IMPORTANCE OF RADIOGRAPHY IN ORTHOSTATISM IN THE CONDUCT OF THORACOLOMBAR TRANSITION FRACTURES

ABSTRACT Objective: To evaluate the importance of radiography in the orthostatic position in the initial assessment of patients with thoracolumbar transition fractures and whether this image changes the surgical indication. Methods: Medical records and imaging tests of patients treated for thoracolumbar transition fractures from June 2018 to June 2019 were evaluated. Trauma patients between 18 and 60 years of age with fractures of T10 to L3 who had been indicated for conservative treatment were included. Cases of fractures considered unstable were excluded. Radiographs were taken with the patient in the supine position (supine X-ray), computed tomography (CT), and orthostatic radiography (orthostatic X-ray). Segmental kyphosis and degree of wedging were evaluated. The measurements were compared using the Wilcoxon test. The McNemar test was used to assess changes in conduct according to the criteria for surgical indication (kyphosis ≥ 25 ° and wedging ≥ 50%). Results: Fifty patients were evaluated, nine of whom (18%) were indicated for a change of conduct according to the orthostatic examinations and were submitted to surgical treatment. Vertebral kyphosis increased by 40.6% (p <0.001). The wedging increased by 25.62% (p <0.0001). Conclusion: Eighteen percent of the total number of patients who did not present instability criteria in radiographs in the supine position satisfied at least one of these criteria when the orthostatic X-ray was performed. Level of evidence 3B; Retrospective case series study.

A RARE CASE OF THORACOLUMBAR TRANSITION VERTEBRAE

The literature states that transitional vertebrae at any junction are characterized by features retained from two adjacent regions in the vertebral column. Currently, there is no published literature available that describes the prevalence or morphology of thoracolumbar transitional vertebrae (TLTV). We present to you a case of thoracolumbar transitional vertebrae with compression fracture.

Thoracolumbar vertebrae and ribs

This chapter describes and presents analysis of all vertebrae and ribs for the Sterkfontein hominins, including those associated with the Sts 14 and 431 skeletons. New rib fragments recently identified and accessioned with Sts 14 are included. Taken together, the vertebrae and ribs of the Sterkfontein hominins tell a consistent story. With one exception from Member 5 that may be attributable to Homo, all other specimens are consistent with being attributed to the same species, likely Australopithecus africanus. Overall, all the Sterkfontein specimens resemble those from other early hominins, reflecting a fundamentally human-like torso, with a series of sinusoidal spinal curvatures similar to those of hominins. These characteristics are distinctly human-like, are dissimilar from any other mammal, and are consistent with a fully upright posture. Sts 14 also displays two common spinal pathologies seen in humans but not in other hominoids, associated with the sinusoidal spinal curvatures that are necessary for habitual bipedality. The rib cage of the Sterkfontein hominins, although fragmentary, appears to indicate declination and torsion of the ribs, features that are unique to hominins. The Sterkfontein fossils also appear to have longer, thicker lower ribs than is typical for humans, but they lack costotransverse articulations at the second-to-last ribs. The thoracolumbar transition in the Sterkfontein hominins is like that of all other early hominins, with a facet transition occurring at the second to last rib-bearing level, rather than the last rib-bearing level as seen in extant humans and great apes. Overall, the Sterkfontein hominins displays rib and vertebral morphologies that among primates are only regularly seen in humans and are associated with habitually orthograde posture.

Compression Fracture Induce Severe Pain Treated by Caloripuncture: A Case Report

Fractures are common diseases that the continuity of the bone is broken. It could occur when the physical force exerted on the bone is stronger than the bone itself. There are many types of fractures, and vertebral compression fracture is one of the most common type which is generally occurs in the spongy bone in the spine and happens from a fall from a standing height or less, but without major trauma such as a motor vehicle accident [1]. Vertebral compression fractures usually occur in the mid-thoracic or thoracolumbar transition zone of the spine. Vertebral compression fracture is common in the elderly. But there is still no ideal treatment for this disease [2].

Comparative Analysis of Pedicle Screw Placement in Children with Congenital Scoliosis: Freehand Technique (in vivo) and Guide Templates (in vitro)

Objective.To evaluate accuracy between pedicle screw placement in vertebral bodies achieved in vivo with freehand techniques versus their placement in vertebrae plastic models achieved in vitro with the use of guide templates, in toddlers and preschool children with congenital kyphoscoliosis of the thoracolumbar transition and lumbar spine amid the vertebral malformation.Material and Methods. The research is based on a retrospective analysis of the results of treatment of 10 patients with congenital kyphoscoliosis of the thoracolumbar transition and lumbar spine amid the vertebral malformation. Age – from 2 years 2 months to 6 years 8 months old (mean 3 years 8 months old), gender – 6 boys, 4 girls. Based on the postoperative multi-slice spiral computed tomography (MSCT) of the spine, the pedicle screws placement accuracy of the correcting multi-support metalwork was evaluated. These patients constituted the 1st research group (in vivo group). The 2nd research group (in vitro group) was formed from 27 vertebrae plastic models with pedicle screws inserted in them with the use of guide templates. The placement accuracy of the installed pedicle support elements was assessed based on the S.D. Gertzbein et al. scale (1990).Results. In the 1st group, there were 52 pedicle screws placed. The screw placement accuracy according to the rate of misplacement, as follows: 53.8% in Grade 0, 25% in Grade I, 11.6% in Grade II, 9.6% in Grade III. The number of screws with the rate of misplacement in Grade 0 + Grade I was 41 (78.8%). In the 2nd group, there were 54 screws placed and slightly larger than the 1st group. The screw placement accuracy according to the rate of misplacement was 94.4% in Grade 0, 1.9% in Grade I, 3.7% in Grade II, respectively. The number of screws with the rate of misplacement in Grade 0 + Grade I was 52 (96.3%).Conclusions.Comparative analysis showed that the number of pedicle screws successfully placed in vertebrae plastic models in children with congenital deformities of the thoracolumbar transition and lumbar spine achieved with the use of guide templates was significantly higher than the number of screws successfully placed with freehand techniques (96.3% versus 80.8%, p = 0.011). The results obtained with method of navigation templates in vitro showed high precision and accuracy of pedicle screw placement which gives the prospect for using this type of navigation in clinical practice in toddlers with congenital scoliosis.

Thoracic vertebral count and thoracolumbar transition in Australopithecus afarensis

The evolution of the human pattern of axial segmentation has been the focus of considerable discussion in paleoanthropology. Although several complete lumbar vertebral columns are known for early hominins, to date, no complete cervical or thoracic series has been recovered. Several partial skeletons have revealed that the thoracolumbar transition in early hominins differed from that of most extant apes and humans. Australopithecus africanus, Australopithecus sediba, and Homo erectus all had zygapophyseal facets that shift from thoracic-like to lumbar-like at the penultimate rib-bearing level, rather than the ultimate rib-bearing level, as in most humans and extant African apes. What has not been clear is whether Australopithecus had 12 thoracic vertebrae as in most humans, or 13 as in most African apes, and where the position of the thoracolumbar transitional element was. The discovery, preparation, and synchrotron scanning of the Australopithecus afarensis partial skeleton DIK-1-1, from Dikika, Ethiopia, provides the only known complete hominin cervical and thoracic vertebral column before 60,000 years ago. DIK-1-1 is the only known Australopithecus skeleton to preserve all seven cervical vertebrae and provides evidence for 12 thoracic vertebrae with a transition in facet morphology at the 11th thoracic level. The location of this transition, one segment cranial to the ultimate rib-bearing vertebra, also occurs in all other early hominins and is higher than in most humans or extant apes. At 3.3 million years ago, the DIK-1-1 skeleton is the earliest example of this distinctive and unusual pattern of axial segmentation.

Lumbosacral pain caused by blockage of dynamic vertebrogenic segments of thoracolumbar transition

Introduction: In the case of the Thoraco-lumbar Junction Syndrome the pain is located in the region of the lumbo-sacral junction. Sudden torsion movements and lifting of objects while the spine is in position of torsion is the cause in most cases. In those cases, a blockade on the Th11-Th12-L1 vertebrae occurs. The aim of this research was to determine the number of patients with the Low Back Pain whose origin is in the thoracic vertebral dynamic segments, in relation to the total number of patients according to gender, age and profession.Methods: In this retrospective, descrtiptive study we have analyzed patients treated for Lumbosacral syndrome of thoracic origin in private specialist ambulant “Cebic” in Zavidovici during one year period. We analyzed data from patients medical records and history.Results: Total of 1882 patients were treated for the Low Back Pain, of which 67 (3.56%) had an origin of the pain in the Thoraco-lumbar Junction. In the analyzed group, there were 49 (73.1%) man and 18 (26.8%) women. The largest number of males, 21 (42.8%), were between 40-49 years old, while the largest number of woman, 9 (50%), was 20 to 29 years old. Largest number of male patients, 35 (71.8%), were physical workers, while most of the female subjects, 7 (38.8%), were of ce workers.Conclusions: Our research concludes that the number of patients with Low Back Pain of the thoracic origin (3.56%) is not disregarded, but these facts are usually overlooked. Therapy for those kinds of patients is in most cases concentrated to the lower segments of the lumbar spine, which gives unsatisfactory therapeutic results.