Analysis of sagittal profile and radiographic parameters in symptomatic thoracolumbar disc herniation patients

Abstract Background Few studies describe thoracolumbar disc herniation (TLDH) as an isolated category, it is frequently classified as the lower thoracic spine or upper lumbar spine. Thus, less is known about the morphology and aetiology of TLDH compared to lumbar disc herniation (LDH). The aim of study is to investigate sagittal alignment in TLDH and analyze sagittal profile with radiographic parameters. Methods Data from 70 patients diagnosed with TLDH were retrospectively reviewed. The thoracic-lumbar alignment was depicted by description of curvatures (the apex of lumbar curvature, the apex of thoracic curvature, and inflexion point of the two curvatures) and radiographic parameters from complete standing long-cassette spine radiographs. The rank sum test was utilised to compare radiographic parameter values in each subtype. Results We found two subtypes differentiated by the apex of thoracic kyphotic curves. The sagittal profile was similar to that of the normal population in type I, presenting the apex of the thoracic kyphotic curve located in the middle thoracic spine. The well aligned thoracic-lumbar curve was disrupted in type II, presenting the apex of the thoracic kyphotic curve located in the thoracolumbar region in type II patients. Thirty-six patients were classified as type I, and 34 patients were classified as type II. The mean sagittal vertical axis, T1 pelvic angle and L1 pelvic angle were 27.9 ± 24.8°, 8.2 ± 7.3° and 6.2 ± 4.9°, respectively. There was significant difference (p < 0.001) of thoracolumbar angle between type I (14.9 ± 7.9°) and type II patients (29.1 ± 13.7°). Conclusions We presented two distinctive sagittal profiles in TLDH patients, and a regional kyphotic deformity with a balanced spine was validated in both subtypes. In type I patients, disc degeneration was accelerated by regional kyphosis in the thoracolumbar junction and eventually caused disc herniation. In type II patients, excessive mechanical stress was directly loaded at the top of the curve (thoracolumbar apex region) rather than being diverted by an arc as in a normal population or type I patients. Mismatch between shape and sacral slope value was observed, and better agreement was found in Type II patients.

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Analysis of sagittal profile and radiographic parameters in symptomatic thoracolumbar disc herniation patients

10.21203/rs.3.rs-34221/v3 ◽

2020 ◽

Author(s):

Ang Gao ◽

Yongqiang Wang ◽

Miao Yu ◽

Xiaoguang Liu

Keyword(s):

Disc Herniation ◽

Thoracic Spine ◽

Normal Population ◽

Sagittal Profile ◽

Sacral Slope ◽

Type I ◽

Type Ii ◽

Radiographic Parameters ◽

Significant Difference ◽

Thoracolumbar Region

Abstract Background: Few studies describe thoracolumbar disc herniation (TLDH) as an isolated category, it is frequently classified as the lower thoracic spine or upper lumbar spine. Thus, less is known about the morphology and aetiology of TLDH compared to lumbar disc herniation (LDH). The aim of study is to investigate sagittal alignment in TLDH and analyze sagittal profile with radiographic parameters.Methods: Data from 70 patients diagnosed with TLDH were retrospectively reviewed. The thoracic-lumbar alignment was depicted by description of curvatures (the apex of lumbar curvature, the apex of thoracic curvature, and inflexion point of the two curvatures) and radiographic parameters from complete standing long-cassette spine radiographs. The rank sum test was utilised to compare radiographic parameter values in each subtype.Results: We found two subtypes differentiated by the apex of thoracic kyphotic curves. The sagittal profile was similar to that of the normal population in type I, presenting the apex of the thoracic kyphotic curve located in the middle thoracic spine. The well aligned thoracic-lumbar curve was disrupted in type II, presenting the apex of the thoracic kyphotic curve located in the thoracolumbar region in type II patients. Thirty-six patients were classified as type I, and 34 patients were classified as type II. The mean sagittal vertical axis, T1 pelvic angle and L1 pelvic angle were 27.9±24.8°, 8.2±7.3° and 6.2±4.9°, respectively. There was significant difference (p<0.001) of thoracolumbar angle between type I (14.9±7.9°) and type II patients (29.1±13.7°).Conclusions: We presented two distinctive sagittal profiles in TLDH patients, and a regional kyphotic deformity with a balanced spine was validated in both subtypes. In type I patients, disc degeneration was accelerated by regional kyphosis in the thoracolumbar junction and eventually caused disc herniation. In type II patients, excessive mechanical stress was directly loaded at the top of the curve (thoracolumbar apex region) rather than being diverted by an arc as in a normal population or type I patients. Mismatch between shape and sacral slope value was observed, and better agreement was found in Type II patients.

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Analysis of sagittal profile and radiographic parameters in symptomatic thoracolumbar disc herniation patients

10.21203/rs.3.rs-34221/v2 ◽

2020 ◽

Author(s):

Ang Gao ◽

Miao Yu ◽

Yongqiang Wang ◽

Xiaoguang Liu

Keyword(s):

Disc Herniation ◽

Thoracic Spine ◽

Lumbar Disc ◽

Sagittal Profile ◽

Sacral Slope ◽

Type I ◽

Type Ii ◽

Radiographic Parameters ◽

Significant Difference ◽

Thoracolumbar Region

Abstract Background Few studies describe thoracolumbar disc herniation (TLDH) as an isolated category, it is frequently classified as the lower thoracic spine or upper lumbar spine. Thus, less is known about the morphology and aetiology of TLDH compared to lumbar disc herniation (LDH). The aim of study is to investigate sagittal alignment in TLDH and analyze sagittal profile with radiographic parameters.Methods Data from 70 patients diagnosed with TLDH were retrospectively reviewed. The thoracic-lumbar alignment was depicted by description of curvatures (the apex of lumbar curvature, the apex of thoracic curvature, and inflexion point of the two curvatures) and radiographic parameters from complete standing long-cassette spine radiographs. The rank sum test was utilised to compare radiographic parameter values in each subtype. Results We found two subtypes differentiated by the apex of thoracic kyphotic curves. The apex of the thoracic kyphotic curve located in the middle thoracic spine in type I, and the apex of the thoracic kyphotic curve located in the thoracolumbar region in type II patients. Thirty-six patients were classified as type I, and 34 patients were classified as type II. The mean sagittal vertical axis, T1 pelvic angle and L1 pelvic angle were 27.9±24.8°, 8.2±7.3° and 6.2±4.9°, respectively. There was significant difference (p<0.001) of thoracolumbar angle between type I (14.9±7.9°) and type II patients (29.1±13.7°).Conclusions We presented two distinctive sagittal profiles in TLDH patients, and a regional kyphotic deformity with a balanced spine was validated in both subtypes. In view of the different curvatures, different aetiologies were discovered in each subtype. Mismatch between shape and sacral slope value was observed, and better agreement was found in Type II patients.

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Analysis of Sagittal Profile and Radiographic Parameters in Symptomatic Thoracolumbar Disc Herniation Patients

10.21203/rs.3.rs-34221/v1 ◽

2020 ◽

Author(s):

Ang Gao ◽

Yongqiang Wang ◽

Miao Yu ◽

Xiaoguang Liu

Keyword(s):

Disc Herniation ◽

Thoracic Spine ◽

Lumbar Disc ◽

Sagittal Profile ◽

Type I ◽

Type Ii ◽

Sagittal Vertical Axis ◽

Radiographic Parameters ◽

Significant Difference ◽

Thoracolumbar Region

Abstract Background Few studies describe thoracolumbar disc herniation (TLDH) as an isolated category, it is frequently classified as the lower thoracic spine or upper lumbar spine. Thus, less is known about the morphology and aetiology of TLDH compared to lumbar disc herniation (LDH)The aim of study is to investigate sagittal alignment in TLDH, and analyze sagittal profile with radiographic parameters.Methods Data from 70 patients diagnosed with TLDH were retrospectively reviewed. The thoracic-lumbar alignment was depicted by description of curvatures (the apex of lumbar curvature, the apex of thoracic curvature, and inflexion point of the two curvatures) and radiographic parameters from complete standing long-cassette spine radiographs. The rank sum test was utilised to compare radiographic parameters values in each subtype. Results We found two subtypes differentiated by the apex of thoracic kyphotic curves. The apex of the thoracic kyphotic curve located in the middle thoracic spine in type I, and the apex of the thoracic kyphotic curve located in the thoracolumbar region in type II patients. Thirty-six patients were classified as type I, and 34 patients were classified as type II. The mean sagittal vertical axis, T1 pelvic angle and L1 pelvic angle were 27.9±24.8°, 8.2±7.3° and 6.2±4.9°, respectively. There was significant difference (p<0.001) of thoracolumbar angle between type I patients (14.9±7.9°) and type II patients (29.1±13.7°).Conclusions We presented two distinctive sagittal profiles in TLDH patients, and a regional kyphotic deformity with a balanced spine was validated in both subtypes. In view of the different curvatures, different aetiologies were discovered in each subtype. Mismatch between shape and SS value was observed, and better agreement was found in Type II patients.

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RA05.04: MANAGEMENT & OUTCOMES OF ANASTOMOTIC LEAKS FOLLOWING ESOPHAGECTOMY: A PROSPECTIVE 10-YEAR SINGLE-SITE EXPERIENCE

Diseases of the Esophagus ◽

10.1093/dote/doy089.ra05.04 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 28-28

Author(s):

Joel Lambert ◽

Sanya Caratella ◽

Eloise Lawrence ◽

Bilal Alkhaffaf

Keyword(s):

Minimally Invasive ◽

Anastomotic Leak ◽

Surgical Intervention ◽

Type I ◽

Oral Contrast ◽

Open Approach ◽

Type Ii ◽

Anastomotic Leaks ◽

Type Iii ◽

Significant Difference

Abstract Background Anastomotic leak after esophagectomy is associated with high levels of morbidity and may impact negatively on oncological outcomes. The aim of this single centre study was to describe our experience in managing these complications Methods From 2007–2017 data was reviewed retrospectively from our prospectively maintained electronic database. All patients underwent either 2 or 3 phase esophagectomy for cancer of the oesophagus or esophago-gastric junction. All histological sub-types and stage of cancer were included in the analysis. Anastomotic leaks were classified according to the Esophagectomy Complications Consensus Group (ECCG) guidelines; type I—conservative management, type II—non-surgical intervention, type III—surgical intervention. Results 224 esophagectomies were included in our analysis (104 (46%) minimally invasive, 120 (54%) open approach). The incidence of all anastomotic leaks was 10% (23/224). Surgical approach did not influence the incidence of anastomotic leak (minimally invasive 10 (43%), open approach 13(57%), P = 0.76). Five patients (22%) had a type I leak, 9 patients (39%) type II and 9 (39%) had a type III leak. There was an increase in the number of leaks managed non-surgically over the last 5 years compared to those in the first five years of our dataset (2012–2017: 11/23 (48%) vs 2007–2012: 4/23 (17%) P = 0.08). The median time for leak diagnosis was 8 days. Most leaks were diagnosed with oral contrast CT 19 (83%). Median hospital stay after anastomotic leak was 58.5 days. Type III leaks were associated with an increased length of stay (median 84 days) compared to type I&II leaks (median (38.5 days) (P = 0.002 95% CI 18.19- 74.41). There was no significant difference in 30-day mortality between type I&II (0 patients) and type III leaks (1 patient) P = 0.260. Conclusion Low mortality rates with anastomotic leak can be achieved. In centres with experienced radiological and endoscopic skills, most anastomotic leaks can be managed non-surgically. Disclosure All authors have declared no conflicts of interest.

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Analysis of the efficacy of ozone therapy on different types of lumbar disc herniation: a new guidance is coming? [abstract]

Journal of Ozone Therapy ◽

10.7203/jo3t.3.4.2019.15506 ◽

2019 ◽

Vol 3 (4) ◽

Author(s):

Kenan Hao ◽

Huan Liu ◽

Yang Yang ◽

Qingle Zeng ◽

Xiaofeng He

Keyword(s):

Nucleus Pulposus ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Ozone Treatment ◽

Type I ◽

Type Ii ◽

Ring Type ◽

Type Iv ◽

Fibre Ring

PURPOSE: To investigate the sub-types of lumbar disc herniation, compare efficacies of ozone treatment in various types of lumbar disc herniation and analyze the mechanisms. MATERIAL AND METHODS: A total of 250 patients (159 males, 91 females; age range: 14 - 85 years) diagnosed of lumbar disc herniation from January 2009 to Jun 2014 in Nanfang Hospital were enrolled. Disc Lesions, classified by Magnetic Resonance examinations and images when injecting ozone under Digital Subtraction Angiography, were divided into four types: type I: Non-prominent nucleus pulposus with ruptured fibre ring; type II: Prominent nucleus pulposus with ruptured fibre ring; type III: Non-prominent nucleus pulposus with Non-ruptured fibre ring; type IV: Prominent nucleus pulposus with Non-ruptured fibre ring. All patients underwent intradiscal and paravertebral injection of oxygen-ozone. Visual Analogue Scale (VAS) weighted score was administered for the measurement of low back pain before treatment, and the evaluation of efficacy respectively at 1 week, 1 month, 6 month and 12 month follow-up period. RESULTS: Most of the patients (about 4/5) showed better response to ozone treatment. Herniated disc shrinkage was obtained among type II and IV. The type II had the most reduction of average score while the type III had the least. The proportion of patients who had once experienced pain relief at the follow up interval, namely the curative efficacy, showed significant difference: type I occupied the most, type IV occupied the least. CONCLUSION: Ozone treatment is effective and safe for all types of lumbar disc herniation, but efficacy varies according the types, of which type I has the best results and type IV has the worst ones.

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Close Reduction Percutaneous Pinning (CRPP) versus Open Reduction Internal Fixation (ORIF) for Pediatric Supracondylar Humerus Fractures Gartland Type II and III: A Systematic Review and Meta-analysis

Journal Of The Indonesian Medical Association ◽

10.47830/jinma-vol.71.4-2021-389 ◽

2021 ◽

Vol 71 (4) ◽

pp. 187-193

Author(s):

Putu Astawa ◽

Made Agus Maharjana ◽

Surya Adisthanaya ◽

Made Winatra Satya Putra ◽

Agus Suarjaya Putra ◽

...

Keyword(s):

Systematic Review ◽

Case Reports ◽

Meta Analysis ◽

Fixed Effect Model ◽

Cosmetic Outcome ◽

Type I ◽

Type Ii ◽

Supracondylar Humerus Fractures ◽

Significant Difference ◽

Humerus Fractures

Introduction: Displaced supracondylar fracture in children is a challenging injury that may result in impaired functional and cosmetic outcome if not well-treated. Utilization of Closed Reduction and Percutaneus Pinning (CRPP) increased for this pathology, some authors believe ORIF results better anatomical reduction and lower rate of loss of reduction. Study aims to compare CRPP and ORIF for pediatric supracondylar humerus fracture. Method: Systematic review was conducted based on PRISMA guideline. Inclusion criteria were age <18 years old, comparing CRPP and ORIF for Supracondylar Humerus Fractures Gartland Type II, II.Studies of one surgical technique, Gartland type I, case reports were excluded. For meta-analysis, 6 studies were included and fixed effect model used to pool the result. In each study, mean difference (MD) with 95% confidence interval (CI) was calculated for dichotomous outcomes using Review Manager. Result: Total of 252 patients aged 0-15 years old were included. CRPP more often performed than ORIF. Satisfactory outcomes measured by Flynn’s criteria were achieved in 87.74% in CRPP and 86.73% in ORIF patient group, indicating significant difference (Heterogeneity, I2 = 23%; WMD, 1.26; 0.58 to 2.73; P =0.56). Conclusion: Current systematic review and meta-analysis suggest that for displaced supracondylar humerus fractures, ORIF offers a comparable functional and cosmetic outcome compared to CRPP.

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Should All Cases of High-Grade Serous Ovarian, Tubal, and Primary Peritoneal Carcinomas Be Reclassified as Tubo-Ovarian Serous Carcinoma?

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000477 ◽

2015 ◽

Vol 25 (7) ◽

pp. 1201-1207 ◽

Cited By ~ 9

Author(s):

Esther Louise Moss ◽

Tim Evans ◽

Philippa Pearmain ◽

Sarah Askew ◽

Kavita Singh ◽

...

Keyword(s):

Overall Survival ◽

Clear Cell ◽

Stage Iii ◽

Serous Carcinoma ◽

Low Grade ◽

Type I ◽

High Grade ◽

Type Ii ◽

Ovarian Serous Carcinoma ◽

Significant Difference

IntroductionThe dualistic theory of ovarian carcinogenesis proposes that epithelial “ovarian” cancer is not one entity with several histological subtypes but a collection of different diseases arising from cells of different origin, some of which may not originate in the ovarian surface epithelium.MethodsAll cases referred to the Pan-Birmingham Gynaecological Cancer Centre with an ovarian, tubal, or primary peritoneal cancer between April 2006 and April 2012 were identified from the West Midlands Cancer Registry. Tumors were classified into type I (low-grade endometrioid, clear cell, mucinous, and low-grade serous) and type II (high-grade serous, high-grade endometrioid, carcinosarcoma, and undifferentiated) cancers.ResultsOvarian (83.5%), tubal (4.3%), or primary peritoneal carcinoma (12.2%) were diagnosed in a total of 583 woman. The ovarian tumors were type I in 134 cases (27.5%), type II in 325 cases (66.7%), and contained elements of both type I and type II tumors in 28 cases (5.7%). Most tubal and primary peritoneal cases, however, were type II tumors: 24 (96.0%) and 64 (90.1%), respectively. Only 16 (5.8%) of the ovarian high-grade serous carcinomas were stage I at diagnosis, whereas 240 (86.6%) were stage III+. Overall survival varied between the subtypes when matched for stage. Stage III low-grade serous and high-grade serous carcinomas had a significantly better survival compared to clear cell and mucinous cases,P= 0.0134. There was no significant difference in overall survival between the high-grade serous ovarian, tubal, or peritoneal carcinomas when matched for stage (stage III,P= 0.3758; stage IV,P= 0.4820).ConclusionsType II tumors are more common than type I and account for most tubal and peritoneal cancers. High-grade serous carcinomas, whether classified as ovarian/tubal/peritoneal, seem to behave as one disease entity with no significant difference in survival outcomes, therefore supporting the proposition of a separate classification of “tubo-ovarian serous carcinoma”.

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Analyzing the Influence of Modic Changes on Patients with Lower Back Pain Undergoing Conservative Treatment

Pain Research and Management ◽

10.1155/2019/8185316 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5

Author(s):

Yufeng Chen ◽

Huilin Yang ◽

Lianfang Zhang ◽

Yue Wang ◽

Jun Zou

Keyword(s):

Back Pain ◽

Lower Back Pain ◽

Modic Changes ◽

Nonsurgical Treatment ◽

Type I ◽

Type Ii ◽

Lower Back ◽

Significant Difference ◽

Modic Type ◽

Vas Scores

Objective. This study aimed to investigate if the presence of Modic changes (MCs) was correlated with lower back pain (LBP) and LBP-related disability in patients who underwent nonsurgical treatment. Methods. In this study, 129 patients who experienced consecutive LBP and underwent lumbar spine magnetic resonance imaging in our institute were divided into three groups according to the presence or type of MCs. The Oswestry Disability Index (ODI) and visual analog scale (VAS) were used to assess the outcomes of the treatment. Results. Based on the achieved results, there was no significant difference between three groups before treatment (P>0.05). Three months after undergoing nonsurgical treatment, the rates of improved ODI and VAS scores were statistically significantly different (P=0.014, 0.023). After an additional 3 months of treatment, in patients with Modic type I changes, the symptoms significantly improved in comparison with those 3 months prior (P=0.037, 0.026), while that improvement did not occur in patients with Modic type II changes (P>0.05). Conclusions. The existence of MCs affects the outcomes of nonsurgical treatment in patients with LBP. However, symptoms can be improved after an additional round of treatment for Modic type I changes, while this is not confirmed for Modic type II changes.

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Significant Differences in the Prevalence of Elevated HbA1c Levels for Type I and Type II Diabetics Attending the Parirenyatwa Diabetic Clinic in Harare, Zimbabwe

Chinese Journal of Biology ◽

10.1155/2014/672980 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Kurai Z. Chako ◽

Heather Phillipo ◽

Erisi Mafuratidze ◽

Danai Tavonga Zhou

Keyword(s):

Public Health ◽

Glycemic Control ◽

Public Health Facility ◽

Poor Glycemic Control ◽

Type I ◽

Type Ii ◽

Cross Sectional ◽

Significant Difference ◽

Type Ii Diabetics ◽

Hba1c Levels

Diabetics have chronically elevated glucose levels. High levels of glucose result in nonenzymatic formation of glycosylated haemoglobin (HbA1c). Therefore, elevated HbA1c is a good indicator of poorly controlled diabetes. We used the standard HbA1c method to determine glycemic control in diabetics attending a public health facility in Harare, Zimbabwe. Our study sought to assess the prevalence of elevated HbA1c amongst treated diabetics and compare the HbA1c levels by type of diabetes. The cross-sectional study was carried out at one of the main public health centres in Zimbabwe: the Parirenyatwa Group of Hospitals in Harare. Type I and type II diabetics were recruited and had their blood HbA1c levels measured. The standard one tailed proportion z test was used to test the hypothesis at 5% significance level. Combined prevalence of type I and type II diabetics with elevated HbA1c was 27%. There was no significant difference in levels of HbA1c by age and sex. Over half (54%) of Type I diabetics had elevated HbA1c, suggesting poor glycemic control. In contrast only 24% of the Type II diabetics studied had elevated HbA1c. The difference in proportion of Type I and Type II diabetics with elevated HbA1c suggestive of poor glycemic control was significant (P=0.0067).

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Association of Lunate Morphology With Carpal Instability in Scapholunate Ligament Injury

Hand ◽

10.1177/1558944717709073 ◽

2017 ◽

Vol 13 (4) ◽

pp. 418-422 ◽

Cited By ~ 2

Author(s):

Eric Quan Pang ◽

Nathan Douglass ◽

Robin N. Kamal

Keyword(s):

Retrospective Chart Review ◽

Plain Film ◽

Ligament Injury ◽

Type I ◽

Type Ii ◽

Scapholunate Ligament ◽

Ligament Injuries ◽

Scapholunate Instability ◽

Significant Difference ◽

Chi Square Analysis

Background: We examined the relationship between lunate morphology (type 1 without a medial facet; type II with a medial facet) and dorsal intercalated segmental instability (DISI) in patients with scapholunate ligament injuries. We tested the primary null hypothesis that there is no relationship between lunate morphology and development of DISI. Secondary analysis compared the agreement of classifying lunate morphology based on the presence of a medial lunate facet, capitate-to-triquetrum (CT) distance, and magnetic resonance imaging (MRI). Methods: We performed a retrospective chart review of patients with known scapholunate ligament injuries from 2001 to 2016. Posterior-anterior radiographs and MRI, when available, were evaluated. CT distances were measured as a secondary classification method. DISI and scapholunate instability were determined as radiolunate angle >15° and scapholunate angle >60°, respectively. Differences between groups were determined using chi-square analysis with significance set at P < .05. Agreement between plain radiographs, MRI, and CT distance was calculated using the kappa statistic. Results: Our search found 58 of 417 patients who met inclusion criteria; 41 of 58 had type II and 17 of 58 had type I lunates. There was no significant difference between groups in regard to DISI or scapholunate instability. Subanalysis using MRI alone or correcting any discrepancy between plain film and MRI classification, using MRI as the standard, found no difference between groups in regard to DISI or scapholunate instability. Conclusions: In patients with scapholunate ligament injuries, there are no differences in the development of DISI or scapholunate instability between patients with type I and type II lunates.

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