Biomechanical Comparison of Vertebral Augmentation and Cement Discoplasty for the Treatment of Symptomatic Schmorl’s Node Combined With Modic Change: Finite Element Analyses

Study design: Finite element simulation study.Objective: To compare the biomechanical effects of percutaneous vertebral augmentation (PVA) and percutaneous cement discoplasty (PCD) in patients with symptomatic Schmorl’s node combined with Modic change.Methods: CT data from a single patient was assembled into finite element models, from which we constructed four distinct surgical models, including PVA-ideal, PVA-nonideal, PCD-ideal, and PCD-nonideal, to compare the stress and strain differences of parapodular tissues.Results: The validity of our model was confirmed. PVA-ideal model showed a moderate reduction in the stress peak of the Schmorl’s node (0.48 vs. 0.81–0.89 Mpa) in the erect position. In the PCD-ideal model, the stress peak of the Schmorl’s node increased significantly when the spine was moved toward the lesion (3.99Mpa). Both PVA-ideal and PCD-ideal models showed global strain inhibition at the Schmorl’s node and BMEZ, which was attenuated in the non-ideal models. The PCD-ideal model significantly reduced segmental ROM (-76.8% to -59.3%) and significantly increases endplate stress (up to 220.8%), with no such effects seen in the PVA-ideal model.Conclusions: Both PVA-ideal and PCD-ideal models facilitated a more stable parapodular biomechanical microenvironment. The PVA-ideal model yielded minimal stress disturbance on the augmented or adjacent vertebral endplate but offered no improvement to segment stability. The PCD-ideal model provides adequate segment stability, but also carries a greater risk for adjacent vertebral fracture. As nonideal implementations of both surgeries can result in poor biomechanical outcomes, the surgical indications of PVA or PCD need to be carefully selected.

Magnetic resonance imaging of the spine in a pediatric population: incidental findings

Objective: To determine the prevalence of incidental findings on magnetic resonance imaging (MRI) scans of the cervical, thoracic and lumbar spine in a paediatric population. Materials and Methods: We evaluated 190 spinal MRI examinations of patients aged ≤ 18 years of age. The study included only patients for whom complete medical records were available and who underwent complete MRI examination of the cervical, thoracic or lumbar spine, including whole-spine sagittal T2-weighted sequences. Imaging findings not related to the symptom or indication for MRI were considered incidental findings. Results: Of the 190 MRI examinations evaluated, 110 were in women and 80 were in men. The mean age of the study population was 12.46 ± 3.68 years. The main clinical indications for MRI in the sample were lumbago, scoliosis, dorsalgia and cervicalgia. Incidental findings were detected in the cervical, thoracic and lumbar spine in 40 (21.05%), 26 (13.83%) and 43 (22.63%) of the patients, respectively. The most common were (in the cervical spine) reversal/correction of the normal curvature; (in the thoracic spine) intravertebral disc herniation (Schmorl’s node) and disc dehydration; and (in the lumbar spine) disc protrusion (12 cases), Schmorl’s node (5 cases) and spondylolysis (4 cases). Conclusion: Incidental findings on MRI of the spine are less common in the paediatric population than in the adult population. Nevertheless, careful clinical evaluation of paediatric patients with complaints of axial and radiating pain is necessary in order to determine the correlation between symptoms and imaging findings.

Percutaneous vertebroplasty (PVP) to treat specialized type of endplate fractures around the Schmorl’s node: a prospective study of 65 patients

Background The Schmorl’s nodes (SNs) are defined as the herniation of the intervertebral disc into the vertebral body. Endplate fractures around the Schmorl’s node could result in severe back pain that is similar to vertebral compression fractures. The objective of this study was to prospectively analyze the surgical effectiveness and safety of percutaneous vertebroplasty (PVP) for endplate fractures around the SNs. Methods Seventy-one consecutive patients with the fresh endplate fracture around SNs from October 2017 to February 2018 were enrolled in this study. The visual analog scale (VAS) and Oswestry disability index (ODI) scores of low back pain were evaluated in all patients preoperatively, postoperatively, and at 1 month, 6 months, and 1 year after primary single level PVP. Surgery-related data including duration of the operation, injected cement volumes, and surgical complications were recorded. Results Sixty-five patients with fresh endplate fractures around the SNs were treated successfully via percutaneous vertebroplasty. Our study showed that the VAS scores and ODI scores of patients were obviously improved after operation. Cement leakage into the disc space occurred in 5 patients (7.7%), and adjacent segment refractures occurred in 2 patients (3.1%). No other surgical complications, including infections or nerve root injuries were encountered. Conclusions Based on the results of this prospective study, PVP was an effective and safe procedure for endplate fractures around the SNs. Trial registration ChiCTR, ChiCTR1800016453. Registered 2 June 2018—retrospectively registered, http://www.chictr.org.cn/com/25/historyversionpuben.aspx?regno=ChiCTR1800017602

Percutaneous vertebroplasty (PVP) to treat specialized type of endplate fractures around the Schmorl's node: a prospective study of 65 patients

Background : The Schmorl's nodes (SNs) is defined as the herniation of the intervertebral disc into the vertebral body. Endplate fractures around the schmorl's node could result in severe back pain that is similar to vertebral compression fractures. The objective of this study was to prospectively analyze the surgical effectiveness and safety of percutaneous vertebroplasty (PVP) for endplate fractures around the SNs. Methods : Seventy-one consecutive patients with the fresh endplate fracture around SNs from October 2017 to February 2018 were enrolled in this study. The visual analog scale (VAS) and Oswestry disability index (ODI) scores of low back pain were evaluated in all patients preoperatively, postoperatively, and at 1 month, 6 months, and 1 year after primary single level PVP . Surgery related data including duration of the operation, injected cement volumes and surgical complications were recorded. Results : Sixty-five patients with fresh endplate fractures around the SNs were treated successfully via percutaneous vertebroplasty. Our study showed that the VAS scores and ODI scores of patients were obviously improved after operation. Cement leakage into the disc space occurred in 5 patients (7.7%), and adjacent segment refractures occurred in 2 patients (3.1%). No other surgical complications, including infections or nerve root injuries were encountered. Conclusions : Based on the results of this prospective study, PVP was an effective and safe procedure for endplate fractures around the SNs.

Percutaneous vertebroplasty (PVP) to treat specialized type of endplate fractures around the Schmorl's node: a prospective study of 65 patients

Background: The Schmorl's nodes (SNs) is defined as the herniation of the intervertebral disc into the vertebral body. Endplate fractures around the schmorl's node could result in severe back pain that is similar to vertebral compression fractures. The objective of this study was to prospectively analyze the surgical effectiveness and safety of percutaneous vertebroplasty (PVP) for endplate fractures around the SNs. Methods: Clinical data and medical records of 65 patients with the fresh endplate fracture aroud SNs who underwent single level (PVP) from October 2017 to February 2018 were enrolled in this study. The visual analog scale (VAS) and Oswestry disability index (ODI) scores of low back pain were evaluated in all patients preoperatively, postoperatively, and at 1 month, 6 months, and 1 year after primary surgery. Surgery related data including duration of the operation, injected cement volumes and surgical complications were recorded. Results: Sixty-five patients with fresh endplate fractures around the SNs were treated successfully via percutaneous vertebroplasty. Our study showed that the VAS scores and ODI scores of patients were obviously improved after operation. Cement leakage into the disc space occurred in 5 patients (7.7%), and adjacent segment refractures occurred in 2 patients (3.1%). No other surgical complications, including infections or nerve root injuries were encountered. Conclusions: Based on the results of this prospective study, PVP was an effective and safe procedure for endplate fractures around the SNs.