorders, including spinal deformity.

Qualitative Grading of Severity of Lumbar Spinal Stenosis Based on the Morphology of the Dural Sac on Magnetic Resonance Images

2010-07-28
Constantin Schizas , Nicolas Theumann , Alexandre Burn +4 more
Retrospective radiologic study on a prospective patient cohort.To devise a qualitative grading of lumbar spinal stenosis (LSS), study its reliability and clinical relevance.Radiologic stenosis is assessed commonly by measuring dural … Retrospective radiologic study on a prospective patient cohort.To devise a qualitative grading of lumbar spinal stenosis (LSS), study its reliability and clinical relevance.Radiologic stenosis is assessed commonly by measuring dural sac cross-sectional area (DSCA). Great variation is observed though in surfaces recorded between symptomatic and asymptomatic individuals.We describe a 7-grade classification based on the morphology of the dural sac as observed on T2 axial magnetic resonance images based on the rootlet/cerebrospinal fluid ratio. Grades A and B show cerebrospinal fluid presence while grades C and D show none at all. The grading was applied to magnetic resonance images of 95 subjects divided in 3 groups as follows: 37 symptomatic LSS surgically treated patients; 31 symptomatic LSS conservatively treated patients (average follow-up, 2.5 and 3.1 years); and 27 low back pain (LBP) sufferers. DSCA was also digitally measured. We studied intra- and interobserver reliability, distribution of grades, relation between morphologic grading and DSCA, as well relation between grades, DSCA, and Oswestry Disability Index.Average intra- and interobserver agreement was substantial and moderate, respectively (k = 0.65 and 0.44), whereas they were substantial for physicians working in the study originating unit. Surgical patients had the smallest DSCA. A larger proportion of C and D grades was observed in the surgical group. Surface measurements resulted in overdiagnosis of stenosis in 35 patients and under diagnosis in 12. No relation could be found between stenosis grade or DSCA and baseline Oswestry Disability Index or surgical result. C and D grade patients were more likely to fail conservative treatment, whereas grades A and B were less likely to warrant surgery.The grading defines stenosis in different subjects than surface measurements alone. Since it mainly considers impingement of neural tissue it might be a more appropriate clinical and research tool as well as carrying a prognostic value.

Initial Outcome and Efficacy of “Kyphoplasty” in the Treatment of Painful Osteoporotic Vertebral Compression Fractures

2001-07-01
Isador H. Lieberman , Sean Dudeney , Mary Kay Reinhardt +1 more
Study Design. An Institutional Review Board-approved Phase I efficacy study of inflatable bone tamp usage in the treatment of symptomatic osteoporotic compression fractures. Objectives. To evaluate the safety and efficacy … Study Design. An Institutional Review Board-approved Phase I efficacy study of inflatable bone tamp usage in the treatment of symptomatic osteoporotic compression fractures. Objectives. To evaluate the safety and efficacy of inflatable bone tamp reduction and cement augmentation, “kyphoplasty,” in the treatment of painful osteoporotic vertebral compression fractures. Summary of Background Data. Osteoporotic compression fractures can result in progressive kyphosis and chronic pain. Traditional treatment for these patients includes bed rest, analgesics, and bracing. Augmentation of vertebral compression fractures with polymethylmethacrylate, “vertebroplasty,” has been used to treat pain. This technique, however, makes no attempt to restore the height of the collapsed vertebral body. Kyphoplasty is a new technique that involves the introduction of inflatable bone tamps into the vertebral body. Once inflated, the bone tamps restore the vertebral body back toward its original height while creating a cavity that can be filled with bone cement. Patients and Methods. Seventy consecutive kyphoplasty procedures were performed in 30 patients. The indications included painful primary or secondary osteoporotic vertebral compression fractures. Mean duration of symptoms was 5.9 months. Symptomatic levels were identified by correlating the clinical data with MRI findings. Perioperative variables and bone tamp complications or issues were recorded and analyzed. Preoperative and postoperative radiographs were compared to calculate the percentage height restored. Outcome data were obtained by comparing preoperative and latest postoperative SF-36 data. Results. At the completion of the Phase I study there were no major complications related directly to use of this technique or use of the inflatable bone tamp. In 70% of the vertebral bodies kyphoplasty restored 47% of the lost height. Cement leakage occurred at six levels (8.6 %). SF-36 scores for Bodily Pain 11.6–58.7, (P = 0.0001) and Physical Function 11.7–47.4, (P = 0.002) were among those that showed significant improvement. Conclusions. The inflatable bone tamp was efficacious in the treatment of osteoporotic vertebral compression fractures. Kyphoplasty is associated with early clinical improvement of pain and function as well as restoration of vertebral body height in the treatment of painful osteoporotic compression fractures.

The Three Column Spine and Its Significance in the Classification of Acute Thoracolumbar Spinal Injuries

1983-11-01
Francis Denis
From a retrospective study of 412 thoracolumbar injuries, the author introduces the concept of middle column or middle osteoligamentous complex between the traditionally recognized posterior ligamentous complex and the anterior … From a retrospective study of 412 thoracolumbar injuries, the author introduces the concept of middle column or middle osteoligamentous complex between the traditionally recognized posterior ligamentous complex and the anterior longitudinal ligament. This middle column is formed by the posterior wall of the vertebral body, the posterior longitudinal ligament and posterior annulus fibrosus. The third column appears crucial, as the mode of its failure correlates both with the type of spinal fracture and with its neurological injury. Spinal injuries were subdivided into minor and major. Minor injuries are represented by fractures of transverse processes, facets, pars interarticularis, and spinous process. Major spinal injuries are classified into four different categories: compression fractures, burst fractures, seat-belt-type injuries, and fracture dislocations. These four well-recognized injuries have been studied carefully in clinical terms as well as on roentgenograms and computerized axial tomograms. They were then subdivided into subtypes demonstrating the very wide spectrums of these four entities. The correlation between the three-column system, the classification, the stability, and the therapeutic indications are presented.

Complications Associated with the Technique of Pedicle Screw Fixation A Selected Survey of ABS Members

1993-11-01
Stephen I. Esses , Barton L. Sachs , Vadim Dreyzin
A limited survey analysis of 617 surgical cases in which pedicle screw implants were used was undertaken to ascertain the incidence and variety of associated complications. The different implant systems … A limited survey analysis of 617 surgical cases in which pedicle screw implants were used was undertaken to ascertain the incidence and variety of associated complications. The different implant systems used included variable spinal plating (n = 249), Edwards (n = 143), and AO fixateur interne (n = 101). The most common intraoperative problem was unrecognized screw misplacement (5.2%). Fracturing of the pedicle during screw insertion and iatrogenic cerebrospinal fluid leak occurred in 4.2% of cases. The postoperative deep infection rate was 4.2%. Transient neuropraxia occurred in 2.4% of cases, and permanent nerve root injury occurred in 2.3% of cases. Previously unreported injury to nerve roots occurred late in the postoperative course in three cases. Screw breakage occurred in 2.9% of cases. All other complications had an incidence of less than 2%. The authors conclude that pedicle screw placement may be associated with significant intraoperative and postoperative complications. This information is of value to surgeons using pedicle implant systems as well as to their patients. Repeat surgery is associated with greater numbers of complications.

Posterior C1–C2 Fusion With Polyaxial Screw and Rod Fixation

2001-11-01
J. Harms , Robert P. Melcher
A novel technique of atlantoaxial stabilization using individual fixation of the C1 lateral mass and the C2 pedicle with minipolyaxial screws and rods is described. In addition, the initial results … A novel technique of atlantoaxial stabilization using individual fixation of the C1 lateral mass and the C2 pedicle with minipolyaxial screws and rods is described. In addition, the initial results of this technique on 37 patients are described.To describe the technique and the initial clinical and radiographic results for posterior C1-C2 fixation with a new implant system.Stabilization of the atlantoaxial complex is a challenging procedure because of the unique anatomy of this region. Fixation by transarticular screws combined with posterior wiring and structural bone grafting leads to excellent fusion rates. The technique is technically demanding and has a potential risk of injury to the vertebral artery. In addition, this procedure cannot be used in the presence of fixed subluxation of C1 on C2 and in the case of an aberrant path of the vertebral artery. To address these limitations, a new technique of C1-C2 fixation has been developed: bilateral insertion of polyaxial-head screws in the lateral mass of C1 and through the pars interarticularis into the pedicle of C2, followed by a fluoroscopically controlled reduction maneuver and rod fixation.After posterior exposure of the C1-C2 complex, the 3.5-mm polyaxial screws are inserted in the lateral masses of C1. Two polyaxial screws are then inserted into the pars interarticularis of C2. Drilling is guided by anatomic landmarks and fluoroscopy. If necessary, reduction of C1 onto C2 can be accomplished by manipulation of the implants, followed by fixation to the 3-mm rod. For definitive fusion, cancellous bone can be added. No structural bone graft or wiring is required. In selected cases, e.g., C1-C2 subluxation or fractures in young patients in whom only temporary fixation is necessary, the instrumentation can be removed after an appropriate time. Because the joint surfaces stay intact, the patient can regain motion in the C1-C2 joints.Thirty-seven patients underwent this procedure. No neural or vascular damage related to this technique has been observed. The early clinical and radiologic follow-up data indicate solid fusion in all patients.Fixation of the atlantoaxial complex using polyaxial-head screws and rods seems to be a reliable technique and should be considered an efficient alternative to the previously reported techniques.

Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial

2009-02-25
Douglas Wardlaw , Steven R. Cummings , Jan Van Meirhaeghe +7 more

The clinical consequences of vertebral compression fracture

1992-01-01
Stuart L. Silverman

Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques

2011-09-06
Ioannis D. Gelalis , Nikolaos K. Paschos , Emilios E. Pakos +5 more
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Internal Fixation of the Lumbar Spine with Pedicle Screw Plating

1986-02-01
R Roy-Camille , G Saillant , Christian Mazel
The results and complications of pedicle screw plate (PSP) stabilizations were investigated in lumbar fresh fractures, malunions, lumbar metastases, primary tumors, lumbosacral fusions, and highgrade spondylolisthesis. The low incidence of … The results and complications of pedicle screw plate (PSP) stabilizations were investigated in lumbar fresh fractures, malunions, lumbar metastases, primary tumors, lumbosacral fusions, and highgrade spondylolisthesis. The low incidence of neurologic complications of PSP is noteworthy, and a reason for recommending the method.

Effects of Bone Mineral Density on Pedicle Screw Fixation

1994-11-01
Thomas L. Halvorson , Lee Ann Kelley , Kevin A. Thomas +2 more
Study Design In an attempt to evaluate the effects of bone mineral density on the quality of fixation of pedicle screws in the lumbar spine, the axial pullout force was … Study Design In an attempt to evaluate the effects of bone mineral density on the quality of fixation of pedicle screws in the lumbar spine, the axial pullout force was determined and compared in normal and osteoporotic human lumbar spines. Objectives Four techniques of screw hole preparation were evaluated. Two pedicle screw/offset laminar hook constructs also were evaluated to determine whether the adjunct fixation of the laminar hooks would improve quality of fixation to a level sufficient to allow their use in the osteoporotic lumbar spine. Methods Pedicle screws were inserted by one of the listed techniques into fresh frozen cadaveric human spines. The fixation strength then was evaluated by pullout on a uniaxial testing frame. Results Bone mineral density was a strong influence on axial pullout force. In normal bone, the method of screw hole preparation did not significantly affect the quality of fixation. However, in the osteoporotic spine, either an untapped screw hole or the tapping of a screw hole with a 5.5 mm tap improved the pullout force a statistically significant amount (P < 0.003). Also, a pedicle screw with offset hooks at two adjacent levels improved the fixation significantly, increasing the pullout force to twice the expected value. Conclusion Pedicle screw pullout strength was highly correlated with bone mineral density. A 5.5 mm tap or preparation with a ganglion knife improved pullout strength. Use of pedicle screws in conjunction with laminar hooks at two levels improved pullout strength.

Segmental Pedicle Screw Fixation in the Treatment of Thoracic Idiopathic Scoliosis

1995-06-01
Se-ll Suk , Choon‐Ki Lee , Won-Joong Kim +2 more
This retrospective clinical study compared the results of correction of idiopathic thoracic scoliosis using Cotrel-Dubousset segmental pedicle screw fixation with those of hooks and screws inserted in a hook pattern.The … This retrospective clinical study compared the results of correction of idiopathic thoracic scoliosis using Cotrel-Dubousset segmental pedicle screw fixation with those of hooks and screws inserted in a hook pattern.The study's objective was to evaluate the efficacy and safety of segmental pedicle screw fixation in the management of idiopathic thoracic scoliosis.Seventy-eight idiopathic thoracic scoliosis patients were treated with Cotrel-Dubousset instrumentation from 1987 to 1991. Thirty-one were treated with hooks; 23 were treated with pedicle screws inserted in a hook pattern; and 24 were treated with segmental pedicle screws.After a minimum follow-up of 2 years (range, 25-52 months), the results of frontal, sagittal, and rotational correction of each group were compared and statistically analyzed using analysis of variance.Major curve correction was 55% with hooks, 66% with hook pattern screws, and 72% with segmental screws, with loss of correction of 6%, 2%, and 1%, respectively. Compensatory curve correction was 57% with hooks, 67% with hook pattern screws, and 70% with segmental pedicle screws. In patients with hypokyphosis, all showed significant improvement with best restoration in segmental screws. Rotational correction of the apical vertebra measured by the Perdriolle method was 19% with hooks, 26% with hook pattern screws, and 59% with segmental screws. Thirteen screws (3%) were malpositioned, but they did not cause neurologic impairment or adversely affect the results of treatment.Segmental pedicle screw fixation is a safe and effective method for correcting the triplanar deformity of the idiopathic thoracic scoliosis.

A comprehensive classification of thoracic and lumbar injuries

1994-08-01
F. Magerl , Max Aebi , S. D. Gertzbein +2 more

New Technologies in Spine

2001-07-01
Steven R. Garfin , Hansen A. Yuan , Mark A. Reiley
Literature review.To describe new treatments for painful osteoporotic compression fractures in light of available scientific literature and clinical experience.Painful vertebral osteoporotic compression fractures lead to significant morbidity and mortality. This … Literature review.To describe new treatments for painful osteoporotic compression fractures in light of available scientific literature and clinical experience.Painful vertebral osteoporotic compression fractures lead to significant morbidity and mortality. This relates to pulmonary dysfunction, eating disorders (nutritional deficits), pain, loss of independence, and mental status change (related to pain and medications). Medications to treat osteoporosis (primarily antiresorptive) do not effectively treat the pain or the fracture, and require over 1 year to reduce the degree of osteoporosis. Kyphoplasty and vertebroplasty are new techniques that help decrease the pain and improve function in fractured vertebrae.This is a descriptive review of the background leading to vertebroplasty and kyphoplasty, a description of the techniques, a review of the literature, as well as current ongoing studies evaluating kyphoplasty.Both techniques have had a very high acceptance and use rate. There is 95% improvement in pain and significant improvement in function following treatment by either of these percutaneous techniques. Kyphoplasty improves height of the fractured vertebra, and improves kyphosis by over 50%, if performed within 3 months from the onset of the fracture (onset of pain). There is some height improvement, though not as marked, along with 95% clinical improvement, if the procedure is performed after 3 months. Complications occur with both and relate to cement leakage in both, and cement emboli with vertebroplasty.Kyphoplasty and vertebroplasty are safe and effective, and have a useful role in the treatment of painful osteoporotic vertebral compression fractures that do not respond to conventional treatments. Kyphoplasty offers the additional advantage of realigning the spinal column and regaining height of the fractured vertebra, which may help decrease the pulmonary, GI, and early morbidity consequences related to these fractures. Both procedures are technically demanding.

The Fourier reconstruction of a head section

1974-06-01
L. A. Shepp , B. F. Logan
The Fourier reconstruction may be viewed simply in the spatial domain as the sum of each line integral times a weighting function of the distance from the line to the … The Fourier reconstruction may be viewed simply in the spatial domain as the sum of each line integral times a weighting function of the distance from the line to the point of reconstruction. A modified weighting function simultaneously achieves accuracy, simplicity, low computation time, as well as low sensitivity to noise. Using a simulated phantom, the authors compare the Fourier algorithm and a search algorithm. The search algorithm required 12 iterations to obtain a reconstruction of accuracy and resolution comparable to that of the Fourier reconstruction, and was more sensitive to noise. To speed the search algorithm by using fewer interactions leaves decreased resolution in the region just inside the skull which could mask a subdural hematoma.

A Biomechanical Study of Intrapeduncular Screw Fixation in the Lumbosacral Spine

1986-02-01
Michael R. Zindrick , Leon L. Wiltse , ERIC H. WIDELL +4 more
This laboratory experiment was undertaken to identify factors contributing to intrapeduncular screw fixation in the vertebra. Testing was performed in axial pull-out and cyclic loading modes using multiple screw designs … This laboratory experiment was undertaken to identify factors contributing to intrapeduncular screw fixation in the vertebra. Testing was performed in axial pull-out and cyclic loading modes using multiple screw designs inserted to various depths into fresh human lumbosacral vertebra. The degree of osteoporosis played a major role in pull-out strength. Larger diameter, full-threaded screws inserted deep enough to engage the anterior vertebral cortex resulted in the most secure fixation. In the sacrum, the second sacral pedicle was the weakest location of insertion. Screws aimed laterally into the ala at 45 or medially into the first sacral pedicle resisted larger axial pull-out loads than those inserted straight anteriorly into the ala. Methyl methacrylate was found to restore secure fixation in previously-loosened screws and pressurization of cement doubled the pull-out force. In cyclic load tests, deeper-inserted screws were found to withstand a greater number of cycles before loosening. Measurements of pedicle outer cortical diameters were found in many specimens to be smaller than both the 4.5-mm and 6.5-mm diameter screws.

AOSpine Thoracolumbar Spine Injury Classification System

2013-08-22
Alexander R. Vaccaro , F. Cumhur Öner , Christopher K. Kepler +7 more
In Brief Study Design. Reliability and agreement study, retrospective case series. Objective. To develop a widely accepted, comprehensive yet simple classification system with clinically acceptable intra- and interobserver reliability for … In Brief Study Design. Reliability and agreement study, retrospective case series. Objective. To develop a widely accepted, comprehensive yet simple classification system with clinically acceptable intra- and interobserver reliability for use in both clinical practice and research. Summary of Background Data. Although the Magerl classification and thoracolumbar injury classification system (TLICS) are both well-known schemes to describe thoracolumbar (TL) fractures, no TL injury classification system has achieved universal international adoption. This lack of consensus limits communication between clinicians and researchers complicating the study of these injuries and the development of treatment algorithms. Methods. A simple and reproducible classification system of TL injuries was developed using a structured international consensus process. This classification system consists of a morphologic classification of the fracture, a grading system for the neurological status, and description of relevant patient-specific modifiers. Forty cases with a broad range of injuries were classified independently twice by group members 1 month apart and analyzed for classification reliability using the Kappa coefficient (κ). Results. The morphologic classification is based on 3 main injury patterns: type A (compression), type B (tension band disruption), and type C (displacement/translation) injuries. Reliability in the identification of a morphologic injury type was substantial (κ= 0.72). Conclusion. The AOSpine TL injury classification system is clinically relevant according to the consensus agreement of our international team of spine trauma experts. Final evaluation data showed reasonable reliability and accuracy, but further clinical validation of the proposed system requires prospective observational data collection documenting use of the classification system, therapeutic decision making, and clinical follow-up evaluation by a large number of surgeons from different countries. Level of Evidence: 4 A simple and reproducible classification system for thoracolumbar injuries was developed by an international team. This system demonstrates acceptable intra- and interobserver reliability and includes 3 major morphologic types: compression, tension band disruption, and displacement/translation.

A Randomized Trial of Vertebroplasty for Osteoporotic Spinal Fractures

2009-08-05
David F. Kallmes , Bryan A. Comstock , Patrick J. Heagerty +7 more
Vertebroplasty is commonly used to treat painful, osteoporotic vertebral compression fractures.In this multicenter trial, we randomly assigned 131 patients who had one to three painful osteoporotic vertebral compression fractures to … Vertebroplasty is commonly used to treat painful, osteoporotic vertebral compression fractures.In this multicenter trial, we randomly assigned 131 patients who had one to three painful osteoporotic vertebral compression fractures to undergo either vertebroplasty or a simulated procedure without cement (control group). The primary outcomes were scores on the modified Roland-Morris Disability Questionnaire (RDQ) (on a scale of 0 to 23, with higher scores indicating greater disability) and patients' ratings of average pain intensity during the preceding 24 hours at 1 month (on a scale of 0 to 10, with higher scores indicating more severe pain). Patients were allowed to cross over to the other study group after 1 month.All patients underwent the assigned intervention (68 vertebroplasties and 63 simulated procedures). The baseline characteristics were similar in the two groups. At 1 month, there was no significant difference between the vertebroplasty group and the control group in either the RDQ score (difference, 0.7; 95% confidence interval [CI], -1.3 to 2.8; P=0.49) or the pain rating (difference, 0.7; 95% CI, -0.3 to 1.7; P=0.19). Both groups had immediate improvement in disability and pain scores after the intervention. Although the two groups did not differ significantly on any secondary outcome measure at 1 month, there was a trend toward a higher rate of clinically meaningful improvement in pain (a 30% decrease from baseline) in the vertebroplasty group (64% vs. 48%, P=0.06). At 3 months, there was a higher crossover rate in the control group than in the vertebroplasty group (51% vs. 13%, P<0.001) [corrected]. There was one serious adverse event in each group.Improvements in pain and pain-related disability associated with osteoporotic compression fractures in patients treated with vertebroplasty were similar to the improvements in a control group. (ClinicalTrials.gov number, NCT00068822.)
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Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial

2010-08-10
C.A.H. Klazen , Paul N.M. Lohle , Jolanda De Vries +7 more
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Adjacent Segment Disease after Lumbar or Lumbosacral Fusion: Review of the Literature

2004-08-26
Paul Park , Hugh Garton , Vishal C. Gala +2 more
Review of the literature.Review the definition, etiology, incidence, and risk factors associated with as well as potential treatment options.The development of pathology at the mobile segment next to a lumbar … Review of the literature.Review the definition, etiology, incidence, and risk factors associated with as well as potential treatment options.The development of pathology at the mobile segment next to a lumbar or lumbosacral spinal fusion has been termed adjacent segment disease. Initially reported to occur rarely, it is now considered a potential late complication of spinal fusion that can necessitate further surgical intervention and adversely affect outcomes.MEDLINE literature search.The most common abnormal finding at the adjacent segment is disc degeneration. Biomechanical changes consisting of increased intradiscal pressure, increased facet loading, and increased mobility occur after fusion and have been implicated in causing adjacent segment disease. Progressive spinal degeneration with age is also thought to be a major contributor. From a radiographic standpoint, reported incidence during average postoperative follow-up observation ranging from 36 to 369 months varies substantially from 5.2 to 100%. Incidence of symptomatic adjacent segment disease is lower, however, ranging from 5.2 to 18.5% during 44.8 to 164 months of follow-up observation. The rate of symptomatic adjacent segment disease is higher in patients with transpedicular instrumentation (12.2-18.5%) compared with patients fused with other forms of instrumentation or with no instrumentation (5.2-5.6%). Potential risk factors include instrumentation, fusion length, sagittal malalignment, facet injury, age, and pre-existing degenerative changes.Biomechanical alterations likely play a primary role in causing adjacent segment disease. Radiographically apparent, asymptomatic adjacent segment disease is common but does not correlate with functional outcomes. Potentially modifiable risk factors for the development of adjacent segment disease include fusion without instrumentation, protecting the facet joint of the adjacent segment during placement of pedicle screws,fusion length, and sagittal balance. Surgical management, when indicated, consists of decompression of neural elements and extension of fusion. Outcomes after surgery, however, are modest.

SURGERY OF EXPERIMENTAL LESION OF SPINAL CORD EQUIVALENT TO CRUSH INJURY OF FRACTURE DISLOCATION OF SPINAL COLUMN

1911-09-09
Alfred Reginald Allen
<h3>PREFATORY REMARKS</h3> In two former papers I have dwelt at length on the mechanical considerations of injury to the spinal cord in cases of fracture dislocation of the spinal column.<sup>1, … <h3>PREFATORY REMARKS</h3> In two former papers I have dwelt at length on the mechanical considerations of injury to the spinal cord in cases of fracture dislocation of the spinal column.<sup>1, 2</sup> In this communication, therefore, I shall limit myself to the discussion of the experimental work in which I have been engaged for the past year in the laboratories of the University of Pennsylvania. I would accentuate the fact that this is a preliminary report and that I am fully aware of the amount of control experimentation necessary before an<i>ex cathedra</i>statement can be made as to applicability of this work in the human subject. <h3>MEASUREMENT OF IMPACT ON SPINAL CORD IN SPINAL FRACTURE DISLOCATION</h3> In order to arrive at an adequate concept as to the amount of impact a spinal cord could receive and yet recover its function, I designed an instrument whereby a given weight could
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The Load Sharing Classification of Spine Fractures

1994-08-01
Thomas McCormack , Eldin E. Karaiković , Robert W. Gaines
A 3 to 4 year follow-up was performed on a consecutive series of 28 patients who had three-column spinal fractures surgically stabilized by short-segment instrumentation with first generation VSP (Steffee) … A 3 to 4 year follow-up was performed on a consecutive series of 28 patients who had three-column spinal fractures surgically stabilized by short-segment instrumentation with first generation VSP (Steffee) screws and plates and autograft fusion. The follow-up revealed 10 patients with broken screws.Retrospective examination of preoperative radiographs and computed tomographic axial and sagittal reconstruction images clearly demonstrated that the screw fractures all occurred in patients with a disproportionately greater amount of injury to the vertebral body.A point system (the load sharing classification) was developed that grades: 1) the amount of damaged vertebral body, 2) the spread of the fragments in the fracture site, and 3) the amount of corrected traumatic kyphosis.This point system can be used preoperatively to: 1) predict screw breakage when short segment, posteriorly placed pedicle screw implants are being used, 2) describe any spinal injury for retrospective studies, or 3) select spinal fractures for anterior reconstruction with strut graft, short-segment-type reconstruction.

Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: technical aspects

2024-12-01
Mary E. Jensen , Avery J. Evans , John M. Mathis +3 more
PURPOSE: To describe a technique for percutaneous vertebroplasty of osteoporotic vertebral body compression fractures and to report early results of its use. METHODS: The technique was used over a 3-year … PURPOSE: To describe a technique for percutaneous vertebroplasty of osteoporotic vertebral body compression fractures and to report early results of its use. METHODS: The technique was used over a 3-year period in 29 patients with 47 painful vertebral fractures. The technique involves percutaneous puncture of the involved vertebra(e) via a transpedicular approach followed by injection of polymethylmethacrylate (PMMA) into the vertebral body. RESULTS: The procedure was technically successful in all patients, with an average injection amount of 7.1 mL PMMA per vertebral body. Two patients sustained single, nondisplaced rib fractures during the procedure; otherwise, no clinically significant complications were noted. Twenty-six patients (90%) reported significant pain relief immediately after treatment. CONCLUSION: Vertebroplasty is a valuable tool in the treatment of painful osteoporotic vertebral fractures, providing acute pain relief and early mobilization in appropriate patients.

A Randomized Trial of Vertebroplasty for Painful Osteoporotic Vertebral Fractures

2009-08-05
Rachelle Buchbinder , Richard H. Osborne , Peter R. Ebeling +6 more
Vertebroplasty has become a common treatment for painful osteoporotic vertebral fractures, but there is limited evidence to support its use.We performed a multicenter, randomized, double-blind, placebo-controlled trial in which participants … Vertebroplasty has become a common treatment for painful osteoporotic vertebral fractures, but there is limited evidence to support its use.We performed a multicenter, randomized, double-blind, placebo-controlled trial in which participants with one or two painful osteoporotic vertebral fractures that were of less than 12 months' duration and unhealed, as confirmed by magnetic resonance imaging, were randomly assigned to undergo vertebroplasty or a sham procedure. Participants were stratified according to treatment center, sex, and duration of symptoms (< 6 weeks or > or = 6 weeks). Outcomes were assessed at 1 week and at 1, 3, and 6 months. The primary outcome was overall pain (on a scale of 0 to 10, with 10 being the maximum imaginable pain) at 3 months.A total of 78 participants were enrolled, and 71 (35 of 38 in the vertebroplasty group and 36 of 40 in the placebo group) completed the 6-month follow-up (91%). Vertebroplasty did not result in a significant advantage in any measured outcome at any time point. There were significant reductions in overall pain in both study groups at each follow-up assessment. At 3 months, the mean (+/-SD) reductions in the score for pain in the vertebroplasty and control groups were 2.6+/-2.9 and 1.9+/-3.3, respectively (adjusted between-group difference, 0.6; 95% confidence interval, -0.7 to 1.8). Similar improvements were seen in both groups with respect to pain at night and at rest, physical functioning, quality of life, and perceived improvement. Seven incident vertebral fractures (three in the vertebroplasty group and four in the placebo group) occurred during the 6-month follow-up period.We found no beneficial effect of vertebroplasty as compared with a sham procedure in patients with painful osteoporotic vertebral fractures, at 1 week or at 1, 3, or 6 months after treatment. (Australian New Zealand Clinical Trials Registry number, ACTRN012605000079640.)
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Validity of a Set of Clinical Criteria to Rule Out Injury to the Cervical Spine in Patients with Blunt Trauma

2000-07-13
Jerome R. Hoffman , William R. Mower , Allan B. Wolfson +2 more
Because clinicians fear missing occult cervical-spine injuries, they obtain cervical radiographs for nearly all patients who present with blunt trauma. Previous research suggests that a set of clinical criteria (decision … Because clinicians fear missing occult cervical-spine injuries, they obtain cervical radiographs for nearly all patients who present with blunt trauma. Previous research suggests that a set of clinical criteria (decision instrument) can identify patients who have an extremely low probability of injury and who consequently have no need for imaging studies.
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Accuracy of Pedicular Screw Placement In Vivo

1990-01-01
Stanley D. Gertzbein , STEPHEN E. ROBBINS
The accuracy of pedicular screw placement was assessed in 40 consecutive patients treated with the AO “Fixateur Interne.” Postoperative CT scans were used to measure canal encroachment from the medial … The accuracy of pedicular screw placement was assessed in 40 consecutive patients treated with the AO “Fixateur Interne.” Postoperative CT scans were used to measure canal encroachment from the medial border of the pedicle, the angle of insertion and the point of entry. Eighty-one percent of the screws were placed within 2 mm of the medial border of the pedicle and 6% had 4–8 mm of canal encroachment with two patients developing minor neurological complications that spontaneously resolved. Four percent were inserted lateral to the pedicle. The parameters linked to satisfactory screw placement include entry point, angle of insertion and pedicular isthmus widths. Improvement in accuracy was noted in the latter 25% of screw insertions, reflecting the learning curve associated with this technique.

Atlanto-axial arthrodesis by the wedge compression method.

1978-04-01
ARTHUR L. BROOKS , Eileen Jenkins
Fifteen patients with atlanto-axial instability (secondary to os odontoideum in three, nonunion of an odontoid fracture in seven, acute odontoid fracture in three, and rheumatoid arthirtis in two) were treated … Fifteen patients with atlanto-axial instability (secondary to os odontoideum in three, nonunion of an odontoid fracture in seven, acute odontoid fracture in three, and rheumatoid arthirtis in two) were treated by wedge compression arthrodesis of the atlanto-axial joint. One patient died at home eight weeks after fusion with the cause of death never established. Of the two patients with rheumatoid arthritis (ankylosing spondylitis), one had a non-union and in the other the posterior arch of the atlas fractured and the fusion had to be extended up to the occiput and down to the third cervical vertebra. The procedure is rarely indicated in patients with long-standing rheumatoid arthritis or severe osteopenia.

The Canadian C-Spine Rule versus the NEXUS Low-Risk Criteria in Patients with Trauma

2003-12-24
Ian G. Stiell , Catherine M. Clement , R.Douglas McKnight +7 more
The Canadian C-Spine (cervical-spine) Rule (CCR) and the National Emergency X-Radiography Utilization Study (NEXUS) Low-Risk Criteria (NLC) are decision rules to guide the use of cervical-spine radiography in patients with … The Canadian C-Spine (cervical-spine) Rule (CCR) and the National Emergency X-Radiography Utilization Study (NEXUS) Low-Risk Criteria (NLC) are decision rules to guide the use of cervical-spine radiography in patients with trauma. It is unclear how the two decision rules compare in terms of clinical performance.
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Updated assessment and current classification of spinal meningeal cysts

1988-03-01
Michael W. Nabors , T. Glenn Pait , E B Byrd +4 more
✓ The classification of spinal meningeal cysts (MC's) in the literature is indistinct, confusing, and in certain categories histologically misleading. Based on a series of 22 cases, the authors propose … ✓ The classification of spinal meningeal cysts (MC's) in the literature is indistinct, confusing, and in certain categories histologically misleading. Based on a series of 22 cases, the authors propose a classification comprising three categories: spinal extradural MC's without spinal nerve root fibers (Type I); spinal extradural MC's with spinal nerve root fibers (Type II); and spinal intradural MC's (Type III). Although water-soluble myelography may disclose a filling defect for all three categories, computerized tomographic myelography (CTM) is essential to reveal communication between the cyst and the subarachnoid space. Communication demonstrated by CTM allows accurate diagnosis of a spinal MC and rules out other mass lesions. Magnetic resonance imaging appears useful as an initial study to identify an intraspinal cystic mass. Final characterization is based on operative inspection and histological examination for all three categories.

FRACTURES OF THE ODONTOID PROCESS OF THE AXIS

2004-09-01
Lewis D. Anderson , RICHARD T. DʼALONZO
Odontoid fractures were classified into three types, and, in a series of forty-nine fractures, two avulsion, thirty-two body, and fifteen basilar fractures were treated and followed for an average of … Odontoid fractures were classified into three types, and, in a series of forty-nine fractures, two avulsion, thirty-two body, and fifteen basilar fractures were treated and followed for an average of twenty-two months (range, six months to nineteen years). Body fractures are most prone to non-union and surgery (spine fusion) is commonly required in this group.

Biomechanics of the cervical spine. I: Normal kinematics

2000-11-01
Nikolai Bogduk , Susan R. Mercer

Long‐term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty

2000-12-01
Franck Grados , C. Depriester , G. Cayrolle +3 more
To assess the immediate and long-term efficacy and safety of percutaneous vertebroplasty with polymethylmethacrylate (PMMA) for the treatment of refractory pain resulting from osteoporotic vertebral fractures.A retrospective, open study of … To assess the immediate and long-term efficacy and safety of percutaneous vertebroplasty with polymethylmethacrylate (PMMA) for the treatment of refractory pain resulting from osteoporotic vertebral fractures.A retrospective, open study of percutaneous vertebroplasty (PV) was conducted with long-term follow-up. PV with PMMA was carried out between 1990 and 1996 in 40 patients with symptomatic osteoporotic vertebral fracture(s) that had not responded to maximum medical therapy. In 1997, each patient was asked to come back to our institution for a physical and spinal X-ray examination. Efficacy was assessed by changes over time in pain on Huskisson's visual analogue scale (VAS).Thirty-four vertebrae treated by PV in 25 patients were evaluated with long-term follow-up. The mean duration of follow-up was 48 months (range 12-84 months). Pain assessed by the VAS significantly (P<0.05) decreased from a mean of 80 mm+/-16 (S.D.) before PV to 37+/-24 mm after 1 month and 34+/-28 mm at the time of maximal follow-up. There was no severe complication related to this treatment, and no progression of vertebral deformity in any of the injected vertebrae. However, there was a slight but significantly increased risk of vertebral fracture in the vicinity of a cemented vertebra (odds ratio 2.27, 95% confidence interval 1.1-4.56). The odds ratio of a vertebral fracture in the vicinity of an uncemented fractured vertebra was 1.44 (0.82-2.55).PV appears to be a safe and useful procedure for the treatment of focal back pain secondary to osteoporotic vertebral fracture when conservative treatment has failed.
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Review Article Fractures, Dislocations, and Fracture-Dislocations of the Spine

1970-12-01
F. W. Holdsworth
Over 1000 patients with traumatic paraplegia or tetraplegia and many more with fractures and dislocations of the spine without damage to the central nervous system have been observed and treated … Over 1000 patients with traumatic paraplegia or tetraplegia and many more with fractures and dislocations of the spine without damage to the central nervous system have been observed and treated at the Sheffield Spinal Injuries Centre. The vertebral lesions with or without injury to the spinal cord or nerve roots have been classified on the basis of the clinical and roentgenographic findings into five groups: 1. Pure flexion which causes a wedge fracture which is stable. 2. Flexion-rotation which produces an unstable fracture-dislocation with rupture of tue posterior ligament complex, separation of the spinous processes, a slice fracture near the upper border of the lower vertebra, and dislocation of the lower articular processes of the upper vertebra. 3. Extension which causes rupture of the intervertebral disc and the anterior common ligament along with avulsion of a small bone fragment from the anterior border of the dislocated vertebra. The dislocation almost always reduces spontaneously and is stable in flexion. 4. Vertebral compression which results in a fracture of the end plate as the nucleus of the intervertebral disc is forced into the vertebral body and causes it to burst with outward displacement of fragments of the body. Since the ligaments remain intact this comminuted fracture is stable. 5. Shearing which results in forward displacement of the whole vertebra and an unstable fracture of the articular processes or pedicles. Accurate diagnosis and prognosis of the neurological lesion depend on knowledge of the anatomy of the spinal cord and nerve roots, a careful neurological examination shortly after the original injury and repeated examinations thereafter, comparison of the level of spinal injury with the level of paraplegia or tetraplegia, differentiation between paraplegia and tetraplegia of immediate and delayed onset, and the appropriate therapy of the various types and levels of lesion. Simple wedge fractures were treated by bed rest for two to three weeks, mobilization of the back, and ambulation with a back support. Rotational fracture-dislocations in the cervical, thoracolumbar, or lumbar spine were almost invariably associated with tetraplegia or paraplegia. Cervical fracture-dislocations with or without tetraplegia were treated by skull-caliper traction. Thoracolumbar or lumbar fracture-dislocations without paraplegia were treated on a plaster bed for twelve weeks followed by a back support for a few weeks. The thoracolumbar fracture-dislocations with paraplegia were never treated by the plaster bed method but rather by open reduction of the dislocation, and maintenance of the reduction by internal fixation with double plating of the spinous processes. Spontaneous fusion was sufficiently advanced after eight to twelve weeks to get the patient out of bed. If the plates cut out of the bone after twelve weeks, they were removed. Patients with loss of sensation resulting from paraplegia or tetraplegia were turned every two hours to avoid pressure sores. Extension dislocations in the cervical spine, if they had reduced spontaneously, were fitted with a collar to hold the head and neck in sligh flexion for a period of eight to twelve weeks. For dislocations in this region which had not reduced spontaneously, manual manipulation under endotracheal anesthesia was employed. Reduction was maintained by skull tongs applied prior to manipulation. If after four weeks there was roentgenographic evidence of new bone indicating Spontaneous fusion, traction was continued for four to six weeks more followed by a neck collar for an additional six weeks. If new bone did not appear on the roentgenograms after four weeks, anterior fusion was performed followed by skull traction for an additional eight weeks. Vertical compression burst fractures in the cervical spine were treated by skull traction for six weeks followed by a neck collar. In the lumbar spine, burst fractures without paraplegia were treated by immobilization in a plaster bed for eight to twelve weeks followed by back support. The plaster bed was never used in burst fractures with paraplegia. Shear fractures were always associated with complete paraplegia. These fractures were usually stable and did not require operative reduction except when the displacement was great.

Clinical Biomechanics of the Spine

1992-01-01
John H. Evans

[Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty].

1987-01-01
P Galibert , H. Deramond , P Rosat +1 more

Fractures of the Odontoid Process of the Axis

1974-12-01
Lewis D. Anderson , RICHARD T. DʼALONZO
Odontoid fractures were classified into three types, and, in a series of forty-nine fractures, two avulsion, thirty-two body, and fifteen basilar fractures were treated and followed for an average of … Odontoid fractures were classified into three types, and, in a series of forty-nine fractures, two avulsion, thirty-two body, and fifteen basilar fractures were treated and followed for an average of twenty-two months (range, six months to nineteen years). Body fractures are most prone to non-union and surgery (spine fusion) is commonly required in this group.

Percutaneous Vertebroplasty for Pain Relief and Spinal Stabilization

2000-04-01
John D. Barr , Michelle S. Barr , Thomas J. Lemley +1 more
Study Design. This was a retrospective review of 47 consecutive patients (1995–1998) in whom percutaneous intraosseous methylmethacrylate cement injection (percutaneous vertebroplasty) was used to treat osteoporotic vertebral compression fractures and … Study Design. This was a retrospective review of 47 consecutive patients (1995–1998) in whom percutaneous intraosseous methylmethacrylate cement injection (percutaneous vertebroplasty) was used to treat osteoporotic vertebral compression fractures and spinal column neoplasms. Objectives. To present initial results regarding pain relief, spinal stabilization, and complications after treatment with percutaneous vertebroplasty. Summary of Background Data. Percutaneous vertebroplasty was developed in France in the late 1980s. Several European reports have described excellent results for treatment of compression fractures and neoplasms. The procedure was not performed in the United States until 1994. Only a single series of 29 patients treated in the United States has been reported. Methods. A retrospective review was conducted of 47 consecutive patients with 84 vertebrae treated with percutaneous vertebroplasty. Thirty-eight patients with 70 vertebrae had symptomatic, osteoporotic fractures and had failed medical therapy. Eight patients with 13 vertebrae had primary or metastatic neoplasms. One patient had a hemangioma. Immediate and long-term pain response, spinal stability, and complications were evaluated. Results. Among the 38 patients treated for osteoporotic fractures, 24 (63%) had marked to complete pain relief, 12 (32%) moderate relief and 2 (5%) no significant change. Only 4 of the 8 patients with malignancies had significant pain relief. In 7 of these patients, no further vertebral compression occurred, and spinal canal compromise was prevented. The patient with the hemangioma had no significant pain reduction. Minor complications occurred in 3 (6%) patients. Conclusions. Percutaneous vertebroplasty provided significant pain relief in a high percentage of patients with osteoporotic fractures. The procedure provided spinal stabilization in patients with malignancies but did not produce consistent pain relief. Complications were minor and infrequent. Percutaneous vertebroplasty is a promising therapy for patients with osteoporotic fractures and for selected vertebral column neoplasms.

Practice Parameter [RETIRED]

1997-03-01
Overview.The Quality Standards Subcommittee of the American Academy of Neurology is charged with developing guidelines for neurologists for diagnostic procedures, treatment modalities, and clinical disorders.The selection of topics for which … Overview.The Quality Standards Subcommittee of the American Academy of Neurology is charged with developing guidelines for neurologists for diagnostic procedures, treatment modalities, and clinical disorders.The selection of topics for which practice parameters are developed is based on the prevalence, frequency of use, economic impact, membership need, controversy, urgency, external constraints, and resources required.Based upon the quality of the evidence, the Quality Standards Subcommittee determines whether the parameter is a standard, guideline, or option.By training and knowledge, neurologists and neurosurgeons are qualified to develop and disseminate guidelines for managing the athlete who suffers a concussion in sports.Questions addressed during neurologic or neurosurgical consultation for sportsrelated concussion require advice to the patient that is guided by neuroscience and the consensus of experts, rather than local lore and individual opinion.Most importantly, consultation to prevent catastrophic outcome and cumulative neurobehavioral deficits from repeated concussions can best be provided by the well-informed physician.

Vertebroplasty and Kyphoplasty: A Systematic Review of 69 Clinical Studies

2006-07-26
Paul A. Hulme , Jörg Krebs , Stephen J. Ferguson +1 more
In Brief Study Design. Systematic literature review. Objective. To evaluate the safety and efficacy of vertebroplasty and kyphoplasty using the data presented in published clinical studies, with respect to patient … In Brief Study Design. Systematic literature review. Objective. To evaluate the safety and efficacy of vertebroplasty and kyphoplasty using the data presented in published clinical studies, with respect to patient pain relief, restoration of mobility and vertebral body height, complication rate, and incidence of new adjacent vertebral fractures. Summary of Background Data. Vertebroplasty and kyphoplasty have been gaining popularity for treating vertebral fractures. Current reviews provide an overview of the procedures but are not comprehensive and tend to rely heavily on personal experience. This article aimed to compile all available data and evaluate the clinical outcome of the 2 procedures. Methods. This is a systematic review of all the available data presented in peer-reviewed published clinical trials. The methodological quality of included studies was evaluated, and data were collected targeting specific standard measurements. Where possible, a quantitative aggregation of the data was performed. Results. A large proportion of subjects had some pain relief, including 87% with vertebroplasty and 92% with kyphoplasty. Vertebral height restoration was possible using kyphoplasty (average 6.6°) and for a subset of patients using vertebroplasty (average 6.6°). Cement leaks occurred for 41% and 9% of treated vertebrae for vertebroplasty and kyphoplasty, respectively. New fractures of adjacent vertebrae occurred for both procedures at rates that are higher than the general osteoporotic population but approximately equivalent to the general osteoporotic population that had a previous vertebral fracture. Conclusions. The problem with stating definitely that vertebroplasty and kyphoplasty are safe and effective procedures is the lack of comparative, blinded, randomized clinical trials. Standardized evaluative methods should be adopted. The safety and efficacy of vertebroplasty and kyphoplasty were evaluated through a systematic review of the literature. Although pain relief appears to be almost universal, other measurements and complications are still controversial. Target research areas have been specified and a need for standardized evaluative methods identified.
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Percutaneous vertebroplasty and kyphoplasty for painful vertebral body fractures in cancer patients

2003-01-01
Daryl R. Fourney , Donald F. Schomer , Remi Nader +5 more
The current North American experience with minimally invasive vertebro- and kyphoplasty is largely limited to the treatment of benign osteoporotic compression fractures. The objective of this study was to assess … The current North American experience with minimally invasive vertebro- and kyphoplasty is largely limited to the treatment of benign osteoporotic compression fractures. The objective of this study was to assess the safety and efficacy of these procedures for painful vertebral body (VB) fractures in cancer patients.The authors reviewed a consecutive group of cancer patients (21 with myeloma and 35 with other primary malignancies) undergoing vertebro- and kyphoplasty at their institution. Ninety-seven (65 vertebro- and 32 kyphoplasty) procedures were performed in 56 patients during 58 treatment sessions. The mean patient age was 62 years (+/- 13 years [standard deviation]) and the median duration of symptoms was 3.2 months. All patients suffered intractable spinal pain secondary to VB fractures. Patients noted marked or complete pain relief after 49 procedures (84%), and no change after five procedures (9%); early postoperative Visual Analog Scale (VAS) pain scores were unavailable in four patients (7%). No patient was worse after treatment. Reductions in VAS pain scores remained significant up to 1 year (p = 0.02, Wilcoxon signed-rank test). Analgesic consumption was reduced at 1 month (p = 0.03, Wilcoxon signed-rank test). Median follow-up length was 4.5 months (range 1 day-19.7 months). Asymptomatic cement leakage occurred during vertebroplasty at six (9.2%) of 65 levels; no cement extravasation was seen during kyphoplasty. There were no deaths or complications related to the procedures. The mean percentage of restored VB height by kyphoplasty was 42 +/- 21%.Percutaneous vertebro- and kyphoplasty provided significant pain relief in a high percentage of patients, and this appeared durable over time. The absence of cement leakage-related complications may reflect the use of 1) high-viscosity cement; 2) kyphoplasty in selected cases; and 3) relatively small volume injection. Precise indications for these techniques are evolving; however, they are safe and feasible in well-selected patients with refractory spinal pain due to myeloma bone disease or metastases.

Rockwood and Green’s fractures in adults.

1997-05-01
Frank Heatley
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Cervical spine fusion in rheumatoid arthritis.

1979-10-01
C S Ranawat , Patrick O'Leary , Paul M. Pellicci +3 more
Spinal fusion for deformity of the cervical spine was done in thirty-three patients with rheumatoid arthritis. The average follow-up was three years. The deformities present were atlano-axial subluxation, superior migration … Spinal fusion for deformity of the cervical spine was done in thirty-three patients with rheumatoid arthritis. The average follow-up was three years. The deformities present were atlano-axial subluxation, superior migration of the odontoid process into the foramen magnum, and subaxial subluxation of the vertebral bodies. We devised a classification of the pain and the neural involvement in these patients and a new method of measuring superior migration. The surgical procedures for treating instability, intractable pain, or neural involvement, or a combination of the three, were: (1) a Gallie fusion of the first and second cervical vertebrae for atlanto-axial subluxation, (2) a fusion of the occiput and the second cervical vertebra for superior migration of the odontoid process, and (3) a posterior fusion for subaxial subluxation. The occiput was included in the fusion if superior migration of the odontoid process was demonstrated. The results show that four of five patients who had an anterior fusion had no improvement. Twenty-five patients had posterior fusion; in seventeen the condition was improved, in five there was improvement, and in three the condition was worse. Of nineteen patients with neural involvement, the condition was improved in eight, it was unchanged in seven, and it was made worse in two. There were three postoperative deaths and six additional unrelated deaths within two years of surgery. There were five pseudarthroses.

A comparison of key performance metrics of major robotic platforms in spine surgery: a network meta-analysis of 14,462 screws

2025-06-25
Robert Koucheki , John-Peter Bonello , Aazad Abbas +7 more | European Spine Journal

Innovative Pedicle Screw Insertion with Mixed Reality Technology Improves Insertion Accuracy in Spinal Surgery

2025-06-24
Shintaro Obata , Akira Shinohara , Daigo Arimura +3 more | Sensors
The accuracy of pedicle screw insertion in pediatric scoliosis correction surgery using augmented reality technology in combination with a conventional navigation system was evaluated, and its usefulness was verified. A … The accuracy of pedicle screw insertion in pediatric scoliosis correction surgery using augmented reality technology in combination with a conventional navigation system was evaluated, and its usefulness was verified. A retrospective study of patients who underwent mixed reality technology-assisted posterior scoliosis correction and fixation was conducted. In total, 361 pedicle screws inserted with a mixed reality technology-assisted navigation system were analyzed; 25 pedicle screws (6.9%) showed Rao Classification Grade 1 deviation, whereas 0.83% showed Rao Classification Grade 2.3 deviation, which is a clinical deviation. In terms of the relationship between the rotation of the vertebral body and the deviation of the pedicle screw, the pedicle screw tended to deviate more easily when it was necessary to insert the pedicle screw in a more strongly oblique position due to the rotation of the vertebral body. The results suggest that the pedicle screw insertion accuracy with augmented reality technology may be superior to that with conventional navigation alone in scoliosis correction and fusion surgery for scoliosis in children. This system is expected to become a standard support tool for spine surgery and will contribute to improving the success rate of surgery and reducing the burden on the surgeon.

Comparative Evaluation of Minimally Invasive versus Conventional Sagittal Split Ramus Osteotomy

2025-06-24
Erkan İlhan , Yusuf Nuri Kaba , Gökçen Çoban +1 more | International Journal of Oral and Maxillofacial Surgery

The Vertebral Squeeze - A Rare Case of Vertebral Artery Compression Syndrome

2025-06-23
K N Devika , Rudresh Hiremath , x Vishnupriya | International Journal of Science and Research (IJSR)

Modified ASH Brace: A Novel Approach to Kyphoscoliotic Curvature Correction

2025-06-23
Sushree Sangita Nayak | International Journal of Science and Research (IJSR)

The impact of robotic surgery on reducing radiation exposure in orthopedic trauma: a meta-analysis

2025-06-23
Marzieh S. Saeedi-Hosseiny , Hanna Rothenberg , Aziza L Jadallah +3 more | Journal of Robotic Surgery
Radiation time is a critical metric influencing safety for both healthcare providers and patients during minimally invasive orthopedic trauma surgeries. This meta-analysis aimed to compare total radiation time between robotic … Radiation time is a critical metric influencing safety for both healthcare providers and patients during minimally invasive orthopedic trauma surgeries. This meta-analysis aimed to compare total radiation time between robotic guidance and manual fluoroscopy, while also compiling global statistics on operative radiation exposure, associated health risks, and compliance with protective measures. Relevant comparative studies were identified through comprehensive searches in PubMed, Scopus, Web of Science, Medline, ClinicalKey, and Embase. Ten studies, encompassing 675 patients, met the inclusion criteria. Data on treatment groups, procedure success rates, robotic systems used, and other pertinent variables were systematically extracted and reviewed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A random-effects model in SPSS was applied to analyze total radiation time. Results revealed a significantly shorter radiation time with robotic guidance, supported by a robust effect size, fragility index, and fragility quotient. These findings suggest that robotic systems may offer significant safety advantages. Future research should explore the broader implementation of robotic guidance and its implications for patient and provider safety across various surgical fields.

Taxa de indicação de cirurgia ortognática em pacientes com fissura transforaminal bilateral completa tratados com o Protocolo de Spina: um estudo retrospectivo

2025-06-23
Marco Aurélio Gamborgi , Kevin Gollo , Beatriz Marcomini Arantes +4 more | Revista Brasileira de Cirurgia Plástica
Resumo A fissura labiopalatina (FLP) é a deformidade congênita facial mais comum e seu manejo requer abordagem multidisciplinar e interdisciplinar. Não há consenso sobre a abordagem cirúrgica ideal para pacientes … Resumo A fissura labiopalatina (FLP) é a deformidade congênita facial mais comum e seu manejo requer abordagem multidisciplinar e interdisciplinar. Não há consenso sobre a abordagem cirúrgica ideal para pacientes com FLP e a busca pelo melhor resultado estético e funcional motiva comparações entre diferentes técnicas cirúrgicas. Uma variável importante que deve ser analisada é o impacto da técnica cirúrgica no crescimento maxilar. O objetivo deste estudo é avaliar a taxa de indicação de cirurgia ortognática em pacientes tratados com o protocolo de Spina. Estudo retrospectivo em um centro acadêmico de atenção terciária em Curitiba, PR, Brasil. Um total de 3.930 prontuários médicos foram revisados no banco de dados da instituição, resultando em 231 pacientes com FLP transforaminal bilateral completa. Dentre estes, 197 foram operados usando o protocolo de Spina e incluídos no estudo. A literatura mostra taxas variáveis de cirurgia ortognática em pacientes com FLP transforaminal bilateral completa. Em nosso serviço, foi observada uma taxa de 39,59% em pacientes tratados com o protocolo de Spina. Isso pode ser resultado de diversos fatores, incluindo a técnica cirúrgica, já que uma vantagem significativa do protocolo de Spina é permitir o melhor crescimento maxilar devido ao menor trauma cirúrgico e menos deslocamentos na região. A aplicação do protocolo de Spina em pacientes com FLP transforaminal bilateral completa resultou em menores taxas de alteração do crescimento maxilar e necessidade futura de cirurgia ortognática.

Finite element analysis of percutaneous uniplanar screw fixation in the treatment of thoracolumbar fractures

2025-06-23
Shen Cao , Tao Xuan , Chengbao Zhang +1 more | European journal of medical research
To compare the biomechanical characteristics of thoracolumbar fractures treated with uniplanar screws, monoaxial screws, and polyaxial screws using finite element analysis. CT data of the thoracolumbar spine T12-L2 from a … To compare the biomechanical characteristics of thoracolumbar fractures treated with uniplanar screws, monoaxial screws, and polyaxial screws using finite element analysis. CT data of the thoracolumbar spine T12-L2 from a healthy volunteer were collected, and using finite element software, models of both normal and fractured spines were created. Three different fixation models were constructed with monoaxial screws (Mps group), polyaxial screws (Pps group), and uniplanar screws (Ups group), respectively. The L2 vertebra was fixed and a compressive load of 150 N and a torque of 10 N•m were applied at the T12 end to simulate flexion, extension, lateral bending, and rotation movements of the spine. The range of motion (ROM) and internal fixation stress within the screws and rods were recorded for each movement direction. A finite element model of the healthy human spine T12-L2 was established and validated for accuracy. All three fixation models demonstrated decreased ROM in all tested movements. The UPS group showed the lowest percentage of ROM in flexion, extension, and lateral bending movements, with a mid-range percentage of ROM in rotation, and relatively the best stability. The PPS group had the highest ROM percentages in all directions of movement, with the worst relative stability. The maximum von Mises stress for pedicle screws and rods in all fixation modes occurred in flexion, with the MPS group's screws showing significantly higher stress peaks in flexion and both rotations than those of the PPS and UPS groups. The rods of the PPS group had significantly lower stress peaks in all motion states compared to those of the MPS and UPS groups. Uniplanar screws can effectively distribute stress, reduce the risk of screw and rod breakage, and ensure stability of spinal fixation.

An Assessment of the World’s Contribution to Osteoporotic Vertebral Compression Fractures: A Bibliometric Analysis of Surgical Management; An AO Spine Knowledge Forum Trauma and Infection Initiative

2025-06-23
Harvinder Singh Chhabra , Jitesh Manghwani , Vandana Phadke +6 more | Global Spine Journal
Study Design Bibliometric analysis. Objectives Analysis of literature on surgical management of osteoporotic vertebral compression fractures to identify the top contributing authors, countries, collaborators and the trends of research. Methods … Study Design Bibliometric analysis. Objectives Analysis of literature on surgical management of osteoporotic vertebral compression fractures to identify the top contributing authors, countries, collaborators and the trends of research. Methods A search to identify original articles published in English between 2011 and 2020 was done using specific keywords in the Web of Science database. After screening, 442 articles met the criteria which were analysed using Biblioshiny R software. Results The top contributing authors were Yang HL (first), Wang H (second) and Hao DJ (third). Amongst the universities, the major contributing ones were Soochow University (first), Guangzhou University of Chinese Medicine (second) and University of Toronto (third). China (first), USA (second) and South Korea (third) were the top contributing countries. The maximum articles were published in Spine, Osteoporosis International and European Spine Journal. The most common articles were on comparisons between kyphoplasty and vertebroplasty, the associated complications and newer modalities of investigations of osteoporosis. Major work surrounds the keywords kyphoplasty and vertebroplasty which are significantly clustered as compared to others. Conclusions The study identified the most prolific contributing authors (Yang HL, Wang H) and universities (Soochow University, Guangzhou University of Chinese Medicine), the journals where this work is considered more impactful (Spine, Osteoporosis International) and the top contributing countries (China, USA) and collaborations. This study showed that major work is regarding the cement augmentation techniques of kyphoplasty/vertebroplasty and the attempts at establishing newer techniques of diagnosis of osteoporosis. The study also brought out major differences in findings from that of the previously published study on spine trauma bibliometrics.

Robotic-Guided Spine Surgery: Implementation of a System in Routine Clinical Practice—An Update

2025-06-23
Mirza Pojskić , Miriam H. A. Bopp , Omar Alwakaa +2 more | Journal of Clinical Medicine
Objective: The aim of this study is to present the initiation of robotic-guided (RG) spine surgery into routine clinical care at a single center with the use of intraoperative CT … Objective: The aim of this study is to present the initiation of robotic-guided (RG) spine surgery into routine clinical care at a single center with the use of intraoperative CT (iCT) automatic registration-based navigation. The workflow included iCT with automatic registration, fusion with preoperative imaging, verification of preplanned screw trajectories, RG introduction of K-wires, and the insertion of pedicle screws (PSs), followed by a control iCT scan. Methods: All patients who underwent RG implantation of pedicle screws using the Cirq® robotic arm (BrainLab, Munich, Germany) in the thoracolumbar spine at our department were included in the study. The accuracy of the pedicles screws was assessed using the Gertzbein–Robbins scale (GRS). Results: In total, 108 patients (60 female, mean age 68.7 ± 11.4 years) in 109 surgeries underwent RG PS placement. Indications included degenerative spinal disorders (n = 30 patients), spondylodiscitis (n = 24), tumor (n = 33), and fracture (n = 22), with a mean follow-up period of 7.7 ± 9 months. Thirty-seven cases (33.9%) were performed percutaneously, and all others were performed openly. Thirty-three operations were performed on the thoracic spine, forty-four on the lumbar and lumbosacral spine, thirty on the thoracolumbar, one on the cervicothoracic spine, and one on the thoracolumbosacral spine. The screws were inserted using a fluoroscopic (first 12 operations) or navigated technique (latter operations). The mean operation time was 228.8 ± 106 min, and the mean robotic time was 31.5 ± 18.4 min. The mean time per K-wire was 5.35 ± 3.98 min. The operation time was lower in the percutaneous group, while the robot time did not differ between the two groups. Robot time and the time per K-wire improved over time. Out of 688 screws, 592 were GRS A screws (86.1%), 54 B (7.8%), 22 C (3.2%), 12 D (1.7%), and 8 E (1.2%). Seven screws were revised intraoperatively, and after revision, all were GRS A. E screws were either revised or removed. In the case of D screws, screws located at the end of the construct were revised, while so-called in-out-in screws in the middle of the construct were not revised. Conclusions: Brainlab’s Cirq® Robotic Alignment Module feature enables placement of pedicle screws in the thoracolumbar spine with high accuracy. A learning curve is shown through improvements in robotic time and time per K-wire.

Associations of preoperative Oswestry Disability Index and EuroQol-5D with long-term all-cause mortality in patients undergoing percutaneous vertebroplasty

2025-06-22
Yu-Hsien Lin , Yun-Che Wu , Yu-Tsung Lin +6 more | Archives of Medical Science
Introduction Oswestry Disability Index (ODI) and EuroQol-5D (EQ-5D) have been widely used to assess general health quality and function in clinical studies of patients with vertebral fractures. We aimed to … Introduction Oswestry Disability Index (ODI) and EuroQol-5D (EQ-5D) have been widely used to assess general health quality and function in clinical studies of patients with vertebral fractures. We aimed to investigate the associations of preoperative ODI and EQ-5D with long-term mortality in patients undergoing percutaneous vertebroplasty. Material and methods We retrospectively identified adult patients who had a single-level vertebral compression fracture and received percutaneous vertebroplasty between 2013 and 2020. Patients with traumatic fractures, burst fractures, and pathologic fractures, as well as those who had missing information on preoperative assessment of ODI and EQ-5D, were excluded. Survival status of the study patients was confirmed at the end of March 2021. The associations of preoperative ODI and EQ-5D with all-cause mortality were examined using Cox-proportional hazard models. Results A total of 167 patients were analyzed (mean age 75.8 ± 9.3 years, 25.7% male). There were 28 patients who died during a median follow-up duration of 2.1 years (63.6 per 1000 patient-years). Preoperative ODI was significantly associated with all-cause mortality after vertebroplasty (HR 1.049, 95% CI 1.008 to 1.092, p=0.018). In contrast, preoperative EQ-5D was independently associated with a lower risk of all-cause mortality after the surgery (HR 0.202, 95% CI 0.043 to 0.936, p=0.041). Conclusions Preoperative assessment of ODI (HR 1.049, 95% CI 1.008 to 1.092) and EQ-5D (HR 0.202, 95% CI 0.043 to 0.936) may help determine postoperative long-term mortality risk in this aging surgical population.

Anatomical variants of the vertebral artery and their relationship with craniocervical disorders and surgical considerations: a systematic review and meta-analysis

2025-06-21
Juan José Valenzuela-Fuenzalida , Javiera del Villar-Valdebenito , Lorenzo Aburto +7 more | Anatomical Science International

Anterior transarticular crossing screw fixation for reducible atlantoaxial dislocation with basilar invagination: a radiological feasibility study

2025-06-21
Jianying Zheng , Yu Wang , Jiahao Xie +4 more | European Spine Journal

Robot-assisted versus navigated spinal fusion surgery: a comparative multicenter study on transpedicular screw placement accuracy and patient outcomes

2025-06-21
Giada Garufi , Gianluca Scalia , Francesca Graziano +7 more | Neurosurgical Review

Percutaneous Vertebroplasty

2025-06-20
Steven D. Waldman | Elsevier eBooks

In Reply: The Rocker Technique for Atlantoaxial Dislocation With or Without Basilar Invagination: A Prospective Observational Study

2025-06-20
Jitin Bajaj | Operative Neurosurgery

Letter: The Rocker Technique for Atlantoaxial Dislocation With or Without Basilar Invagination: A Prospective Observational Study

2025-06-20
Xin Zhou | Operative Neurosurgery

Atlanto-occipital Block Technique

2025-06-20
Steven D. Waldman | Elsevier eBooks

Atlantoaxial Block Technique

2025-06-20
Steven D. Waldman | Elsevier eBooks

Vertebral Compression Fracture Augmentation Using the Kiva VCF System

2025-06-20
Steven D. Waldman | Elsevier eBooks

Percutaneous Balloon Kyphoplasty

2025-06-20
Steven D. Waldman | Elsevier eBooks

Síndrome de Grisel: anatomía, fisiopatología, diagnóstico y tratamiento. Revisión bibliográfica

2025-06-20
M. S. Gonzalez , Maria Rosario Varela Gomez | Revista Ciencia y Salud Integrando conocimientos
El síndrome de Grisel, descrito en el año 1830 por sir Charles Bell y, posteriormente, detallado en varios casos por Pierre Grisel, es una patología poco frecuente, por ende, poco … El síndrome de Grisel, descrito en el año 1830 por sir Charles Bell y, posteriormente, detallado en varios casos por Pierre Grisel, es una patología poco frecuente, por ende, poco conocida, la cual consiste en una subluxación atlantoaxoidea no traumática. Usualmente se presenta, en primer lugar, como una complicación de intervenciones quirúrgicas otorrinolaringológicas, o infecciones de la vía aérea superior. Principalmente, se manifiesta en edades pediátricas, pero también puede observarse en adultos jóvenes sin predilección de sexo. Su presentación clínica puede confundirse con gran cantidad de diagnósticos, sobre todo por la aparición de fiebre y otros signos inespecíficos de infección, por lo que la sospecha clínica por este síndrome debe ser alta y confirmada mediante la realización de estudios de imagen, como la TAC, debido a las consecuencias que pueden llegar a ser potencialmente fatales. El manejo de esta patología debe individualizarse en cada caso y puede ir desde un tratamiento conservador en etapas tempranas, pudiendo recurrir a la fisioterapia, hasta llegar a requerir un manejo más agresivo como las intervenciones quirúrgicas. Su adecuado manejo, a menudo, tiene una evolución favorable para el paciente.

Letter: Traumatic Vertebral Artery Injury After Subaxial Cervical Spine Injuries: Incidence, Risk Factors, and Long-Term Outcomes: A Population-Based Cohort Study

2025-06-19
Xin Zhou | Neurosurgery

Letter re: CT vs MRI C-Spine Imaging for C-Spine Clearance in Obtunded Patients in Low-Energy Trauma Mechanisms

2025-06-19
Ajay Malhotra , Xiao Wu | The American Surgeon

MPC-based postural control: Mimicking CNS strategies for head–neck stabilization under eyes closed conditions

2025-06-19
Chrysovalanto Messiou , Riender Happee , Γεώργιος Παπαϊωάννου | Control Engineering Practice

Kyphoplasty as a Treatment Option for Traumatic Burst Fractures: A Case Series Evaluating Patient Outcomes and Functional Benefits

2025-06-19
Anoop S. Chinthala , Barnabas Obeng-Gyasi , Trenton A. Line +3 more | Brain Sciences
Background/Objectives: Kyphoplasty and vertebroplasty are minimally invasive approaches for spinal fractures aiming to reduce pain, increase mobilization, and prevent further vertebral height loss. Their efficacy in treating burst fractures has … Background/Objectives: Kyphoplasty and vertebroplasty are minimally invasive approaches for spinal fractures aiming to reduce pain, increase mobilization, and prevent further vertebral height loss. Their efficacy in treating burst fractures has been questioned due to fragment mobility and concerns for cement leakage. We aim to report outcomes in patients who underwent kyphoplasty for spinal burst fractures. Methods: We conducted a retrospective review of patients with burst fractures treated from 2018 to 2023. Those who underwent kyphoplasty or vertebroplasty and had follow-up imaging were included. Clinical characteristics and follow-up outcomes were obtained through chart review. The primary outcome was the need for surgical intervention after kyphoplasty. Results: We identified ten patients (mean age 67.9 years, range 36-93 years) with burst fractures who underwent kyphoplasty/vertebroplasty. Six received kyphoplasty/vertebroplasty within 1 week of injury and four between 1 and 4 months post-injury. Nine patients had a TLICS score of 2, and one had a TLICS score of 5. Kyphoplasty/vertebroplasty was performed for pain management in seven patients and significant/worsening vertebral height loss in three patients. At follow-up, 70% of patients reported an improvement in pain and 75% of patients reported improved mobility. One patient experienced progression of an L2 burst fracture but improved with conservative management. No patient required additional surgical fixation. Conclusions: In this series of ten patients with spinal burst fractures, standalone kyphoplasty was a safe and effective treatment. Our findings suggest kyphoplasty may be a viable treatment option for select spinal traumatic burst fractures, offering potential pain relief and mobility improvement in the short term.

Forensic medical evaluation of uncomplicated compression fractures of bodies of the thoracic and lumbar parts of the spine in children

2025-06-18
V.A. Akbashev , Л. Г. Александрова , A. K. Khusainova | Forensic Medical Expertise
The article considers compression fractures of the thoracic and lumbar parts of the spine without neurological complications in children considering age features, their diagnosis by X-ray, computed tomography, magnetic resonance … The article considers compression fractures of the thoracic and lumbar parts of the spine without neurological complications in children considering age features, their diagnosis by X-ray, computed tomography, magnetic resonance imaging (MRI) and ultrasound, as well as differential diagnosis with degenerative-dystrophic changes of different etiology. Routine X-ray is usually insufficient for forensic medical evaluation of uncomplicated compression fractures of the vertebral bodies without gross deformities, especially to decide the issue of the age of trauma. It is necessary to critically evaluate the established diagnosis and to analyze clinical and instrumental data, considering the completeness and accuracy of the studies to exclude overdiagnosis in the forensic examination of cases of compression fractures of the vertebral bodies. A case report demonstrating the use of MRI to determine the volume and age of trauma is presented.

Atlas realignment as novel approach to whiplash recovery: A case study on cervical stability and neurovascular flow

2025-06-18
Jonathan Verderame , Melis Arslan , Zaheer Abbas | Interdisciplinary Neurosurgery

Fracture of Fused Vertebrae More Than 20 Years After Anterior Cervical Fusion: A Case Report

2025-06-18
Yoshihiro Ishihama , Terumasa Ikeda , Shunki Iemura +2 more | Cureus

Os odontoideum-induced sudden onset myelopathy following cervical extension injury in an adult—case report on challenges and management with 3D navigation technology

2025-06-18
Sathish Muthu , Guna Pratheep Kalanchiam , Hyun Jun Jang +2 more | Frontiers in Surgery
Os odontoideum is a relatively rare congenital anomaly of the upper cervical spine. It occurs due to developmental failure of the C2 odontoid process. Symptomatic patients develop instability resulting in … Os odontoideum is a relatively rare congenital anomaly of the upper cervical spine. It occurs due to developmental failure of the C2 odontoid process. Symptomatic patients develop instability resulting in cervical spinal cord compression. Surgical fixation is the management of choice in such patients to mitigate the risks of neurological worsening. On the other hand, such pathologies are challenging conditions to treat, mainly due to the surrounding delicate neurovascular structures and smaller bony anatomy of the atlas and axis. Especially in patients with variability in the normal anatomy of osseous and vascular structures, it is even more difficult to establish an effective stabilization strategy. Over the years, it has been proven that the use of pedicle screws is far superior to other techniques like sublaminar wiring in the cervical spine. However, it may not be possible in several cases due to anatomical constraints and lack of sufficient experience for early career surgeons to execute the surgical plan with ease and confidence. 3D-CT-based navigation has enabled real-time guidance for screw trajectory. They have significantly helped surgeons in the appropriate placement of surgical hardware, even with lesser surgical exposure and in minimally invasive techniques. We present the utilization of this technology in a case of sudden onset quadriparesis due to atlantoaxial instability secondary to Os odontoideum. This article highlights the effectiveness, safety, and precision of 3D-CT guidance in managing such complex case scenarios.

Biomechanical Design and Validation of a Novel Elliptical Sleeve Pedicle Screw for Enhanced Spinal Fixation Stability

2025-06-18
Ting-Shuo Hsu , Chang-Jung Chiang , Hsuan-Wen Wang +2 more | Bioengineering
This study aimed to develop a novel modular pedicle screw system incorporating an elliptical sleeve to conform the pedicle's elliptical cross-section and enhance fixation strength with mechanical stability. The biomechanical … This study aimed to develop a novel modular pedicle screw system incorporating an elliptical sleeve to conform the pedicle's elliptical cross-section and enhance fixation strength with mechanical stability. The biomechanical evaluation was conducted based on fundamental mechanics principles, followed by a finite element (FE) analysis to assess stress distribution under compressive and torsional loads. Subsequently, mechanical testing was performed to evaluate static and fatigue bending performance and in vitro biomechanical fatigue in porcine vertebrae by pull-out testing after 5000 and 100,000 cycles to assess fixation stability. The FE analysis demonstrated that the elliptical sleeve design improved bending resistance by 1.21× and torsional resistance by 1.91× compared to conventional cylindrical screws. Mechanical testing revealed greater bending/torsion stiffness and fatigue resistance, with the elliptical sleeve screw withstanding 5 million cycles at 235.4 N, compared to 175.46 N for cylindrical screws. Biomechanical pull-out testing further confirmed significantly higher retention strength after 100,000 cycles (1229.75 N vs. 867.83 N, p = 0.0101), whereas cylindrical screws failed prematurely at 10,663 cycles due to excessive displacement (>2 mm). The elliptical sleeve pedicle screw system demonstrated enhanced fixation strength, reduced micromotion, and superior fatigue resistance, making it a promising alternative to conventional pedicle screws for improving long-term spinal fixation stability.

Posterior accessory C1-C2 articulation

2025-06-18
Tim Hughes | Radiopaedia.org

Posterior accessory C1-C2 articulation

2025-06-18
Tim Hughes | Radiopaedia.org

Effect of Screw Thread Pitch, Purchase Depth, and Trajectory on Cervical Lateral Mass Fixation Strength

2025-06-17
Monther Abuhantash , Drew Mulhall , Sara Gustafson +1 more | Clinical Spine Surgery A Spine Publication
Study Design: Biomechanical study. Objective: Determine the effect of screw thread pitch, trajectory, and purchase depth on the screw pull-out strength in lateral mass fixation constructs. Summary of Background Data: … Study Design: Biomechanical study. Objective: Determine the effect of screw thread pitch, trajectory, and purchase depth on the screw pull-out strength in lateral mass fixation constructs. Summary of Background Data: Fusion of the cervical spine is routinely performed with lateral mass screw fixation. It is imperative to optimize the lateral mass fixation construct strength to minimize the risk of hardware failure and subsequent complications and reoperations. Methods: Biomechanical testing was performed using bicortical artificial bone models to replicate the lateral mass of the cervical spine. Cortical and cancellous screws of 3.5 mm diameter were compared at 3 purchase depths: unicortical, bicortical, and bicortical backed-out to unicortical, and 2 trajectories: Roy-Camille (RC) and Magerl. In a second construct, bicortical 3.5 mm screws were replaced with unicortical 4.0 mm screws. Both thread pitches and trajectories were also compared. Results: Fixation with the RC technique was stronger than with Magerl in all constructs. Roy-Camille fixation using cortical screws was stronger than cancellous screws in all purchase depths. Magerl fixation using cancellous screws was stronger in all purchase depths but only statistically significant for the group where the bicortical screw was backed-out to unicortical. The construct where the bicortical 3.5 mm screw was replaced with a 4.0 mm unicortical screw was stronger than when the screw was backed-out to a unicortical depth. This was significant for cortical screws in both trajectories but only significant for cancellous screws using the RC technique. Conclusions: Biomechanical strength of cervical lateral mass fixation was shown to be directly influenced by thread pitch, depth, and trajectory. Thus, spine surgeons should be cognizant of their fixation constructs and any changes made to their components.

Craniocervical Junction and Upper Cervical Spine Fractures: Historical Systems and Advancements with the AO Spine Classification

2025-06-17
Barry Ting Sheen Kweh , Alexander R. Vaccaro , Gregory D. Schroeder +7 more | Global Spine Journal
Study Design Systematic Review. Objectives To describe existing craniocervical junction and upper cervical spine classification systems and their integration into a unified rational hierarchical system of the AO Spine Upper … Study Design Systematic Review. Objectives To describe existing craniocervical junction and upper cervical spine classification systems and their integration into a unified rational hierarchical system of the AO Spine Upper Cervical Injury Classification System (UCIC). Methods A systematic review of MEDLINE, EMBASE and Cochrane Databases was performed in keeping with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Results 859 articles were identified which yielded 10 established classification systems for injuries of the occipital condyles, craniocervical junction as well as atlas and axis. All systems were either non-hierarchical, conferred minimal clinical significance or failed to consider neurological status of patients. For example, the Traynelis classification simply relies upon describing the direction of displacement which has dubious clinical significance. Similarly, the Jefferson description of atlas fractures simply grades injuries by fracture line pattern. The AO Spine UCIC system synthesizes each published historical scheme into a rational graded method by which clinicians can assess the severity of injuries to this region. The three grades of injury range from type A being generally stable bony injuries, type B constituting potentially unstable (osseoligamentous) injuries and type C representing grossly unstable translational injuries. Conclusion The AO Spine UCIC System is a validated methodoogy of integrating historical landmark grading systems and evolving this into a structured means of grading severity of injuries to guide timely clinical management. The implementation of this universal system will enable clinicians to consistently assess craniocervical junction injuries and implement appropriate managemen strategies. Future studies will examine outcomes after operative or non-operative management with progression to a standardized quantified algorithm.

Construction and Validation of a Survival Prediction Model for Patients After Vertebroplasty

2025-06-17
Li-Hong Wang , Tong-Bo Deng , Ting-Ting Jin | Journal of the American Academy of Orthopaedic Surgeons
To analyze the risk factors that affect the survival of patients undergoing vertebroplasty and construct a predictive nomogram. Retrospective analysis of the survival status for patients age ≥50 years who … To analyze the risk factors that affect the survival of patients undergoing vertebroplasty and construct a predictive nomogram. Retrospective analysis of the survival status for patients age ≥50 years who underwent vertebroplasty in our hospital from January 2013 to August 2022. Demographic information, inpatient data, laboratory examination results, medication records, and other information were extracted from the clinical scientific research database of our hospital. Through proportional hazards assumption, univariate and subsequent multivariate COX regression, the independent risk factors that affect the survival prognosis of patients after vertebroplasty were summarized. A survival prediction nomogram based on these independent risk factors were constructed and validated. Three hundred fifty-nine patients were enrolled, 251 in the training set and 108 in the validation set. Multivariate COX regression showed that mean serum albumin (hazard ratio [HR] = 0.59565, 95% confidence interval [CI], 0.36160 to 0.9812), number of vertebroplasty (HR = 0.1978, 95% CI, 0.06529 to 0.2197), interval between the first two vertebroplasty procedures (HR = 0.05642, 95% CI, 0.02933 to 0.1085), and number of activating vitamin D prescriptions (HR = 0.34975, 95% CI, 0.19855 to 0.6161) were independent risk factors for the survival prognosis of patients after vertebroplasty. Based on these independent risk factors, a predictive nomogram was constructed. The area under the curve of the 5- and 8-year survival prediction models in the validation set was 0.889 and 0.760, respectively. The calibration curves of the nomogram in the training and validation sets were close to the ideal diagonal. The decision curve analysis showed that the predictive model exhibited good net benefit and predictive ability. Mean serum albumin, number of vertebroplasty, interval between the first two vertebroplasty procedures, and number of activating vitamin D prescriptions were independent risk factors for the survival prognosis of patients after vertebroplasty. The predictive nomogram constructed based on these risk factors had a good predictive ability and certain potential for clinical decision making.

Lumbar Spine Instability Fracture in a Patient With Residual Adolescent Idiopathic Scoliosis: A Case Report

2025-06-17
Yuta Masaki , Tomohito Mukaihata , Yasuhiro Shiga +2 more | Cureus

O-Arm Vs Surgivisio for Pedicle Screw Insertion: A Prospective Study on Screw Accuracy and Irradiation on 100 Patients

2025-06-17
Marc Prod’homme , Maxime Saad , Jérôme Tonetti +5 more | The International Journal of Spine Surgery
Computerized navigation improves the accuracy of spine procedures. However, intraoperative imaging is plagued by ionizing irradiation and its cancer risk. Advanced technologies attempt to optimize the radiation dose. The goal … Computerized navigation improves the accuracy of spine procedures. However, intraoperative imaging is plagued by ionizing irradiation and its cancer risk. Advanced technologies attempt to optimize the radiation dose. The goal of this study was to compare radiation exposure and screw accuracy of O-arm navigation and the Surgivisio device (SD) in pedicle screw insertion. All patients operated on by navigated pedicle screw insertion during a 19-month period were prospectively included in 2 spine centers: the first with the O-arm and the second with the SD. Demographic, operative, and irradiation data were collected. The accuracy of the screw positioning was assessed using the Heary and Gertzbein classifications. The effective dose in millisievert (mSv) was calculated. One hundred patients were included, 50 per group. Five hundred and twelve screws were inserted, among them 228 in 120 vertebrae with the O-am and 284 in 145 vertebrae with the SD. Screw accuracy was 99.1% with the O-arm vs 93.3% with the SD (P = 0.07). Operative times were similar, with 145 vs 139 minutes respectively, P = 0.68. The effective dose was significantly higher in the O-arm group, with 5.43 vs 2.70 mSv with the SD (P < 0.01). The effective dose related to 2-dimensional imaging was significantly lower in the O-arm group than in the SD group, with 0.26 vs 1.16 mSv, respectively, P < 0.01, related to a shorter imaging duration (4 vs 109 seconds respectively, P < 0.01). Accuracy of pedicle screws was higher with the O-arm than with the Surgivisio, but the latter showed less radiation exposure. Despite promising results, improvements in technology should be pursued for ergonomics and surgical safety.

Decompression surgery with intraoperative vertebroplasty: A reduced invasiveness treatment strategy for aggressive vertebral hemangiomas

2025-06-17
Ben Wang , Jiasheng Chen , Ruomu Qu +7 more | Research Square (Research Square)
<title>Abstract</title> Purpose Aggressive vertebral hemangiomas (VHs) are rare benign tumors but can cause neurological deficits. Currently, the optimal treatment strategy for aggressive VHs remains controversial. The purpose of study is … <title>Abstract</title> Purpose Aggressive vertebral hemangiomas (VHs) are rare benign tumors but can cause neurological deficits. Currently, the optimal treatment strategy for aggressive VHs remains controversial. The purpose of study is to evaluate the safety and efficacy of decompression surgery with intraoperative vertebroplasty for the treatment of aggressive VHs. Methods A total of 85 aggressive VH patients with neurological deficits who underwent decompression surgery with intraoperative vertebroplasty between January 2010 and May 2024 were included in this study. Clinical data such as patient demographics, symptoms, neurological function, pain levels, radiologic features, surgical information, pathology, and perioperative complications, were recorded and analyzed. Enneking staging was determined based on radiological findings. Neurological function and pain levels were assessed using the Frankel grade and the Visual Analogue Scale (VAS), respectively. The minimum follow-up duration was 12 months. Results The average age of 85 patients (49 male and 36 female) was 51.1 ± 14.3 (21–77) years. Lesions were located in the cervical spine in 1 case, the thoracic spine in 67 cases, and the lumbar spine in 17 cases. All surgery procedures were completed successfully with an average surgery duration of 168.2 ± 83.3 (90–500) minutes and an average blood loss of 670.1 ± 674.8 (50–2500) ml. Preoperative embolization significantly reduced intraoperative blood loss (P &lt; 0.01). Postoperatively, the pain levels of patients were significantly alleviated (P &lt; 0.01). The average follow-up duration was 76.1 ± 55.1 (12–182) months and all patients remained alive at the final follow-up. Recurrence was observed in eight patients, one of whom underwent surgery combined with radiotherapy, while the remaining seven received radiotherapy alone, and at the last follow-up, these patients were symptom-free. Adequate and satisfactory intraoperative filling of bone cement could reduce the risk of recurrence (P &lt; 0.01). Conclusions Decompression surgery with intraoperative vertebroplasty can effectively reduce blood loss, alleviate neurological symptoms and reduce the risk of recurrence, and is a safe and effective approach in the management of aggressive VHs.

Corrigendum: MRI Enhancement Associated with TFCC and Scapholunate Interosseous Ligament Tears

2025-06-17
Nick Daunt , Mark Ross , Greg Couzens +2 more | Journal of Wrist Surgery

Vertebrobasilar occlusion

2025-06-16
Francis Deng | Radiopaedia.org

The Domino Effect: When Vertebral Fractures Lead to Sternal Pain

2025-06-16
Mayalen Uthurriague , M Masson | Research Square (Research Square)
<title>Abstract</title> <bold>Background:</bold> Sternal insufficiency fractures remain an uncommon but increasingly recognized condition in elderly patients with advanced osteoporosis. They typically manifest as acute anterior chest pain, which can closely mimic … <title>Abstract</title> <bold>Background:</bold> Sternal insufficiency fractures remain an uncommon but increasingly recognized condition in elderly patients with advanced osteoporosis. They typically manifest as acute anterior chest pain, which can closely mimic cardiac pathology, leading to potential delays in diagnosis if not investigated with appropriate imaging. <bold>Case Presentation:</bold> We describe the case of an 81-year-old woman with a history of severe osteoporosis who was admitted for management of a painful osteoporotic compression fracture at the fifth thoracic vertebra (T5). Her osteoporosis had previously been managed with oral bisphosphonates, followed by three years of denosumab therapy. However, no antiresorptive consolidation therapy was administered after her last denosumab injection, given nine months prior, due to recent dental issues. Within 24 hours of admission, the patient developed sudden-onset anterior chest pain while moving from a seated position. The pain was reproducible on palpation over the sternum. A chest CT scan revealed a spontaneous, non-displaced transverse sternal fracture. The recent vertebral collapse had further accentuated her thoracic kyphosis, likely increasing mechanical stress on the sternum and contributing to the fracture. Management included local application of lidocaine patches, which provided effective pain relief, along with a single intravenous dose of zoledronic acid for osteoporosis consolidation. <bold>Conclusion:</bold> This case underscores the importance of considering sternal insufficiency fractures in elderly patients with osteoporosis who present with chest pain, especially in the context of recent vertebral fractures or postural deformities. It also highlights the potential complications associated with denosumab discontinuation when not followed by appropriate consolidation therapy. Finally, it draws attention to the utility of topical lidocaine as a simple, well-tolerated option for localized bone pain in frail, elderly patients.

Characteristics of Unilateral Cervical Spine Facet Fractures

2025-06-16
Danielle E. Chipman , Thomas J. Ryan , David Kowalski +7 more | Clinical Spine Surgery A Spine Publication
Study Design: Clinical case series. Objective: The objective of this case series is to describe the demographics, mechanisms of injury, radiologic imaging measurements, and treatment of unilateral cervical facet fractures … Study Design: Clinical case series. Objective: The objective of this case series is to describe the demographics, mechanisms of injury, radiologic imaging measurements, and treatment of unilateral cervical facet fractures in adult trauma patients. Summary of Background Data: Unilateral cervical facet fractures are rare and traumatic injuries of the spine that are frequently misdiagnosed and misclassified. There is a lack of consensus on the appropriate management for various severities of unilateral facet fractures. Methods: All patients over 18 years old who presented at a single center between September 2015 and March 2023 with a unilateral cervical facet fracture were identified. Fracture height and percentage of the lateral mass were measured on computerized tomography (CT). Demographics, treatment course, and intrahospital data were collected. Results: Of the 554 patients identified, 22 met final inclusion and exclusion criteria. The median age was 37.5 (IQR: 36) years, and 68% were male. The most common mechanisms of injury were a motor vehicle crash (55%) or a fall (23%). Seven (32%) patients required surgical intervention, and 15 (68%) patients were treated nonoperatively. The average fracture height for all participants was 1.11 ± 0.4 cm, and the average percentage of the lateral mass was 42.3% ± 18.0%. After 1 year of follow-up, all patients treated nonoperatively had successful outcomes, with no treatment failures or need for surgical intervention. Conclusion: Patients who sustained a unilateral cervical spine facet fracture from a traumatic injury mechanism with fracture fragments &gt;1 cm or &gt;40% of the lateral mass on CT scan can effectively be treated nonoperatively. No patient treated nonoperatively failed treatment and required surgery at 1 year. We recommend considering operative intervention in patients with high-energy mechanisms of injury coupled with the abovementioned radiographic parameters.

Frakturen des Felsenbeins

2025-06-16
Armin Bachhuber | Deleted Journal
The temporal bone is one of the most complex bones in the human body. Fractures require significant force and are usually associated with extensive damage to adjacent structures. Which imaging … The temporal bone is one of the most complex bones in the human body. Fractures require significant force and are usually associated with extensive damage to adjacent structures. Which imaging modality facilitates the assessment of petrous bone fractures, and which anatomical landmarks may be used for orientation? A literature search on PubMed.gov was conducted to determine the current state of research. Injuries to the petrous part of the temporal bone often involve the facial nerve and the vestibulocochlear nerve, as well as the cochlea and the vestibular organ. This article presents strategies to facilitate correct diagnosis. In addition to the (often knotty) description of the fracture, it is essential to assess the cranial nerves that transverse the petrous bone and to evaluate the auditory ossicles.

Prevalence of suboccipital and intradural vertebral artery variants: a systematic review with meta-analysis

2025-06-16
George Triantafyllou , Panagiotis Papadopoulos-Manoralarakis , Răzvan Costin Tudose +3 more | Neuroradiology

The Impact of Intraoperative Imaging on Outcomes in Combined Neurosurgical and Reconstructive Procedures: A Systematic Review

2025-06-15
Muhammad Ilyas Alozai , Omar Amgad Yehia Elassra , Aliaa H Alkhazendar +7 more | Cureus

Galeazzi fracture-dislocation

2025-06-15
Mostafa Elfeky | Radiopaedia.org

Inadequacy of anterior-only fixation for reducible three-column injury of the subaxial cervical spine: case report

2025-06-13
Yuying Wu , Po‐Yuan Chen , Kang Lu +1 more | International Surgery
Abstract Introduction: Managing three-column injuries in the subaxial cervical spine in patients with prior spinal fusion surgery is complex. Current treatment algorithms generally advocate that an anterioronly approach is adequate … Abstract Introduction: Managing three-column injuries in the subaxial cervical spine in patients with prior spinal fusion surgery is complex. Current treatment algorithms generally advocate that an anterioronly approach is adequate for reducible subaxial cervical spine injuries. However, comprehensive studies on cervical trauma in patients with previously fused spines are lacking. Case presentation: We report a case of a 62-year-old male with a history of C4 to C6 anterior cervical spine fusion. The patient sustained a C6–C7 translational injury from a fall. Despite successful intraoperative reduction and anterior instrumentation, instrument failure occurred within a month without further trauma. This complication may be due to increased mechanical load from the fused segments above the injury site. Conclusion: This case underscores the need for customized treatment strategies for patients with prior spinal fusion surgery. Initial circumferential stabilization might be crucial to distribute mechanical loads effectively and prevent instrument failure. Further research is necessary to develop definitive management protocols for these challenging cases.

Clinical Outcomes and Biomechanical Evaluation of the Cement-Catching Screw Technique for Osteoporotic Vertebral Fractures

2025-06-13
Hisakazu Shitozawa , Haruo Misawa , Yoshiaki Oda +7 more | Cureus

Traumatic atlantoaxial rotatory fixation

2025-06-13
Mehmet Haydar Atalar | Journal of Clinical Neuroscience