Risk factor analysis of proximal junctional kyphosis after posterior fusion in patients with idiopathic scoliosis
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Keywords:
Kyphosis
Vertebra
Cobb angle
Thoracic vertebrae
In Brief Study Design. Retrospective case review at a single center. Objective. To analyze the incidence and risk factors associated with proximal junctional kyphosis (PJK) and distal junctional kyphosis (DJK) in patients undergoing instrumented spinal fusion for Scheuermann kyphosis. Summary of Background Data. Previously reported risk factors for junctional kyphosis include improper end vertebrae selection, curve correction greater than 50%, or excessive junctional soft tissue dissection. Methods. Clinical and radiographic data on 67 patients (mean age 37) from a single center treated with instrumented fusion for Scheuermann kyphosis were reviewed. All patients had complete radiographic data with a minimum 5-year follow-up (mean: 73 months). Abnormal PJK was defined by a proximal junctional angle greater than 10° and at least 10° greater than the corresponding preoperative measurement. DJK was similarly defined between the caudal endplate of the lower instrumented vertebra to the caudal endplate that was 1 vertebra below. Results. The incidence of PJK as defined above was seen in 20 patients (30%). The development of PJK was associated with failure to incorporate the proximal end vertebra (15 patients), disruption of junctional ligamentum flavum (3 patients), or combination of both (2 patients). The most common cause of inappropriate end vertebra selection was poor visualization of the upper thoracic vertebra. DJK occurred in 8 patients (12%) and 7 of them had fusion short of including the first lordotic disc. Conclusion. The incidence of PJK can be minimized by the appropriate selection of the upper end vertebra to be fused and avoiding disruption of the junctional ligamentum flavum. The development of DJK can be minimized by incorporation of the first lordotic disc into the fusion construct. An analysis of 67 surgically treated patients with Scheuermann kyphosis (mean follow-up: 73 months) revealed proximal junctional kyphosis in 30% and related either to too short a fusion, or disruption of the posterior ligament complex. Distal junctional kyphosis was seen in 12% and was related to failure in incorporating the first lordotic disc.
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Objective: To study m orphology of transverse process of thoracic and lum bar vertebracomparatively, and to investigate its clinical significance. Methods: Forty-five adult (male 25 and female 20)dehydration skeletons (T1￣T10 and L1￣L5 segment) were obtained, then the length, thickness, height, and theangle of elevation (upward and backward) of thoracic and lumbar vertebra were measured. The data wereanalysed statistically to compare the morphometric difference of thoracic and lumbar vertebra. Results:Morphology of thoracic and lumbar vertebra was different significantly (P0.05)exceptL3 and L5 segment.Compared with that of lumbar vertebra, the thoracic transverse process was longer, thicker, higher and hadlarger backward angle of elevation. Conclusions:M orphology of thoracic and lum bar vertebra are differentsignificantly, the transverse process of lumbar vertebra is suitable to be a localization landmarks, while thetransverse process of thoracic vertebra is suitable to load fixation. Screw fixation from the transverse process tovertebra body is possible in thoracic spine.
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Vertebra
Thoracic vertebrae
Vertebral column
Lumbosacral joint
Kyphosis
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Vertebra
Thoracic vertebrae
Vertebral Compression Fracture
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The pre and postoperative rib-vertebra angles and Cobb angles in patients with idiopathic scoliosis pre and post operatively treated with full transpedicular screw constructs were compared. Eighteen patients had right thoracic curves while only two had a left curve. 7 curves were Lenke's type 3C, 6 type 5C, 4 type 1A, 3 type 6C and one type 2A. Convex side showed larger RVAs compared to the concaved side. The rib vertebra angle decreased from T1 to T12. The rib vertebra angles pre operatively (left vs right) were significantly different in every single level apart from T1, T7, T8 and T9. Cobb angle significantly improved post - operatively (p=0.0001). The post-operative rib vertebra angle differences significantly differed at all levels (p>0.05), but not in the region spanning the thoracic apex (T6-T7-T8). The powerful full-screw instrumentation corrects the Cobb angle very satisfactorily, but only partially corrects the rib cage asymmetry as this is expressed by the rib vertebra angle differences pre and post operatively. The small or no effect on the stiff apical ribs (T6-T8) and the possible role of the related musculature need to be further evaluated and analyzed.
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Thoracic spine
Thoracic vertebrae
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Objective To discuss the Diagnostic Value for Spine Tuberculosis by CT.Methods Retrospective analysis of 44 CT lmagings of Spine Tuberculosis.Results Lesions:the thoracic vertebra cases-12;the lumbar vertebra cases-24;the thoracic and lumar vertebra cases-4;the lumbosacral vertebrae cases-4;the single vertebrae cases-11;the multi-vertebrae cases-33.Conclusions CT has a great vallue for diagnosing Spine Tuberculosis.
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Thoracic vertebrae
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The literature states that transitional vertebrae at any junction are characterized by features retained from two adjacent regions in the vertebral column. Currently, there is no published literature available that describes the prevalence or morphology of thoracolumbar transitional vertebrae (TLTV). The aim of this study was to identify the qualitative characteristics of transitional vertebrae at the thoracolumbar junction and establish a technique to differentiate the various subtypes that may be found. A selection of vertebral columns from skeletal remains (n = 35) were evaluated in this study. Vertebrae were taken based on features that are atypical for vertebrae in each relative region. The transitional vertebrae were qualitatively identified based on overlapping thoracic and lumbar features of vertebrae at the thoracolumbar junction. The following general overlapping characteristics were observed: aplasia or hypoplasia of the transverse process, irregular orientation on the superior articular process and atypical mammillary bodies. The results show that the most frequent location of the transitional vertebrae was in the thoracic region (f = 23). The second most frequent location was in the lumbar region (f = 10). In two specimens of the selection (f = 2), an additional 13th thoracic vertebra was present which functioned as a transitional vertebra. This study concluded that one can accurately identify the characteristics of transitional vertebrae at the thoracolumbar junction. In addition, the various subtypes can be differentiated according to the region in the vertebral column the vertebra is located in and the relative number of vertebral segments in the adjacent regions of the vertebral column. This provides a qualitative tool for researchers to differentiate the transitional vertebrae from distinctly different typical thoracic or lumbar vertebrae at the thoracolumbar junction.
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Objective: To compare the spinal enumeration methods that establish the first lumbar vertebra in patients with spinal variants.Materials and Methods: Of the 1446 consecutive patients who had undergone computed tomography of the spine from March 2012 to July 2016, 100 patients (62 men, 38 women; mean age, 47.9 years; age range, 19-88 years) with spinal variants were included.Two radiologists (readers 1 and 2) established the first lumbar vertebra through morphologic analysis of the thoracolumbar junction, and labeled the vertebra by counting in a cranial-to-caudal manner.Inter-observer agreement was established.Additionally, reader 1 detected the 20th vertebra under the assumption that there are 12 thoracic vertebra, and then classified it as a thoracic vertebra, lumbar vertebra, or thoracolumbar transitional vertebra (TLTV), on the basis of morphologic analysis. Results:The first lumbar vertebra, as established by morphologic analysis, was labeled by each reader as the 21st segment in 65.0% of the patients, as the 20th segment in 31.0%, and as the 19th segment in 4.0%.Inter-observer agreement between the two readers in determining the first lumbar vertebra, based on morphologic analysis, was nearly perfect (κ value: 1.00).The 20th vertebra was morphologically classified as a TLTV in 60.0% of the patients, as the first lumbar segment in 31.0%, as the second lumbar segment in 4.0%, and as a thoracic segment in 5.0%. Conclusion:The establishment of the first lumbar vertebra using morphologic characteristics of the thoracolumbar junction in patients with spinal variants was consistent with the morphologic traits of vertebral segmentation.
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Objective To study the clinical efficacy of in Spinal Kyphoplasty bone expander System in trearment of osteoporotic fracture of lumbar vertebra and fracture of thoracic vertebra.Methods45 cases of osteoporotic fracture of lumbar vertebra and fracture of thoracic vertebra were treated body of vertebra –plasty by Spinal Kyphoplasty bone expander System.The pain and the height of vertebra anterior border and the vertebra post-lobe were observed after operation.ResultsThe pain and the height of vertebra anterior border were relieved obviously and the vertebra post-lobe growed down obviously after the operation.ConclusionSpinal Kyphoplasty bone expander system in trearment of osteoporotic fracture of lumbar vertebra and fracture of thoracic vertebra is good.It not only reaches relieving pain ,but also recovers the height of vertebra anterior border and corrects spinal kyphosis.
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Kyphosis
Spinal fracture
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The pig spine is widely used as a large animal model for preclinical research in human medicine to test new spinal implants and surgical procedures. Among them, pedicle screw is one of the most common method of fixation of those implants. However, the pedicle of the porcine vertebra is not as well defined and not as large as the pedicle of the human vertebra. Therefore, the position of the screw should be adapted to the pig and not merely transposed based on the literature on humans. The purpose of this study is to determine the characteristics of the optimum implantation corridors for pedicle screws in the thoracolumbar spine of piglets of different ages using computed tomography (CT) and to determine the size and length of these corridors in pigs of different ages. CT scans from five groups of age: 6, 10, 14, 18, and 26 weeks were reviewed. For each thoracolumbar vertebrae, the pedicle width, pedicle axis length, and the pedicle angle was measured for the left and right pedicle. A total of 326 thoracic vertebrae and 126 lumbar vertebrae were included in the study. Pedicles are statistically larger but not longer for the lumbar vertebrae. An important variation of the pedicle angle is observed along the spine. In all pigs, an abrupt modification of the pedicle angle between T10 and T11 was observed, which corresponds to the level of the anticlinal vertebra which is the vertebra for which the spinous process is nearly perpendicular to the vertebral body. In conclusion, this study provides a quantitative database of pedicle screw implantation corridors in pigs of different ages. When using pedicle screws in experimental studies in pigs, these results should be considered for selecting the most suitable implants for the study but also to ensure a correct and safer screw position. Improving study procedures may limit postoperative complications and pain, thereby limiting the use of live animals.
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