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PubMed1995

Trabecular texture analysis of CT images in the relationship with spinal fracture.

PURPOSE: To evaluate age-related changes in trabecular texture and bone mineral density (BMD) and to determine the usefulness of texture analysis in the assessment of the risk of fracture. MATERIALS AND METHODS: The vertebral trabecular BMD was measured in 209 women aged 18-86 years. Run length analysis was applied to computed tomographic images obtained with 2-mm section thickness. The width of the trabecula (T-texture) and the width of the intertrabecular space (I-texture) were calculated. RESULTS: I-texture significantly increased with age in women 50 years of age or older (P < .0001). Women with fracture had significantly lower BMD (P < .0001 at 60-69 years, P < .05 at 70-79 years) and significantly higher I-texture (P < .05 at 60-69 years, P < .01 at 70-79 years). For fracture risk, BMD had the highest sensitivity and I-texture had the highest specificity in women aged 60-69 years; I-texture had the highest sensitivity and specificity in women aged 70-79 years. CONCLUSION: Texture analysis was helpful in the assessment of fracture risk, especially in elderly women.

Adolescent↗
PubMedDate not supplied

[Bone mass, bone metabolism, and prevalence of spinal fractures in recipients of allogenic bone marrow transplantation for leukemia].

The aim of this study was to evaluate in 65 patients, who had previously undergone allogenic bone marrow transplantation (ABMT), the bone mineral density (BMD), the skeletal turnover and the prevalence of vertebral fractures. At the moment of recruiting, 10 of 65 transplanted subjects (15.3%) presented with signs of rejection of the transplanted tissue, thus they were excluded. The remaining 55 patients (21 males, 34 females, mean age 30.8 +/- 6.4 years), with a follow-up of 60 +/- 9 months after the transplant and without any treatment inducing osteopenia, underwent ABMT respectively for: chronic myeloid leukemia (n = 24); acute myeloid leukemia (n = 18); acute lymphatic leukemia (n = 13). One hundred and ten healthy control subjects (42 males and 68 females, mean age 31.0 +/- 3.7 years) matching with the patients for age, weight and height, were successively enrolled. All the participants were submitted to a densitometric evaluation (DEXA) of lumbar spine (L1-L4), of femoral neck and total femur; besides some skeletal metabolism parameters were dosed, such as: total alkaline phosphatase, bone alkaline phosphatase and urinary excretion of C-terminal telopeptide fragments normalized to creatinine. On the contrary, the morphometric evaluation, performed through a lateral dorsolumbar radiography, was actually carried out only in patients who had already undergone ABMT. The L1-L4 BMD study showed: 10/55 osteoporotic (18.1%), 19/55 osteopenic (34.5%) and 26/55 normal patients (47.4%). In transplanted patients BMD values, obtained at the three considered sites, resulted significantly reduced (p < 0.01) in comparison to controls. Moreover, in patients who underwent ABMT, a statistically significant increase was observed, in comparison to healthy subjects, in total alkaline phosphatase (p < 0.01), in bone alkaline phosphatase (p < 0.01) and in urinary excretion of C-terminal telopeptide fragments normalized to creatinine levels (p < 0.001). Seven of the 55 transplanted patients (12.7%) presented at the moment of Rx morphometric evaluation at least one vertebral fracture: 6 of whom were affected by osteoporosis and 1 by osteopenia. In conclusion, the subjects who had previously undergone ABMT maintain, even at a certain time after the transplant and without any rejection, an increased skeletal turnover and BMD values meanly lower than normal, leading to an increased risk for vertebral fracture.

Adolescent↗
PubMed1995

Cervical spinal fractures in Alpine skiers.

A 5-year review of skiing injuries in the Aspen/Snowmass area revealed 18 cervical fractures. This represents a yearly average of 3.6 fractures (range: 2 to 5). There were 16 men and 2 women identified, with an average age of 40.8 years (range: 20 to 73). Using estimates of skier days and total injuries, cervical fractures represented approximately 0.1% of all skiing injuries. Six of 18 injuries (33%) were avulsion injuries of the spinous processes and were treated symptomatically with a soft collar. However, five patients had neurologic involvement secondary to fracture displacement, two with lasting quadriparesis. In addition, there was one death attributed to cervical fracture. Forty-four percent of the patients had associated injuries, most commonly facial and head (33%). The three oldest patients (average age: 67 years, range: 57 to 73) had three of the more serious injuries. Two of these patients were the quadriplegics, and a third required halo stabilization of bilateral C2 facet fractures. Typically, those patients who were involved in collisions with immovable objects (trees or fences) had more severe injuries and a greater chance of neurologic involvement.

Adult↗
PubMedDate not supplied

Entrapment of bowel within a spinal fracture.

Entrapment of bowel by fracture fragments is extremely rare. A case of entrapment of a loop of jejunum between two vertebral bodies in the lumbar spine is reported. The mechanism appeared to be a hyperextension force with a rotatory component.

Child, Preschool↗
PubMed1993

Negative scintigraphy despite spinal fractures in the multiply injured.

Skeletal injuries may be overlooked in multiply-injured patients. Skeletal scintigraphy, a very sensitive indicator of skeletal injuries, may give complementary information. We therefore performed scintigraphic screening in 20 patients with multiple injuries. In all, 38 fractures were diagnosed by plain skeletal radiography, and were also visualized scintigraphically. Furthermore, scintigraphy revealed a fracture of the pelvis in one patient and a tibial plateau fracture in another. Scintigraphy was, however, negative in three patients; two with fractures of the transverse processes in the lumbar spine and one with a cervical spine fracture of the articular processes with dislocation. The use of scintigraphy as a screening method in patients with multiple injuries may be helpful in the diagnosis of skeletal injuries. However, fractures of the vertebral column were not always visualized, possibly because of technically inadequate examinations in injured patients unable to co-operate.

Accidental Falls↗
PubMed1991

[The value of the Nanković internal fixator in surgical treatment and rehabilitation of spinal fractures].

By fixateur interna light for spine fractures introduced and used by Magerl and Dick, we wanted to estimate fixateur interna validity by Nanković. We considered 37 patients with spine fracture, operated by method previously mentioned. With no patient there was no deformation or fixateur fracture during the rehabilitation. With 3 patients (8%) fixateur was removed according to documentation because of infection. Because of all the things mentioned we consider the fixateur to be good and applied in the case of any indication for it.

Adolescent↗
PubMed1988

Vertebral morphometry in diagnosis of spinal fractures.

Vertebral morphometry was performed on lateral thoracic and lumbar radiographs of 153 women with a preliminary diagnosis of spinal osteoporosis. Measurements included anterior and posterior vertebral height, width, area, wedge angle, percent reduction of anterior to posterior height (PRH) and percent difference in anterior height between adjoining vertebrae (PDAH). A vertebral fracture was identified if any of the measurements which control for interindividual variation in vertebral size (wedge angle, PRH, PDAH) were below the normal range. Among individuals with mild osteoporosis (0-2 fractures) PDAH identified 86% of the fractures and 95% of the individuals with fractures. Other measurements identified less than 71% of the fractures and less than 80% of the individuals with fractures. Although the results reflect a relative rather than a true sensitivity it appears that PDAH is the better diagnostic measurement for fractures in the earlier stages of spinal osteoporosis.

Aged↗
PubMed1990

[Spinal fracture in the course of spondylarthritis ankylopoietica (Bechterew disease)].

In 1965-1986 fifty-six patients were treated for fracture of the spine in the course of spondyloarthritis ankylopoetica. In 47 patients the cervical spine was injured. In 53 patients concomitant neurological symptoms were observed. Total or partial palsy were dominant in injuries of the cervical spine (72 per cent). A marked neurological improvement was achieved in the course of treatment in most of the patients. The authors recommend non-surgical treatment.

Adult↗
PubMed1997

[Magnetic resonance tomography examination of thoracolumbar spinal fractures after fixateur interne stabilization].

To analyse the possible injuries of vertebral segments, especially the disc, after unstable thoracolumbar fractures stabilised with AO internal fixator, we performed magnetic resonance imaging (MRI) of the traumatised region after implant removal. There were two aspects of disc degeneration (DD):(1) biochemical changes and (2) structural damage. MRI detects biochemical processes as one aspect of DD that is often small even in the presence of greater structural damage of the nucleus pulposus caused by fracture. None of the patients presented with structural failure of the anulus fibrosus, which is the essential structural component of the vertebral segments with regard to stability. We observed biochemical changes more often in the lower of the two fracture-adjacent discs and alterations of discal shape more often in the upper of the two, whereas loss of height concerned both discs to approximately the same degree. The supporters of upper-disc resection in thoracolumbar fractures justify their procedure among other things with the structural disc damage, such as alteration of shape and loss of height (altogether more frequent in the upper disc). Our observations that a disc with a structurally altered nucleus pulposus can be biochemically intact and can show an intact anulus fibrosus are arguments in favour of disc preservation. With regard to the upper disc, the widespread opinion that complete and regular disc damage requires a resection has to be revised. The question of whether the lower disc should be resected more often because of its greater biochemical changes cannot be answered by the present study alone. Besides the excellent static information in all anatomical structures of the vertebral column available by MRI, a repeat examination in a prone position yields dynamic information on the spinal cord in the case of suspected dorsal adhesions.

Adolescent↗
PubMed1994

[Epidemiology, treatment and long-term results of spinal fractures at a non-university affiliated central hospital with special reference to fractures of the lumbar spine].

In a retrospective study epidemiology, treatment, clinical and radiological results of 283 patients with spine fractures in a five-year period are presented. The operation rate ranges from 42% of the cervical to 9% of the thoracical and 24% of the lumbar spine. We found good radiological results concerning the correction of the wedge compression and the collapse of the lumbar vertebral body by fixation with an internal fixator. After a follow-up of 2-5 years nearly 80% of conservative as well as operative treated patients had more or less residual back pain. Because there is a correlation between the quantity of pain and the radiological dislocation, exact initial diagnosis, without overlooking an instability, and adequate conservative or operative treatment is very important.

Adolescent↗
PubMed1999

Vertebral bone mass, size, and volumetric density in women with spinal fractures.

Bone densitometry provides a measure of bone mass expressed as bone mineral content (BMC) or areal bone mineral density (aBMD). BMC is unadjusted for bone size while aBMD is adjusted for the projected area of the region scanned but not its depth. Because patients with fractures often have reduced bone size, the deficit in BMC or aBMD relative to controls may be partly the result of the comparison of a smaller bone in patients with fractures with a bigger bone in controls without fractures. We asked, what proportion of the deficit in BMC and aBMD found in women with spine fractures relative to controls is attributable to smaller vertebral size? We measured BMC (g), volume (cm3, derived from projected area3/2), aBMD (g/cm2), and volumetric BMD (vBMD, g/cm3) of the third lumbar vertebra by dual-energy X-ray absorptiometry in 270 premenopausal women aged 18-43 years, 163 postmenopausal women with spine fractures aged 54-83 years, and 209 women without fractures aged 54-87 years. The regression of BMC and aBMD on volume in the premenopausal women was used to calculate volume adjusted BMC and aBMD in postmenopausal women with and without fractures (adjusted BMC = observed BMC + [50 - observed volume] x 0.29; adjusted aBMD = observed aBMD + [50 - observed volume] x 0.0044). The data were expressed in the original units and as standard deviation scores (SD) above or below the young normal mean (T scores) or the age predicted mean (Z scores). All results were expressed as mean +/- SEM. Women with spine fractures had reduced BMC (T = -2.35 +/- 0.07 SD, Z = -1.18 +/- 0.06 SD), volume (T = -1.08 +/- 0.08 SD, Z = -0.82 +/- 0.08 SD), aBMD (T = -3. 06 +/- 0.09 SD, Z = -1.14 +/- 0.06 SD) and vBMD (T = -2.67 +/- 0.10 SD, Z = - 0.94 +/- 0.07 SD) (all p < 0.001). About 48% of the difference in BMC between postmenopausal women with and without spine fractures, and about 16% of the difference in aBMD was explained by the difference in vertebral volume between them. When women with and without spine fractures were intentionally matched by aBMD (and age, height, and weight), vertebral volume was reduced (Z = -0.66 +/- 0.13 SD, p < 0.001). When women with and without fractures were intentionally matched by vertebral volume (and age, height, and weight), vBMD was reduced (Z = -1.07 +/- 0.10 SD, p < 0. 001). Women with spine fractures have smaller vertebrae with less bone in the smaller bone. About half the deficit in BMC relative to controls is due to their smaller bone size. The remainder may be due to reduced bone accrual, increased bone loss, or both. Thus, the pathogenesis of bone fragility is heterogeneous. Factors responsible for a deficit in bone mass (due to reduced accrual or excess bone loss) are unlikely to be identified when reduced bone size exaggerates the deficit, and increased bone size obscures it. Understanding the pathogenesis of bone fragility requires acknowledgment of this heterogeneity and the description of its varied morphological basis. This can be achieved by the study of the periosteal and endosteal surfaces of bone because the absolute and relative changes in these surfaces during growth and aging determine skeletal size, its mass, and architecture.

Absorptiometry, Photon↗
PubMed2001

[Treatment of thoracolumbar spinal fractures using internal fixators (evaluation of 120 cases)].

PURPOSE OF THE STUDY: A group of 120 patients was evaluated with acute injury of Th-L spine who were operated on from posterior approach with the use of Dick AO fixator or USS fixator in the period of 1991-1996. MATERIAL: In the period of 1991-1996, 128 patients were operated on with the acute injury of Th-L spine. Evaluated were 120 patients: 81 men (67.5%) of average age 40.1 years (age range, 16-74 years) and 39 women (32.5%) of average age 35.4 years (age range, 15-66 years). Posterior stabilization using the internal fixator was combined with posterolateral or posterior interarticular fusion. In comminuted fractures of the vertebral body transpedicular cancellous bone grafting was performed and starting for 1995 also intercorporal transpedicular fusion. METHODS: The evaluation covered location and type of fractures, injury of other levels of the spine, other associated injuries, neurological symptomatology prior to the surgery and 3 months after the surgery, duration of surgery and of image intensifier exposure, peroperative and early postoperative complications, radiograph evaluation of the degree of reduction, the loss of correction after 12 months and after the hardware removal. RESULTS: Evaluated were 120 patients. Average interval after the surgery at the time of the evaluation was 43.7 months (range, 24-93 months). The injury was caused in 82 cases (68.3%) by a fall from height, in 26 cases (21.7%) by a car accident and in 12 cases (10%) by another cause. Associated injuries included: calcaneus fracture 18 times, the fracture of ankle 4 times, pelvis fracture 4 times, other fractures 18 times. In 89 cases the injury involved only one vertebra, i.e. one level, 31 cases were multi-level injuries. The angle of the kyphosis of vertebral body was on average 21.8 degrees. Patients with neurological symptoms were on average operated on 2-12 hours after the admission, other patients were operated on in the interval between 5 hours and 7 days. Bilateral transpedicular cancellous bone grafting was performed in 106 affected vertebrae, the canal was revised in 27 injured vertebrae. The surgery took on average 172 minutes (range, 62-430 minutes). Image intensifier exposure lasted on average 2.4 minutes. Average blood loss was peroperatively estimated at 725 ml, postoperatively on average at 815 ml. Postoperative complications: healing of the wound per secundam 6 times, thromboembolic complication in 9 cases--never fatal, pneumonia 3 times, uroinfection 5 times. The total number of these complications was about 8%. Vertebral body was completely restored in 72 cases, incompletely in 34 cases (up to 5 degrees deficit). The correction of kyphosis achieved was on average 6.5 degrees. After 12 months the correction loss with the fixator in place was on average 2.5 degrees. After the removal of the fixator the average correction loss was 5.5 degrees. In 2 cases there occurred a significant re-dislocation which required revision surgery. Transpedicular screws broke 6 times in the total of 4 patients, fixator loosened in 2 cases. DISCUSSION: Surgical treatment of thoracolumbar spine is indicated in unstable injuries and all injuries with neurological lesion and a proved compression of spinal canal. Decompression of the spinal canal is often achieved by reduction, lordotization and distraction. In other cases revision of the canal is indicated. Stabilization is performed by means of a transpedicular internal fixator. Part of the surgery is posterior fusion. The defect in the reduced body is treated by transpedicular cancellous bone grafting. The affected inervertebral disc must be treated by intersomatic fusion. Anterior operation is indicated as a complementary one. CONCLUSIONS: 1. Absolute majority of injuries of thoracolumbar spine may be treated from the posterior approach. In this it is necessary to restore the stability of the anterior column. An indispensable part of the operation is a flawless posterior fusion. 2. Some types of injuries require a complementary anterior approach in the first or second step. This applies mainly to the injuries with a defect of anterior column evaluated on the basis of classification after Gaines. 3. A primary isolated anterior approach to the treatment of the injury of Th-L spine is not in our view suitable as a routine.

Adolescent↗