Clinical Outcome of Internal Fixation and Fusion in the Treatment of Spinal Fractures by Paraspinal Muscular Space Approach

Objective:To explore the clinical effect of internal fixation and fusion with the paraspinal muscle gap approach in the treatment of spinal fracture patients.Methods:104 spinal fracture patients admitted to Central Hospital of TCM from October 2022 to April 2024 were selected as the study subjects and were randomly divided into the control group(n=52)and the observation group(n=52)according to the random number table method.The control group was treated with the conventional approach of internal fixation surgery,and the observation group was treated with the paraspinal muscular interspace approach of internal fixation fusion.The two groups’general data,surgical indexes,pain,lumbar spine function,and postoperative complications were observed.Results:The baseline data of the two groups of patients were not statistically significant(all P>0.05)while the intraoperative bleeding,the first postoperative time getting up from bed,and the length of hospital stay of the patients in the observation group were shorter than that of the control group(all P=0.000<0.001),and the duration of the operation was longer than that of the control group(t=2.644,P=0.010<0.05);at 3 months postoperatively,the VAS scores of the patients in the observation group were significantly lower than those in the control group(t=10.768,P=0.000<0.001),and the JOA score was higher than that of the control group(t=6.498,P=0.000<0.001);the total complication rate of patients in the observation group(3/5.77%)was significantly lower than that of the control group(12/23.08%)(χ^(2)=6.310,P=0.012<0.05).Conclusion:In the treatment of spinal fracture patients,compared with the conventional approach to internal fixation surgery,the paraspinal muscular gap approach to internal fixation and fusion treatment is less traumatic,postoperative lumbar spine function recovery is faster,and can reduce the incidence of postoperative complications.

Treatment of Thoracic Spine Tuberculosis by Paraspinal Muscle Gap Approach

Objective: To evaluate the clinical feasibility and efficacy in treatment of thoracic tuberculosis via paraspinal approach. Methods: From June 2011 to August 2016, 24 patients with mono-segmental thoracic spine tuberculosis were treated by transfacet debridement combined with bone grafting and internal fixation through paraspinal approach. There were 11 males and 13 females with age ranging from 21 to 63 years (average, 39.5). There were 3 patients in T4/5, 2 patients in T5/6, 3 patients in T7/8, 3 patients in T8/9, 4 patients in T9/10, 3 patients in T10/11, and 6 patients in T11/12. Patients had different degraded local kyphosis deformity shown on X-ray, and different degraded bone destruction and abscess in thoracic spine shown on CT and MRI before the operation. All of the patients before the regular anti tuberculosis treatment for 2 to 4 weeks, the surgical approach used by paraspinal muscle approach, postoperative regular anti tuberculosis treatment for 9 to 12 weeks. Record the clinical symptoms of patients before and after surgery, preoperative Frankel functional classification of spinal cord injury, the operative time, intraoperative blood loss, postoperative ESR, CRP, complications, VAS score, ODI score and Cobb angle changes, imaging check regularly to evaluate the fusion and follow-up of nerve functional recovery. Results: The average operation time was 198 min. The average blood loss was 436 ml. There were no severe complications during and after operation. All patients were followed up for 1 year to 2 years, average 1.5 years of follow-up, the clinical symptoms improved significantly after operation and last follow-up ESR, CRP, VAS score, ODI score and Cobb angle were significantly improved after operation (P < 0.05), grade I Eck fusion, the fusion rate was 100% and the neurological function were improved. Conclusion: on the basis of strict anti tuberculosis chemotherapy, the use of paraspinal muscle gap approach for the treatment of thoracic tuberculosis is less invasive, less destructive to spinal stability, and can achieve obvious curative effect. It is worthy of clinical application.

Dosimetric Effect of Cobalt-Chrome Stabilization Hardware in Paraspinal Radiation Treatments

High density materials are assigned with an apparent density of 3.2 g/cm3 in 12-bit CT images due to saturation. This is often ignored in planning for spine tumors with titanium (density 4.40 g/cm3) spinal hardware. However, new cobalt-chrome hardware has a density of 8.11 g/cm3, which would increase dosimetric uncertainty if the true density is not utilized in planning. This effect was evaluated in this study. Calculation accuracy was examined using MapCHECK2 with a single 20 × 10 cm2 field with a titanium and a cobalt-chrome rod in a solid water phantom for 6X, 6FFF and 15X, at 2 cm and 6 cm beneath the rods. Measurement was compared to the calculation with density override (DO) with the true density and to the calculation with no-density override (NDO). Additionally, the dosimetric effect in clinical treatment plans was investigated for six IMRT and VMAT paraspinal cases. Plan quality was compared with the original NDO calculation and the DO recalculation. Compared to measurements, the treatment planning system (TPS) overestimated the dose locally by up to 13.2% for cobalt-chrome and 4.8% for titanium with NDO calculations. DO calculations improved the differences to 8.4% and 4.0%, respectively. Scatter from the rod increased the lateral dose and diminished as depth increased but was not properly accounted for by the TPS even with the correct density assigned. For the clinical plans, PTV coverage was lowered by an average of ~1.0% (range: 0.5% - 2.0%) and ~0.3% (range: 0.2% - 0.7%) in DO recalculations for cobalt-chrome and titanium, respectively. In conclusion, neglecting the true density of cobalt-chrome hardware during planning may result in an unexpected decrease in target coverage.

The vertebral body structure as well as the whole body and nerve injury after treatment of thoracolumbar fractures through paraspinal muscle approach and traditional approach

Objective:To study the vertebral body structure as well as the whole body and nerve injury after treatment of thoracolumbar fractures through paraspinal muscle approach and traditional approach.Methods:A total of 74 patients with thoracolumbar fractures who received surgical treatment in our hospital between September 2013 and October 2015 were selected and randomly divided into the paraspinal approach group and the median approach group who received the internal fixation surgery through paraspinal muscle approach and the internal fixation surgery through traditional median approach respectively. Before surgery as well as 3 months, 6 months after surgery, Cobb Angle was detected;before surgery as well as 1 d and 3 d after surgery, serum levels of creatase, stress hormones and nerve injury molecules were determined.Results:3 months, 6 months after surgery, the Cobb Angle of paraspinal approach group and median approach group were significantly lower than those before surgery and the Cobb Angle were not significantly different between the two groups of patients;serum LDH, CK, Myo, NE, E, Cor and Ins levels of both groups 1 d and 3 d after surgery were significantly higher than those before surgery and the serum LDH, CK, Myo, NE, E, Cor and Ins levels of paraspinal approach group were significantly lower than those of median approach group, serum NSE, S100B and GFAP levels of both groups 1 d and 3 d after surgery were significantly lower than those before surgery and serum NSE, S100B and GFAP levels of paraspinal approach group were significantly lower than those of median approach group. Conclusion: The vertebral body stability are equivalent after treatment of thoracolumbar fractures through paraspinal muscle approach and traditional approach, and the trauma extent of paraspinal muscle approach is less.

Quantification Threshold Pixel Technique of Magnetic Resonance Imaging in Paraspinal Muscles Atrophy among Discopathy Patients

Purpose: To evaluate the relationship between lumbosacral discopathy status and paraspinal atrophic changes (Cross-sectional area (CSA) and fatty infiltration (FI)) among different age groups. Materials and Methods: We retrospectively evaluated 200 patients with confirmed discopathy who were examined by lumbosacral Magnetic Resonance Imaging (MRI) at the two main governmental hospitals in Gaza Strip. Using ImageJ software and quantification threshold technique, we measured the CSA and FI of paraspinal muscles {multifidus (MF) & erector spinae (ES)}. The interpretation of MRI images was performed by two radiologists with a good inter-observer agreement between the radiological discopathy findings. Results: The highest percentage and severity of discopathy were noticed at the level of L4/5 (89.5%), followed by L5/S1 (14.5%). The FI is increased towards lower levels of L3/4 to L5/S1. No correlation was found between discopathy level, the severity of discopathy, and CSA of MF & ES muscles. In contrast, a correlation was observed between FI of MF & ES muscles, discopathy level, and severity. Also, the results illustrated no significant relation was observed between CSA of MF & ES muscles and age groups (P > 0.05), while a significant correlation was reported between FI and age groups (P Conclusion: The MRI quantification threshold pixel technique for paraspinal muscles reflected the atrophic changes like CSA and FI in discopathy patients.

Paraspinal Intramuscular Schwannoma: Case Presentation and Literature Review of a Rare Pathology

Background: A pure intramuscular paraspinal schwannoma is extremely rare, with only few case reports in the literature. Due to low frequency, lack of specific clinical signs and symptoms and difficult radiological assessment, the pre-surgical workup leads to a broad differential diagnosis. The aim of the work carried out was therefore to search for evidence of common clinical and radiological signs of the intramuscular paraspinal schwannoma, useful in the diagnostic work-up, and to highlight possible standards of treatment. Methods: Starting from the analysis of our case, we have extended a search to similar cases on the databases PubMed and Google Scholar. The outcome of the analysis gathered, up to August 2021, six relevant papers. Result: We treated a 69-year-old female with a thoracic intramuscular paraspinal mass. The pre-operative MRI had identified two typical signs of schwannoma (“split-fat” sign and the “entry-exit” sign). Intraoperative nerve isolation was performed and complete surgical excision was achieved. At the pathological analysis, we could confirm a rare OMS grade I “ancient schwannoma”. The analysis of the literature data showed a homogeneous picture of radiological presentation of the pathology. Moreover, surgical treatment was always the treatment of choice. Conclusions: The proposed assessment and treatment were consistent with the standard collected in the literature. Typical radiological signs were also found in the other cases collected. Radical surgery is the preferred treatment.

Neuralgic amyotrophy with hourglass-like constrictions:A case report

BACKGROUND Neuralgic amyotrophy(NA)is a rare disease with sudden upper limb pain followed by affected muscle weakness.The most commonly affected area in NA is the upper part of the brachial plexus,and the paraspinal muscles are rarely affected(1.5%),making these cases difficult to distinguish from cervical radiculopathy.CASE SUMMARY A 76-year-old male presented to the emergency department with left hip pain post-fall.After undergoing left femoral neck fracture surgery,he experienced sudden left shoulder pain for 10 days with subsequent left arm weakness.Cervical spine computed tomography revealed mild right asymmetric intervertebral disc bulging with a decreased C5-6disc space.Three weeks later,an electrodiagnostic study confirmed brachial plexopathy findings involving the cervical root.Magnetic resonance neurography was performed for a differential diagnosis.Contrast enhancement was identified at the upper trunk of the brachial plexus,including the C5 nerve root.A suprascapular nerve hourglass-like focal constriction(HLFC)was also identified,confirming NA.After being diagnosed with NA,the patient received 15 mg prednisolone,twice daily,for 3 weeks.Physical therapy was initiated,including left arm strengthening exercises and electrical stimulation therapy.Left shoulder muscle strength significantly improved one CONCLUSION NA's unique features like HLFC and paraspinal involvement are crucial for accurate diagnosis,avoiding confusion with cervical radiculopathy.

Comparison of the modified Wiltse’s approach with spinal minimally invasive system and traditional approach for the therapy of thoracolumbar fracture

Thoracolumbar fractures are usually treated by open posterior pedicle screw fixation.However,this procedure involves massive paraspinal muscle stripping,inflicting surgical trauma,and prolonged X-ray exposure.In this study,we observed 127 patients with single-segment injury thoracolumbar fractures.Thirty-six patients were treated by the modified Wiltse’s paraspinal approach with minimally invasive channel system,while 91 patients were treated via traditional posterior approach.Operation time,intraoperative blood loss,intraoperative fluoroscopy frequency,screw placement accuracy,visual analogue scale score,and Cobb’s angle of two groups were compared.The X-ray exposure times were notably reduced(4.2±1.6) in the new approach group(P<0.05).The pedicle screw placement accuracy and Cobb’s angle after surgery were similar in the two groups.We conclude that modified Wiltse’s paraspinal approach w ith spinal minimally invasive channel system surgery can significantly reduce the X-ray exposure times and is an alternative therapy for the thoracolumbar fracture.

Spine system changes in soldiers after load carriage training in a plateau environment: A prediction model research

Background: Low back pain is the most common spinal disorder among soldiers, and load carriage training(LCT) is considered the main cause. We aimed to investigate changes in the spine system of soldiers after LCT at high altitudes and the change trend of the lumbar spine and surrounding soft tissues under different load conditions.Methods: Magnetic resonance imaging scans of the lumbar spines of nine soldiers from plateau troops were collected and processed. We used ImageJ and Surgimap software to analyze changes in the lumbar paraspinal muscles, intervertebral discs(IVDs), intervertebral foramina, and curvature. Furthermore, the multiple linear regression equation for spine injury owing to LCT at high altitudes was established as the mathematical prediction model using SPSS Statistics version 23.0 software.Results: In the paraspinal muscles, the cross-sectional area(CSA) increased significantly from(9126.4±691.6) mm~2 to(9862.7±456.4) mm~2, and the functional CSA(FCSA) increased significantly from(8089.6±707.7) mm~2 to(8747.9±426.2) mm~2 after LCT(P<0.05);however, the FCSA/CSA was not significantly different. Regarding IVD, the total lumbar spine showed a decreasing trend after LCT with a significant difference(P<0.05). Regarding the lumbar intervertebral foramen, the percentage of the effective intervertebral foraminal area of L3/4 significantly decreased from 91.6%±2.0% to 88.1%±2.9%(P<0.05). For curvature, the lumbosacral angle after LCT(32.4°±6.8°) was significantly higher(P<0.05) than that before LCT(26.6°±5.3°), while the lumbar lordosis angle increased significantly from(24.0°±7.1°) to(30.6°±7.4°)(P<0.05). The linear regression equation of the change rate, ΔFCSA%=–0.718+23.085×load weight, was successfully established as a prediction model of spinal injury after LCT at high altitudes.Conclusion: The spinal system encountered increased muscle volume, muscle congestion, tissue edema, IVD compression, decreased effective intervertebral foramen area, and increased lumbar curvature after LCT, which revealed important pathophysiological mechanisms of lumbar spinal disorders in soldiers following short-term and high-load weight training. The injury prediction model of the spinal system confirmed that a load weight <60% of soldiers' weight cannot cause acute pathological injury after short-term LCT, providing a reference supporting the formulation of the load weight standard for LCT.

Uncovering the prominent role of satellite cells in paravertebral muscle development and aging by single-nucleus RNA sequencing

To uncover the role of satellite cells(SCs)in paravertebral muscle development and aging,we constructed a single-nucleus transcriptomic atlas of mouse paravertebral muscle across seven timepoints spanning the embryo(day 16.5)to old(month 24)stages.Eight cell types,including SCs,fast muscle cells,and slow muscle cells,were identified.An energy metabolism-related gene set,TCA CYCLE IN SENESCENCE,was enriched in SCs.Forty-two skeletal muscle disease-related genes were highly expressed in SCs and exhibited similar expression patterns.Among them,Pdha1 was the core gene in the TCA CYCLE IN SENESCENCE;Pgam2,Sod1,and Suclg1 are transcription factors closely associated with skeletal muscle energy metabolism.Transcription factor enrichment analysis of the 42 genes revealed that Myod1 and Mef2a were also highly expressed in SCs,which regulated Pdha1 expression and were associated with skeletal muscle development.These findings hint that energy metabolism may be pivotal in SCs development and aging.Three ligand-receptor pairs of extracellular matrix(ECM)-receptor interactions,Lamc1-Dag1,Lama2-Dag1,and Hspg2-Dag1,may play a vital role in SCs interactions with slow/fast muscle cells and SCs self-renewal.Finally,we built the first database of a skeletal muscle single-cell transcriptome,the Musculoskeletal Cell Atlas(http://www.mskca.tech),which lists 630,040 skeletal muscle cells and provides interactive visualization,a useful resource for revealing skeletal muscle cellular heterogeneity during development and aging.Our study could provide new targets and ideas for developing drugs to inhibit skeletal muscle aging and treat skeletal muscle diseases.