Biomedical subjects

Li-Yang Dai

Publications and source records attributed to Li-Yang Dai.

18 recordsLinked to original sources

PubMed2007

Partial scapulectomy for congenital elevation of the scapula.

We treated 26 patients with congenital elevation of the scapula by excising the superomedial part of the scapula. We also simultaneously resected the omovertebral bone when present. A modified inverted L-shape incision was used to release the contracted tissue around the medial edge of the scapula. We evaluated 28 shoulders (26 patients) at a minimum of 10 months followup (mean, 3.9 years; range, 10 months-7 years). The improvement rate for range of shoulder abduction was 59.11%. Eighteen shoulders with preoperative abduction less than 120 degrees achieved an average improvement of 52 degrees, whereas 10 shoulders with a preoperative abduction range greater than 120 degrees achieved an average improvement of 19 degrees. However, there was no difference in the improvement rate of the range of shoulder abduction between the two groups (60.94% versus 56%). Twenty-three shoulders (82.24%) attained various degrees of cosmetic improvement after the operation. There were no neurologic complications during or after surgery. No patients complained of scar problems. Excising the superomedial part of the scapula is a safe, simple operation for treating congenital elevation of the scapula.

Adolescent↗

PubMed2006

Stabilizing effect of the transferred conjoined tendon on shoulder stability.

The modified Boytchev procedure, i.e., rerouting of the coracoid process with its attached conjoined tendon (short head of biceps and coracobrachialis) deep to the subscapularis and reattachment to its anatomical location, has been advocated for recurrent anterior glenohumeral instability with controversial clinical outcomes. We aimed to investigate the dynamic contribution of the conjoined tendon in situ or transferred to the glenohumeral articulation in stable and unstable shoulders. Eight cadaveric shoulders were tested with the arm in 90 degrees abduction and 90 degrees external rotation. A constant 1.5 kg anterior translation force was applied to the proximal humerus, combined with 0, 1.5, 3.0 kg of load applied to the conjoined tendon sequentially. Anterior displacement of the humeral head relative to the scapula was recorded before and after an imitation Bankart lesion was created, and after treated with the modified Boytchev procedure for the Bankart lesion. Application of load to the conjoined tendon significantly reduced anterior displacement of the humeral head either with the capsule intact or with Bankart lesion simulated. The most significant decrease of the anterior displacement occurred when the conjoined tendon was transferred beneath the subscapularis. Our findings show that the conjoined tendon per se has a stabilizing effect on stable and unstable shoulders and therefore provide scientific support for the treatment of recurrent shoulder instability using the modified Boytchev procedure.

Adolescent↗

PubMed2006

Surgical treatment of pyogenic vertebral osteomyelitis with spinal instrumentation.

Pyogenic vertebral osteomyelitis responds well to conservative treatment at early stage, but more complicated and advanced conditions, including mechanical spinal instability, epidural abscess formation, neurologic deficits, and refractoriness to antibiotic therapy, usually require surgical intervention. The subject of using metallic implants in the setting of infection remains controversial, although more and more surgeons acknowledge that instrumentation can help the body to combat the infection rather than to interfere with it. The combination of radical debridement and instrumentation has lots of merits such as, restoration and maintenance of the sagittal alignment of the spine, stabilization of the spinal column and reduction of bed rest period. This issue must be viewed in the context of the overall and detailed health conditions of the subjecting patient. We think the culprit for the recurrence of infection is not the implants itself, but is the compromised general health condition of the patients. In this review, we focus on surgical treatment of pyogenic vertebral osteomyelitis with special attention to the role of spinal instrumentation in the presence of pyogenic infection.

Anti-Bacterial Agents↗

PubMed2006

Prediction of spinal canal expansion following cervical laminoplasty: a computer-simulated comparison between single and double-door techniques.

STUDY DESIGN: Laminoplasty was simulated using a computer-assisted technique to assess the amount of canal expansion. OBJECTIVES: This study was designed to clarify the relationship between laminoplasty opening size and increase in sagittal canal diameter, increase in canal area, and the angle of the opened lamina following laminoplasty, and to determine whether a spinous process-splitting laminoplasty achieves the similar canal expansion as a single open-door method. SUMMARY OF BACKGROUND DATA: Single and double-door cervical laminoplasty (SDCL and DDCL, respectively) have been widely used in the treatment of multilevel stenotic conditions. However, the relationship between laminoplasty opening size and spinal canal expansion following laminoplasty, and the comparison of postoperative spinal canal expansion between single and double-door techniques have not been well investigated. METHODS: SDCL and DDCL, based on preoperative computerized tomography scans of 34 patients who had undergone the laminoplasty surgery, were simulated using a computer-assisted technique. Laminoplasty with an opening size of 6, 8, 10, 12, 14, 16, and 18 mm were simulated to determine the amount of canal enlargement with the various opening size. RESULTS: Sagittal diameter, canal area, and lamina angle were increased steadily following either single or double-door laminoplasty with the door opened from 6 to 18 mm. Significant positive correlation was found between laminoplasty opening size and increase in sagittal diameter (R2 = 0.969 and P = 0.001 in SDCL; R2 = 0.926 and P < 0.001 in DDCL), increase in canal area (R2 = 0.961 and P < 0.001 in SDCL; R2 = 0.937 and P < 0.001 in DDCL), and lamina angle (R2 = 0.959 and P < 0.001 in SDCL; R2 = 0.943 and P < 0.001 in DDCL). No significant correlation was observed between preoperative sagittal diameter and increase in sagittal diameter of the spinal canal, whereas significant positive correlation was found between preoperative cross-section area and increase in cross-section area of the spinal canal. The differences between postoperative canal increase in sagittal diameter and canal area for the single versus double-door technique were statistically significant when the door was opened by more than 12 mm (P < 0.05). CONCLUSIONS: Our investigation provides insight into canal expansion after laminoplasty. The increased amount of canal following laminoplasty can be predicted by the regression equations. This may allow preoperative determination of the optimal size of the opening needed to establish adequate canal space for the spinal cord. Both single and double-door techniques of laminoplasty provide sufficient room for posterior migration of the spinal cord, although gaining different canal expansion.

Adult↗

PubMed2006

Bone mineral density of the thoracolumbar spine in relation to burst fractures: a quantitative computed tomography study.

The most common pattern among thoracolumbar burst fractures involves failure of the superior vertebra end-plate. There have been many biomechanical studies of thoracolumbar burst fractures, but the biomechanics related to the internal architecture of thoracolumbar vertebrae has been rarely documented. The objective of this study was to test the hypotheses that distribution of the bone mineral density (BMD) of the thoracolumbar spine is related to the stress concentration in this region and therefore, supports the pattern of burst fractures that occur most commonly. We measured spinal BMD of the first lumbar vertebra in 22 individuals using quantitative computed tomography (QCT) in three levels. At each level, the BMD for the trabecular compartment was determined from each of six sites and from one site within each pedicle. Thus the trabecular density was measured at a total of 20 sites for each person. The highest average QCT BMD was in the pedicle (sites 13 and 14), whereas the BMD was abruptly decreased at the posterior part of the vertebral body near the pedicles. The results of the study indicate that stress concentration of the spine related to the regional variation in vertebral bone density may be implicated in the biomechanical mechanism underlying thoracolumbar burst fractures. This finding may be correlated with the injury mechanism of thoracolumbar burst fractures and of clinical significance.

Adult↗

PubMed2006

Biomechanical evaluation of a dynamic pedicle screw fixation device.

BACKGROUND: Recent innovations in dynamic devices have promised a reduction in stress shielding, protection of adjacent segment degeneration, and decreased implant failure. However, there have been few studies comparing the biomechanical properties of a rigid device in comparison to a dynamic posterior fixation device. The purpose of this study was to compare the immediate stability of a new dynamic pedicle screw fixation device with an equivalent rigid device. METHODS: Six thoracolumbar cadaver spines (T10-L4) were fixed in a biomechanical testing frame. Pure moments of 10Nm were loaded in six directions: flexion, extension, right and left lateral bending, and right and left axial rotation. For each spine, four different stages were tested: intact, destabilization of the middle segment, fixation with the dynamic device, and fixation with the rigid device. Ranges of motion were measured using stereophotogrammetry. The specimens with each device were then subjected to flexion-compression loading for five cycles on a MTS 858 Universal Testing Machine. The average stiffness of the last three cycles was recorded. FINDINGS: Both dynamic and rigid devices were found to provide stability for the injured segment in flexion-extension and lateral bending. In axial rotation, the devices could restore the stability to levels similar to those in an intact spine. Results also indicated a slight increase in range of motion in flexion-extension and significant reduction in stiffness of flexion-compression with the dynamic device (P < 0.01), in comparison to the rigid device. INTERPRETATION: The dynamic device offers a system that may alter favorably the movement and load transmission of a spinal motion segment without sacrificing construct stability.

Adult↗

PubMed2006

Programmed cell death in intervertebral disc degeneration.

Intervertebral disc (IVD) degeneration is largely a process of destruction and failure of the extracellular matrix (ECM), and symptomatic IVD degeneration is thought to be one of the leading causes of morbidity or life quality deterioration in the elderly. To date, however, the mechanism of IVD degeneration is still not fully understood. Cellular loss from cell death in the process of IVD degeneration has long been confirmed and considered to contribute to ECM degradation, but the causes and the manners of IVD cell death remain unclear. Programmed cell death (PCD) is executed by an active cellular process and is extensively involved in many physiological and pathological processes, including embryonic development and human degenerative diseases. Thus, the relationship between PCD and IVD degeneration has become a new research focus of interest in recent years. By reviewing the available literature concentrated on PCD in IVD and discussing the methodology of detecting PCD in IVD cells, its inducing factors, the relationship of cell death to ECM degradation, and the potential therapy for IVD degeneration by modulation of PCD, we conclude that IVD cells undergo PCD via different signal transduction pathways in response to different stimuli, that PCD may play a role in the process of IVD degeneration, and that modulation of PCD might be a potential therapeutic strategy for IVD degeneration.

Animals↗

PubMed2006

Mechanisms of osteoporosis in spinal cord injury.

Osteoporosis is a known complication of spinal cord injury (SCI), but its mechanism remains unknown. The pathogenesis of osteoporosis after SCI is generally considered disuse. However, although unloading is an important factor in the pathogenesis of osteoporosis after SCI, neural lesion and hormonal changes also seem to be involved in this process. Innervation and neuropeptides play an important role in normal bone remodelling. SCI results in denervation of the sublesional bones and the neural lesion itself may play a pivotal role in the development of osteoporosis after SCI. Although upper limbs are normally loaded and innervated, bone loss also occurs in the upper extremities in patients with paraplegia, indicating that hormonal changes may be associated with osteoporosis after SCI. SCI-mediated hormonal changes may contribute to osteoporosis after SCI by different mechanisms: (1) increased renal elimination and reduced intestinal absorption of calcium leading to a negative calcium balance; (2) vitamin D deficiency plays a role in the pathogenesis of SCI-induced osteoporosis; (3) SCI antagonizes gonadal function and inhibits the osteoanabolic action of sex steroids; (4) hyperleptinaemia after SCI may contribute to the development of osteoporosis; (5) pituitary suppression of TSH may be another contributory factor to bone loss after SCI; and (6) bone loss after SCI may be caused directly, at least in part, by insulin resistance and IGFs. Thus, oversupply of osteoclasts relative to the requirement for bone resorption and/or undersupply of osteoblasts relative to the requirement for cavity repair results in bone loss after SCI. Mechanisms for the osteoporosis following SCI include a range of systems, and osteoporosis after SCI should not be simply considered as disuse osteoporosis. Unloading, neural lesion and hormonal changes after SCI result in severe bone loss. The aim of this review is to improve understanding with regard to the mechanisms of osteoporosis after SCI. The understanding of the pathogenesis of osteoporosis after SCI can help in the consideration of new treatment strategies. Because bone resorption after SCI is very high, intravenous bisphosphonates and denosumab should be considered for the treatment of osteoporosis after SCI.

Biomechanical Phenomena↗

PubMed2005

A systematic review of the management of hangman's fractures.

During the past 30 years various treatment protocols for hangman's fractures have been attempted. In order to guide the management of hangman's fractures, different classifications have been introduced. However, opinions on operative or nonoperative treatment have not yet been solidified. To evaluate both conservative and operative management of hangman's fractures in the published literature and to provide appropriate guidelines for treatment of hangman's fractures, a systematic review of the literature regarding the management of hangman's fractures was performed. An English literature search from January 1966 to January 2004 was completed with reference to treatment of hangman's fractures. The classification for treatment guidance from the literature was also reviewed. Regarding a primary therapy for hangman's fractures, there were 20 papers (62.5%) that advocated for a conservative treatment and 11 of the remaining 12 papers suggested that conservative treatment was suitable for some stable fractures. The classification of Effendi et al. modified by Levine and Edwards was used widely. Most hangman's fractures could be managed successfully with traction and external immobilization, especially in Effendi Type I, Type II and Levine-Edwards Type II fractures. It is necessary for Levine-Edwards Type IIa and III fractures to be treated with rigid immobilization. Only for some stable Type I and Levine-Edwards Type II injuries, nonrigid external fixation alone was sufficient. Rigid immobilization alone was necessary for most cases. Surgical stabilization is recommended in unstable cases when there is the possibility of later instability, such as Levine-Edwards Type IIa and III fractures with significant dislocation. The classification system proposed by Effendi et al. and modified by Levine and Edwards provided a clinically reasonable guideline for successful management of hangman's fractures.

Axis, Cervical Vertebra↗

PubMed2005

Single-stage anterior autogenous bone grafting and instrumentation in the surgical management of spinal tuberculosis.

STUDY DESIGN: Results of single-stage anterior autogenous bone grafting and instrumentation for spinal tuberculosis were reported. OBJECTIVE: To determine the efficacy of anterior instrumentation following radical debridement and autogenous bone grafting in patients with spinal tuberculosis over a 3-year period at a single institution. SUMMARY OF BACKGROUND DATA: Patients with spinal tuberculosis have been not always successfully treated by radical debridement and bone grafting with or without supplementary posterior instrumentation and fusion, although most surgeons use posterior instrumentation to support anterior strut grafts. METHODS: In this prospective study, the authors evaluated 39 patients (22 male and 17 female; average age, 48 years) with spinal tuberculosis, who underwent single-stage anterior radical debridement, autogenous bone grafting, and instrumentation. The average follow-up period was 39.9 months (range, 30-54 months). RESULTS: A solid fusion was achieved in all cases; there were 2 cases of draining fistula formation. Of all 28 patients with preoperative kyphosis, the deformity was corrected from an average of 13.5 degrees on admission to an average of 1.9 degrees after surgery. No significant loss of deformity correction was noted in these patients. There was no other recurrence of the tuberculous infection. CONCLUSIONS: The authors think that the single-stage anterior autogenous bone grafting and instrumentation are a safe and effective method in the surgical management of spinal tuberculosis.

Adult↗

PubMed2005

Osteoporosis after spinal cord injury.

Osteoporosis is a known consequence of spinal cord injury (SCI) and occurs in almost every SCI patient. It manifests itself as an increase in the incidence of lower extremity fractures. The pattern of bone loss seen in SCI patients is different from that usually encountered with endocrine disorders and disuse osteoporosis. In general, there is no demineralization in supralesional areas following SCI. Several factors appear to have a major influence on bone mass in SCI individuals, such as the degree of the injury, muscle spasticity, age, sex and duration after injury. At the lumbar spine, bone demineralization remains relatively low compared to that of the long bones in the sublesional area. A new steady state level between bone resorption and formation is reestablished about 2 years after SCI. SCI may not only cause bone loss, but also alter bone structure and microstructure. Trabecular bone is more affected than cortical bone in the SCI population. Numerous clinical series have reported a high incidence ranging from 1 to 34% of lower extremity fractures in SCI patients. The pathogenesis of osteoporosis after SCI remains complex and perplexing. Disuse may play an important role in the pathogenesis of osteoporosis, but neural factors also appear to be important. SCI also leads to impaired calcium and phosphate metabolism and the parathyroid hormone (PTH)-vitamin D axis. Pharmacologic intervention for osteoporosis after SCI includes calcium, phosphate, vitamin D, calcitonin and biphosphonates. However, the concomitant prescription of bone-active drugs for the prevention and treatment of osteoporosis remains low, despite the availability of effective therapies. Functional stimulated exercises may contribute to the prevention of bone loss to some extent. In addition, many unanswered questions remain about the pathogenesis of osteoporosis and its clinical management.

Aging↗

PubMed2005

Reliability of classification systems for intertrochanteric fractures of the proximal femur in experienced orthopaedic surgeons.

INTRODUCTION: The aim of this study was to determine the reliability of currently used classification systems for intertrochanteric fractures of the proximal femur, and to determine the reliability of these systems in experienced orthopaedic surgeons. MATERIALS AND METHODS: Forty intertrochanteric fractures of the proximal femur were classified independently by five experienced observers using the AO, Evans, Kyle, and Boyd classification systems on two separate occasions 3 months apart. The interobserver and intraobserver variation was assessed using kappa statistics. RESULTS: The level of agreement for classification into AO groups was almost perfect or substantial, and higher than other classification systems. When the fractures were further classified using the AO classification with subgroups, reliability became worse. CONCLUSIONS: The current study suggests that the AO classification system with groups can be used more reliably to measure intertrochanteric fractures of the proximal femur than Evans, Kyle, and Boyd classification systems. However, the reliability of the AO classification with subgroups is not satisfactory.

Femur Head↗

PubMed2005

Interobserver and intraobserver reliability in the load sharing classification of the assessment of thoracolumbar burst fractures.

STUDY DESIGN: The Load Sharing Classification of spinal fractures was evaluated by 5 observers on 2 occasions. OBJECTIVE: To evaluate the interobserver and intraobserver reliability of the Load Sharing Classification of spinal fractures in the assessment of thoracolumbar burst fractures. SUMMARY OF BACKGROUND DATA: The Load Sharing Classification of spinal fractures provides a basis for the choice of operative approaches, but the reliability of this classification system has not been established. METHODS: The radiographic and computed tomography scan images of 45 consecutive patients with thoracolumbar burst fractures were reviewed by 5 observers on 2 different occasions 3 months apart. Interobserver reliability was assessed by comparison of the fracture classifications determined by the 5 observers. Intraobserver reliability was evaluated by comparison of the classifications determined by each observer on the first and second sessions. Ten paired interobserver and 5 intraobserver comparisons were then analyzed with use of kappa statistics. RESULTS: All 5 observers agreed on the final classification for 58% and 73% of the fractures on the first and second assessments, respectively. The average kappa coefficient for the 10 paired comparisons among the 5 observers was 0.79 (range 0.73-0.89) for the first assessment and 0.84 (range 0.81-0.95) for the second assessment. Interobserver agreement improved when the 3 components of the classification system were analyzed separately, reaching an almost perfect interobserver reliability with the average kappa values of 0.90 (range 0.82-0.97) for the first assessment and 0.92 (range 0.83-1) for the second assessment. The kappa values for the 5 intraobserver comparisons ranged from 0.73 to 0.87 (average 0.78), expressing at least substantial agreement; 2 observers showed almost perfect intraobserver reliability. For the 3 components of the classification system, all observers reached almost perfect intraobserver agreement with the kappa values of 0.83 to 0.97 (average, 0.89). CONCLUSIONS: Kappa statistics showed high levels of agreement when the Load Sharing Classification was used to assess thoracolumbar burst fractures. This system can be applied with excellent reliability.

Humans↗

PubMed2005

Recurrent lumbar disc herniation after discectomy: outcome of repeat discectomy.

BACKGROUND: Recurrent disc herniation after discectomy is relatively lacking in specific studies and is usually reviewed along with other causes of failed disc surgery. The purpose of the current study was to address the outcome in the patients who had recurrent disc herniation treated with repeat discectomy and to identify the factors that may influence the outcome. METHODS: Thirty-nine patients who underwent repeat discectomy for recurrent lumbar disc herniation were retrospectively analyzed. Of these patients, 27 had recurrent disc herniation at the L4 to L5 level, 11 at the L5 to S1, and 1 at the L3 to L4. They almost had the typical presentation of sciatica. The time from prior discectomy to that of recurrence ranged 6 months to 17 years (average, 5 years and 4 months). The Japanese Orthopaedic Association (JOA) score averaged 12 (range, -3 to 18). All patients had a follow-up evaluation at 1 and 15 years (average, 7 years and 8 months) after surgery. RESULTS: Their JOA score increased to 12 to 29 (average, 24), with the recovery rate of 29% to 100% (average, 72%). Twenty-nine patients returned to their previous work status or normal daily activity, 7 had significant improvement, and 3 needed analgesic drugs although they had pain relief to different degrees. CONCLUSIONS: The outcomes of repeat discectomy for recurrent disc herniation were satisfactory. No factors such as age, sex, traumatic events, times of prior surgery, level of herniation, side of recurrence, pain-free interval, duration of recurrence symptoms, walking capacity, the preoperative JOA score, associated spinal stenosis, procedures of revision surgery, and dural tear were found to be of predictive value for a prognosis of revision surgery for recurrent disc herniation (P>.05).

Adult↗

PubMed2004

Significance of prevertebral soft tissue measurement in cervical spine injuries.

OBJECTIVE: The objective of this study was to evaluate the diagnostic value of prevertebral soft tissue swelling in cervical spine injuries. MATERIALS AND METHODS: A group of 107 consecutive patients with suspected injuries of the cervical vertebrae were reviewed retrospectively to identify the presence of prevertebral soft tissue swelling and to investigate the association of prevertebral soft tissue swelling with the types and degrees of cervical spine injuries. RESULTS: Prevertebral soft tissue swelling occurred in 47 (43.9%) patients. Of the 47 patients, 38 were found with bony injury and nine were without. The statistic difference was significant (P < 0.05). No correlation was demonstrated between soft tissue swelling and either the injured level of the cervical vertebrae or the degree of the spinal cord injury (P > 0.05). Anterior element injuries in the cervical vertebrae had widening of the prevertebral soft tissue more than posterior element injuries (P < 0.05). CONCLUSION: The diagnostic value of prevertebral soft tissue swelling for cervical spine injuries is significant, but the absence of this sign does not mean that further image evaluation can be spared.

Adolescent↗

PubMed2004

Thoracolumbar fractures in patients with multiple injuries: diagnosis and treatment-a review of 147 cases.

BACKGROUND: The initial evaluation and treatment of patients with multiple injuries are challenging. However, little is known about thoracolumbar fractures in patients with multiple injuries. We aimed to determine the incidence of missed injuries of the thoracolumbar spine in patients with multiple injuries, to examine the reasons for the delay in diagnosis, and to study the selection of treatment options in the management and timing of surgical intervention. METHODS: One hundred forty-seven consecutive patients with acute thoracolumbar fractures and multiple trauma at the authors' hospital between 1988 and 1997 were retrospectively reviewed. The incidence of missed injuries of the thoracolumbar spine and the reasons for the delay in diagnosis were determined. All these patients were observed for a minimum of 3 years after surgery, except four who died during their hospital stay. RESULTS: Delayed diagnosis of thoracolumbar fractures was made in 28 patients (19%). There was an increased incidence of pulmonary complications (p < 0.01) and increased length of hospital stay (p < 0.05) in patients treated nonoperatively compared with patients treated operatively. Although no significant differences in the recovery rate of neurologic function (p > 0.05) were noted between the groups, the surgical patients had highly significantly less pain compared with the nonoperative patients (p < 0.01). The relationship between the timing of thoracolumbar surgery and complications failed to show statistical significance (p > 0.05). Neither the severity of injury nor the timing of surgery had any significant effect on the recovery rate (p > 0.05). CONCLUSION: Patients with blunt trauma caused by high-energy impact injuries are much more likely to have thoracolumbar fractures even if injuries elsewhere have been noted. Further radiographic studies of the thoracolumbar spine should be performed if there is any question related to a thorough and systematic examination. Choice of treatment options of thoracolumbar fractures in patients with multiple injuries is not different from that in patients with no associated injuries to other systems. Appropriate timing of thoracolumbar fracture fixation in patients with multiple injuries should not be dependent on a rigid protocol.

Adolescent↗

PubMed2004

The natural history of cervical disc calcification in children.

BACKGROUND: Calcification of cervical intervertebral discs is uncommon in children. The cases of approximately 200 children have been reported in the literature. The objective of the present study was to examine the natural history of this condition. METHODS: Seventeen consecutive children, ten boys and seven girls, with calcified cervical intervertebral discs were included in the study. The mean age at diagnosis was 7.7 years. Three children had had a fever, and two had a history of trauma. All of the children complained of neck pain except one who was asymptomatic and was identified by chance. On radiographs, the calcification was seen within the central part of the cervical intervertebral discs. All children had treatment of the symptoms, and they were then followed periodically until the disappearance of both the symptoms and the calcific deposits. RESULTS: The children were followed for a mean of five years, and all had a complete disappearance of both the symptoms and the calcification. None had recurrent symptoms or calcifications. The average time to resolution of the symptoms and the calcifications was 34.3 days (range, seventeen to 173 days) and fifteen months (range, three to sixty months), respectively. With the numbers available, factors such as age, level of disc calcification, severity of symptoms, and degree of spinal canal compromise were not related to the time of resolution. CONCLUSIONS: Cervical disc calcification in children is a self-limiting condition with an excellent prognosis. Even if clinical symptoms due to nerve-root or spinal cord compression are present, conservative therapy produces satisfactory results. Therefore, nerve-root or spinal cord compression by a calcified cervical disc should not be considered an absolute indication for surgical intervention.

Adolescent↗

PubMed2004

Imaging diagnosis of thoracolumbar burst fractures.

OBJECTIVE: To review imaging use in the diagnosis of thoracolumbar burst fractures and to determine the diagnostic value of different imaging methods. METHODS: One hundred and fourteen patients with 120 thoracolumbar burst fractures were retrospectively reviewed. Plain radiographs were available in all cases; CT scans and MRI were obtained in 96 and 74 cases, respectively. RESULTS: A total of 27 burst fractures were misdiagnosed as other types of fractures on radiographs alone, and accounted for 22.5% of all fractures. The results indicated that plain radiographs often fail to delineate the pathological features of thoracolumbar burst fractures, leading to delay in diagnosis. CONCLUSION: In regard to thoracolumbar injury diagnosis, burst fractures should be differentiated from compression fractures. CT should be routinely indicated and MRI examination, when necessary, may be simultaneously considered.

Adolescent↗