BACKGROUND Surgical intervention is a critical treatment approach for symptomatic atlantoaxial dislocation.However,vertebral artery injury remains a significant challenge during such procedures.We present a case of su...BACKGROUND Surgical intervention is a critical treatment approach for symptomatic atlantoaxial dislocation.However,vertebral artery injury remains a significant challenge during such procedures.We present a case of successful treatment of atlantoaxial dislocation with concurrent vertebral artery injury using interlaminar screw technology,and review the relevant literature.CASE SUMMARY A 69-year-old female patient,with no history of trauma,was diagnosed with atlantoaxial dislocation based on X-ray,computed tomography(CT),and magnetic resonance imaging.Preoperative CT angiography(CTA)revealed vertebral artery developmental anomalies,and she underwent posterior cervical surgery.Postoperative follow-up showed improvement in the patient’s clinical symptoms such as unstable walking and dizziness,as well as functional scores compared to pre-surgery.Intraoperative vertebral artery injury was successfully managed,and postoperative CTA review revealed no complications related to vascular damage.CONCLUSION Thorough preoperative evaluation,such as CTA imaging,and the surgeon’s expertise in various spinal screw placement techniques are crucial for improving the success rate of atlantoaxial dislocation surgeries.展开更多
BACKGROUND Osteoporotic vertebral fracture(OVF)is one of the most common sequelae of osteoporosis.Differential diagnosis between OVF and malignant vertebral fracture(MVF)is a challenge in clinical practice.Findings on...BACKGROUND Osteoporotic vertebral fracture(OVF)is one of the most common sequelae of osteoporosis.Differential diagnosis between OVF and malignant vertebral fracture(MVF)is a challenge in clinical practice.Findings on computed tomography and magnetic resonance images(MRI)may help to differentiate between these two types of fracture.AIM To determine whether paravertebral soft tissue swelling is useful for differentiation between OVF and MVF.METHODS We retrospectively reviewed the MRI for 165 patients diagnosed with a vertebral fracture between May 2021 and July 2022.Three radiologists evaluated the vertebral segments and thickness of soft tissue swelling on sagittal MRI by consensus.The morphology of the soft tissue swelling was also evaluated.The statistical analyses were performed using theχ^(2) test and analysis of variance.RESULTS The study included 117 patients(153 vertebrae)with OVF and 48 patients(63 vertebrae)with MVF.Soft tissue swelling was observed beneath the anterior longitudinal ligament on sagittal MRI and rim-shaped in the paravertebral area on axial MRI in all 153 vertebrae with OVF(100%)and in 12(19%)of the 63 vertebra with MVF;the difference was statistically significant(P<0.001),95%CI:3.156–8.735.Soft tissue swelling beneath the anterior longitudinal ligament spanned significantly more vertebral segments in patients with OVF than in those with MVF(P<0.001),95%CI:0.932-1.546.The mean thickness of the soft tissue swelling was significantly greater for OVF than for MVF(5.62 mm±2.50 mm vs 3.88 mm±1.73 mm,P<0.05,95%CI:0.681–0.920).Post-contrast examination was performed in 13 patients;T1-weighted images confirmed OVF in 11 cases and MVF in 2 cases.Soft tissue swelling in OVF and MVF had a fusiform appearance or appeared as a thin line on sagittal MRI and was rim-shaped on axial MRI.The length and diameter of the soft tissue swelling in patients with OVF decreased during follow-up.CONCLUSION Paravertebral soft tissue swelling is helpful for differentiating between OVF and MVF.展开更多
Objective To observe the clinical effects on spinal stenosis treated with acupuncture on Huatuo Jiaji （夹脊EX-B 2） and vertebral curvature adjustment. Methods Comprehensive therapy was applied to all of 189 cases of...Objective To observe the clinical effects on spinal stenosis treated with acupuncture on Huatuo Jiaji （夹脊EX-B 2） and vertebral curvature adjustment. Methods Comprehensive therapy was applied to all of 189 cases of any type of spinal stenosis, in which gukong needling technique was applied to Huatuo Jiaji （夹脊EX-B 2） at C4 - T5 and T12 - L5, associated with vertebral curvature adjustment with traction. The therapeutic effects were observed. Results Total effective rate was 96.8%, in which, clinical cured rate was 31.7% and excellent and good rate was 89.9% in average 28-month fol- low-up visit. Conclusion Spinal stenosis is segmental dynamic stenosis. It can be cured by acupuncture on Huatuo Jiaji （夹脊EX-B 2） and vertebral curvature adjustment and satisfactory result is achieved.展开更多
Osteoporotic vertebral compression fractures(OVCFs)are the most common fragility fracture and significantly influence the quality of life in the elderly.Currently,the literature lacks a comprehensive narrative review ...Osteoporotic vertebral compression fractures(OVCFs)are the most common fragility fracture and significantly influence the quality of life in the elderly.Currently,the literature lacks a comprehensive narrative review of the management of OVCFs.The purpose of this study is to review background information,diagnosis,and surgical and non-surgical management of the OVCFs.A comprehensive search of PubMed and Google Scholar for articles in the English language between 1980 and 2021 was performed.Combinations of the following terms were used:compression fractures,vertebral compression fractures,osteoporosis,osteoporotic compression fractures,vertebroplasty,kyphoplasty,bisphosphonates,calcitonin,and osteoporosis treatments.Additional articles were also included by examining the reference list of articles found in the search.OVCFs,especially those that occur over long periods,can be asymptomatic.Symptoms of acute OVCFs include pain localized to the mid-line spine,a loss in height,and decreased mobility.The primary treatment regimens are pain control,medication management,vertebral augmentation,and anterior or posterior decompression and reconstructions.Pain control can be achieved with acetaminophen or nonsteroidal anti-inflammatory drugs for mild pain or opioids and/or calcitonin for moderate to severe pain.Bisphosphonates and denosumab are the first-line treatments for osteoporosis.Vertebroplasty and kyphoplasty are reserved for patients who have not found symptomatic relief through conservative methods and are effective in achieving pain relief.Vertebroplasty is less technical and cheaper than kyphoplasty but could have more complications.Calcium and vitamin D supplementation can have a protective and therapeutic effect.Management of OVCFs must be combined with multiple approaches.Appropriate exercises and activity modification are important in fracture prevention.Medication with different mechanisms of action is a critical long-term causal treatment strategy.The minimally invasive surgical interventions such as vertebroplasty and kyphoplasty are reserved for patients not responsive to conservative therapy and are recognized as efficient stopgap treatment methods.Posterior decompression and fixation or Anterior decompression and reconstruction may be required if neurological deficits are present.The detailed pathogenesis and related targeted treatment options still need to be developed for better clinical outcomes.展开更多
Objective:To investigate the effect of osteoporosis and intervertebral disc degeneration on the endplate cartilage injury in rats.Methods:A total of 48 female Sprague Dawley rats(3 months)were randomly divided into Gr...Objective:To investigate the effect of osteoporosis and intervertebral disc degeneration on the endplate cartilage injury in rats.Methods:A total of 48 female Sprague Dawley rats(3 months)were randomly divided into Groups A,B,C and D with 12 rats in each group.Osteoporosis and intervertebral disc degeneration composite model,simple degeneration model and simple osteoporosis model were prepared in Groups A,B and C respectively.After modeling,four rats of each group at 12th.18th and 24th week were sacrificed,Intervertebral height of cervical vertebra C6/C7 was measured.Micro-CT was used to image the endplate of cephalic and caudal cartilage at C6/C7 intervertebral disc.Abraded area rate of C6 caudal and C7 cephalic cartilage endplate was calculated,and then C6/C7 intervertebral disc was routinely embedded and sectioned.stained with safranin O to observe histological changes microscopically.Results:At 12,18 and24 weeks,intervertebral disc height of C6/C7 were(0.58±0.09)mm,(0.53±0.04)mm and(0.04±0.06)mm in Group A rats,(0.55±0.05)mm,(0.52±0.07)mm and(0.07±0.05)mm in Group B rats.At 24th week.intervertebral disc height of Group A rats was significantly lower than that of Group B rats(P<0.05);intervertebral disc height of Groups A and B rats at each time point were significantly lower than that of Groups C and D(P<0.05).There was no significantly statistical difference of intervertebral disc height between Groups C and D(P>0.05).At 12 and 18 weeks,the abraded rate of C6 caudal and C7 cephalic cartilage endplate in Group A rats were significantly higher than that in Groups B.C and D rats(P<0.05);the abraded rate in Group B was significantly higher than that in Groups C and D(P>0.05).Microscopic observation of CT showed that ventral defects in C6caudal or C7 cephalic cartilage endplate in Groups A and B appeared after 12 weeks of modeling;obvious cracks were found in front of the C6 and C7 vertebral body,and cartilage defect shown the trend of"repairing"at 18 and 24 weeks after modeling.Conclusions:Intervertebral disc degeneration and osteoporosis can cause damage to the cartilage endplate.Co-existence of these two factors can induce more serious damage to the endplate.which has possitive correlation with intervertebral disc degeneration.Osteoporosis plays a certain role in intervertebral disc degeneration process,and accelerates the degeneration of intervertebral disc in a specific time window.展开更多
Objective To compare the differences in the efficacy on cervical spondylosis of the vertebral artery type （CSA） treated with the warm needling therapy combined with the rehabilitation physiotherapy, the simple warm ...Objective To compare the differences in the efficacy on cervical spondylosis of the vertebral artery type （CSA） treated with the warm needling therapy combined with the rehabilitation physiotherapy, the simple warm needling therapy and the simple rehabilitation physiotherapy separately and observe the impacts of them on the vertebral basilar artery （VBA） in hemodynamics. Methods Ninety cases of CSA patients were randomized divided into an acupuncture plus rehabilitation group, a warm needling group and a rehabilitation group, 30 cases in each. In the acupuncture ＋ rehabilitation group, the warm needling therapy was used at Jiájǐ （夹脊 EX-B 2） from C3 to C7 in combination with the rehabilitation physiotherapy such as traction and magnetic therapy. In the warm needling group, the simple warm needling therapy was applied. In the rehabilitation group, the simple rehabilitation physiotherapy was adopted. The VBA hemodynamic parameters, Vp, Vd, Vm and PI values were detected under the transcranial Doppler and taken as the indexes for the efficacy assessment of the groups. The efficacy of each group was assessed in association with the clinical curative rate. Results After treatment, the VBA hemodynamic parameters, Vp, Vd, Vm and PI values were all remarkably improved as compared with those before treatment in the three groups （P〈0.01, P〈0.05）. The improvement of the indexes in the acupuncture plus rehabilitation group were more significant as compared with either of the other two groups （all P〈0.01）. The clinical curative rate was 70.0% （21/30） in the acupuncture plus rehabilitation group, which was superior to 53.3% （16/30） in the warm needling group and 53.3% （16/30） in the rehabilitation group （all P〈0.01）. Conclusion The warm needling in combination with the rehabilitation physiotherapy significantly improves in VBA hemodynamic parameters for CSA and its clinical efficacy is superior to either the simple warm needling or the rehabilitation physiotherapy. Hence, this combined therapy was highly deserved to be promoted in clinical practice.展开更多
BACKGROUND Osteoporotic vertebral compression fractures(OVCFs)contribute to back pain and functional limitations in older individuals,with percutaneous vertebroplasty(PVP)emerging as a minimally invasive treatment.How...BACKGROUND Osteoporotic vertebral compression fractures(OVCFs)contribute to back pain and functional limitations in older individuals,with percutaneous vertebroplasty(PVP)emerging as a minimally invasive treatment.However,further height loss post-PVP prompts investigation into contributing factors.AIM To investigate the factors associated with further height loss following PVP with cement augmentation in OVCF patients.METHODS A total of 200 OVCF patients who underwent successful PVP between January 2021 and December 2022 were included in this study.“Further height loss”during 1 year of follow-up in OVCF patients with bone edema was defined as a vertical height loss of≥4 mm.The study population was divided into two groups for analysis:The“No Further Height Loss group(n=179)”and the“Further Height Loss group(n=21).”RESULTS In comparing two distinct groups of patients,significant differences existed in bone mineral density(BMD),vertebral compression degree,prevalence of intravertebral cleft(IVF),type of bone cement used,and cement distribution patterns.Results from binary univariate regression analysis revealed that lower BMD,the presence of IVF,cleft distribution of bone cement,and higher vertebral compression degree were all significantly associated with further height loss.Notably,the use of mineralized collagen modified-poly(methyl methacrylate)bone cement was associated with a significant reduction in the risk of further height loss.In multivariate regression analysis,lower BMD and the presence of IVF remained significantly associated with further height loss.CONCLUSION Further height loss following PVP in OVCF patients is influenced by a complex interplay of factors,especially lower BMD and the presence of IVF.These findings underscore the importance of assessing and managing these factors when addressing height loss following PVP in OVCF patients.展开更多
Background: Traditional open instrumentation may cause surgical complications due to fragile bones and induce medical comorbidities in senile patients. Vertebroplasty and kyphoplasty are palliative augmentation proced...Background: Traditional open instrumentation may cause surgical complications due to fragile bones and induce medical comorbidities in senile patients. Vertebroplasty and kyphoplasty are palliative augmentation procedures that have been associated with increased risks of cement leakage, adjacent fractures and non-union. Objective: The aim of this study was to describe a novel approach for the union of osteoporotic vertebral compression fractures with minimally invasive open reduction and internal fixation. Patients and Methods: Seven consecutive patients with intractable back pain without neurological deficits due to osteoporotic vertebral compression fractures were treated using minimally invasive fixation with intra-vertebral expandable pillars and artificial bone substitute. The clinical symptoms and image findings were recorded. Results: All of the patients reported relief of back pain, and the height of the vertebral bodies was well restored. X-ray findings obtained 2 to 4 years after the procedures showed fracture healing and favorable formation of the callus confirmed in the anterior longitudinal ligament. Conclusion: This mini-open procedure with intravertebral devices is an effective and reliable technique for osteoporotic vertebral compression fractures and may avoid complications related to traditional open spinal instrumentation procedures and augmentation with bone cement.展开更多
Purpose: Osteoporotic vertebral fractures with no sign of vertebral collapse on initial radiographs, which is so-called occult vertebral fractures (VFs), exist. Occult VFs have a high rate of missed diagnosis, and the...Purpose: Osteoporotic vertebral fractures with no sign of vertebral collapse on initial radiographs, which is so-called occult vertebral fractures (VFs), exist. Occult VFs have a high rate of missed diagnosis, and the treatment of these fractures has rarely been discussed in the literature. We evaluated the effects of vertebral bone drilling for the pain due to occults VFs. Materials and Methods: Eighteen patients with painful osteoporotic occult VFs underwent the vertebral bone drilling. We evaluated the clinical outcome by comparing numerical rating scale (NRS) and activity of daily life (ADL) values between before and after the vertebral bone drilling. Comparisons were made by using Wilcoxon signed rank test. Results: The mean baseline NRS and ADL score, and the mean NRS and ALD score after the bone drilling were 8.4 ± 0.8, 2.2 ± 0.6, 2.4 ± 1.0, 4.6 ± 0.5, respectively. Among the patients, we detected significant improvements in NRS pain score and ADL score after the drilling compared with baseline score (p < 0.0002). Conclusion: Vertebral bone drilling at the site of painful vertebral compression fractures alleviated the intractable pain due to osteoporotic occult VFs.展开更多
The drop in the MRI signal intensity, analysed without any normalisation, was found related to the intervertebral disc degeneration, but its association with low back pain remains controversial. The authors developed ...The drop in the MRI signal intensity, analysed without any normalisation, was found related to the intervertebral disc degeneration, but its association with low back pain remains controversial. The authors developed the analysis of MR signal intensity distribution (AMRSID) method that analyzes the 3D distribution of the normalized T2-weighted MR signal intensity within the intervertebral disc using descriptive statistics of histograms and weighted centers. In this study, we hypothesized that the distribution of the normalized MRI signal intensity within T2- weighted images of the intervertebral disc is a bio-marker of low back pain (LBP) independently of age and disc degenerescence. The aims were to: 1) characterize intervertebral disc degeneration in vertebral fracture from MR T1-weighted and T2-weighted images;2) evaluate the sensitivity of the normalized MRI signal distribution to the presence of LBP, discs height loss and aging. We prospectively studied 22 patients who underwent an MRI acquisition within 48h after an accidental lumbar vertebral fracture. The presence of prefracture low back pain, spinal stenosis, annular disruption, intervertebral disc height loss was noted from each patient’s medical record. The presence of Modic changes, High-Intensity Zones (HIZs) and vertebral endplate perforations was recorded from MRI. The descriptive statistics of the normalized T2-weighted signal were compared using one-way ANOVAs and a principal component analysis was proposed. MRI, associated to normalisation of the signal intensity and principal component analysis, offers a remarkable potential for in-vivo imaging and analysis of vertebral fractures and adjacent tissues for the patient’s follow-up. The mean normalized MRI signal intensity of the adjacent intervertebral disc to the vertebral fracture was found to be a bio-marker of pain, independently of age and disc degeneration. However, the parameters describing the distribution of the normalized signal intensity were found to be not sensitive to the presence of low back pain, discs height loss and aging. Further studies need to be performed to detect small abnormalities that may explain the presence of LBP.展开更多
Objective:The influence of vertebral compression fracture on the degeneration of adjacent disc was analyzed.Methods:88 patients with osteoporotic vertebral compression fractures admitted to the orthopedic pain departm...Objective:The influence of vertebral compression fracture on the degeneration of adjacent disc was analyzed.Methods:88 patients with osteoporotic vertebral compression fractures admitted to the orthopedic pain department from July 2014 to July 2019 were selected as the research objects.According to the previous MRI and the improved MRI results of admission,the patients were converted into old fractures after conservative treatment.They were followed up in 3,6 and 12 months after discharge,and the VAS score at each time point(visual acuity score)was calculated We collected and analyzed the classifcation of intervertebral disc degeneration and MRI index.Results:The follow-up rate was 659%(58/88);There were 42 cases(72.4%)of degenerative disc adjacent to the diseased vertebra,and 16 cases(27.5%)of adjacent intervertebral disc did not degenerate;VAS scores were 1ower at 14 days,3 months,6 months and 12 months after admission;The number of grade 1 of disc degeneration was lower in 6 months and 12 months than that in admission(P<0.05),and the number of grade 2,3 and 4 was significantly higher than that in the follow-up in December(P<0.05).The difference between 6 and 12 months was not statistically significant(P>0.05);MRI index at 6 and 12 months follow-up was lower than that at admission(P<0.05).Conclusion:Through the research and analysis,we found that osteoporotic vertebral compression fracture will have a corresponding impact on the adjacent intervertebral disc,which can make the adjacent intervertebral disc degenerate.展开更多
MASSAGE has been recommended to more people as an adjunct to health care. We illustrate a case of vertebral artery dissection(VAD) probably caused by massage that almost resulted in the patient's death. The patien...MASSAGE has been recommended to more people as an adjunct to health care. We illustrate a case of vertebral artery dissection(VAD) probably caused by massage that almost resulted in the patient's death. The patient experienced sudden cardiac arrest and paralysis. After treatment with anticoagulation and antiplatelet, he finally discharged without any sequelae.展开更多
BACKGROUND Osteoporosis is the leading cause of vertebral fractures.Dual-energy X-ray absor-ptiometry(DXA)and radiographs are traditionally used to detect osteoporosis and vertebral fractures/deformities.Magnetic reso...BACKGROUND Osteoporosis is the leading cause of vertebral fractures.Dual-energy X-ray absor-ptiometry(DXA)and radiographs are traditionally used to detect osteoporosis and vertebral fractures/deformities.Magnetic resonance imaging(MRI)can be utilized to detect the relative severity of vertebral deformities using three-dimen-sional information not available in traditional DXA and lateral two-dimensional radiography imaging techniques.AIM To generate normative vertebral parameters in women using MRI and DXA scans,determine the correlations between MRI-calculated vertebral deformities and age,DXA T-scores,and DXA Z-scores,and compare MRI vertebral deformity values with radiography values previously published in the literature.METHODS This study is a retrospective vertebral morphometric analysis conducted at our institution.The patient sample included MR images from 1638 female patients who underwent both MR and DXA imaging between 2005 and 2014.Biconcavity,wedge,crush,anterior height(Ha)/posterior height(Hp),and middle height(Hm)/posterior height values were calculated from the MR images of the patient’s vertebrae.Associations between vertebral deformity values,patient age,and DXA T-scores were analyzed using Spearman correlation.The MRI-derived measure-ments were compared with radiograph-based calculations from population-based data compiled from multiple studies.RESULTS Age was positively correlated with lumbar Hm/Hp(P=0.04)and thoracic wedge(P=0.03)and biconcavity(P=0.001)and negatively correlated with thoracic Ha/Hp(P=0.002)and Hm/Hp(P=0.001)values.DXA T-scores correlated positively with lumbar Hm/Hp(P<0.0001)and negatively with lumbar wedge(P=0.046),biconcavity(P<0.0001),and Ha/Hp(P=0.046)values.Qualitative analysis revealed that Ha/Hp differed between MRI and radiography population-based data by no more than 0.3 and Hm/Hp by a maximum of 1.2.CONCLUSION Compared with traditional imaging techniques,MRI detects vertebral deformities with high accuracy and re-liability.It may be a sensitive,ionizing,radiation-free tool for use in clinical settings.展开更多
Objective:Underwater shock can produce extremely high accelerations, resulting in severe human injuries on shipboard, and human thoraco lumbar spines are prone to suffer from injuries by ship shock motion. To observe ...Objective:Underwater shock can produce extremely high accelerations, resulting in severe human injuries on shipboard, and human thoraco lumbar spines are prone to suffer from injuries by ship shock motion. To observe the viscoelasticity of thoracolumbar of young fresh cadavers, and to provide biomechanical parameters for both research and clinical practice. Materials and Methods:5 fresh young male cadavers (aged 22 to 31 years) were provided, and 15 thoracolumbar spinal anatomies of 5 samples were harvested within 1 hour of death. WE-10A universal testing machine was used for creep and relaxation tests.Results:Stress relaxation and creep deformation equations are derived from the biomechanics model and the measured and simulated curves are compared. The creep in vertebral bodies and intervertebral discs exhibited significantly changes in the first 5 min and 10 min, respectively. The stress rapidly decreased in the first 2 min, and then gradually went balance during the relaxation process. Conclusion:The change in creep rate is significant at early stage,and gradually slows down.This indicates that the differences between internal pressure and local pressure are decreased until balance. The simulated curve derived from equation coincides with the experimental data to a large degree, which states that the equation is rational and reliable.展开更多
OBJECTIVE:To determine the clinical effect,treatment times,and rheoencephalogram changes in vertebral artery type cervical spondylosis patients treated with innovative Tuina manipulations.METHODS:One hundred and twent...OBJECTIVE:To determine the clinical effect,treatment times,and rheoencephalogram changes in vertebral artery type cervical spondylosis patients treated with innovative Tuina manipulations.METHODS:One hundred and twenty six cervical spondylosis patients(vertebral artery type) were randomly divided into test and control groups.Patients in the test group were treated with innovative Tuina manipulations,while those in the control group were treated with the routine Tuina manipulations according to the textbook of Chinese Massage for Acupuncture and Moxibustion majors.The clinical effects,treatment times,clinical symptoms,and cerebral blood flow were measured.RESULTS:The response to the treatment was 100% in the test group and 88.71% in the control group.Patients in the test group required(7 ± 4) treatments before recovery,while those in the control group required(15 ± 7) treatments before recovery(P<0.05).The clinical symptoms exhibited greater improvement in the test group compared to the control group(P<0.05).There were no differences in cerebral blood flow between the two groups.CONCLUSION:Both innovative Tuina manipulations and routine Tuina manipulations produced satisfactory therapeutic results in vertebral artery type cervical spondylosis patients.However,the innovative manipulation was more effective in improving the functional symptoms,although there were no changes in the cerebral blood flow.展开更多
Percutaneous angioplasty and stenting for the treatment of extracranial vertebral artery(VA) stenosis seems a safe,effective and useful technique for resolving symptoms and improving blood flow to the posterior circul...Percutaneous angioplasty and stenting for the treatment of extracranial vertebral artery(VA) stenosis seems a safe,effective and useful technique for resolving symptoms and improving blood flow to the posterior circulation,with a low complication rate and good long-term results.In patients with severe tortuosity of the vessel,stent placement is a real challenge.The new coronary balloon-expandable stents may be preferred.A large variability of restenosis rates has been reported.Drug-eluting stents may be the solution.After a comprehensive review of the literature,it can be concluded that percutaneous angioplasty and stenting of extracranial VA stenosis is technically feasible,but there is insufficient evidence from randomized trials to demonstrate that endovascular management is superior to best medical management.展开更多
Key FactsDefinition: Benign vertebral body vascular tumor.Classic imaging appearance: Hypodense lesion (CT) with coarse, verticallyoriented trabeculae;hyperintense (MRI) on both T1WI and T2WI.Most common spinal axis t...Key FactsDefinition: Benign vertebral body vascular tumor.Classic imaging appearance: Hypodense lesion (CT) with coarse, verticallyoriented trabeculae;hyperintense (MRI) on both T1WI and T2WI.Most common spinal axis tumor: (1) Incidental lesion identified on imaging performed for unrelated reasons. (2) Rarer presentation (clinical or radiographic) is “aggressive hemangioma”.Radiographic diagnostic criteria are lesion growth, bone destruction, vertebral collapse, absence of fat in lesion, and active vascular component.May extend epidurally and cause cord compression.展开更多
This retrospective study investigated the impact of endplate fracture on postoperative vertebral height loss and kyphotic deformity in 144 patients with osteoporotic vertebral compression fracture （OVCF）, who receiv...This retrospective study investigated the impact of endplate fracture on postoperative vertebral height loss and kyphotic deformity in 144 patients with osteoporotic vertebral compression fracture （OVCF）, who received balloon kyphoplasty. Patients were divided into four groups： Group 1 had no superior endplate fracture, Group 2 had fractures on the anterior portion of the superior endplate, Group 3 had fractures on the posterior portion of the superior endplate, and Group 4 had complete superior endplate fractures. Anterior and middle vertebral body height, vertebral compression ratio, vertebral height loss rate, and kyphosis Cobb angle of each patient were measured and visual analogue scale （VAS） and Oswestry disability index （ODI） scores were recorded. The anterior vertebral height and kyphosis deformity of all groups significantly improved after the surgery, whereas substantial anterior vertebral height loss and increased Cobb angle were observed in all patients at the last follow-up. Although the vertebral height loss rate and the Cobb angle in Group 2, 3 and 4 were larger compared with Group 1 at the last follow-up, only the vertebral height loss rate in Group 4 and the increase in the Cobb angle in Group 2 and 4 were statistically different from those in Group 1. The VAS and ODI scores in all groups measured after the surgery and at the last follow-up were significantly lower compared with preoperative scores, but there was no significant difference among these groups. Balloon kyphoplasty significantly improved vertebral fracture height and kyphosis. Vertebral height loss and increased kyphotic deformity were observed in OVCF patients with endplate fractures after the surgery. Postoperative aggravation of kyphosis was observed in Group 2. Furthermore, severe vertebral height loss and increased kyphotic deformity were confirmed in Group 4 after the surgery. Our results suggested that postoperative vertebral height loss and aggravation of kyphosis may be associated with biomechanical changes in the vertebral body caused by endplate fracture. Therefore, surgery should not only restore compressed vertebral body height and correct kyphosis, but also correct the deformity of endplate to achieve an effective treatment of OVCF patients with endplate fracture.展开更多
The efficacy of injecting sclerosing agent next to transverse process of cervical vertebra to induce vertebral artery type of cervical syndrome(CSA)was observed.Twenty rabbits were randomly divided into two groups:the...The efficacy of injecting sclerosing agent next to transverse process of cervical vertebra to induce vertebral artery type of cervical syndrome(CSA)was observed.Twenty rabbits were randomly divided into two groups:the model group and the control group.The rabbits in the model group were injected with sclerosing agent next to transverse process of cervical vertebray,on the contrary,the rabbits in the control group were injected with nothing.Transcranial Doppler(TCD)was used to detect the average speed of blo...展开更多
Lumbar vertebral body(VB) fractures are increasingly common in an ageing population that is at greater risk of osteoporosis and metastasis. This review aims to identify different models, as alternatives to bone minera...Lumbar vertebral body(VB) fractures are increasingly common in an ageing population that is at greater risk of osteoporosis and metastasis. This review aims to identify different models, as alternatives to bone mineral density(BMD), which may be applied in order to predict VB failure load and fracture risk. The most representative models are those that take account of normal spinal kinetics and assess the contribution of the cortical shell to vertebral strength. Overall, predictive models for VB fracture risk should encompass a range of important parameters including BMD, geometric measures and patient-specific factors. As interventions like vertebroplasty increase in popularity for VB fracture treatment and prevention, such models are likely to play a significant role in the clinical decision-making process. More biomechanical research is required, however, to reduce the risks of post-operative adjacent VB fractures.展开更多
基金Supported by Applied Basic Research Programs of Science and Technology Commission Foundation of Yunnan Province of China,No.202401AY070001-158.
文摘BACKGROUND Surgical intervention is a critical treatment approach for symptomatic atlantoaxial dislocation.However,vertebral artery injury remains a significant challenge during such procedures.We present a case of successful treatment of atlantoaxial dislocation with concurrent vertebral artery injury using interlaminar screw technology,and review the relevant literature.CASE SUMMARY A 69-year-old female patient,with no history of trauma,was diagnosed with atlantoaxial dislocation based on X-ray,computed tomography(CT),and magnetic resonance imaging.Preoperative CT angiography(CTA)revealed vertebral artery developmental anomalies,and she underwent posterior cervical surgery.Postoperative follow-up showed improvement in the patient’s clinical symptoms such as unstable walking and dizziness,as well as functional scores compared to pre-surgery.Intraoperative vertebral artery injury was successfully managed,and postoperative CTA review revealed no complications related to vascular damage.CONCLUSION Thorough preoperative evaluation,such as CTA imaging,and the surgeon’s expertise in various spinal screw placement techniques are crucial for improving the success rate of atlantoaxial dislocation surgeries.
基金approved by the Institutional Review Board of the Affiliated hospital of Qingdao University(No.QYFYWZLL29413/dated 5rd September 2023),and all patient requirements for informed consent were waived.
文摘BACKGROUND Osteoporotic vertebral fracture(OVF)is one of the most common sequelae of osteoporosis.Differential diagnosis between OVF and malignant vertebral fracture(MVF)is a challenge in clinical practice.Findings on computed tomography and magnetic resonance images(MRI)may help to differentiate between these two types of fracture.AIM To determine whether paravertebral soft tissue swelling is useful for differentiation between OVF and MVF.METHODS We retrospectively reviewed the MRI for 165 patients diagnosed with a vertebral fracture between May 2021 and July 2022.Three radiologists evaluated the vertebral segments and thickness of soft tissue swelling on sagittal MRI by consensus.The morphology of the soft tissue swelling was also evaluated.The statistical analyses were performed using theχ^(2) test and analysis of variance.RESULTS The study included 117 patients(153 vertebrae)with OVF and 48 patients(63 vertebrae)with MVF.Soft tissue swelling was observed beneath the anterior longitudinal ligament on sagittal MRI and rim-shaped in the paravertebral area on axial MRI in all 153 vertebrae with OVF(100%)and in 12(19%)of the 63 vertebra with MVF;the difference was statistically significant(P<0.001),95%CI:3.156–8.735.Soft tissue swelling beneath the anterior longitudinal ligament spanned significantly more vertebral segments in patients with OVF than in those with MVF(P<0.001),95%CI:0.932-1.546.The mean thickness of the soft tissue swelling was significantly greater for OVF than for MVF(5.62 mm±2.50 mm vs 3.88 mm±1.73 mm,P<0.05,95%CI:0.681–0.920).Post-contrast examination was performed in 13 patients;T1-weighted images confirmed OVF in 11 cases and MVF in 2 cases.Soft tissue swelling in OVF and MVF had a fusiform appearance or appeared as a thin line on sagittal MRI and was rim-shaped on axial MRI.The length and diameter of the soft tissue swelling in patients with OVF decreased during follow-up.CONCLUSION Paravertebral soft tissue swelling is helpful for differentiating between OVF and MVF.
文摘Objective To observe the clinical effects on spinal stenosis treated with acupuncture on Huatuo Jiaji （夹脊EX-B 2） and vertebral curvature adjustment. Methods Comprehensive therapy was applied to all of 189 cases of any type of spinal stenosis, in which gukong needling technique was applied to Huatuo Jiaji （夹脊EX-B 2） at C4 - T5 and T12 - L5, associated with vertebral curvature adjustment with traction. The therapeutic effects were observed. Results Total effective rate was 96.8%, in which, clinical cured rate was 31.7% and excellent and good rate was 89.9% in average 28-month fol- low-up visit. Conclusion Spinal stenosis is segmental dynamic stenosis. It can be cured by acupuncture on Huatuo Jiaji （夹脊EX-B 2） and vertebral curvature adjustment and satisfactory result is achieved.
文摘Osteoporotic vertebral compression fractures(OVCFs)are the most common fragility fracture and significantly influence the quality of life in the elderly.Currently,the literature lacks a comprehensive narrative review of the management of OVCFs.The purpose of this study is to review background information,diagnosis,and surgical and non-surgical management of the OVCFs.A comprehensive search of PubMed and Google Scholar for articles in the English language between 1980 and 2021 was performed.Combinations of the following terms were used:compression fractures,vertebral compression fractures,osteoporosis,osteoporotic compression fractures,vertebroplasty,kyphoplasty,bisphosphonates,calcitonin,and osteoporosis treatments.Additional articles were also included by examining the reference list of articles found in the search.OVCFs,especially those that occur over long periods,can be asymptomatic.Symptoms of acute OVCFs include pain localized to the mid-line spine,a loss in height,and decreased mobility.The primary treatment regimens are pain control,medication management,vertebral augmentation,and anterior or posterior decompression and reconstructions.Pain control can be achieved with acetaminophen or nonsteroidal anti-inflammatory drugs for mild pain or opioids and/or calcitonin for moderate to severe pain.Bisphosphonates and denosumab are the first-line treatments for osteoporosis.Vertebroplasty and kyphoplasty are reserved for patients who have not found symptomatic relief through conservative methods and are effective in achieving pain relief.Vertebroplasty is less technical and cheaper than kyphoplasty but could have more complications.Calcium and vitamin D supplementation can have a protective and therapeutic effect.Management of OVCFs must be combined with multiple approaches.Appropriate exercises and activity modification are important in fracture prevention.Medication with different mechanisms of action is a critical long-term causal treatment strategy.The minimally invasive surgical interventions such as vertebroplasty and kyphoplasty are reserved for patients not responsive to conservative therapy and are recognized as efficient stopgap treatment methods.Posterior decompression and fixation or Anterior decompression and reconstruction may be required if neurological deficits are present.The detailed pathogenesis and related targeted treatment options still need to be developed for better clinical outcomes.
基金supported by National Science Foundation.Grant No.81171764
文摘Objective:To investigate the effect of osteoporosis and intervertebral disc degeneration on the endplate cartilage injury in rats.Methods:A total of 48 female Sprague Dawley rats(3 months)were randomly divided into Groups A,B,C and D with 12 rats in each group.Osteoporosis and intervertebral disc degeneration composite model,simple degeneration model and simple osteoporosis model were prepared in Groups A,B and C respectively.After modeling,four rats of each group at 12th.18th and 24th week were sacrificed,Intervertebral height of cervical vertebra C6/C7 was measured.Micro-CT was used to image the endplate of cephalic and caudal cartilage at C6/C7 intervertebral disc.Abraded area rate of C6 caudal and C7 cephalic cartilage endplate was calculated,and then C6/C7 intervertebral disc was routinely embedded and sectioned.stained with safranin O to observe histological changes microscopically.Results:At 12,18 and24 weeks,intervertebral disc height of C6/C7 were(0.58±0.09)mm,(0.53±0.04)mm and(0.04±0.06)mm in Group A rats,(0.55±0.05)mm,(0.52±0.07)mm and(0.07±0.05)mm in Group B rats.At 24th week.intervertebral disc height of Group A rats was significantly lower than that of Group B rats(P<0.05);intervertebral disc height of Groups A and B rats at each time point were significantly lower than that of Groups C and D(P<0.05).There was no significantly statistical difference of intervertebral disc height between Groups C and D(P>0.05).At 12 and 18 weeks,the abraded rate of C6 caudal and C7 cephalic cartilage endplate in Group A rats were significantly higher than that in Groups B.C and D rats(P<0.05);the abraded rate in Group B was significantly higher than that in Groups C and D(P>0.05).Microscopic observation of CT showed that ventral defects in C6caudal or C7 cephalic cartilage endplate in Groups A and B appeared after 12 weeks of modeling;obvious cracks were found in front of the C6 and C7 vertebral body,and cartilage defect shown the trend of"repairing"at 18 and 24 weeks after modeling.Conclusions:Intervertebral disc degeneration and osteoporosis can cause damage to the cartilage endplate.Co-existence of these two factors can induce more serious damage to the endplate.which has possitive correlation with intervertebral disc degeneration.Osteoporosis plays a certain role in intervertebral disc degeneration process,and accelerates the degeneration of intervertebral disc in a specific time window.
文摘Objective To compare the differences in the efficacy on cervical spondylosis of the vertebral artery type （CSA） treated with the warm needling therapy combined with the rehabilitation physiotherapy, the simple warm needling therapy and the simple rehabilitation physiotherapy separately and observe the impacts of them on the vertebral basilar artery （VBA） in hemodynamics. Methods Ninety cases of CSA patients were randomized divided into an acupuncture plus rehabilitation group, a warm needling group and a rehabilitation group, 30 cases in each. In the acupuncture ＋ rehabilitation group, the warm needling therapy was used at Jiájǐ （夹脊 EX-B 2） from C3 to C7 in combination with the rehabilitation physiotherapy such as traction and magnetic therapy. In the warm needling group, the simple warm needling therapy was applied. In the rehabilitation group, the simple rehabilitation physiotherapy was adopted. The VBA hemodynamic parameters, Vp, Vd, Vm and PI values were detected under the transcranial Doppler and taken as the indexes for the efficacy assessment of the groups. The efficacy of each group was assessed in association with the clinical curative rate. Results After treatment, the VBA hemodynamic parameters, Vp, Vd, Vm and PI values were all remarkably improved as compared with those before treatment in the three groups （P〈0.01, P〈0.05）. The improvement of the indexes in the acupuncture plus rehabilitation group were more significant as compared with either of the other two groups （all P〈0.01）. The clinical curative rate was 70.0% （21/30） in the acupuncture plus rehabilitation group, which was superior to 53.3% （16/30） in the warm needling group and 53.3% （16/30） in the rehabilitation group （all P〈0.01）. Conclusion The warm needling in combination with the rehabilitation physiotherapy significantly improves in VBA hemodynamic parameters for CSA and its clinical efficacy is superior to either the simple warm needling or the rehabilitation physiotherapy. Hence, this combined therapy was highly deserved to be promoted in clinical practice.
基金the 2022 Panzhihua City Science and Technology Guidance Plan Project,No.2022ZD-S-35.
文摘BACKGROUND Osteoporotic vertebral compression fractures(OVCFs)contribute to back pain and functional limitations in older individuals,with percutaneous vertebroplasty(PVP)emerging as a minimally invasive treatment.However,further height loss post-PVP prompts investigation into contributing factors.AIM To investigate the factors associated with further height loss following PVP with cement augmentation in OVCF patients.METHODS A total of 200 OVCF patients who underwent successful PVP between January 2021 and December 2022 were included in this study.“Further height loss”during 1 year of follow-up in OVCF patients with bone edema was defined as a vertical height loss of≥4 mm.The study population was divided into two groups for analysis:The“No Further Height Loss group(n=179)”and the“Further Height Loss group(n=21).”RESULTS In comparing two distinct groups of patients,significant differences existed in bone mineral density(BMD),vertebral compression degree,prevalence of intravertebral cleft(IVF),type of bone cement used,and cement distribution patterns.Results from binary univariate regression analysis revealed that lower BMD,the presence of IVF,cleft distribution of bone cement,and higher vertebral compression degree were all significantly associated with further height loss.Notably,the use of mineralized collagen modified-poly(methyl methacrylate)bone cement was associated with a significant reduction in the risk of further height loss.In multivariate regression analysis,lower BMD and the presence of IVF remained significantly associated with further height loss.CONCLUSION Further height loss following PVP in OVCF patients is influenced by a complex interplay of factors,especially lower BMD and the presence of IVF.These findings underscore the importance of assessing and managing these factors when addressing height loss following PVP in OVCF patients.
文摘Background: Traditional open instrumentation may cause surgical complications due to fragile bones and induce medical comorbidities in senile patients. Vertebroplasty and kyphoplasty are palliative augmentation procedures that have been associated with increased risks of cement leakage, adjacent fractures and non-union. Objective: The aim of this study was to describe a novel approach for the union of osteoporotic vertebral compression fractures with minimally invasive open reduction and internal fixation. Patients and Methods: Seven consecutive patients with intractable back pain without neurological deficits due to osteoporotic vertebral compression fractures were treated using minimally invasive fixation with intra-vertebral expandable pillars and artificial bone substitute. The clinical symptoms and image findings were recorded. Results: All of the patients reported relief of back pain, and the height of the vertebral bodies was well restored. X-ray findings obtained 2 to 4 years after the procedures showed fracture healing and favorable formation of the callus confirmed in the anterior longitudinal ligament. Conclusion: This mini-open procedure with intravertebral devices is an effective and reliable technique for osteoporotic vertebral compression fractures and may avoid complications related to traditional open spinal instrumentation procedures and augmentation with bone cement.
文摘Purpose: Osteoporotic vertebral fractures with no sign of vertebral collapse on initial radiographs, which is so-called occult vertebral fractures (VFs), exist. Occult VFs have a high rate of missed diagnosis, and the treatment of these fractures has rarely been discussed in the literature. We evaluated the effects of vertebral bone drilling for the pain due to occults VFs. Materials and Methods: Eighteen patients with painful osteoporotic occult VFs underwent the vertebral bone drilling. We evaluated the clinical outcome by comparing numerical rating scale (NRS) and activity of daily life (ADL) values between before and after the vertebral bone drilling. Comparisons were made by using Wilcoxon signed rank test. Results: The mean baseline NRS and ADL score, and the mean NRS and ALD score after the bone drilling were 8.4 ± 0.8, 2.2 ± 0.6, 2.4 ± 1.0, 4.6 ± 0.5, respectively. Among the patients, we detected significant improvements in NRS pain score and ADL score after the drilling compared with baseline score (p < 0.0002). Conclusion: Vertebral bone drilling at the site of painful vertebral compression fractures alleviated the intractable pain due to osteoporotic occult VFs.
文摘The drop in the MRI signal intensity, analysed without any normalisation, was found related to the intervertebral disc degeneration, but its association with low back pain remains controversial. The authors developed the analysis of MR signal intensity distribution (AMRSID) method that analyzes the 3D distribution of the normalized T2-weighted MR signal intensity within the intervertebral disc using descriptive statistics of histograms and weighted centers. In this study, we hypothesized that the distribution of the normalized MRI signal intensity within T2- weighted images of the intervertebral disc is a bio-marker of low back pain (LBP) independently of age and disc degenerescence. The aims were to: 1) characterize intervertebral disc degeneration in vertebral fracture from MR T1-weighted and T2-weighted images;2) evaluate the sensitivity of the normalized MRI signal distribution to the presence of LBP, discs height loss and aging. We prospectively studied 22 patients who underwent an MRI acquisition within 48h after an accidental lumbar vertebral fracture. The presence of prefracture low back pain, spinal stenosis, annular disruption, intervertebral disc height loss was noted from each patient’s medical record. The presence of Modic changes, High-Intensity Zones (HIZs) and vertebral endplate perforations was recorded from MRI. The descriptive statistics of the normalized T2-weighted signal were compared using one-way ANOVAs and a principal component analysis was proposed. MRI, associated to normalisation of the signal intensity and principal component analysis, offers a remarkable potential for in-vivo imaging and analysis of vertebral fractures and adjacent tissues for the patient’s follow-up. The mean normalized MRI signal intensity of the adjacent intervertebral disc to the vertebral fracture was found to be a bio-marker of pain, independently of age and disc degeneration. However, the parameters describing the distribution of the normalized signal intensity were found to be not sensitive to the presence of low back pain, discs height loss and aging. Further studies need to be performed to detect small abnormalities that may explain the presence of LBP.
基金This work was supported by the Project of the Department of Science And Technology in Shaanxi Province(2020JM-702).
文摘Objective:The influence of vertebral compression fracture on the degeneration of adjacent disc was analyzed.Methods:88 patients with osteoporotic vertebral compression fractures admitted to the orthopedic pain department from July 2014 to July 2019 were selected as the research objects.According to the previous MRI and the improved MRI results of admission,the patients were converted into old fractures after conservative treatment.They were followed up in 3,6 and 12 months after discharge,and the VAS score at each time point(visual acuity score)was calculated We collected and analyzed the classifcation of intervertebral disc degeneration and MRI index.Results:The follow-up rate was 659%(58/88);There were 42 cases(72.4%)of degenerative disc adjacent to the diseased vertebra,and 16 cases(27.5%)of adjacent intervertebral disc did not degenerate;VAS scores were 1ower at 14 days,3 months,6 months and 12 months after admission;The number of grade 1 of disc degeneration was lower in 6 months and 12 months than that in admission(P<0.05),and the number of grade 2,3 and 4 was significantly higher than that in the follow-up in December(P<0.05).The difference between 6 and 12 months was not statistically significant(P>0.05);MRI index at 6 and 12 months follow-up was lower than that at admission(P<0.05).Conclusion:Through the research and analysis,we found that osteoporotic vertebral compression fracture will have a corresponding impact on the adjacent intervertebral disc,which can make the adjacent intervertebral disc degenerate.
文摘MASSAGE has been recommended to more people as an adjunct to health care. We illustrate a case of vertebral artery dissection(VAD) probably caused by massage that almost resulted in the patient's death. The patient experienced sudden cardiac arrest and paralysis. After treatment with anticoagulation and antiplatelet, he finally discharged without any sequelae.
基金the Institutional Review Board at the University of Pennsylvania (Approval No.824040).
文摘BACKGROUND Osteoporosis is the leading cause of vertebral fractures.Dual-energy X-ray absor-ptiometry(DXA)and radiographs are traditionally used to detect osteoporosis and vertebral fractures/deformities.Magnetic resonance imaging(MRI)can be utilized to detect the relative severity of vertebral deformities using three-dimen-sional information not available in traditional DXA and lateral two-dimensional radiography imaging techniques.AIM To generate normative vertebral parameters in women using MRI and DXA scans,determine the correlations between MRI-calculated vertebral deformities and age,DXA T-scores,and DXA Z-scores,and compare MRI vertebral deformity values with radiography values previously published in the literature.METHODS This study is a retrospective vertebral morphometric analysis conducted at our institution.The patient sample included MR images from 1638 female patients who underwent both MR and DXA imaging between 2005 and 2014.Biconcavity,wedge,crush,anterior height(Ha)/posterior height(Hp),and middle height(Hm)/posterior height values were calculated from the MR images of the patient’s vertebrae.Associations between vertebral deformity values,patient age,and DXA T-scores were analyzed using Spearman correlation.The MRI-derived measure-ments were compared with radiograph-based calculations from population-based data compiled from multiple studies.RESULTS Age was positively correlated with lumbar Hm/Hp(P=0.04)and thoracic wedge(P=0.03)and biconcavity(P=0.001)and negatively correlated with thoracic Ha/Hp(P=0.002)and Hm/Hp(P=0.001)values.DXA T-scores correlated positively with lumbar Hm/Hp(P<0.0001)and negatively with lumbar wedge(P=0.046),biconcavity(P<0.0001),and Ha/Hp(P=0.046)values.Qualitative analysis revealed that Ha/Hp differed between MRI and radiography population-based data by no more than 0.3 and Hm/Hp by a maximum of 1.2.CONCLUSION Compared with traditional imaging techniques,MRI detects vertebral deformities with high accuracy and re-liability.It may be a sensitive,ionizing,radiation-free tool for use in clinical settings.
文摘Objective:Underwater shock can produce extremely high accelerations, resulting in severe human injuries on shipboard, and human thoraco lumbar spines are prone to suffer from injuries by ship shock motion. To observe the viscoelasticity of thoracolumbar of young fresh cadavers, and to provide biomechanical parameters for both research and clinical practice. Materials and Methods:5 fresh young male cadavers (aged 22 to 31 years) were provided, and 15 thoracolumbar spinal anatomies of 5 samples were harvested within 1 hour of death. WE-10A universal testing machine was used for creep and relaxation tests.Results:Stress relaxation and creep deformation equations are derived from the biomechanics model and the measured and simulated curves are compared. The creep in vertebral bodies and intervertebral discs exhibited significantly changes in the first 5 min and 10 min, respectively. The stress rapidly decreased in the first 2 min, and then gradually went balance during the relaxation process. Conclusion:The change in creep rate is significant at early stage,and gradually slows down.This indicates that the differences between internal pressure and local pressure are decreased until balance. The simulated curve derived from equation coincides with the experimental data to a large degree, which states that the equation is rational and reliable.
基金Supported by the Fund of Capital Medical Development and Research(No.Ⅲ-11)the Subject Growth Fund of Guang'anmen Hospital,China Academy of Chinese Medical Sciences(No.81392)
文摘OBJECTIVE:To determine the clinical effect,treatment times,and rheoencephalogram changes in vertebral artery type cervical spondylosis patients treated with innovative Tuina manipulations.METHODS:One hundred and twenty six cervical spondylosis patients(vertebral artery type) were randomly divided into test and control groups.Patients in the test group were treated with innovative Tuina manipulations,while those in the control group were treated with the routine Tuina manipulations according to the textbook of Chinese Massage for Acupuncture and Moxibustion majors.The clinical effects,treatment times,clinical symptoms,and cerebral blood flow were measured.RESULTS:The response to the treatment was 100% in the test group and 88.71% in the control group.Patients in the test group required(7 ± 4) treatments before recovery,while those in the control group required(15 ± 7) treatments before recovery(P<0.05).The clinical symptoms exhibited greater improvement in the test group compared to the control group(P<0.05).There were no differences in cerebral blood flow between the two groups.CONCLUSION:Both innovative Tuina manipulations and routine Tuina manipulations produced satisfactory therapeutic results in vertebral artery type cervical spondylosis patients.However,the innovative manipulation was more effective in improving the functional symptoms,although there were no changes in the cerebral blood flow.
文摘Percutaneous angioplasty and stenting for the treatment of extracranial vertebral artery(VA) stenosis seems a safe,effective and useful technique for resolving symptoms and improving blood flow to the posterior circulation,with a low complication rate and good long-term results.In patients with severe tortuosity of the vessel,stent placement is a real challenge.The new coronary balloon-expandable stents may be preferred.A large variability of restenosis rates has been reported.Drug-eluting stents may be the solution.After a comprehensive review of the literature,it can be concluded that percutaneous angioplasty and stenting of extracranial VA stenosis is technically feasible,but there is insufficient evidence from randomized trials to demonstrate that endovascular management is superior to best medical management.
文摘Key FactsDefinition: Benign vertebral body vascular tumor.Classic imaging appearance: Hypodense lesion (CT) with coarse, verticallyoriented trabeculae;hyperintense (MRI) on both T1WI and T2WI.Most common spinal axis tumor: (1) Incidental lesion identified on imaging performed for unrelated reasons. (2) Rarer presentation (clinical or radiographic) is “aggressive hemangioma”.Radiographic diagnostic criteria are lesion growth, bone destruction, vertebral collapse, absence of fat in lesion, and active vascular component.May extend epidurally and cause cord compression.
基金supported by National Natural and Science Foundation(81271988)Jiangsu Natural and Science Foundation (BK2012876)
文摘This retrospective study investigated the impact of endplate fracture on postoperative vertebral height loss and kyphotic deformity in 144 patients with osteoporotic vertebral compression fracture （OVCF）, who received balloon kyphoplasty. Patients were divided into four groups： Group 1 had no superior endplate fracture, Group 2 had fractures on the anterior portion of the superior endplate, Group 3 had fractures on the posterior portion of the superior endplate, and Group 4 had complete superior endplate fractures. Anterior and middle vertebral body height, vertebral compression ratio, vertebral height loss rate, and kyphosis Cobb angle of each patient were measured and visual analogue scale （VAS） and Oswestry disability index （ODI） scores were recorded. The anterior vertebral height and kyphosis deformity of all groups significantly improved after the surgery, whereas substantial anterior vertebral height loss and increased Cobb angle were observed in all patients at the last follow-up. Although the vertebral height loss rate and the Cobb angle in Group 2, 3 and 4 were larger compared with Group 1 at the last follow-up, only the vertebral height loss rate in Group 4 and the increase in the Cobb angle in Group 2 and 4 were statistically different from those in Group 1. The VAS and ODI scores in all groups measured after the surgery and at the last follow-up were significantly lower compared with preoperative scores, but there was no significant difference among these groups. Balloon kyphoplasty significantly improved vertebral fracture height and kyphosis. Vertebral height loss and increased kyphotic deformity were observed in OVCF patients with endplate fractures after the surgery. Postoperative aggravation of kyphosis was observed in Group 2. Furthermore, severe vertebral height loss and increased kyphotic deformity were confirmed in Group 4 after the surgery. Our results suggested that postoperative vertebral height loss and aggravation of kyphosis may be associated with biomechanical changes in the vertebral body caused by endplate fracture. Therefore, surgery should not only restore compressed vertebral body height and correct kyphosis, but also correct the deformity of endplate to achieve an effective treatment of OVCF patients with endplate fracture.
基金supported by a grant from Key Program of Science and Technology of Hubei Province(No.2005AA302B07)
文摘The efficacy of injecting sclerosing agent next to transverse process of cervical vertebra to induce vertebral artery type of cervical syndrome(CSA)was observed.Twenty rabbits were randomly divided into two groups:the model group and the control group.The rabbits in the model group were injected with sclerosing agent next to transverse process of cervical vertebray,on the contrary,the rabbits in the control group were injected with nothing.Transcranial Doppler(TCD)was used to detect the average speed of blo...
文摘Lumbar vertebral body(VB) fractures are increasingly common in an ageing population that is at greater risk of osteoporosis and metastasis. This review aims to identify different models, as alternatives to bone mineral density(BMD), which may be applied in order to predict VB failure load and fracture risk. The most representative models are those that take account of normal spinal kinetics and assess the contribution of the cortical shell to vertebral strength. Overall, predictive models for VB fracture risk should encompass a range of important parameters including BMD, geometric measures and patient-specific factors. As interventions like vertebroplasty increase in popularity for VB fracture treatment and prevention, such models are likely to play a significant role in the clinical decision-making process. More biomechanical research is required, however, to reduce the risks of post-operative adjacent VB fractures.
