ĐÁNH GIÁ KẾT QUẢ BƯỚC ĐẦU PHẪU THUẬT BỆNH NHÂN BIẾN DẠNG CỘT SỐNG DO THOÁI HÓA BẰNG PHƯƠNG PHÁP CỐ ĐỊNH CỘT SỐNG LỐI SAU NGỰC THẮT LƯNG ĐẾN S2 BẰNG VÍT QUA KHỚP CÙNG CHẬU, GIẢI ÉP, HÀN XƯƠNG LIÊN THÂN ĐỐT THẮT LƯNG CÙNG TẠI KHOA PHẪU THUẬT CỘT SỐNG BỆNH V

Mục tiêu: Đánh giá sự cải thiện kết quả lâm sàng và chỉ số trên phim Xquang toàn bộ cột sống sau phẫu thuật điều trị biến dạng cột sống thoái hóa bằng phương pháp phẫu thuật cố định cột sống lối sau ngực thắt lưng đến S2 bằng vít qua khớp cùng chậu, giải ép, hàn xương liên thân đốt thắt lưng cùng (Long Fusion from Sacrum to Thoracic Spine - LFSTS). Phương pháp: nghiên cứu hồi cứu trên 15 bệnh nhân được chẩn đoán Biến dạng cột sống thoái hóa ở người trưởng thành (Adult spinal deformity - ASD) được phẫu thuật LFSTS tại khoa Phẫu thuật cột sống Bệnh viện Hữu nghị Việt Đức từ 1/2018 đến tháng 01/2021. Kết quả: có 14 bệnh nhân nữ (93,3%) và 1 bệnh nhân nam (6,7%), độ tuổi trung bình là 63,6±6,4. Sự cải thiện về SVA trước mổ là 75,19mm sau mổ là 42,22mm. Có sự cải thiện có ý nghĩa thống kê về chất lượng cuộc sống của bệnh nhân qua các chỉ số ODI, bộ câu hỏi SRS-22. Kết luận: Phẫu thuật LFSTS đem lại kết quả tốt về cân bằng đứng dọc trên Xquang và sự cải thiện về chất lượng cuộc sống của bệnh nhân.

NERVOUS FACTORS OF ARTERIAL HYPERTENSION PROSPECTS FOR PREVENTION AND REHABILITATION

The article provides a theoretical analysis of the causes of arterial hypertension, describes a three-month observation of the initial stage of the development of hypertension and experiments on non-drug normalization of blood pressure on a group of volunteers. It has been shown that arterial hypertension is associated with spastic conditions of the intervertebral muscles in the lower thoracic spine, which lead to compression of the sympathetic nerves that control the transport of water through the kidneys and disturb the balance of fluid circulation through the circulatory system. The possibility of prevention of arterial hypertension and non-drug rehabilitation of patients with this disease has been shown.

Computed Tomography of the Chest as a Screening Tool for Low Bone Mineral Density

ABSTRACT Introduction Computed tomography (CT) Hounsfield units (HU) recently emerged as a promising screening tool for low bone mineral density (BMD). We hypothesized that CT HU measurements of the thoracic spine would significantly and positively correlate with dual X-ray absorptiometry (DXA) BMD scans of the femoral neck. Materials and methods The study included patients with DXA scans and thoracic CT scans at the Walter Reed National Military Medical Center. One author, blinded to the DXA scans, measured HU from the cancellous bone in T4 vertebrae. Another author statistically compared femoral neck DXA T-scores to the CT HU measurements. Results The study included 145 patients with CT scans and femoral neck DXAs. The osteoporotic and osteopenic groups had a significant difference in HU measurements compared to the normal group within the study (P < .0001 and .002, respectively). A low BMD screening value of 231 HU provided a sensitivity of 90.1% and negative predictive value of 85.7%. Conclusion Thoracic vertebrae HU measurements correlate with a low BMD of the femoral neck as determined by DXA T-scores. A high sensitivity and negative predictive value was achieved with a screening value of 231 HU. Utilization of chest or thoracic spine CT imaging as a screening method provides a quick and available screening tool for assessing low BMD in patients with these scans. Level of Evidence: III (Diagnostic)

The Role of the Thoracic Spine during Breathing in Osteogenesis Imperfecta: A Combined Traditional Morphometry and 3D Geometric Morphometrics Research

OsteogenesisImperfecta (OI) is a rare disease with respiratory problems, which are usually attributed to the secondary effects of scoliosis and rib fractures and to severe restrictive pulmonary disease. Conventional morphometry has already been studied in OI patients but three-dimensional geometric morphometrics (3D GMM) has never been used to assess how the thoracic spine shape changes during maximal breathing. A total of 6 adult subjects with OI type III and 16 healthy controls underwent a spirometric study and two computed tomography scans in maximal inspiration and expiration. Shape data by means of 3D GMM and Cobb angle values of scoliosis and kyphosis were obtained and their relationship with spirometric values was analysed using regressions and mean shape comparisons. No differences in kyphosis (p = 0.285) and scoliosis Cobb values (p = 0.407) were found between inspiration and expiration in OI patients. The 3D GMM analysis revealed significant shape differences between OI and control subjects (p < 0.001) that were related to the inspiration (p = 0.030) and not to the expiration (p = 0.079). Nevertheless, no significant relation was found between thoracic spine shape, scoliosis, kyphosis and breathing outcomes in both OI patients and controls. There were thoracic spine shape differences during maximal breathing between OI patients and controls that were mainly related to the inspiration.

Risk Factors for Cervical Spine Injury in an Obtunded Blunt Trauma Patient

Background: In Thailand, many hospitals cannot send every obtunded blunt trauma patient for cervical spine CT scan because of the socioeconomic status. Knowing about the risk factors for cervical spine injury in an obtunded blunt trauma patient would help the clinician monitor for cervical spine injury. Objective: To identify the risk factors of cervical spine injury in an obtunded blunt trauma patient. Materials and Methods: The present study evaluated 400 obtunded blunt trauma patients with a GCS of less than 15, in the trauma center of Srinagarind Hospital between January 2015 and December 2019. The patients were chosen from the patient’s registry for the present retrospective cross-sectional study. A univariate analysis was fulfilled with potential risk factors such as age, gender, mechanism of injury, GCS, associated injury, and intracranial lesion. Then, multivariate analysis was used to identify the risk factors of cervical spine injury in obtunded blunt trauma patients. Results: Four hundred patients were included in the present study. Eighty-eight (22%, 95% CI 18.04 to 26.38) had a cervical spine injury. The mean age was 40.04 years, 73% were males with a male to female ratio of 2.7 to 1. For the mechanisms of injury, 66% of injuries resulted from motorcycle accidents, 15% from car accidents, and 14% from falls. From univariate analysis, age older than 60 years had significant higher odds of cervical spine injury than age younger than 60 years (OR 1.93, 95% CI 1.05 to 3.54). Thoracic spine fracture had significant higher odds of cervical spine injury than other associate injuries (OR 6.2, 95% CI 1.45 to 26.5). From multivariate analysis, age older than 60 years had significant higher odds of cervical spine injury than age younger than 60 years (aOR 1.99, 95% CI 1.07 to 3.68). Thoracic spine fracture had a significantly higher odds of cervical spine injury than the other associated injuries (aOR 6.4, 95% CI 1.48 to 27.63). In patients age older than 60 years, 42% of cervical spine injuries occurred from fall. Conclusion: From the present study, age older than 60 years and thoracic spine fracture are the significant risk factors of cervical spine injury in obtunded blunt trauma patients. Keywords: Cervical spine injury; Risk factors; Obtunded blunt trauma patient

Holocord spontaneous pneumorrhachis in the setting of refractory emesis

Background: Pneumorrhachis (PNR) is the presence of air within the spinal canal and may be either intramedullary or extramedullary in location. The etiology is most commonly iatrogenic or traumatic in nature. Treatment is dependent on underlying cause and physical exam. Case Description: Herein, we describe the second case in the literature of spontaneous holocord PNR in a young patient without risk factors. A 22-year-old male with no past medical history presented to the hospital for 2 days of vomiting and cramping in his hands and feet secondary to severe dehydration. He recently started a new job as a manual laborer and had to leave work early 2 days prior due to overexertion working outside in heat ranging from 100 to 120 degrees Fahrenheit. CT abdomen and pelvis demonstrated spontaneous pneumomediastinum and extramedullary PNR extending upward from L3 throughout the thoracic spine to the upper limit of the scan. Subsequent CT cervical and thoracic spine showed the full length of the extradural air from C2-T12 and again at L3. Conclusion: Spontaneous PNR is an uncommon, typically self-limited condition in which air is introduced into the spinal axis. Anatomic predisposition makes the extradural, dorsal cord in the cervicothoracic region the most common location. Patients are rarely symptomatic, and treatment is supportive in nature once secondary causes with high rates of morbidity and mortality are ruled out.

Adult-onset Acute Calcific Discitis

Acute calcific discitis is a rare condition of unknown etiology, observed mainly in childhood.1 Few cases have been described in adults, and most of these involve the thoracic spine.2