Transitional vertebrae and numerical variants of the spine

Aims Although lumbosacral transitional vertebrae (LSTV) are well-documented, few large-scale studies have investigated thoracolumbar transitional vertebrae (TLTV) and spinal numerical variants. This study sought to establish the prevalence of numerical variants and to evaluate their relationship with clinical problems. Methods A total of 1,179 patients who had undergone thoracic, abdominal, and pelvic CT scanning were divided into groups according to the number of thoracic and lumbar vertebrae, and the presence or absence of TLTV or LSTV. The prevalence of spinal anomalies was noted. The relationship of spinal anomalies to clinical symptoms (low back pain, Japanese Orthopaedic Association score, Roland-Morris Disability Questionnaire) and degenerative spondylolisthesis (DS) was also investigated. Results Normal vertebral morphology (12 thoracic and five lumbar vertebrae without TLTV and LSTV) was present in 531 male (76.7%) and 369 female patients (75.8%). Thoracolumbar transitional vertebrae were present in 15.8% of males and 16.0% of females. LSTV were present in 7.1% of males and 9.0% of females. The prevalence of the anomaly of 16 presacral mobile vertebrae (total number of thoracolumbar vertebrae and TLTV) without LSTV was 1.0% in males and 4.1% in females, and that of the anomaly of 18 vertebrae without LSTV was 5.3% in males and 1.2% in females. The prevalence of DS was significantly higher in females with a total of 16 vertebrae than in those with normal morphology. There was no significant correlation between a spinal anomaly and clinical symptoms. Conclusion Overall, 24% of subjects had anomalies in the thoracolumbar region: the type of anomaly differed between males and females, which could have significant implications for spinal surgery. A decreased number of vertebrae was associated with DS: numerical variants may potentially be a clinical problem. Cite this article: Bone Joint J 2021;103-B(7):1301–1308.

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Comparison of CT versus MRI measurements of transverse atlantal ligament integrity in craniovertebral junction injuries. Part 1: A clinical study

Journal of Neurosurgery Spine ◽

10.3171/2015.9.spine13808 ◽

2016 ◽

Vol 24 (6) ◽

pp. 897-902 ◽

Cited By ~ 10

Author(s):

Luis Perez-Orribo ◽

Laura A. Snyder ◽

Samuel Kalb ◽

Ali M. Elhadi ◽

Forrest Hsu ◽

...

Keyword(s):

Japanese Orthopaedic Association ◽

Ct Scanning ◽

Japanese Orthopaedic Association Score ◽

Craniovertebral Junction ◽

Occipital Condyle ◽

Injury Treatment ◽

Occipital Condyle Fractures ◽

Atlas Fractures ◽

Transverse Atlantal Ligament ◽

Lateral Diameter

OBJECTIVE Craniovertebral junction (CVJ) injuries complicated by transverse atlantal ligament (TAL) disruption often require surgical stabilization. Measurements based on the atlantodental interval (ADI), atlas lateral diameter (ALD1), and axis lateral diameter (ALD2) may help clinicians identify TAL disruption. This study used CT scanning to evaluate the reliability of these measurements and other variants in the clinical setting. METHODS Patients with CVJ injuries treated at the authors' institution between 2004 and 2011 were evaluated retrospectively for demographics, mechanism and location of CVJ injury, classification of injury, treatment, and modified Japanese Orthopaedic Association score at the time of injury and follow-up. The integrity of the TAL was evaluated using MRI. The ADI, ALD1, and ALD2 were measured on CT to identify TAL disruption indirectly. RESULTS Among the 125 patients identified, 40 (32%) had atlas fractures, 59 (47.2%) odontoid fractures, 31 (24.8%) axis fractures, and 4 (3.2%) occipital condyle fractures. TAL disruption was documented on MRI in 11 cases (8.8%). The average ADI for TAL injury was 1.8 mm (range 0.9–3.9 mm). Nine (81.8%) of the 11 patients with TAL injury had an ADI of less than 3 mm. In 10 patients (90.9%) with TAL injury, overhang of the C-1 lateral masses on C-2 was less than 7 mm. ADI, ALD1, ALD2, ALD1 – ALD2, and ALD1/ALD2 did not correlate with the integrity of the TAL. CONCLUSIONS No current measurement method using CT, including the ADI, ALD1, and ALD2 or their differences or ratios, consistently indicates the integrity of the TAL. A more reliable CT-based criterion is needed to diagnose TAL disruption when MRI is unavailable.

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Ongoing randomized clinical trials for the treatment of thrombosis in the antiphospholipid syndrome

Hämostaseologie ◽

10.1055/s-0037-1619507 ◽

2001 ◽

Vol 21 (02) ◽

pp. 77-81 ◽

Cited By ~ 2

Author(s):

G. Finazzi

Keyword(s):

Clinical Trials ◽

Large Scale ◽

Low Dose ◽

Randomized Clinical Trials ◽

Oral Anticoagulants ◽

Collaborative Study ◽

Clinical Problem ◽

Vascular Events ◽

Dose Oral ◽

Adverse Pregnancy

SummaryThrombotic events are a major clinical problem for patients with antiphospholipid antibodies (APA). However, current recommendations for their prevention and treatment are still based on retrospective studies. Data from large scale, prospective clinical trials are required to ultimately identify the optimal management of these patients. To date, at least four randomized studies are underway. The WAPS and PAPRE clinical trials are aimed to establish the correct duration and intensity of oral anticoagulation in APA patients with major arterial or venous thrombosis. The WARSS-APASS is a collaborative study to evaluate the efficacy and safety of aspirin or low-dose oral anticoagulants in preventing the recurrence of ischemic stroke. The recently announced UK Trial compares low-dose aspirin with or without low-intensity anticoagulation for the primary prevention of vascular events in APA-positive patients with SLE or adverse pregnancy history, but still thrombosis-free. It is hoped that the results of these trials will be available soon since clinicians urgently need more powerful data to treat their patients with the APA syndrome.

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Frameless robotic stereotactic biopsies: a consecutive series of 100 cases

Journal of Neurosurgery ◽

10.3171/2014.9.jns14107 ◽

2015 ◽

Vol 122 (2) ◽

pp. 342-352 ◽

Cited By ~ 49

Author(s):

Michel Lefranc ◽

Cyrille Capel ◽

Anne-Sophie Pruvot-Occean ◽

Anthony Fichten ◽

Christine Desenclos ◽

...

Keyword(s):

Stereotactic Biopsy ◽

Clinical Symptoms ◽

Diagnostic Yield ◽

Ct Scanning ◽

Fiducial Marker ◽

Surface Registration ◽

Histological Diagnosis ◽

Consecutive Series ◽

Mortality And Morbidity ◽

Stereotactic Biopsies

OBJECT Stereotactic biopsy procedures are an everyday part of neurosurgery. The procedure provides an accurate histological diagnosis with the least possible morbidity. Robotic stereotactic biopsy needs to be an accurate, safe, frameless, and rapid technique. This article reports the clinical results of a series of 100 frameless robotic biopsies using a Medtech ROSA device. METHODS The authors retrospectively analyzed their first 100 frameless stereotactic biopsies performed with the robotic ROSA device: 84 biopsies were performed by frameless robotic surface registration, 7 were performed by robotic bone fiducial marker registration, and 9 were performed by scalp fiducial marker registration. Intraoperative flat-panel CT scanning was performed concomitantly in 25 cases. The operative details of the robotic biopsies, the diagnostic yield, and mortality and morbidity data observed in this series are reported. RESULTS A histological diagnosis was established in 97 patients. No deaths or permanent morbidity related to surgery were observed. Six patients experienced transient neurological worsening. Six cases of bleeding within the lesion or along the biopsy trajectory were observed on postoperative CT scans but were associated with transient clinical symptoms in only 2 cases. Stereotactic surgery was performed with patients in the supine position in 93 cases and in the prone position in 7 cases. The use of fiducial markers was reserved for posterior fossa biopsy via a transcerebellar approach, via an occipital approach, or for pediatric biopsy. CONCLUSIONS ROSA frameless stereotactic biopsies appear to be accurate and safe robotized frameless procedures.

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Repair of Pars Interarticularis Defect by Segmental Wire Fixation in Young Athletes with Spondylolysis

The American Journal of Sports Medicine ◽

10.1177/03635465030310030601 ◽

2003 ◽

Vol 31 (3) ◽

pp. 359-364 ◽

Cited By ~ 42

Author(s):

Satoshi Nozawa ◽

Katsuji Shimizu ◽

Kei Miyamoto ◽

Mizuo Tanaka

Keyword(s):

Japanese Orthopaedic Association ◽

Japanese Orthopaedic Association Score ◽

Radiographic Examination ◽

Young Athletes ◽

Sports Activity ◽

Association Score ◽

Lumbar Spondylolysis ◽

Pars Interarticularis ◽

Wire Fixation ◽

Sports Activities

Background Although segmental wire fixation has been successful in the treatment of nonathletes with spondylolysis, no information exists on the results of this type of surgery in athletes. Purpose To evaluate the outcome of surgical repair of pars interarticularis defect by segmental wire fixation in young athletes with lumbar spondylolysis. Methods Between 1993 and 2000, 20 athletes (6 women and 14 men; average age, 23.7) with lumbar spondylolysis were treated surgically with this technique. They were actively engaged in sports such as baseball, tennis, and golf. Nineteen athletes had one level of spondylolysis and one athlete had two levels. The level of spondylolysis was L4 in 2 athletes and L5 in 19. The average follow-up period was 3.5 years (range, 1.3 to 8.6). Surgical outcome was evaluated by radiographic examination, the Japanese Orthopaedic Association score, preoperative and postoperative sports activity levels and intensities, and the presence of complications. Results Bony fusion at the site of spondylolysis was obtained in all cases, and the Japanese Orthopaedic Association score was increased significantly after surgery (preoperatively, 21.2 ± 3.9; postoperatively, maximum 27.7 ± 1.0; recovery rate, 80.4%). All of the patients returned to their sports activities, although at varying degrees. No severe complications were noted. Conclusion We recommend this technique in cases of lumbar spondylolysis in athletes who hope to resume their sports activities.

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Factors Associated With Return to Work After Surgery for Degenerative Cervical Spondylotic Myelopathy: Cohort Analysis From the Canadian Spine Outcomes and Research Network

Global Spine Journal ◽

10.1177/2192568220958669 ◽

2020 ◽

pp. 219256822095866

Author(s):

Alexander Romagna ◽

Jefferson R. Wilson ◽

W. Bradley Jacobs ◽

Michael G. Johnson ◽

Christopher S. Bailey ◽

...

Keyword(s):

Confidence Interval ◽

Return To Work ◽

Odds Ratio ◽

Cohort Analysis ◽

Japanese Orthopaedic Association ◽

Japanese Orthopaedic Association Score ◽

Research Network ◽

Duration Of Symptoms ◽

Factors Associated

Study design: Retrosepctive analysis of prospectively collected data from the multicentre Canadian Surgical Spine Registry (CSORN). Objective: Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction in North America. Few studies have evaluated return to work (RTW) rates after DCM surgery. Our goals were to determine rates and factors associated with postoperative RTW in surgically managed patients with DCM. Methods: Data was derived from the prospective, multicenter Canadian Spine Outcomes and Research Network (CSORN). From this cohort, we included all nonretired patients with at least 1-year follow-up. The RTW rate was defined as the proportion of patients with active employment at 1 year from the time of surgery. Unadjusted and adjusted analyses were used to identify patient characteristics, disease, and treatment variables associated with RTW. Results: Of 213 surgically treated DCM patients, 126 met eligibility, with 49% working and 51% not working in the immediate period before surgery; 102 had 12-month follow-up data. In both the unadjusted and the adjusted analyses working preoperatively and an anterior approach were associated with a higher postoperative RTW ( P < .05), there were no significant differences between the postoperative employment groups with respect to age, gender, preoperative mJOA (modified Japanese Orthopaedic Association) score, and duration of symptoms ( P > .05). Active preoperative employment (odds ratio = 15.4, 95% confidence interval = 4.5, 52.4) and anterior surgical procedures (odds ratio = 4.7, 95% confidence interval = 1.2, 19.6) were associated with greater odds of RTW at 1 year. Conclusions: The majority of nonretired patients undergoing surgery for DCM had returned to work 12 months after surgery; active preoperative employment and anterior surgical approach were associated with RTW in this analysis.

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Conservative management of ossification of the posterior longitudinal ligament

Neurosurgical FOCUS ◽

10.3171/2011.1.focus10273 ◽

2011 ◽

Vol 30 (3) ◽

pp. E2 ◽

Cited By ~ 25

Author(s):

Martin H. Pham ◽

Frank J. Attenello ◽

Joshua Lucas ◽

Shuhan He ◽

Christopher J. Stapleton ◽

...

Keyword(s):

Conservative Management ◽

Japanese Orthopaedic Association ◽

Posterior Longitudinal Ligament ◽

Japanese Orthopaedic Association Score ◽

Clinical Progression ◽

Association Score ◽

Rate Of Progression ◽

The Mean ◽

High Chance

Object Ossification of the posterior longitudinal ligament (OPLL) can result in significant myelopathy. Surgical treatment for OPLL has been extensively documented in the literature, but less data exist on conservative management of this condition. Methods The authors conducted a systematic review to identify all reported cases of OPLL that were conservatively managed without surgery. Results The review yielded 11 published studies reporting on a total of 480 patients (range per study 1–359 patients) over a mean follow-up period of 14.6 years (range 0.4–26 years). Of these 480 patients, 348 (72.5%) were without myelopathy on initial presentation, whereas 76 patients (15.8%) had signs of myelopathy; in 56 cases (15.8%), the presence of myelopathy was not specified. The mean aggregate Japanese Orthopaedic Association score on presentation for 111 patients was 15.3. Data available for 330 patients who initially presented without myelopathy showed progression to myelopathy in 55 (16.7%), whereas the other 275 (83.3%) remained progression free. In the 76 patients presenting with myelopathy, 37 (48.7%) showed clinical progression, whereas 39 (51.5%) remained clinically unchanged or improved. Conclusions Patients who present without myelopathy have a high chance of remaining progression free. Those who already have signs of myelopathy at presentation may benefit from surgery due to a higher rate of progression over continued follow-up.

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Gliomatosis Cerebri: A Brain Tumour Which is too Difficult to Treat?

Scottish Medical Journal ◽

10.1177/003693309804300308 ◽

1998 ◽

Vol 43 (3) ◽

pp. 84-86 ◽

Cited By ~ 8

Author(s):

D. Choi ◽

U. Schulz ◽

K. Seex

Keyword(s):

Brain Tumour ◽

Clinical Symptoms ◽

Ct Scanning ◽

Mass Effect ◽

World Health Organisation ◽

Gliomatosis Cerebri ◽

World Health ◽

Low Grade ◽

The Brain ◽

Diffuse Brain

Gliomatosis cerebri is a rare form of primary diffuse brain tumour first described by Nevin in 1938.1 It was originally considered to be a post-mortem diagnosis before Troost et al reported a clinically diagnosed case in 1987.2 However antemortem diagnosis remains difficult due to vague clinical symptoms and often non-specific findings on CT scanning. Gliomatosis cerebri has been classified by the World Health Organisation as an infiltrative tumoural process, which involves at least two, and usually three, lobes of the brain.3 Magnetic resonance (MR) imaging shows a diffuse infiltrative process with possible mass effect but no necrosis. histology is usually of a low grade astrocytic neoplasm which seemingly infiltrates out of proportion to the degree of anaplasia. We report two patients who presented over the past year, whose clinical and radiological features prompted a preoperative diagnosis of gliomatosis cerebri, confirmed by biopsy.

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Perforated viscus in the critically ill

10.1093/med/9780199600830.003.0185 ◽

2016 ◽

Author(s):

Ori D. Rotstein

Keyword(s):

Clinical Symptoms ◽

Ct Scanning ◽

Accurate Method ◽

Pathological Process ◽

Diffuse Abdominal Pain ◽

Ulcer Disease ◽

Source Of Infection ◽

Common Causes ◽

Principles Of Treatment ◽

Perforated Viscus

Visceral perforation presents with either localized or diffuse abdominal pain and tenderness depending on the ability of the peritoneal host defence mechanisms to contain the spread of gastrointestinal content from the site of perforation. The most common causes of perforation are appendicitis, diverticulitis, and peptic ulcer disease. The diagnosis is based on clinical symptoms and signs, supported by appropriate imaging. CT scanning is an accurate method of diagnosing perforation and can provide information about the underlying pathological process. The principles of treatment include adequate physiological support, appropriate antimicrobial therapy and intervention to control the source of infection and prevent its recurrence.

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Genetic heterogeneity in self-reported depressive symptoms identified through genetic analyses of the PHQ-9

Psychological Medicine ◽

10.1017/s0033291719002526 ◽

2019 ◽

Vol 50 (14) ◽

pp. 2385-2396 ◽

Cited By ~ 6

Author(s):

Jackson G. Thorp ◽

Andries T. Marees ◽

Jue-Sheng Ong ◽

Jiyuan An ◽

Stuart MacGregor ◽

...

Keyword(s):

Depressive Symptoms ◽

Genetic Heterogeneity ◽

Structural Equation ◽

Large Scale ◽

Clinical Symptoms ◽

Factor Model ◽

Genetic Correlations ◽

Genetic Covariance ◽

Association Analyses ◽

Genome Wide

AbstractBackgroundDepression is a clinically heterogeneous disorder. Previous large-scale genetic studies of depression have explored genetic risk factors of depression case–control status or aggregated sums of depressive symptoms, ignoring possible clinical or genetic heterogeneity.MethodsWe analyse data from 148 752 subjects of white British ancestry in the UK Biobank who completed nine items of a self-rated measure of current depressive symptoms: the Patient Health Questionnaire (PHQ-9). Genome-Wide Association analyses were conducted for nine symptoms and two composite measures. LD Score Regression was used to calculate SNP-based heritability (h2SNP) and genetic correlations (rg) across symptoms and to investigate genetic correlations with 25 external phenotypes. Genomic structural equation modelling was used to test the genetic factor structure across the nine symptoms.ResultsWe identified nine genome-wide significant genomic loci (8 novel), with no overlap in loci across symptoms. h2SNP ranged from 6% (concentration problems) to 9% (appetite changes). Genetic correlations ranged from 0.54 to 0.96 (all p < 1.39 × 10−3) with 30 of 36 correlations being significantly smaller than one. A two-factor model provided the best fit to the genetic covariance matrix, with factors representing ‘psychological’ and ‘somatic’ symptoms. The genetic correlations with external phenotypes showed large variation across the nine symptoms.ConclusionsPatterns of SNP associations and genetic correlations differ across the nine symptoms, suggesting that current depressive symptoms are genetically heterogeneous. Our study highlights the value of symptom-level analyses in understanding the genetic architecture of a psychiatric trait. Future studies should investigate whether genetic heterogeneity is recapitulated in clinical symptoms of major depression.

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Revision decompression with fusion as a treatment for same level restenosis after laminotomy for lumbar spinal stenosis

Journal of Orthopaedics Trauma and Rehabilitation ◽

10.1177/2210491719842690 ◽

2020 ◽

Vol 27 (1) ◽

pp. 3-9

Author(s):

Zhuohao Chow Liang ◽

Wing Ngai Yim ◽

Chung Ting Martin Wong ◽

Hung On Cheng ◽

Ka Kin Cheung

Keyword(s):

Clinical Outcomes ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Revision Surgery ◽

Japanese Orthopaedic Association ◽

Japanese Orthopaedic Association Score ◽

Leg Pain ◽

Complication Rates ◽

Salvage Procedure ◽

Lumbar Spinal

Background/Purpose: Laminotomy is an established procedure to relieve symptoms of lumbar spinal stenosis. However, there is a group of patients with symptomatic recurrence. Re-decompression and fusion could be an effective salvage procedure but the results are seldom found in the literature. In this study, we focused on investigating the clinical outcomes and complication rates of revision decompression with fusion in this patient group. Methods: A retrospective study including patients who had undergone revision decompression with fusion for recurrent symptoms due to same level restenosis after primary laminotomy for lumbar spinal stenosis was performed. Patients with recurrent symptoms due to prolapsed intervertebral disc, trauma, infection, and neoplasm were excluded. Demographics, clinical outcomes, and complications were retrieved. Results: Twenty-eight patients with a total number of 42 levels of revision decompression and fusion were included. With a mean follow-up time of 27 months after revision surgery, there were statistically significant improvement of 63, 49, and 13% in Japanese Orthopaedic Association score, visual analog scale for leg pain, and Roland-Morris disability questionnaire score, respectively. There were 6(21%), 2(7%), 0(0%), and 2(7%) cases of dural tear, infection requiring reoperation, new neurological deficit, and other complications, respectively, in these revision cases. Conclusion: Bearing potential complications in mind, re-decompression with fusion is a viable option with reasonable clinical outcomes for patients with recurrent symptoms after laminotomy for lumbar spinal stenosis. As a treatment option for symptomatic lumbar spinal stenosis, primary laminotomy could have the potential benefit of lower complication rates in revision surgery.

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