European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Although the structural changes occurring in the scoliotic spine have been reported as early as the 19th century, the descriptions and biomechanical explanations have not always been complete and consistent. In this study, three-dimensionally rendered CT images of two human skeletons with a scoliotic deformity and two patients with serious scoliosis were used to describe the intrinsic vertebral and rib deformities. The pattern of structural deformities was found to be consistent. ⋯ The rib deformities at the convex side of the scoliotic curve showed an increased angulation of the rib at the posterior angle, whereas the rib curve on the concave side was flattened. The observed vertebral deformities suggest that these are caused by bone remodelling processes due to forces in the anterior spinal column, which drive the apical vertebral body out of the midline, whereas forces of the musculo-ligamentous structures at the posterior side of the spinal column attempt to minimize the deviations and rotations of the vertebrae. The demonstrated rib deformities suggest an adaptation to forces imposed by the scoliotic spine.
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A study was undertaken to analyse the prevalence of low back pain (LBP) and confounding factors in primary school children in the city of Antwerp. A total of 392 children aged 9 were included in the study. All children completed a validated three-page questionnaire and they all underwent a specific lumbar spine oriented medical examination during their annual routine medical school control. ⋯ The visual analogue scales concerning general well-being were all very significantly correlated with self-reported LBP, with children who reported LBP being more tired, less happy, and worse sleepers. Of the 19 clinical parameters taken down during the medical examination, only one was significantly more prevalent in the group of children reporting LBP: pain on palpation at the insertion site on the iliac crest of the ilio-lumbar ligament. From this study we can establish that there are few clinical signs that can help to single out school children with LBP.
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The latest open MRI technology allows to perform open and closed surgical procedures under real-time imaging. Before performing spinal trauma surgery preclinical examinations had to be done to evaluate the artifacts caused by the implants. ⋯ The open MRI has proven useful in orthopedic and trauma surgery. The size and configuration of the artifacts caused by instruments and implants is predictable. Therefore exact positioning of the implants is achieved more easily. Dorsal instrumentation of unstable thoracolumbar fractures with a percutaneous technique has turned out safe and less traumatic under MR-imaging. Real-time imaging of soft tissue and bone in any plane improves security for the patient and allows the surgeon to work less invasively and more precisely.
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Flexion tear-drop fractures (FTDF) in the cervical spine constitute a highly unstable condition with a high incidence of neurological complications due to posterior displacement of the fractured vertebra in the spinal canal. The widely accepted surgical management for this condition includes complete excision and grafting of the vertebral body through an anterior approach. Thorough radiological and CT analysis of FTDF shows that the vertebral body is often separated into two parts by a sagittal plane fracture, but remains continuous through the pedicle and anterior arch of the vertebral foramen with the lateral mass and the articular processes. ⋯ Out of seven neurologically impaired patients, five showed some motor recovery at the latest follow-up. The posterior technique is described, and the rationale and pros and cons are discussed. The study showed that posterior reduction and fixation of flexion tear-drop fracture is not only possible, but permits an accurate restoration of the anatomy of the fractured cervical spine.
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Various conditions such as fracture, dislocation, tumor, or infection adversely affect the vertebral body and lead to instability. Restoration of a stable anterior column is essential for normal spinal biomechanics. Various biological and mechanical spacers have been used to reconstruct the anterior column after corpectomy. ⋯ For patients presenting with neurological symptoms (n = 4), the recovery was complete in three and partial in one. No patient was made neurologically worse, and there were no vascular injuries intra- or postoperatively. The study suggests that TSM-bone graft composite offers excellent biomechanical stability in the immediate postoperative period, permitting progressive maturation of the fusion mass.