Concept: Thoracic vertebrae
This study was aimed to introduce a novel entry point for pedicle screw fixation in the thoracic spine and compare it with the traditional entry point. A novel entry point was found with the aim of improving accuracy, safety and stability of pedicle screw technique based on anatomical structures of the spine. A total of 76 pieces of normal thoracic CT images at the transverse plane and the thoracic pedicle anatomy of 6 cadaveric specimens were recruited. Transverse pedicle angle (TPA), screw length, screw placement accuracy rate and axial pullout strength of the two different entry point groups were compared. There were significant differences in the TPA, screw length, and the screw placement accuracy rate between the two groups (P<0.05). The maximum axial pullout strength of the novel entry point group was slightly larger than that of the traditional group. However, the difference was not significant (P>0.05). The novel entry point significantly improved the accuracy, stability and safety of pedicle screw placement. With reference to the advantages above, the new entry point can be used for spinal internal fixations in the thoracic spine.
Spinal immobilisation during extrication of patients in road traffic collisions is routinely used despite the lack of evidence for this practice. In a previous proof of concept study (n=1), we recorded up to four times more cervical spine movement during extrication using conventional techniques than self-controlled extrication.
Study Design Literature review. Objective The aim of this literature review was to detail the effects of smoking in spine surgery and examine whether perioperative smoking cessation could mitigate these risks. Methods A review of the relevant literature examining the effects of smoking and cessation on surgery was conducted using PubMed, Google Scholar, and Cochrane databases. Results Current smokers are significantly more likely to experience pseudarthrosis and postoperative infection and to report lower clinical outcomes after surgery in both the cervical and lumbar spines. Smoking cessation can reduce the risks of these complications depending on both the duration and timing of tobacco abstinence. Conclusion Smoking negatively affects both the objective and subjective outcomes of surgery in the lumbar and cervical spine. Current literature supports smoking cessation as an effective tool in potentially mitigating these unwanted outcomes. Future investigations in this field should be directed toward developing a better understanding of the complex relationship between smoking and poorer outcomes in spine surgery as well as developing more efficacious cessation strategies.
- Proceedings of the National Academy of Sciences of the United States of America
- Published over 3 years ago
The evolution of the human pattern of axial segmentation has been the focus of considerable discussion in paleoanthropology. Although several complete lumbar vertebral columns are known for early hominins, to date, no complete cervical or thoracic series has been recovered. Several partial skeletons have revealed that the thoracolumbar transition in early hominins differed from that of most extant apes and humans. Australopithecus africanus, Australopithecus sediba, and Homo erectus all had zygapophyseal facets that shift from thoracic-like to lumbar-like at the penultimate rib-bearing level, rather than the ultimate rib-bearing level, as in most humans and extant African apes. What has not been clear is whether Australopithecus had 12 thoracic vertebrae as in most humans, or 13 as in most African apes, and where the position of the thoracolumbar transitional element was. The discovery, preparation, and synchrotron scanning of the Australopithecus afarensis partial skeleton DIK-1-1, from Dikika, Ethiopia, provides the only known complete hominin cervical and thoracic vertebral column before 60,000 years ago. DIK-1-1 is the only known Australopithecus skeleton to preserve all seven cervical vertebrae and provides evidence for 12 thoracic vertebrae with a transition in facet morphology at the 11th thoracic level. The location of this transition, one segment cranial to the ultimate rib-bearing vertebra, also occurs in all other early hominins and is higher than in most humans or extant apes. At 3.3 million years ago, the DIK-1-1 skeleton is the earliest example of this distinctive and unusual pattern of axial segmentation.
Abstract Purpose: The aim of this systematic review was to determine the efficacy of thoracic spine manipulation (TSM) in reducing pain and disability in patients diagnosed with non-specific neck pain. Methods: An extensive literature search of PubMed, The Cochrane Library, CINAHL and EMBASE was conducted in February 2012. Randomized controlled trials (RCTs) or controlled clinical trials evaluating the effect of TSM in patients aged 18 to 65 years with non-specific neck pain were eligible. Methodological quality of the studies was assessed according to the Physiotherapy Evidence Database scale (PEDro). Qualitative analyses were conducted by means of the best evidence synthesis of van Peppen et al. Results: The methodological quality of the 10 included RCTs (677 patients) varied between four and eight points. Eight studies reported significant reduction in pain and/or disability by TSM. Overall, according to the best evidence synthesis, there is insufficient evidence that TSM is more effective than control interventions in reducing pain and disability in patients with non-specific neck pain. Conclusions: TSM has a therapeutic benefit to some patients with neck pain, when compared to the effect of interventions such as electrotherapy/thermal programme, infrared radiation therapy, spinal mobilization and exercises. However, in comparison to cervical spine manipulation, no evidence is found that TSM is more effective in reducing pain and disability. Implications for Rehabilitation TSM is often used in the treatment of non-specific neck pain, which is a major health problem in the Western society. There is insufficient evidence that TSM is more effective in reducing pain and disability than control treatments in patients with non-specific neck pain. Despite the insufficient evidence that TSM is more effective than control treatments, TSM has a therapeutic benefit to some patients with neck pain. Therefore, TSM alone or in combination with other interventions is a suitable intervention to use in the treatment of non-specific neck pain.
STUDY DESIGN.: This is a case report. OBJECTIVE.: To report a case of soft-tissue reaction to wear debris and osteolysis around a pedicle screw after posterior spine fusion in a pediatric patient. SUMMARY OF BACKGROUND DATA.: Posterior spine fusion with instrumentation is a standard procedure for stabilization and curve correction in patients with scoliosis. Late operative site pain accounts for the highest frequency of reoperation. Debris accumulation for steel and titanium constructs occurs at the pedicle screw-rod junction. Cellular reaction to metal wear may be responsible for osteolysis and aseptic loosening around spinal implants. METHODS.: A 14-year-old male patient with neurofibromatosis and right thoracic scoliosis of 50° underwent posterior spine fusion from T2 to T10. The postoperative course was complicated by continuous pain, and imaging studies demonstrated hardware failure, requiring a revision and subsequent development of a perihilar opacity of unknown origin. Further studies demonstrated hypermobility with adjacent soft-tissue reactivity and inflammation surrounding the right T5 transpedicle screw. RESULTS.: After hardware removal, the patient’s recovery was uneventful. Six months later, a repeated computed tomographic scan demonstrated resolution of the previously described soft-tissue mass and a satisfactory fusion of the thoracic spine. CONCLUSION.: Metal wear debris can form in pediatric patients during the healing process after spinal fusions or when pseudarthrosis is present. Clinically, this manifests as back pain with a possible aseptic inflammatory abscess. Hardware removal can achieve resolution of symptoms and regression of inflammation.
Vertebral resection with spine shortening has been primarily reported for the treatment of demanding cases of nontraumatic disorders. Recently, this technique has been applied to the treatment of traumatic disorders. The current treatment of vertebral fracture-dislocation when there is partial or total telescoping of the involved vertebrae is a combined anterior-posterior approach with corpectomy, anterior support implant, and further posterior instrumentation. These procedures usually require 2 surgical teams, involve longer operating times and greater risk of surgical complications related to the anterior approach, and commonly entail longer postoperative care before discharge. The authors report on 2 patients with high thoracic fracture-dislocations with telescoping (T-2 and T-4) who were treated in the subacute phase with total spondylectomy (T-3 and T-5, respectively) and spine shortening by using only a posterior approach. Complete recovery of the sagittal balance was achieved with this technique and the postoperative periods were clinically uneventful. One patient presented with asymptomatic hemothorax that did not require drainage. In paraplegic patients with anterior thoracic dislocation fractures in which one vertebral body blocks the reduction of the other, total spondylectomy and spine shortening seem to be a reasonably safe and effective technique.
- The Journal of bone and joint surgery. American volume
- Published almost 8 years ago
Despite meticulous hemostasis, persistent postoperative drain output following posterior cervical spine procedures often necessitates a prolonged length of hospital stay. We sought to determine if thrombin-soaked absorbable gelatin compressed sponge can decrease postoperative drain output and the length of hospital stay after multilevel posterior cervical spine surgery.
The goal of this 3-D operative video report is to demonstrate the technical nuances and intra-operative steps in a minimally invasive posterolateral approach to thoracic corpectomy and the reconstruction of the pathologic anterior column. A 3-D-operative video from surgery in a 54 year-old female with Stage IV breast cancer, metastatic to the cervical and thoracic spine, is presented. The patient had progressive lower extremity dysfunction secondary to a significant T12 lytic mass lesion with an associated intra-canal component causing significant cord compression. A minimally invasive direct lateral corpectomy was elected to remove this pathologic vertebral body, decompress the spine, and reconstruct the anterior column. The intra-operative steps were documented by intra-operative 3-D video and edited to demonstrate the steps in this procedure. As demonstrated in this case, minimally invasive techniques can be safely utilized for anterior column pathologies for decompression of the spine and reconstruction of the vertebral column. These techniques may minimize soft-tissue and approach-related injury. However, the focus of this report is to demonstrate the technical aspects of this surgery through 3-D video.
PURPOSE: We aimed to describe the morphological changes in the thoracic cage and spinal column induced in New Zealand White (NZW) prepubertal rabbits subjected to dorsal arthrodesis and observed at skeletal maturity by computed tomography (CT) scans. This was done to evaluate the plasticity of the thoracic cage of rabbits with non-deformed spine, by highlighting its modifications after spinal arthrodesis. Emogas data analysis, echocardiographic assessment and cardio-pulmonary measurements completed the evaluation. METHODS: Surgery was performed in 16 female rabbits, 6 weeks old. Nine were subjected to T1-T12 dorsal arthrodesis, while seven were sham-operated. Surgery involved the implant of two C-shaped stainless steel bars and heterologous bone graft. CT scans were performed before surgery, 2, 6 and 12 months after surgery. One week after the last CT scan, echocardiographic and emogas evaluations were performed. RESULTS: Chest depth (8 %), thoracic kyphosis (ThK) (23 %), dorsal and ventral length of the thoracic spine (11 %) and sternal length (7 %) were significantly reduced in operated compared to sham-operated rabbits. Mean values ± standard deviation (SD) of PaCO(2), PaO(2) and sO(2) were not significantly different. Mean values ± SD of echocardiographic measurements were not significantly different between the two groups of rabbits, except for thickness of the interventricular septum in systole, contractile capacity of the left ventricle and ejection fraction. CONCLUSIONS: T1-T12 dorsal arthrodesis in prepubertal NZW rabbits with non-deformed spine induced changes of the thoracic cage morphology. However, those changes are source of cardio-pulmonary complications not severe enough to reproduce a clinical picture comparable to thoracic insufficiency syndrome in humans.