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1.
2.
Tomography ; 9(1): 150-161, 2023 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-36649000

RESUMO

BACKGROUND: Multidetector computer tomography (CT) has been used to diagnose pathologies such as osteoporosis via opportunistic screening, where the assessment of the bone structure and the measurement of bone mineral density (BMD) are of great relevance. PURPOSE: To construct reference BMD values based on the measurement of the attenuation of the L1 vertebral body by multidetector CT scan (in the soft tissue and bone windows) in adult patients and to establish normative ranges by sex and age of BMD values. MATERIALS AND METHODS: A retrospective cross-sectional study of 5080 patients who underwent multidetector CT scan between January and December 2021. Adult patients (≥18 years) with non-contrast multidetector CT scan of the abdomen or thorax-abdomen at a voltage 120 kV. The attenuation of the L1 vertebral body in Hounsfield units (HU) in both windows were compared using the Mann-Whitney U-test with α = 0.05. Additionally, the quartiles of the BMD were constructed (in both windows) grouped by sex and age. RESULTS: Only 454 (51.30 ± 15.89 years, 243 women) patients met the inclusion criteria. There is no difference in BMD values between windows (soft tissue: 163.90 ± 57.13, bone: 161.86 ± 55.80, p = 0.625), mean L1 attenuation decreased linearly with age at a rate of 2 HU per year, and the presence of BMD deficit among patients was high; 152 of 454 (33.48%) patients presented BMD values suggestive of osteoporosis, and of these, approximately half 70 of 454 (15.42%) corresponded to patients with BMD values suggestive of a high risk of osteoporotic fracture. CONCLUSIONS: From clinical practice, the bone mineral density (BMD) of a patient in either window below the first quartile for age- and sex-matched peers suggests a deficit in BMD that cannot be ignored and requires clinical management that enables identification of the etiology, its evolution, and the consequences of this alteration.


Assuntos
Densidade Óssea , Osteoporose , Humanos , Adulto , Feminino , Estudos Retrospectivos , Estudos Transversais , Absorciometria de Fóton/métodos , Tomografia Computadorizada por Raios X/métodos , Vértebras Lombares/diagnóstico por imagem , Osteoporose/diagnóstico por imagem
3.
Coluna/Columna ; 22(4): e274190, 2023. tab, graf, il
Artigo em Inglês | LILACS | ID: biblio-1528457

RESUMO

ABSTRACT: Introduction: The knowledge of the intervertebral disc morphology and its relation with the vertebrae is vital for managing degenerative spine disease. It is imperative to study the role of preventable and treatable causes, such as Vitamin D deficiency, so that standard guidelines can be framed for apt management. Objective: To evaluate the correlation between serum vitamin D levels and MRI morphometry of lumbar intervertebral discs. Methods: A total of 100 subjects (20-40 years) underwent an MRI of the lumbosacral spine. Intervertebral disc and vertebral body heights were measured, and disc degenerative changes were noted. Serum vitamin D levels were correlated with disc changes using the Pearson/Spearman rank correlation coefficient. A p-value of <0.05 was considered significant. Results: Vitamin D deficiency showed a high prevalence in patients with disc degenerative diseases, even in young adults and females with more severe vitamin D deficiency than males (p-value < 0.001). However, a significant relationship between vitamin D levels and disc or vertebral body heights could not be established. Conclusion: Vitamin D deficiency is more prevalent in patients with disc degenerative changes; however, its effect on disc and vertebral body heights needs to be extrapolated further in larger studies. Level of Evidence I; Cross-Sectional, Observational Study.


RESUMO: Introdução: O conhecimento da morfologia do disco intervertebral e sua relação com as vértebras é vital para o manejo da doença degenerativa da coluna. É imperativo estudar o papel das causas evitáveis e tratáveis, como a deficiência de vitamina D, para que possam ser elaboradas diretrizes padrão para um manejo adequado. Objetivo: Avaliar a morfometria da ressonância magnética dos discos intervertebrais lombares em correlação com os níveis séricos de vitamina D. Métodos: Um total de 100 indivíduos (20-40 anos) foram submetidos a ressonância magnética da coluna lombossacra. As alturas do disco intervertebral e do corpo vertebral foram medidas e alterações degenerativas do disco foram anotadas. Os níveis séricos de vitamina D foram correlacionados com alterações discais usando o coeficiente de correlação de Pearson/Spearman. Um valor de p <0,05 foi considerado significativo. Resultados: A deficiência de vitamina D apresentou alta prevalência em pacientes com doenças degenerativas do disco, mesmo em adultos jovens e mulheres que apresentavam deficiência de vitamina D mais grave que os homens (valor p < 0,001). No entanto, não foi possível estabelecer uma relação significativa entre os níveis de vitamina D e a altura do disco ou do corpo vertebral. Conclusão: A deficiência de vitamina D é mais prevalente em pacientes com alterações degenerativas do disco, no entanto, seu efeito na altura do disco e do corpo vertebral precisa ser extrapolado em estudos maiores. Nível de Evidência I; Estudio Observacional Transversal.


RESUMEN: Introducción: El conocimiento de la morfología del disco intervertebral y su relación con las vértebras es vital para el tratamiento de las enfermedades degenerativas de la columna vertebral. Es imprescindible estudiar el papel de las causas prevenibles y tratables, como la deficiencia de vitamina D, para poder elaborar directrices estándar para un tratamiento adecuado. Objetivo: Evaluar la morfometría por resonancia magnética de los discos intervertebrales lumbares en correlación con los niveles séricos de vitamina D. Métodos: Un total de 100 individuos (20-40 años) se sometieron a una resonancia magnética de la columna lumbosacra. Se midieron las alturas del disco intervertebral y del cuerpo vertebral y se observaron cambios degenerativos en el disco. Los niveles séricos de vitamina D se correlacionaron con los cambios discales mediante el coeficiente de correlación Pearson/Spearman. Se consideró significativo un valor p <0,05. Resultados: La deficiencia de vitamina D mostró una elevada prevalencia en pacientes con enfermedad degenerativa discal, incluso en adultos jóvenes y mujeres que presentaban una deficiencia de vitamina D más grave que los hombres (valor p < 0,001). Sin embargo, no fue posible establecer una relación significativa entre los niveles de vitamina D y la altura del disco o del cuerpo vertebral. Conclusión: La deficiencia de vitamina D es más prevalente en pacientes con cambios degenerativos del disco; sin embargo, su efecto sobre la altura del disco y del cuerpo vertebral debe extrapolarse en estudios mayores. Nivel de Evidencia I; Estudio Observacional Transversal.


Assuntos
Humanos , Adolescente , Adulto , Degeneração do Disco Intervertebral
4.
Rev. colomb. reumatol ; 29(4)oct.-dic. 2022.
Artigo em Inglês | LILACS | ID: biblio-1536209

RESUMO

Kummel's disease is a crush fracture of a vertebral body caused by a minor trauma, with the most accepted etiology being avascular necrosis. It is more frequent in individuals with risk factors such as osteoporosis or prolonged treatment with corticosteroids. Initially, it usually has normal radiological tests and an asymptomatic period, followed by a progressive onset of pain along with probable kyphosis and a sign of void or fluid abscess on radiological tests, which may create nerve/spinal involvement. The case is presented of a 76-year-old man, who was admitted to this center for the differential diagnosis of a single vertebral lesion. After imaging tests and biopsy, the definitive diagnosis of Kummel's disease was reached. The confirmatory diagnosis was reached by vertebral biopsy, but given its invasive nature, imaging techniques can play a significant role. As regards metabolic imaging tests, bone scintigraphy has shown to be one of the most sensitive tools to detect ischemia in earlier stages or to determine if it affects other locations. The whole body scan with diphosphonates shows an increase in activity in relation to bone remodeling activity in this condition. The 3-phase study makes it possible to differentiate whether it is an acute/subacute or chronic process, and can influence the therapeutic decision. Knowledge of this disease is important to make a differential diagnosis with tumour or infectious pathology, with emphasis on performing imaging tests in the event of persistent pain with a normal initial plaque.


La enfermedad de Kummel es una fractura-aplastamiento de un cuerpo vertebral precedida por un traumatismo menor, cuya etiología más aceptada es la necrosis avascular. Es más frecuente en individuos con factores de riesgo como osteoporosis o tratamiento prolongado con corticoides. Inicialmente, suele presentar pruebas radiológicas normales y un periodo asintomático, con aparición progresiva del dolor junto a probable cifosis y signo del vacío o absceso líquido en las pruebas radiológicas, pudiendo llegar a crear compromiso nervioso/medular. Presentamos el caso de un varón de 76 arios que ingresa en nuestro centro para el diagnóstico diferencial de una lesión única vertebral; tras la realización de las pruebas de imagen y biopsia se llega al diagnóstico definitivo de enfermedad de Kummel. El diagnóstico de confirmación de esta enfermedad se alcanza mediante la biopsia vertebral, pero dada su naturaleza invasiva, las técnicas de imagen toman un papel relevante. En relación con las pruebas de imagen metabólicas, la gammagrafía ósea ha demostrado ser una de las herramientas más sensibles para detectar isquemia en fases más tempranas o para conocer si afecta a otras localizaciones. El rastreo corporal de cuerpo completo con difosfonatos muestra un aumento de actividad en relación con la actividad ósea remodelativa en este cuadro. El estudio de tres fases permite diferenciar si se trata de un proceso agudo/subagudo o crónico, lo que influye en la decisión terapéutica. Es importante el conocimiento de esta enfermedad para realizar diagnóstico diferencial con patología tumoral o infecciosa e insistir en la realización de pruebas de imagen ante la persistencia del dolor con una placa inicial normal.


Assuntos
Humanos , Masculino , Idoso , Doenças Ósseas , Cintilografia , Doenças Musculoesqueléticas , Embriófitas , Técnicas e Procedimentos Diagnósticos , Carum , Diagnóstico , Eucariotos , Necrose da Cabeça do Fêmur
5.
Radiol Bras ; 55(4): 216-224, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35983340

RESUMO

Objective: To promote advanced research using magnetic resonance imaging (MRI) in the diagnosis of and screening for osteoporosis by looking for correlations among the T-scores measured by dual-energy X-ray absorptiometry (DEXA), the apparent diffusion coefficient (ADC) values on diffusion-weighted imaging (DWI), and the T1-weighted signal intensity values. Materials and Methods: This was a prospective study of postmenopausal women with no contraindications to MRI and no history of cancer who underwent DEXA within 30 days before or after the MRI examination. A 3.0-T scanner was used in order to acquire sagittal sequences targeting the lumbar spine. Results: Thirteen women underwent DEXA and MRI. In two cases, the MRI was discontinued early. Therefore, the final sample comprised 11 patients. The ADC values and T1-weighted signal intensity were found to be higher in patients with osteoporosis. However, among the patients > 60 years of age with osteoporosis, ADC values were lower and T1-weighted signal intensity was even higher. Conclusion: It is unlikely that MRI will soon replace DEXA for the diagnostic workup of osteoporosis. Although DWI and ADC mapping are useful for understanding the pathophysiology of osteoporosis, we believe that T1-weighted sequences are more sensitive than is DWI as a means of performing a qualitative analysis of vertebral alterations.


Objetivo: Promover pesquisas avançadas usando ressonância magnética (RM) no diagnóstico e rastreamento de osteoporose, procurando correlações entre os escores T medidos por absorciometria de raios-X de dupla energia (DEXA), valores de coeficiente de difusão aparente (ADC) na difusão e valores de intensidade de sinal ponderado em T1. Materiais e Métodos: Estudo prospectivo de mulheres na pós-menopausa sem contraindicações para RM e sem histórico de câncer que foram submetidas a DEXA 30 dias antes ou após o exame de RM. Um scanner 3.0-T foi utilizado para adquirir sequências sagitais direcionadas à coluna lombar. Resultados: Treze mulheres foram submetidas a DEXA e RM. Em dois casos, a RM foi interrompida precocemente. Portanto, a amostra final foi composta por 11 pacientes. Os valores de ADC e intensidade de sinal ponderado em T1 foram mais elevados nas pacientes com osteoporose. No entanto, no subgrupo de pacientes > 60 anos de idade com osteoporose, os valores de ADC foram menores e a intensidade do sinal ponderado em T1 foi ainda maior. Conclusão: É improvável que a RM substitua DEXA para a investigação diagnóstica da osteoporose no futuro próximo. Embora a difusão e o mapeamento ADC sejam úteis para a compreensão da fisiopatologia da osteoporose, acreditamos que as sequências ponderadas em T1 são mais sensíveis do que a difusão como meio de realizar uma análise qualitativa das alterações vertebrais.

6.
Radiol. bras ; Radiol. bras;55(4): 216-224, Aug. 2022. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1394568

RESUMO

Abstract Objective: To promote advanced research using magnetic resonance imaging (MRI) in the diagnosis of and screening for osteoporosis by looking for correlations among the T-scores measured by dual-energy X-ray absorptiometry (DEXA), the apparent diffusion coefficient (ADC) values on diffusion-weighted imaging (DWI), and the T1-weighted signal intensity values. Materials and Methods: This was a prospective study of postmenopausal women with no contraindications to MRI and no history of cancer who underwent DEXA within 30 days before or after the MRI examination. A 3.0-T scanner was used in order to acquire sagittal sequences targeting the lumbar spine. Results: Thirteen women underwent DEXA and MRI. In two cases, the MRI was discontinued early. Therefore, the final sample comprised 11 patients. The ADC values and T1-weighted signal intensity were found to be higher in patients with osteoporosis. However, among the patients > 60 years of age with osteoporosis, ADC values were lower and T1-weighted signal intensity was even higher. Conclusion: It is unlikely that MRI will soon replace DEXA for the diagnostic workup of osteoporosis. Although DWI and ADC mapping are useful for understanding the pathophysiology of osteoporosis, we believe that T1-weighted sequences are more sensitive than is DWI as a means of performing a qualitative analysis of vertebral alterations.


Resumo Objetivo: Promover pesquisas avançadas usando ressonância magnética (RM) no diagnóstico e rastreamento de osteoporose, procurando correlações entre os escores T medidos por absorciometria de raios-X de dupla energia (DEXA), valores de coeficiente de difusão aparente (ADC) na difusão e valores de intensidade de sinal ponderado em T1. Materiais e Métodos: Estudo prospectivo de mulheres na pós-menopausa sem contraindicações para RM e sem histórico de câncer que foram submetidas a DEXA 30 dias antes ou após o exame de RM. Um scanner 3.0-T foi utilizado para adquirir sequências sagitais direcionadas à coluna lombar. Resultados: Treze mulheres foram submetidas a DEXA e RM. Em dois casos, a RM foi interrompida precocemente. Portanto, a amostra final foi composta por 11 pacientes. Os valores de ADC e intensidade de sinal ponderado em T1 foram mais elevados nas pacientes com osteoporose. No entanto, no subgrupo de pacientes > 60 anos de idade com osteoporose, os valores de ADC foram menores e a intensidade do sinal ponderado em T1 foi ainda maior. Conclusão: É improvável que a RM substitua DEXA para a investigação diagnóstica da osteoporose no futuro próximo. Embora a difusão e o mapeamento ADC sejam úteis para a compreensão da fisiopatologia da osteoporose, acreditamos que as sequências ponderadas em T1 são mais sensíveis do que a difusão como meio de realizar uma análise qualitativa das alterações vertebrais.

7.
Int. j. morphol ; 38(2): 374-381, abr. 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1056450

RESUMO

The degeneration of the Lumbar Intervertebral Disc (LIVD) and the other elements of the spine are an inevitable result of aging. However, it is observed that the same degree of degenerative change does not occur in each individual. In the present study, the purpose was to compare the morphometric changes on the lumbar spine with or without intervertebral disc herniation in early period. Group 1 (the Patient Group) consisted of the patients who were diagnosed with lumbar intervertebral disc hernia and who were not operated at least one month clinical duration. Group 2 (the Control Group) consisted of individuals who were selected randomly, had only back pain, underwent magnetic resonance imaging (MRI), and were determined to have intact intervertebral disc. The sagittal and axial MRI sections of lumbar spine was used for measurements and statistical evaluation. There were no statistically significant differences between the intervertebral disc volumes, vertebral body volumes and intervertebral disc anterior and posterior heights of Group 1 and 2 (p>0.05). In terms of anterior-posterior length, the length of the L5 vertebral body was determined to be more in the Patient Group (p<0.05). A correlation was determined in terms of the increase in L2, L4 and L5 volumes with increasing age; however, there were no statistically significant correlations between age increase and a decrease in the intervertebral disc volumes. There were no correlations between the increase in age and the decrease in intervertebral disc heights (p>0.05). There were no apparent relations between the change on the lumbar vertebra corpus and intervertebral disc in early period. It was concluded that the intact intervertebral disc could protect the lower lumbar vertebra corpus from degenerative changes. Although the herniation of the intervertebral disc is newly formed, it is understood that the physiological process or morphometric changes started earlier.


La degeneración del disco intervertebral lumbar y de otros elementos de la columna vertebral son un resultado inevitable del envejecimiento. Sin embargo, no se observa el mismo grado de degeneración en cada individuo. En el presente estudio, el objetivo era comparar los cambios morfométricos en la columna lumbar con o sin hernia de disco intervertebral en el período temprano. El grupo 1 (grupo de pacientes) estaba formado por los pacientes diagnosticados con hernia de disco intervertebral lumbar y que no fueron operados durante al menos un mes. El Grupo 2 (Grupo de Control) consistió en sujetos que fueron seleccionados al azar, reportaban solamente dolor de espalda, fueron sometidos a una resonancia magnética (MRI) y se determinó un disco intervertebral intacto. Las secciones de resonancia magnética sagital y axial de la columna lumbar se utilizaron para las mediciones y la evaluación estadística. No hubo diferencias estadísticamente significativas entre los volúmenes del disco intervertebral, los volúmenes del cuerpo vertebral y las alturas anterior y posterior del disco intervertebral de los Grupos 1 y 2 (p> 0,05). En términos de longitud anterior-posterior, se determinó que la longitud del cuerpo vertebral L5 era mayor en el grupo de pacientes (p <0,05). Se determinó una correlación en términos del aumento en los volúmenes L2, L4 y L5 con el aumento de la edad; sin embargo, no hubo correlaciones estadísticamente significativas entre el aumento de la edad y una disminución en los volúmenes del disco intervertebral. No hubo correlaciones entre el aumento de la edad y la disminución de las alturas de los discos intervertebrales (p> 0,05). No hubo relaciones aparentes entre el cambio en el cuerpo de la vértebra lumbar y el disco intervertebral en el período temprano. Se concluyó que el disco intervertebral intacto podría proteger el cuerpo de la vértebra lumbar inferior de los cambios degenerativos. Aun cuando la formación de la hernia del disco fue reciente, se entiende que el proceso fisiológico o los cambios morfométricos habían comenzado antes.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Envelhecimento , Dor nas Costas/patologia , Degeneração do Disco Intervertebral/patologia , Disco Intervertebral/patologia
8.
Global Spine J ; 8(5): 446-452, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30258749

RESUMO

STUDY DESIGN: Retrospective analysis. Level of evidence III. OBJECTIVES: Low-energy vertebral compression fractures are an increasing socioeconomic problem among elderly patients. Percutaneous vertebroplasty has been extensively used for the treatment of painful fractures because of its effectiveness. However, some complications have been described; among them, new vertebral compression fractures, whether adjacent or not to the treated vertebra, are commonly reported complications (8% to 52%). METHODS: We retrospectively analyzed epidemiological and technical variables presumably associated with new vertebral compression fractures. To determine the relationship between new vertebral compression fracture and percutaneous vertebroplasty, 30 patients (study group) with this complication were compared with 60 patients treated with percutaneous vertebroplasty without this condition (control group). RESULTS: A higher cement percentage was found in the study group (40.3%) compared with the control group (30.5%). Initial vertebral kyphosis was significantly higher in the first group (15°) compared with the control group (9°). Epidemiological factors were similar in both groups. CONCLUSIONS: In our study, increased cement percentage injected and a higher kyphosis were associated with new vertebral compression fractures.

9.
J Radiol Case Rep ; 10(1): 27-34, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27200153

RESUMO

This report describes a case of chronically ruptured abdominal aortic aneurysm contained within the lumbar vertebral bodies that presented with dull abdominal pain. Sudden, massive hemorrhage is an uncommon, yet well-known complication of an untreated abdominal aortic aneurysm. In addition, misleading clinical and radiological findings present difficult diagnostic challenges in such cases. This report emphasizes the findings obtained with multidetector computed tomography and delineates the differentiation of this condition from similar pathologies.


Assuntos
Aneurisma da Aorta Abdominal/complicações , Ruptura Aórtica/complicações , Doenças da Coluna Vertebral/etiologia , Dor Abdominal/etiologia , Idoso , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Ruptura Aórtica/diagnóstico por imagem , Doença Crônica , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Tomografia Computadorizada Multidetectores , Doenças da Coluna Vertebral/diagnóstico por imagem
10.
J Morphol ; 277(2): 204-30, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26596514

RESUMO

Calyptocephalella gayi is one of over 6,000 neobatrachians arranged into two main groups, Hyloides and Ranoides. Phylogenetically, C. gayi is placed in Australobatrachia, a Gondwanan clade that is either the most basal clade of Hyloides or the sister group of Hyloidea, depending on the cladistic hypothesis; as such, this species is a key taxon in the study of the early evolution of Neobatrachia. The ontogeny of the postcranial skeleton of C. gayi is described in this article. The description is based on pattern of chondrification and ossification of skeletal elements in a growth series of tadpoles, on juveniles and adult individuals. Particular attention was devoted to some developmental aspects and morphological traits of the adult skeleton. The body of Presacral Vertebra VIII is formed from three centers of ossification, in contrast to the usual two dorsolateral centers observed in the remaining vertebrae of C. gayi, as well as in most anuran taxa for which the development of the axial skeleton is known. Each half of the pelvic girdle arises from a single cartilaginous element. The early development of the autopodia of both the forelimb and hindlimb includes the presence of an additional chondral element, which occurs during the formation of Distal Carpal 5 and the transient formation of Distal Tarsal 4 before the latter is incorporated in the cartilaginous distal end of the fibular. Some osteological aspects of other australobatrachian anurans also are reviewed (e.g., presence of intervertebral discs) based on reports in the literature, as well as first hand observations. In the course of this study, it became evident that further osteological studies are needed to formulate a clear picture of the evolution of skeletal characters not only within Australobatrachia, but also within Neobatrachia.


Assuntos
Evolução Biológica , Bufonidae/anatomia & histologia , Osteogênese , Adolescente , Animais , Bufonidae/genética , Bufonidae/crescimento & desenvolvimento , Cartilagem/anatomia & histologia , Membro Anterior/anatomia & histologia , Membro Posterior/anatomia & histologia , Humanos , Pelve/anatomia & histologia , Filogenia
11.
Int. j. morphol ; 29(2): 463-472, June 2011. ilus, mapas, tab
Artigo em Inglês | LILACS | ID: lil-597476

RESUMO

Instrumentation of anterior vertebral body screws has become an important approach for treatment of unstable fracture or curvature of the spine, but little attention has been paid to the starting point of placing the screws and variability of the rib head position. We analyzed the variability of rib head position in a Chinese population in terms of the spinal canal and vertebral body using computed tomography (CT). Images from transverse CT scan of the T4-T12 vertebral bodies of 30 normal individuals were 3D reconstructed, and analyzed for measurement of parameters, which included: 1) distance between the left (or right) anterior border of the rib head and the posterior (or anterior) margin of the vertebral body [L(R )ARHP(A)VB], 2) left (or right) transverse dimension [L(R)TD], 3) left (or right) posterior (or anterior) safe angle [L(R)P(A)SA], and 4) distance between the inferior border of the left (or right) rib head and the superior (or inferior) end-plate in the sagittal plane [IL(R)RHS(I)EP]. The ARHPVB, PSA, and IRHIEP gradually decrease, but ARHAVB, TD, ASA, and IRHSEP gradually increase from T4 to T12, indicating that the position of the rib head changes from a more anterior position to a more posterior position and from a more superior position to a more inferior position as the number of the vertebra increases. Our study has provided comprehensive reference guide for accurate and safe instrumentation of vertebral body screws in treating related spine diseases.


La instrumentación del cuerpo anterior vertebral con tornillos ha sido una vía importante para el tratamiento de las fracturas inestables y curvaturas de la columna, pero se ha prestado poca atención a la zona de colocación de los tornillos y la variabilidad de la posición de la cabeza costal. Se analizó la variabilidad de la posición de la cabeza de la costilla en una población de China en relación al canal vertebral y cuerpo vertebral mediante tomografía computarizada (TC). Imágenes de cortes transversales de TC correspondientes a los cuerpos vertebrales T4-T12 de 30 individuos normales fueron reconstruidos tridimensionalmente, y se analizó la medida de algunos parámetros: 1) la distancia entre el margen anterior izquierdo (o derecho) de la cabeza de la costilla y el margen posterior (o anterior) del cuerpo vertebral [L(R)ARHP(A)VB], 2) Dimensión transversa izquierda (o derecha) [L(R)TD], 3) ángulo de seguridad izquierdo (o derecho) posterior (o anterior) [L(R)P(A)SA], y 4) la distancia entre el margen inferior de la cabeza de la costilla izquierda (o derecha) y la placa terminal superior (o inferior) en el plano sagital [IL(R)RHS(I)EP]. El ARHPVB, PSA, y IRHIEP disminuyeron gradualmente, pero ARHAVB, TD, ASA, y IRHSEP aumentaron gradualmente de T4 a T12, lo que indica que la posición de la cabeza de la costilla cambia desde una posición más anterior a una posición más posterior y de una posición más superior a una posición más inferior a medida que aumenta el número de vértebras. Nuestro estudio ha proporcionado completa guía de referencia para la instrumentación precisa y segura de tornillos en el cuerpo vertebral para el tratamiento de enfermedades relacionadas con la columna vertebral.


Assuntos
Humanos , Costelas/cirurgia , Coluna Vertebral/cirurgia , Parafusos Ósseos , Procedimentos Ortopédicos/instrumentação , Costelas/anatomia & histologia , Escoliose/cirurgia , Fusão Vertebral/instrumentação , Coluna Vertebral/anatomia & histologia , Tomografia Computadorizada por Raios X , China , Imageamento Tridimensional
12.
Int. j. morphol ; 27(4): 1299-1303, dic. 2009. ilus
Artigo em Inglês | LILACS | ID: lil-582087

RESUMO

It is necessary to have precise anatomical knowledge of lumbar pedicles for the safe placement of screws. There are not reports about the morphometry of lumbar pedicles in a Mexican population exist. A descriptive, observational and cross-sectional study was done in 60 cadavers from the dissection lab of the Human Anatomy Department of the Medicine School. The aim of the study was to quantify the morphometric characteristics of the pedicles of the lumbar spine in a Mexican population. A total of 60 cadavers were evaluated by fluoroscopy and CT from L1 to L5, in the age range of 40 to 78 years. Each vertebral pedicle was measured in the axial, sagittal and coronal planes. The measurements included the minimum pedicle width, the pedicle angle, the distance to anterior cortex, and anteroposterior and interpedicular spinal canal diameters. CT evaluation showed a progressive and gradual increase in the width of the pedicles from L1 (7.81 +/- 1.30 mm) to L5 (14.36 +/- 14.36 mm). A progressive and gradual decrease of pedicle length from L1 (20.92 +/- 2.62 mm) to L5 (17.23 +/- 1.35 mm). When fluoroscopy was used there was the same relationship, but the values were higher than those obtained by CT. The values for widths and lengths are slightly higher in males than in females, but do not reveal any significant difference (p<0.05). The data in this study indicates that pedicle screws (5.5-6.5mm) may be used in the lumbar region.


Es necesario tener un conocimiento anatómico preciso de la morfología de los pedículos en la region lumbar para la colocación segura de tornillos intrapediculares. No existen reportes de la morfometría de los pedículos lumbares en la población Mexicana. Se desarrolló un estudio descriptivo, observacional y transversal en 60 cadaveres en el laboratorio del Departamento de Anatomía Humana de la Facultad de Medicina. El objetivo del estudio fue determinr las características morfométricas de los pedículos de la region lumbar en una muestra de población Mexicana. Se evaluaron las regiones lumbares (L1-L5) de un total de 60 cadaveres por fluroscopía y TC en un rango de edad entre 40 y 78 años. Cada pedículo fue medido en los planos axial, sagital y coronal. La evaluacion por TC muestra un aumento progresivo y gradual de la anchura de los pedículos de L1 (7,81 +/- 1,30 mm) a L5 (14,36 +/- 14,36 mm). También se observó una disminución gradul de la longitud del pedículo de L1 (14,36 +/- 14,36 mm) a L5 (17,23 +/- 1,35 mm). Al realizar las mediciones por fluroscopia se observaron las mismas condiciones, pero los valores fueron proporcionalmente mayores que los obtenidos por TC. La anchura y longitud pedicular fueron ligeramente mayores en hombres que en mujeres, pero no revelan significancia estadística (p<0,05). Los datos obtenidos del estudio indican que los tornillos intrapediculares (5,5- 6,5mm) pueden ser utilizados en la region lumbar.


Assuntos
Humanos , Masculino , Adulto , Feminino , Pessoa de Meia-Idade , Parafusos Ósseos , Vértebras Lombares/anatomia & histologia , Vértebras Lombares , Cadáver , Estudos Transversais , Fluoroscopia , México , Fusão Vertebral , Tomografia Computadorizada por Raios X
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