Why the patients with Hirayama disease have abnormal cervical sagittal alignment? A radiological measurement analysis of posterior cervical extensors

Purpose To explore the relationship between the strength of posterior cervical extensors (PCEs) and cervical sagittal alignment in Hirayama disease (HD) patients. Methods We analyzed the (magnetic resonance imaging) MRI T2WI and X-rays of 60 HD patients who visited Huashan Hospital from June 2017 to February 2020. Symptoms of these patients include adolescent onset, manifestation of unilateral upper limb muscle weakness and muscle atrophy of the forearm and hand. MRI images were used to measure (the cross-sectional area) CSA of cervical PCEs. The ratio of muscle CSA to vertebral body areas at the same level is defined as R-CSA. Cervical sagittal alignment includes the C2–7 Cobb angle, T1 slope and C2–7 sagittal vertical axis (SVA). The geometric center of the C3–6 vertebral body was determined using the line connecting the C2 inferior endplate and the C7 upper endplate. When located behind the line, it is defined as a “local kyphotic deformity.” The number of vertebral bodies involved in kyphotic deformity was determined by measuring the local kyphosis angle (LKA). Spearman correlation analysis (α = 0.05) was used to determine the relationship between R-CSA and sagittal parameters. ROC curves were used to analyze the sensitivity and specificity of relevant variables. Results Spearman correlation test revealed that R-CSA negatively correlated with T1S (S = 0.34, r = 0.34, p = 0.01) and LKA (S = 0.44, r = 0.5, p = 0.01), but did not correlate with the C2-C7 Cobb angle (S = 0.20, p = 0.12) or C2-C7 SVA (S = − 0.17, p = 0.46). (p < 0.05). ROC curve analysis showed that the areas under the curve (AUCs) of the T1 slope and LKA was 0.6696 and 0.7646, respectively. T1 slope, cutoff value: 17.2°; sensitivity: 0.5806; specificity: 0.7241; p < 0.05. LKA: cutoff value: − 14°; sensitivity: 1; specificity: 0.5333; p < 0.05. Conclusions In patients with Hirayama disease, the strength of posterior cervical extensors and cervical sagittal alignment are closely related. The local kyphosis angle can be used as a reference for the strength of posterior cervical extensors. These results indicate the weakness of PCEs, which may predispose the cervical spine of HD patients to a less stable situation. Therefore, patients with Hirayama disease should strengthen the exercise of the PCEs.

Efficiency of a Novel Vertebral Body Augmentation System (Tektona™) in Non-osteoporotic Spinal Fractures

BackgroundThe restauration of the local kyphosis is crucial for spinal fractures outcomes. Recently, the Tektona™, (Spine Art) system, constituted by a flexible lamella for reduction has emerged as a promising solution for osteoporotic fractures. However, no study has yet focused on its results on traumatic fractures. MethodsA retrospective longitudinal study on prospectively collected data was conducted on 53 patients. The data collected were clinical, surgical and scannographic (measurement of AVH, MVH and PVH (anterior/medium/posterior vertebral height), and RTA (regional traumatic angle) in°), preoperatively, early post-operative and at follow-up. ResultsFractures were mainly located at the upper lumbar spine and were Magerl A3.1 type for 51%. The mean RTA was 12° in pre-operative, 4° in post-operative (p=2e-9), and 8° at the last follow-up (p=0,01). The mean correction of RTA for the fixation group was -10±6° versus -7±4° for the vertebroplasty alone group (p=0,006). The mean correction for fractures located at T10-T12 was -9±3°, -9±5° for L1, -8±3° for L2 and -5±3° for L3-L5 (p=0,045). ConclusionsThe Tektona® system appears to be efficient for acute thoraco-lumbar fractures, comparable to other available systems, allowing a real intracorporeal reduction work. Its relevance, especially in the long term needs further investigation. The association of a percutaneous fixation allow to obtain a better correction of the RTA but did not seem to prevent the loss of correction at follow-up.

Clinical observation of two bone cement distribution modes after percutaneous vertebroplasty for osteoporotic vertebral compression fractures

Background Current findings suggest that percutaneous vertebroplasty(PVP) is a suitable therapeutic approach for osteoporotic vertebral compression fractures (OVCFs). The present retrospective study aimed to investigate the differences in clinical efficacy and related complications between the two bone cement distribution modes. Methods We retrospectively reviewed the medical records of the patients with single-segment OVCFs who underwent bilateral percutaneous vertebroplasty. Patients were divided into blocky and spongy group according to the type of postoperative bone cement distribution. Clinical efficacy and related complications was compared between the two bone cement distribution modes on 24 h after the operation and last follow-up. Results A total of 329 patients with an average follow up time of 17.54 months were included. The blocky group included 131 patients, 109 females(83.2 %) and 22 males(16.8 %) with a median age of 72.69 ± 7.76 years, while the Spongy group was made up of 198 patients, 38 females(19.2 %) and 160 males(80.8 %) with a median age of 71.11 ± 7.36 years. The VAS and ODI after operation improved significantly in both two groups. The VAS and ODI in the spongy group was significantly lower than that in the blocky group, 24 h postoperatively, and at the last follow-up. There were 42 cases (12.8 %) of adjacent vertebral fractures, 26 cases (19.8 %) in the blocky group and 16 cases (8.1 %) in the spongy group. There were 57 cases (17.3 %) of bone cement leakage, 18 cases (13.7 %) in blocky group and 39 cases (19.7 %) in the spongy group. At 24 h postoperatively and at the last follow-up, local kyphosis and anterior vertebral height were significantly corrected in both groups, but gradually decreased over time, and the degree of correction was significantly higher in the spongy group than in the block group. The change of local kyphosis and loss of vertebral body height were also less severe in the spongy group at the last follow-up. Conclusions Compared with blocky group, spongy group can better maintain the height of the vertebral body, correct local kyphosis, reduce the risk of the vertebral body recompression, long-term pain and restore functions.

Clinical Observation of Two Bone Cement Distribution Modes After Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures

Background:Current findings suggest that percutaneous vertebroplasty(PVP) is a suitable therapeutic approach for osteoporotic vertebral compression fractures (OVCFs).The present retrospective study aimed to investigate the differences in clinical efficacy and related complications between the two bone cement distribution modes. Methods:We retrospectively reviewed the medical records of the patients with single-segment OVCFs who underwent bilateral percutaneous vertebroplasty.Patients were divided into blocky and spongy group according to the type of postoperative bone cement distribution. Clinical efficacy and related complications was compared between the two bone cement distribution modes on 24h after the operation and last follow-up.RESULTS: The mean follow-up time was 17.54 months. The VAS and ODI after operation improved significantly in both two groups. The VAS and ODI in the spongy group was significantly lower than that in the blocky group, 24h postoperatively, and at the last follow-up. There were 42 cases (12.8%) of adjacent vertebral fractures, 26 cases (19.8%) in the blocky group and 16 cases (8.1%) in the spongy group. There were 57 cases (17.3%) of bone cement leakage, 18 cases (13.7%) in blocky group and 39 cases (19.7%) in the spongy group. At 24 hour postoperatively and at the last follow-up, local kyphosis and anterior vertebral height were significantly corrected in both groups, but gradually decreased over time, and the degree of correction was significantly higher in the spongy group than in the block group. Loss of local kyphosis and loss of vertebral body height were also less severe in the spongy group at the last follow-up.Conclusions: Compared with blocky group, spongy group can better maintain the height of the vertebral body, correct local kyphosis, reduce the risk of the vertebral body recompression, long-term pain and restore functions.

Risk factors of the poor long-term prognosis of osteoporotic vertebral fractures: A multicenter cohort study

Introduction: The presence of existing osteoporotic vertebral fracture (OVF) increases the mortality risk. However, the influence of the characteristics of OVF is unclear. This study aimed to investigate the influence of new OVF on patients’ long-term prognosis using our past cohort study. Method: This is an extension study of our cohort study carried out between 2005 and 2007. In the present extension study, of 420 patients, 197 whose contact information was available at the 6-month follow-up were included in the telephone survey in 2018. Five patients refused to participate in the survey, and 82 could not be contacted. Eventually, 110 patients were enrolled. Of the Demographic data, radiological findings, medical history, and clinical outcome were investigated at injury onset and at the 6-month follow-up. A proportional hazard model was used to investigate the risk factors for mortality. Results: Among 110 patients, 33 died. Male sex and low body mass index (BMI <18.5 kg/m2) were significant risk factors for mortality [hazard ratio (HR) = 6.40, 1.01–40.50; 5.24, 1.44–19.04, respectively]. The history of stroke and liver disease increased the risk of mortality (HR = 13.37, 1.93–92.7; 6.62, 1.15–38.14, respectively). As regards radiological findings, local kyphosis progression per 1° or ≥7° were significant risk factors of mortality (HR = 1.20, 1.06–1.36; 5.38, 1.81–16.03, respectively). Conclusions: A telephone survey at 12 years after the occurrence of OVF analyzed risk factors for mortality and showed that a progression of local kyphosis in fractures between injury onset and 6 months after injury was a risk factor of poor prognosis.

Incidence and Risk Factors for Symptomatic Spinal Epidural Hematoma Following Posterior Thoracic Spinal Surgery in a Single Institute

Study Design: Case-control study. Objectives: To investigate the incidence of symptomatic spinal epidural hematoma (SSEH) and recognize its risk factors in a cohort of patients undergoing posterior thoracic surgery in isolation. Methods: From January 2010 to December 2019, patients who developed SSEH after posterior thoracic surgery and underwent hematoma evacuation were enrolled. For each SSEH patient, 2 or 3 controls who did not develop SSEH and underwent the same procedures with similar complexity at the same section of the thoracic spine in the same period were collected. The preoperative and intraoperative factors, blood pressure-related factors and radiographic parameters were collected to identify possible risk factors by comparing between the 2 groups. Results: A total of 24 of 1612 patients (1.49%) were identified as having SSEH after thoracic spinal surgery. Compared to the control group (53 patients), SSEH patients had significant differences in the APTT (p = 0.028), INR (p = 0.009), ratio of previous spinal surgery (p = 0.012), ratio of cerebrospinal fluid leakage (p = 0.004), thoracic kyphosis (p<0.05), local kyphosis angle (p<0.05), epidural fat ratio at T7 (p = 0.003), occupying ratio of the cross-sectional area (p<0.05) and spinal epidural venous plexus grade (p<0.05). Multiple logistic regression analysis revealed 3 risk factors for SSEH: cerebrospinal fluid leakage, the local kyphosis angle (>8.77°) and the occupying ratio of the cross-sectional area (>49.58%). Conclusions: The incidence of SSEH was 1.49% in posterior thoracic spinal surgeries. Large local kyphosis angle (>8.77°), high occupying ratio of cross-sectional area (>49.58%) and cerebrospinal fluid leakage were identified as risk factors for SSEH.

Lumbar Posterior Muscle and Local Kyphosis in Patients with Degenerative Thoracolumbar Kyphosis: A Case-Control Study

Purpose: To explore the relationship between thoracolumbar kyphosis (TLK), body mass index (BMI) and the content of lumbar posterior muscles in patients with degenerative thoracolumbar kyphosis (DTLK) combined with lumbar stenosis syndrome (LSS).Methods: 126 patients with DTLK and LSS (DTLK group) and 87 patients with simple LSS (control group) were retrospectively included with well-matched demographics. TLK and lumbar lordosis (LL) were obtained on the X-ray of the whole spine. Lumbar crossing indentation value (LCIV) was introduced to evaluate the content of the lumbar muscles, with was measured from T12-L1 to L4-L5 at T2-MRI axial imaging. Three subgroups of normal weight, overweight and obesity were respectively divided into in both groups according to BMI. Three subgroups of increased LL, normal LL normal and decreased LL were also divided into in DTLK group.Results: The mean LCIV (mLCIV) of the DTLK group was less than control group and LCIV showed an increasing trend in DTLK group from T12-L1 to L4-L5. Different from control group, there were no significances in gender and BMI distribution of mLCIV in DTLK group (P>0.05). LCIV in increased LL subgroup was larger than that of normal LL and less LL subgroup (P<0.01). There were no relationship between TLK and BMI in both groups. BMI was positively correlated with mLCIV in control group(P=0.004). TLK and LCIV were negatively correlated (P<0.001) in DTLK group with LCIV=13.75-0.48×TLK.Conclusion: LCIV in DTLK group was less than control group with no gender- and BMI-difference. LCIV and TLK were mutually predictable in DTLK with LCIV=13.75-0.48×TLK.

Usefulness of K-line in predicting prognosis of laminoplasty for cervical spondylotic myelopathy

Background: K-line is widely recognized as a useful index to evaluate alignment and size of the cervical ossification of the posterior longitudinal ligament (OPLL) in one parameter. The purpose of this study was to investigate that K-line could be a tool to predict the prognosis of LP for cervical spondylotic myelopathy (CSM) as well. Methods: Sixty-eight patients who underwent LP were enrolled. C2-7 angle, local kyphosis angle, and K-line which is the straight line connecting the midpoints of the spinal canal at C2 and C7 was evaluated on T2- weighted sagittal magnetic resonance imaging (MRI). The JOA score and the recovery rate of the JOA score were evaluated at pre-operation and at follow-up. C2/C7 angle, local kyphosis angle, the JOA score, and the recovery rate were compared between K-line (-) and K-line (+) groups. Results: The recovery rate of K-line (+) group (50.6%) was significantly better than that of K-line (-) (19.4%). In K-line (-), the disc type in which the protruded disc was absorbed during the follow-up showed statistically better recovery rate (27.6%) at follow-up compared to other K-line (-) in which anterior cord compression due to the osteophyte or the kyphotic beak was not absorbed (osseous type, 5.0%).Conclusion: The present study has indicated that K-line can be a factor to predict the clinical outcome of LP for CSM. In K-line (-), the disc type showed somewhat better outcomes compared to the osseous type. However, the results were not sufficient.

Early corset reclination of uncomplicated type А3 comminuted vertebral fractures in the thoracolumbar spine

Objective. To analyze the results of staged preoperative correction of uncomplicated comminuted fractures in the thoracolumbar spine.Material and Methods. Retrospective study included data from 51 patients (33 men and 18 women) 17–35 years old with type A3 spinal injuries without urgent indications for surgery. In preparation for a possible operation, patients received a corset treatment with reclination pneumopelot for 2–3 days.Results. The results were evaluated based on clinical, radiological and CT data. The result after reclination corset treatment was considered good if a restoration of the vertebral height was achieved with its residual deficit of less than 10 % or local wedge shape not more than 10°; satisfactory – with a residual decrease in vertebral body height from 10 to 30 % or in kyphotic deformity from 10 to 20°; and unsatisfactory – with a decrease in body height of more than 30 %, and in kyphotic deformity of more than 20°. With an average decrease in the height of the fractured vertebral body before surgery by 45 % and the local kyphosis magnitude of 27.0° ± 5.5°, the staged reclination provided complete correction of kyphosis in all cases and restoration of the height of the compressed vertebra to a residual deficit of less than 10 % in 78 % of cases. Neurological disorders were not noted.Conclusion. In case of incomplete burst vertebral fractures not complicated by compression of the spinal cord, the method of early (in the first 7 days after the injury) corset treatment with staged fracture reclination by a pneumatic chamber can be effectively used to eliminate local kyphotic deformity and restore the height of fractured vertebra.