RESUMO
BACKGROUND: Thoracic paravertebral block (TPVB) is frequently used to treat pain following a pediatric Nuss procedure but is associated with various undesirable risks. The erector spinae plane block (ESPB) also provides postoperative analgesia, which is purported to be easier to administer and has a favorable safety profile. However, it remains unknown whether ESPB provides analgesia comparable to the TPVB technique post pediatric Nuss procedure. OBJECTIVE: This study aimed to compare the analgesic effects of ultrasound-guided ESPB and TPVB in children undergoing the Nuss procedure. STUDY DESIGN: A prospective, randomized, noninferiority trial. SETTING: A university hospital in the People's Republic of China. METHODS: A total of 68 children aged 4 to 18 scheduled for the Nuss procedure were enrolled in the study. They were randomly assigned to receive a single-injection ultrasound-guided bilateral T5-level ESPB or TPVB with 0.5 mL/kg of 0.25% ropivacaine post anesthesia induction. All patients received postprocedure multimodal analgesia. The primary outcomes were pain scores at rest and 24 hours postprocedure. The secondary outcomes included total rescue morphine milligram equivalents, emergence agitation, chronic postprocedure pain, and side effects. RESULTS: The median difference in pain scores at rest 24 hours postprocedure was 0 (95% CI, 0 to 1), demonstrating the noninferiority of ESPB to TPVB. In addition, the difference in oral morphine milligram equivalents at 24 hours postprocedure was -4.9 (95% CI, -16.7 to 7.9) with the ESPB group consuming median (interquartile range) 37.7 mg (12-53.2) vs 36.9 mg (23.9-58.1) for the TPVB group. We concluded that the non-inferiority of ESPB with regard to opioid consumption as the 95% CI upper limit of 7.9, which was within the predefined margin of 10. We found no significant differences in pain scores at rest or during coughing, incidences of chronic postoperative pain, emergence agitation, or side effects. LIMITATIONS: We did not evaluate the effect of analgesic protocols on patient-centric outcomes, such as resuming functional status and emotional wellbeing. Also, the sample size is small to some extent. CONCLUSIONS: Preoperative ESPB, when combined with multimodal analgesia, was noninferior in analgesic effect compared with TPVB in terms of pain scores and opioid consumption in pediatric patients undergoing the Nuss procedure.
Assuntos
Tórax em Funil , Bloqueio Nervoso , Dor Pós-Operatória , Humanos , Bloqueio Nervoso/métodos , Criança , Tórax em Funil/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Adolescente , Masculino , Feminino , Pré-Escolar , Estudos Prospectivos , Ultrassonografia de Intervenção/métodos , Analgesia/métodos , Vértebras Torácicas/cirurgia , Medição da Dor , Anestésicos Locais/administração & dosagem , Anestésicos Locais/uso terapêutico , Manejo da Dor/métodosRESUMO
Percutaneous vertebroplasty (PVP) is a surgical procedure that involves injecting polymethylmethacrylate (PMMA) bone cement into the diseased vertebrae to rapidly relieve pain and strengthen the vertebrae. We reported a 73-year-old patient who underwent percutaneous vertebroplasty (PVP) surgery for thoracolumbar vertebral compression fracture. After the surgery, the patient experienced symptoms such as chest tightness and dyspnea. Further examination revealed multiple high-density foreign bodies in the blood vessels/heart and concomitant multi-organ dysfunction. It was considered that the multi-organ embolism was caused by bone cement leakage. The patient improved after undergoing surgical treatment and anticoagulant therapy.
Assuntos
Cimentos Ósseos , Corpos Estranhos , Embolia Pulmonar , Vertebroplastia , Humanos , Idoso , Cimentos Ósseos/efeitos adversos , Corpos Estranhos/complicações , Corpos Estranhos/cirurgia , Embolia Pulmonar/etiologia , Embolia Pulmonar/cirurgia , Vertebroplastia/efeitos adversos , Masculino , Fraturas por Compressão/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Tomografia Computadorizada por Raios X , Vértebras Torácicas/cirurgia , Vértebras Lombares/cirurgia , Polimetil Metacrilato/efeitos adversosRESUMO
BACKGROUND: Schwannomas originating from the intravertebral canal rarely extend into the paravertebral region or form large masses. There are few reports on such medical cases, and their clinical diagnosis and management are poorly understood. Here, we report a case of an intraspinal schwannoma with a giant extraspinal mass in a middle-aged Chinese woman and the clinical implications of the symptoms, diagnosis, and treatment of thoracic vertebral schwannoma. CASE PRESENTATION: A 59-year-old female patient who presented with sudden lower limb numbness and difficulty in walking was referred to our department. Magnetic resonance imaging (MRI) revealed a tumor compressing the T11-T12 spinal canal and extensively invading the left thoracic cavity to form a giant paravertebral mass. Schwannoma was diagnosed after intraoperative pathological examination, in which tumor cells were immunoreactive to S100 and Sox10 but negative for smooth muscle actin (SMH). Intraspinal mass resection through the posterior approach and extraspinal chest mass resection under video-assisted thoracoscopy through the left lateral approach were performed simultaneously, and instrumentation was used to maintain thoracic spinal stability. CONCLUSION: In patients with large schwannomas, customized treatment plans are crucial. Tailoring the approach to an individual's specific condition by considering factors such as tumor size and location is essential for optimal outcomes.
Assuntos
Neurilemoma , Neoplasias da Coluna Vertebral , Vértebras Torácicas , Humanos , Feminino , Neurilemoma/cirurgia , Neurilemoma/diagnóstico por imagem , Neurilemoma/complicações , Neurilemoma/patologia , Pessoa de Meia-Idade , Vértebras Torácicas/cirurgia , Vértebras Torácicas/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/complicações , Imageamento por Ressonância Magnética , Cirurgia Torácica Vídeoassistida , Resultado do TratamentoRESUMO
BACKGROUND The objective of this study was to develop and validate machine learning (ML) algorithms to predict the 30-day and 6-month risk of deteriorating functional status following surgical treatment for thoracic spinal stenosis (TSS). We aimed to provide surgeons with tools to identify patients with TSS who have a higher risk of postoperative functional decline. MATERIAL AND METHODS The records of 327 patients with TSS who completed both follow-up visits were analyzed. Our primary endpoint was the dichotomized change in the perioperative Japanese Orthopedic Association (JOA) score, categorized based on whether it deteriorated or not. The models were developed using Naïve Bays, LightGBM, XGBoost, logistic regression, and random forest classification models. The model performance was assessed by accuracy and the c-statistic. ML algorithms were trained, optimized, and tested. RESULTS The best-performing algorithms for predicting functional decline at 30 days and 6 months after TSS surgery were XGBoost (accuracy=88.17%, c-statistic=0.83) and Naïve Bays (accuracy=86.03%, c-statistic=0.80). Both algorithms presented good calibration and discrimination in our testing data. We identified several significant predictors, including poor quality of intraoperative SSEP/MEP baseline, poor quality of preoperative SSEP, duration of symptoms, operated level, and motor dysfunction of the lower extremity. CONCLUSIONS The best-performing algorithms for predicting functional decline at 30 days and 6 months after TSS surgery were XGBoost (accuracy=88.17%, c-statistic=0.83) and Naïve Bays (accuracy=86.03%, c-statistic=0.80). Both algorithms presented good calibration and discrimination in our testing data. We identified several significant predictors, including poor quality of intraoperative SSEP/MEP baseline, poor quality of preoperative SSEP, duration of symptoms, operated level, and motor dysfunction of the lower extremity.
Assuntos
Aprendizado de Máquina , Estenose Espinal , Humanos , Masculino , Feminino , Estenose Espinal/cirurgia , Idoso , Pessoa de Meia-Idade , Algoritmos , Vértebras Torácicas/cirurgia , Resultado do Tratamento , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/diagnóstico , Período Pós-Operatório , Estudos RetrospectivosRESUMO
The significant progress made in the diagnosis and treatment of malignant tumors has led to improved patient survival rates. However, the metastatic spread of these tumors to the thoracic vertebrae remains a significant challenge, often resulting in bone-related adverse events, such as pathological fractures and severe complications. To address this issue, a refined multidisciplinary approach has been explored, which utilizes thoracoscopic techniques for tumor resection and spinal interventions. Thoracoscopic techniques offer a minimally invasive alternative to traditional open surgical methods, aiming to reduce the overall trauma experienced by patients. By leveraging the advantages of thoracoscopy, clinicians can effectively resect metastatic tumors within the thoracic vertebrae while minimizing the impact on surrounding tissues and structures. This approach, combined with targeted spinal interventions, has the potential to improve patient outcomes and quality of life by mitigating the debilitating effects of pathological fractures and other complications associated with metastatic bone disease. The implementation of this multidisciplinary strategy, incorporating thoracoscopic tumor resection and spinal interventions, represents a promising avenue for the management of metastatic tumors within the thoracic vertebrae. Further research and clinical evaluation are necessary to fully elucidate the long-term benefits and establish the optimal treatment protocols for this patient population, ultimately enhancing the care and outcomes for individuals afflicted by this challenging condition.
Assuntos
Neoplasias da Coluna Vertebral , Vértebras Torácicas , Humanos , Vértebras Torácicas/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Neoplasias da Coluna Vertebral/secundário , Toracoscopia/métodos , Cirurgia Torácica Vídeoassistida/métodosAssuntos
Vértebras Lombares , Vértebras Torácicas , Tuberculose da Coluna Vertebral , Humanos , Tuberculose da Coluna Vertebral/cirurgia , Tuberculose da Coluna Vertebral/diagnóstico por imagem , Tuberculose da Coluna Vertebral/tratamento farmacológico , Estudos Retrospectivos , Estudos de Casos e Controles , Vértebras Torácicas/cirurgia , Vértebras Lombares/cirurgia , Resultado do Tratamento , SeguimentosAssuntos
Vértebras Lombares , Fraturas da Coluna Vertebral , Vértebras Torácicas , Humanos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/etiologia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/lesões , Vértebras Lombares/diagnóstico por imagem , Espondiloartrite Axial/diagnóstico por imagem , Masculino , Adulto , Feminino , Resultado do TratamentoRESUMO
This study aimed to evaluate the effectiveness and feasibility of the posterior-only approach for debridement, interbody fusion, and internal fixation in treating upper thoracic tuberculosis. This study retrospectively analysed the clinical and radiographic data of 8 patients diagnosed with upper thoracic tuberculosis. All patients underwent posterior approach debridement, interbody fusion, and internal fixation. We conducted pre- and postoperative assessments of the visual analog scale (VAS), Oswestry disability index (ODI) scores, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), ASIA score, and kyphotic Cobb angle. Back pain and lower limb weakness were the most common presenting symptoms. The mean duration of surgery, amount of blood loss, and volume of postoperative drainage were 262.5 ± 43.3 min, 625.0 ± 333.8 mL, and 285.0 ± 118.1 mL, respectively. Patients were followed up for 36 to 48 months. Three months after surgery, there was a significant improvement in VAS and ODI scores, which further improved until the final follow-up. A statistically significant difference was observed between the preoperative and postoperative periods (P < .05). At the final follow-up, lower extremity function had fully returned to normal in all 5 paralyzed patients. The ESR and CRP returned to normal, 18.1 ± 7.3 mm/h and 9.95 ± 5.41 mg/L, respectively, within 3 months postoperatively. There were statistical differences between the preoperative and postoperative periods (P < .05). The average kyphotic correction rate was (71.5 ± 7.3)%, and the average loss of correction angle was (3.5 ± 1.4)°. Intervertebral bone fusion was achieved by all patients within 15 months (mean 8.3 ± 3.2 months) postoperatively. The posterior-only approach seems an effective, safe, and reliable treatment method for upper thoracic tuberculosis, with favourable clinical and radiological outcomes. Level IV, Therapeutic study.
Assuntos
Desbridamento , Fixação Interna de Fraturas , Fusão Vertebral , Vértebras Torácicas , Tuberculose da Coluna Vertebral , Humanos , Fusão Vertebral/métodos , Masculino , Desbridamento/métodos , Feminino , Vértebras Torácicas/cirurgia , Tuberculose da Coluna Vertebral/cirurgia , Estudos Retrospectivos , Adulto , Pessoa de Meia-Idade , Fixação Interna de Fraturas/métodos , Resultado do Tratamento , Medição da Dor , Avaliação da DeficiênciaRESUMO
Chiropractic spinal manipulation therapy (CSMT) of the cervical spine has been reported to cause mechanical dural injuries that result in cerebrospinal fluid (CSF) leaks. We present a case of symptomatic intracranial hypotension after isolated thoracic CSMT. Initial imaging was unable to definitively localize the CSF leak, but dynamic imaging was able to better identify the defect. Multiple epidural blood patches were attempted, including image-guided approaches and with fibrin sealant, but surgical repair was ultimately required. Our case illustrates the risk of dural tear in the setting of recent CSMT and the challenges of managing such an injury.
Assuntos
Vazamento de Líquido Cefalorraquidiano , Hipotensão Intracraniana , Manipulação Quiroprática , Vértebras Torácicas , Humanos , Vazamento de Líquido Cefalorraquidiano/etiologia , Vazamento de Líquido Cefalorraquidiano/terapia , Vértebras Torácicas/lesões , Manipulação Quiroprática/efeitos adversos , Hipotensão Intracraniana/etiologia , Hipotensão Intracraniana/terapia , Feminino , Masculino , Placa de Sangue Epidural , Pessoa de Meia-IdadeRESUMO
In this article, we attempted to identify risk factors affecting the loss of vertebral height and kyphosis correction on type A thoracolumbar fractures. Patients with type A thoracolumbar fractures who underwent short segments with intermediate screws at the fracture level management between 2017 and 2022 were included in this study. Clinical factors including patients' demographic characteristics (age, sex), history (smoking, hypertension and/or diabetes), value of height/kyphosis correction, the thoracolumbar injury classification and severity score (TLICS), the load sharing classification (LSC) scores and bone mineral density were collected. Correlation coefficient, simple linear regression analysis and multivariate regression analysis were performed to identify the clinical factors associated with the loss of vertebral height/kyphosis correction. Finally, 166 patients were included in this study. The mean height and kyphosis correction were 21.8%â ±â 7.5% and 9.9°â ±â 3.8°, respectively, the values of the loss were 6.5%â ±â 4.0% and 3.9°â ±â 1.9°, respectively. Simple linear regression analysis and multivariate regression analysis showed that age, value of height correction, LSC scores and bone mineral density were significantly associated with the loss of vertebral height and kyphosis correction (Pâ <â .01) We could draw the conclusion that patients with older age, lower bone mineral density, higher LSC scores and diabetes are at higher risk of vertebral height and kyphosis correction loss increase. For these patients, appropriate clinical measures such as long segment fixation, control of blood glucose, and increase of bone density must be taken to reduce the loss of correction.
Assuntos
Cifose , Vértebras Lombares , Fraturas da Coluna Vertebral , Vértebras Torácicas , Humanos , Masculino , Feminino , Estudos Retrospectivos , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia , Pessoa de Meia-Idade , Fraturas da Coluna Vertebral/cirurgia , Fraturas da Coluna Vertebral/etiologia , Vértebras Lombares/lesões , Vértebras Lombares/cirurgia , Cifose/cirurgia , Cifose/etiologia , Adulto , Parafusos Ósseos , Fatores de Risco , Fixação Interna de Fraturas/métodos , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Idoso , Densidade ÓsseaRESUMO
Objective: To explore the safety and effectiveness of multisegmental thoracic ossification of posterior longitudinal ligament (T-OPLL) treated by laminectomy, posterior longitudinal ligament ossification block release combined with dekyphosis orthopedic surgery using ultrasonic bone scalpel system. Methods: The clinical data of 8 patients with multisegmental T-OPLL treated with laminectomy, posterior longitudinal ligament ossification block release combined with dekyphosis orthopedic surgery using ultrasonic bone scalpel system between January 2020 and April 2023 was retrospectively analyzed. There were 3 males and 5 females; the age ranged from 41 to 67 years, with a mean of 57.1 years. The disease duration ranged from 3 to 74 months, with a mean of 33.4 months. Symptoms were progressive numbness and weakness of both lower limbs, unsteady walking, chest and back pain in 3 cases, and urinary and bowel dysfunction in 5 cases; 7 cases showed increased muscle strength of the lower limbs, hyperreflexia of the tendons, and a positive Babinski sign, and 1 case showed decreased muscle strength of the lower limbs, decreased skin sensation, decreased knee and Achilles tendon reflexes, and a negative pathologic sign. Multisegmental posterior longitudinal ligament ossification of thoracic spine was found in 8 cases, with 4-8 segments of ossification, and in 5 cases with multisegmental ossification of the ligamentum flavum. The preoperative Japanese Orthopaedic Association (JOA) thoracic spinal function score was 4.3±0.9, the visual analogue scale (VAS) score was 6.9±1.0, and the the kyphotic Cobb angle of the stenosis segment was (34.62±10.76)°. The operation time, intraoperative blood loss, and complications were recorded. VAS score was used to evaluate the back pain, JOA score was used to evaluate the thoracic spinal cord function and the JOA improvement rate was calculated, and the kyphotic Cobb angle of the stenosis segment was measured and the Cobb angle improvement rate was calculated. Results: The operation time ranged from 210 to 340 minutes, with a mean of 271.62 minutes; intraoperative blood loss ranged from 900 to 2 100 mL, with a mean of 1 458.75 mL; the number of resected vertebral plates ranged from 4 to 8, with a mean of 6.1; dural tears and cerebrospinal fluid leakage occurred in 3 cases, and the incisions healed by first intention. All 8 cases were followed up 12-26 months, with a mean of 18.3 months. There was no complication such as loosening of internal fixator, breakage of screws and rods, and no significant progress of ossification. At last follow-up, the VAS score was 1.4±0.7, the JOA thoracic spinal function score was 9.8±0.7, and the the kyphotic Cobb angle of the stenosis segment was (22.12±8.28)°, all of which significantly improved when compared with preoperative ones ( t=11.887, P<0.001; t=13.015, P<0.001; t=7.395, P<0.001). The JOA improvement rate was 81.06%±10.93%, of which 5 cases were rated as excellent and 3 cases as good; the Cobb angle improvement rate was 36.51%±14.20%. Conclusion: Laminectomy, posterior longitudinal ligament ossification block release combined with dekyphosis orthopedic surgery using ultrasonic bone scalpel system is a safe, effective, and simple method for the treatment of multisegmental T-OPLL, which is a feasible option.
Assuntos
Laminectomia , Ossificação do Ligamento Longitudinal Posterior , Vértebras Torácicas , Humanos , Masculino , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Feminino , Pessoa de Meia-Idade , Laminectomia/métodos , Idoso , Adulto , Vértebras Torácicas/cirurgia , Cifose/cirurgia , Resultado do Tratamento , Procedimentos Ortopédicos/métodos , Procedimentos Ortopédicos/instrumentação , Osteotomia/métodosRESUMO
Vertebral compression fractures (VCFs) are the most common osteoporotic fractures. Only 1/3 of patients with VCFs are clinically diagnosed. In our institution, the Fracture Liaison Service (FLS) was launched in 2017 to improve osteoporosis management for hospitalized patients. (1) To assess osteoporosis awareness among medical providers for emergency department (ED)/hospitalized patients aged 50 or greater; (2) To estimate the rate of FLS consults or referrals to primary care providers (FLS/PCP) by primary teams. A centralized radiology system was used to examine all thoracic and lumbar computed tomography (CT) scans conducted between June 1, 2017 and June 1, 2022. 449 studies were identified with the radiologic impression "compression fracture". 182 studies were excluded after manual chart review. 267 hospitalizations/ED visits with lumbar and/or thoracic spine CT scans were included. Referrals to FLS (26) or PCP (27) were made in 53 cases (~ 20% of the total). In the ED subgroup (131 hospitalizations), only 17 patients had FLS/PCP referrals. The "compression fracture" was mentioned in 227 (85%) discharge notes (any part), while "osteoporosis" was mentioned in only 74 (28%) hospitalizations. A statistically significant difference was found between the two groups when "osteoporosis" was mentioned in the "assessment and plan" section (p = 0.02). Our data show that the overall osteoporosis care for affected patients is suboptimal. Medical providers often overlook the presence of osteoporosis, leading to a lack of consultation with the FLS of referral to PCPs for further evaluation and treatment.
Assuntos
Fraturas por Compressão , Hospitalização , Osteoporose , Fraturas por Osteoporose , Encaminhamento e Consulta , Fraturas da Coluna Vertebral , Tomografia Computadorizada por Raios X , Humanos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/terapia , Fraturas da Coluna Vertebral/epidemiologia , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/terapia , Estudos Retrospectivos , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/terapia , Feminino , Idoso , Osteoporose/diagnóstico por imagem , Osteoporose/terapia , Osteoporose/epidemiologia , Osteoporose/complicações , Masculino , Pessoa de Meia-Idade , Hospitalização/estatística & dados numéricos , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/lesões , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/lesões , Idoso de 80 Anos ou mais , Serviço Hospitalar de EmergênciaRESUMO
Spinal cord (SC) reconstruction (process to reestablish the severed neural continuity at the injury site) may provide better recovery from blunt SC injury (SCI). A miniature swine model of blunt SC compression was used to test the hypothesis that reconstruction of the SC with sural nerve in combination with surgical decompression and stabilization improves functional, macro- and microstructural recovery compared to decompression and stabilization alone. Following blunt T9-T11 SC compression injury, five adult Yucatan gilts randomly received laminectomy and polyethylene glycol (as fusogen) with (n = 3) or without (n = 2) sural nerve graft SC reconstruction. Fusogens are a heterogeneous collection of chemicals that fuse the axon membrane and are currently used to augment epineural coaptation during peripheral nerve graft reconstruction. Outcome measures of recovery included weekly sensory and motor assessments, various measurements obtained from computed tomography (CT) myelograms up to 12 weeks after injury Measurements from postmortem magnetic resonance imaging (MRI) and results from spinal cord histology performed 12 weeks after injury were also reported. Vertebral canal (VC), SC and dural sac (DS) dimensions and areas were quantified on 2-D CT images adjacent to the injury. Effort to stand and response to physical manipulation improved 7 and 9 weeks and 9 and 10 weeks, respectively, after injury in the reconstruction group. Myelogram measures indicated greater T13-T14 VC, smaller SC, and smaller DS dimensions in the reconstruction cohort, and increased DS area increased DS/VC area ratio, and higher contrast migration over time. Spinal cord continuity was evident in 2 gilts in the reconstruction cohort with CT and MRI imaging. At the SCI, microstructural alterations included axonal loss and glial scarring. Better functional outcomes were observed in subjects treated with sural nerve SC reconstruction. Study results support the use of this adult swine model of blunt SCI. Long-term studies with different nerve grafts or fusogens are required to expand upon these findings.
Assuntos
Modelos Animais de Doenças , Traumatismos da Medula Espinal , Vértebras Torácicas , Animais , Suínos , Traumatismos da Medula Espinal/diagnóstico por imagem , Traumatismos da Medula Espinal/cirurgia , Vértebras Torácicas/cirurgia , Vértebras Torácicas/diagnóstico por imagem , Feminino , Imageamento por Ressonância Magnética , Procedimentos de Cirurgia Plástica/métodos , Tomografia Computadorizada por Raios X , Recuperação de Função Fisiológica , Porco Miniatura , Medula Espinal/diagnóstico por imagem , Medula Espinal/cirurgia , Medula Espinal/patologiaRESUMO
Purpose: The aim of this study is to investigate the dynamic and biomechanical response of the pelvis and thoracolumbar spine in simulated under-body blast (UBB) impacts and design of protective seat cushion for thoracolumbar spine injuries. Methods: A whole-body FE (finite element) human body model in the anthropometry of Chinese 50th% adult male (named as C-HBM) was validated against existing PHMS (Postmortem Human Subjects) test data and employed to understand the dynamic and biomechanical response of the pelvis and thoracolumbar spine from FE simulations of UBB impacts. Then, the protective capability of different seat cushion designs for UBB pelvis and thoracolumbar injury risk was compared based on the predictions of the C-HBM. Results: The predicted spinal accelerations from the C-HUM are almost within the PHMS corridors. UBB impact combined with the effects from physiological curve of the human thoracolumbar spine and torso inertia leads to thoracolumbar spine anterior bending and axial compression, which results in stress concentration in the segments of T4-T8, T12-L1 and L4-L5. Foam seat cushion can effectively reduce the risk of thoracolumbar spine injury of armored vehicle occupants in UBB impacts, and the DO3 foam has better protective performance than ordinary foam, the 60 mm thick DO3 foam could reduce pelvic acceleration peak and DRIz value by 52.8% and 17.2%, respectively. Conclusions: UBB spinal injury risk is sensitive to the input load level, but reducing the pelvic acceleration peak only is not enough for protection of spinal UBB injury risk, control of torso inertia effect would be much helpful.
Assuntos
Vértebras Lombares , Pelve , Vértebras Torácicas , Humanos , Vértebras Lombares/fisiopatologia , Masculino , Fenômenos Biomecânicos , Traumatismos por Explosões/prevenção & controle , Traumatismos por Explosões/fisiopatologia , Adulto , Desenho de Equipamento , Explosões , Análise de Elementos Finitos , Simulação por Computador , Aceleração , Modelos Biológicos , Estresse Mecânico , Equipamentos de ProteçãoRESUMO
BACKGROUND: The Wiltse approach has been extensively employed in thoracolumbar surgeries due to its minimal muscle damage. However, in the middle and lower thoracic spine, the conventional Wiltse approach necessitates the severance of the latissimus dorsi and trapezius muscles, potentially leading to muscular injury. Consequently, we propose a modified Wiltse approach for the middle and lower thoracic vertebrae, which may further mitigate muscular damage. METHODS: From May 2018 to April 2022, 60 patients with spinal fractures in the middle and lower thoracic vertebrae (T5-12) were enrolled in this study. Thirty patients underwent surgery using the modified Wiltse approach (Group A), while the remaining 30 patients received traditional posterior surgery (Group B). The observation indices included operation time, intraoperative blood loss, incision length, number of C-arm exposures, postoperative drainage, postoperative ambulation time, discharge time, as well as preoperative and postoperative Cobb's angle, percentage of anterior vertebral body height (PAVBH), visual analog scale (VAS) Score, and Oswestry disability index (ODI). RESULTS: Compared to the traditional posterior approach, the modified Wiltse approach demonstrated significant advantages in operation time, intraoperative blood loss, length of incision, postoperative ambulation time, postoperative drainage, and discharge time, as well as postoperative VAS and ODI scores. No significant differences were observed between the two groups in terms of number of C-arm exposures, postoperative Cobb's angle, or postoperative PAVBH. CONCLUSION: We propose a modification of the Wiltse approach for the middle and lower thoracic vertebral regions, which may further minimize muscular damage and facilitate the recovery of patients who have undergone surgery in the middle and lower thoracic vertebrae.
Assuntos
Fraturas da Coluna Vertebral , Vértebras Torácicas , Humanos , Vértebras Torácicas/cirurgia , Vértebras Torácicas/lesões , Vértebras Torácicas/diagnóstico por imagem , Masculino , Feminino , Fraturas da Coluna Vertebral/cirurgia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Pessoa de Meia-Idade , Adulto , Estudos de Casos e Controles , Idoso , Duração da Cirurgia , Resultado do Tratamento , Perda Sanguínea Cirúrgica , Fixação Interna de Fraturas/métodos , Estudos RetrospectivosRESUMO
BACKGROUND: Current research lacks comprehensive investigation into the biomechanical changes in the spinal cord and nerve roots during scoliosis correction. This study employs finite element analysis to extensively explore these biomechanical variations across different Cobb angles, providing valuable insights for clinical treatment. METHODS: A personalized finite element model, incorporating vertebrae, ligaments, spinal cord, and nerve roots, was constructed using engineering software. Forces and displacements were applied to achieve Cobb angle improvements, designating T1/2-T4/5 as the upper segment, T5/6-T8/9 as the middle segment, and T9/10-L1/2 as the lower segment. Simulations under traction, pushing, and traction + torsion conditions were conducted, and biomechanical changes in each spinal cord segment and nerve roots were analyzed. RESULTS: Throughout the scoliosis correction process, the middle spinal cord segment consistently exhibited a risk of injury under various conditions and displacements. The lower spinal cord segment showed no significant injury changes under traction + torsion conditions. In the early correction phase, the upper spinal cord segment demonstrated a risk of injury under all conditions, and the lower spinal cord segment presented a risk of injury under pushing conditions. Traction conditions posed a risk of nerve injury on both sides in the middle and lower segments. Under pushing conditions, there was a risk of nerve injury on both sides in all segments. Traction + torsion conditions implicated a risk of injury to the right nerves in the upper segment, both sides in the middle segment, and the left side in the lower segment. In the later correction stage, there was a risk of injury to the upper spinal cord segment under traction + torsion conditions, the left nerves in the middle segment under traction conditions, and the right nerves in the upper segment under pushing conditions. CONCLUSION: When the correction rate reaches 61-68%, particular attention should be given to the upper-mid spinal cord. Pushing conditions also warrant attention to the lower spinal cord and the nerve roots on both sides of the main thoracic curve. Traction conditions require attention to nerve roots bilaterally in the middle and lower segments, while traction combined with torsion conditions necessitate focus on the right-side nerve roots in the upper segment, both sides in the middle segment, and the left-side nerve roots in the lower segment.
Assuntos
Análise de Elementos Finitos , Escoliose , Medula Espinal , Raízes Nervosas Espinhais , Tração , Humanos , Escoliose/fisiopatologia , Raízes Nervosas Espinhais/fisiopatologia , Fenômenos Biomecânicos/fisiologia , Medula Espinal/fisiopatologia , Tração/métodos , Vértebras Torácicas , Vértebras Lombares , AdolescenteRESUMO
OBJECTIVES: We conducted a multicenter retrospective analysis to compare the clinical outcomes and complications associated with the posterior-anterior and posterior-only approaches in treating Thoracolumbar Junction (TLJ) Tuberculosis (TB) in children aged 3-10 years. METHODS: Herein, 52 TLJ TB patients (age range = 3-10 years; mean age = 6.8 ± 2.2 years; females = 22; males = 30) treated with debridement, fusion, and instrumentation were recruited from two hospitals in China between May 2008 and February 2022, and their clinical data were reviewed retrospectively. Among them, 24 group A patients and 28 group B patients underwent the posterior-anterior and posterior-only approaches, respectively. The two groups were assessed for surgical time, blood loss, hospitalization duration, operative complications, inflammatory indicators, Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI) scores, kyphosis angles, and neurologic functions. Results or differences with P < 0.05 were considered statistically significant. RESULTS: The average follow-up period was 37.5 ± 23.3 months. Compared to group A patients, group B patients exhibited significantly lower surgical time, blood loss amount, time it took to stand, and hospitalization duration, as well as fewer complications. Notably, the Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) values of patients in both groups returned to normal one year post-surgery. Furthermore, compared to the preoperative values, patients' VAS and ODI scores, as well as neurological functions and kyphosis angles, were significantly improved postoperatively and at the final follow-up, but with no statistically significant differences between the two groups. Moreover, there was no internal fixation failure or TB recurrence, and all patients exhibited solid bone fusion at the last follow-up. CONCLUSION: For pediatric TLJ TB involving no or at most two segments, both posterior-anterior and posterior-only approaches could effectively remove lesions and decompress the spinal cord, restore spinal stability, correct kyphosis, and prevent deformity deterioration. Nonetheless, the posterior-only approach can more effectively shorten the surgical time, reduce related trauma and complications, and promote rapid recovery, making it a safer and highly preferable minimally invasive approach.
Assuntos
Vértebras Lombares , Fusão Vertebral , Vértebras Torácicas , Tuberculose da Coluna Vertebral , Humanos , Criança , Masculino , Feminino , Tuberculose da Coluna Vertebral/cirurgia , Tuberculose da Coluna Vertebral/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Vértebras Lombares/cirurgia , Estudos Retrospectivos , Pré-Escolar , Resultado do Tratamento , Fusão Vertebral/métodos , Desbridamento/métodos , Seguimentos , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Perda Sanguínea Cirúrgica/estatística & dados numéricosRESUMO
BACKGROUND: As few anaesthetists provide lumbar erector spinae block for disc surgery, there is a need to provide training to enable a randomised controlled trial investigating analgesia after painful spinal surgery (NIHR153170). The primary objective of the study was to develop and measure the construct validity of a checklist for assessment of skills in performing lumbar and thoracic erector spinae fascial plane injection using soft-embalmed Thiel cadavers. METHODS: Twenty-four UK consultant regional anaesthetists completed two iterations of a Delphi questionnaire. The final checklist consisted of 11 steps conducive to best practice. Thereafter, we validated the checklist by comparing the performance of 12 experts with 12 novices, each performing lumbar and thoracic erector spinae plane injections or fascia iliaca, serrato-pectoral (PEC II) and serratus injections, randomly allocated to the left and right sides of six soft-embalmed Thiel cadavers. Six expert, trained raters blinded to operator and site of block examined 120 videos each. RESULTS: The mean (95% confidence interval) internal consistency of the 11-item checklist for erector spinae plane injection was 0.72 (0.63-0.79) and interclass correlation was 0.88 (0.82-0.93). The checklist showed construct validity for lumbar and thoracic erector spinae injection, experts vs novices {median (interquartile range [range]) 8.0 (7.0-10.0 [1-11]) vs 7.0 (5.0-9.0 [4-11]), difference 1.5 (1.0-2.5), P<0.001}. Global rating scales showed construct validity for lumbar and thoracic erector spinae injection, 28.0 (24.0-31.0 [7-35]) vs 21.0 (17.0-24.0 [7-35]), difference 7.5 (6.0-8.5), P<0.001. The most difficult items to perform were identifying the needle tip before advancing and always visualising the needle tip. Instrument handling and flow of procedure were the areas of greatest difficulty on the global rating scale (GRS). Checklists and GRS scores correlated. There was homogeneity of regression slopes controlling for status, type of injection, and rater. Generalisability analysis showed a high reliability using the checklist and GRS for all fascial plane blocks (Rho [ρ2] 0.93-0.96: Phi [Ï] 0.84-0.87). CONCLUSIONS: An 11-point checklist developed through a modified Delphi process to provide best practice guidance for fascial plane injection showed construct validity in performing lumbar and thoracic erector spinae fascial plane injection in soft-embalmed Thiel cadavers.
Assuntos
Cadáver , Lista de Checagem , Competência Clínica , Bloqueio Nervoso , Ultrassonografia de Intervenção , Humanos , Ultrassonografia de Intervenção/métodos , Bloqueio Nervoso/métodos , Lista de Checagem/métodos , Técnica Delphi , Reprodutibilidade dos Testes , Fáscia/diagnóstico por imagem , Masculino , Vértebras Lombares/cirurgia , Feminino , Vértebras Torácicas , Músculos Paraespinais/diagnóstico por imagemRESUMO
Osteoporosis is under-diagnosed while detectable by measuring bone mineral density (BMD) using quantitative computer tomography (QCT). Opportunistic screening for low BMD has previously been suggested using lumbar QCT. However, thoracic QCT also possesses this potential to develop upper and lower cut-off values for low thoracic BMD, corresponding to the current cut-offs for lumbar BMD. In participants referred with chest pain, lumbar and thoracic BMD were measured using non-contrast lumbar- and cardiac CT scans. Lumbar BMD cut-off values for very low (< 80 mg/cm3), low (80-120 mg/cm3), and normal BMD (> 120 mg/cm3) were used to assess the corresponding thoracic values. A linear regression enabled identification of new diagnostic thoracic BMD cut-off values. The 177 participants (mean age 61 [range 31-74] years, 51% women) had a lumbar BMD of 121.6 mg/cm3 (95% CI 115.9-127.3) and a thoracic BMD of 137.0 mg/cm3 (95% CI: 131.5-142.5), p < 0.001. Categorization of lumbar BMD revealed 14%, 35%, and 45% in each BMD category. When applied for the thoracic BMD measurements, 25% of participants were reclassified into a lower group. Linear regression predicted a relationship of Thoracic BMD = 0.85 * Lumbar BMD + 33.5, yielding adjusted thoracic cut-off values of < 102 and > 136 mg/cm3. Significant differences in BMD between lumbar and thoracic regions were found, but a linear relationship enabled the development of thoracic upper and lower cut-off values for low BMD in the thoracic spine. As Thoracic CT scans are frequent, these findings will strengthen the utilization of CT images for opportunistic detection of osteoporosis.
Assuntos
Densidade Óssea , Vértebras Lombares , Osteoporose , Vértebras Torácicas , Tomografia Computadorizada por Raios X , Humanos , Densidade Óssea/fisiologia , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Vértebras Torácicas/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Osteoporose/diagnóstico por imagem , Osteoporose/diagnóstico , Vértebras Lombares/diagnóstico por imagemRESUMO
BACKGROUND: Photon-counting detector computed tomography (PCD-CT) is a groundbreaking technology with promising results for visualization of small bone structures. PURPOSE: To analyze the delineation of the thoracic spine in multiplanar reconstructions (MPR) on PCD-CT compared to energy-integrating detector (EID)-CT. MATERIAL AND METHODS: Two euthanized mice were examined using different scanners: (i) 20-slice EID-CT and (ii) dual-source PCD-CT at various CTDIVol values. Readers evaluated the thoracic spine and selected series with best visualization among signal-to-noise ratio (SNR)-matched pairs. RESULTS: SNR was significantly higher in PCD-CT reconstructions (Br68) and lower in Hr98 reconstructions compared to EID-CT. Bone detail visualization was superior in PCD-CT (especially in Hr98 reconstructions) compared to EID-CT. CONCLUSION: MPR on a PCD-CT had a higher SNR and better bone detail visualization even at lower radiation doses compared to EID-CT. PCD-CT with bone reconstructions showed the best delineation of small bone structures and might be considered in clinical routine.