Thoracic spine infection caused by Pseudomonas fluorescens:A case report and review of literature

BACKGROUND The clinical incidence of spinal infection is gradually increasing,and its onset is insidious,easily leading to missed diagnosis and misdiagnosis,which may lead to serious complications such as nervous system dysfunction,spinal instability and/or deformity,and cause a huge burden on society and families.Early identification of the causative agent and precision medicine will greatly reduce the suffering of patients.At present,the main pathogenic bacteria that cause spinal infection are Staphylococcus aureus,Streptococcus,Pneumococcus,Escherichia coli,and Klebsiella.There are no reports of spinal infection caused by Pseudomonas fluorescens.CASE SUMMARY We report a 32-year-old female patient with spinal infection.She presented with flank pain,initially thought to be bone metastases or bone tuberculosis,and had a family background of tumors.Her clinical features and changes in imaging and laboratory tests led to the suspicion of thoracic spine infection.Histopathology of the lesion showed inflammation,tissue culture of the lesion was negative several times,and the possible pathogen-Pseudomonas fluorescens was found after gene sequencing of the lesion.The patient recovered completely after a full course of antibiotic treatment.CONCLUSION This report increases the range of pathogens involved in spinal infections,highlights the unique advantages of gene sequencing technology in difficult-todiagnose diseases,and validates conservative treatment with a full course of antibiotics for spinal infections without complications.

Thoracic giant cell tumor after two total en bloc spondylectomies including one emergency surgery:A case report

BACKGROUND For patients with acute paraplegia caused by spinal giant cell tumor(GCT)who require emergency decompressive surgery,there is still a lack of relevant reports on surgical options.This study is the first to present the case of an acute paraplegic patient with a thoracic spinal GCT who underwent an emergency total en bloc spondylectomy(TES).Despite tumor recurrence,three-level TES was repeated after denosumab therapy.CASE SUMMARY A 27-year-old female patient who underwent single-level TES in an emergency presented with sudden severe back pain and acute paraplegia due to a thoracic spinal tumor.After emergency TES,the patient's spinal cord function recovered,and permanent paralysis was avoided.The postoperative histopathological examination revealed that the excised neoplasm was a rare GCT.Unfortunately,the tumor recurred 9 months after the first surgery.After 12 months of denosumab therapy,the tumor size was reduced,and tumor calcification.To prevent recurrent tumor progression and provide a possible cure,a three-level TES was performed again.The patient returned to an active lifestyle 1 month after the second surgery,and no recurrence of GCT was found at the last follow-up.CONCLUSION This patient with acute paraplegia underwent TES twice,including once in an emergency,and achieved good therapeutic results.TES in emergency surgery is feasible and safe when conditions permit;however,it may increase the risk of tumor recurrence.

Normal and abnormal spine and thoracic cage development

Development of the spine and thoracic cage consists of a complex series of events involving multiple metabolic processes, genes and signaling pathways. During growth, complex phenomena occur in rapid succession. This succession of events, this establishment of elements, is programmed according to a hierarchy. These events are well synchronized to maintain harmonious limb, spine and thoracic cage relationships, as growth in the various body segments does not occur simultaneously at the same magnitude or rate. In most severe cases of untreated progressive earlyonset spinal deformities, respiratory insufficiency and pulmonary and cardiac hypertension(cor pulmonale), which characterize thoracic insufficiency syndrome(TIS), can develop, sometimes leading to death. TIS is the inability of the thorax to ensure normal breathing. This clinical condition can be linked to costo-vertebral malformations(e.g., fused ribs, hemivertebrae, congenital bars), neuromuscular diseases(e.g., expiratory congenital hypotonia), Jeune or Jarcho-Levin syndromes or to 50% to 75% fusion of the thoracic spine before seven years of age. Complex spinal deformities alter normal growth plate development, and vertebral bodies become progressively distorted, perpetuating the disorder. Therefore, many scoliotic deformities can become growth plate disorders over time. This review aims to provide a comprehensive review of how spinal deformities can affect normal spine and thoracic cage growth. Previous conceptualizations are integrated with more recent scientific data to provide a better understanding of both normal and abnormal spine and thoracic cage growth.

A novel entry point for pedicle screw placement in the thoracic spine

This study was aimed to introduce a novel entry point for pedicle screw fixation in the thoracic spine and compare it with the traditional entry point. A novel entry point was found with the aim of improving accuracy, safety and stability of pedicle screw technique based on anatomical structures of the spine. A total of 76 pieces of normal thoracic CT images at the transverse plane and the thoracic pedicle anatomy of 6 cadaveric specimens were recruited.Transverse pedicle angle（TPA）, screw length, screw placement accuracy rate and axial pullout strength of the two different entry point groups were compared. There were significant differences in the TPA, screw length, and the screw placement accuracy rate between the two groups（P〈0.05）. The maximum axial pullout strength of the novel entry point group was slightly larger than that of the traditional group. However, the difference was not significant（P 〉 0.05）. The novel entry point significantly improved the accuracy, stability and safety of pedicle screw placement.With reference to the advantages above, the new entry point can be used for spinal internal fixations in the thoracic spine.

Spinal Epidural Cavernous Hemangioma of the Thoracic Spine: A Case Report

Cavernous hemangiomas can arise in any region of the body, including the central nervous system. Spinal cavernous hemangiomas account for 5% - 12% of all cases of vertebral vascular malformation. Most of these are of vertebral origin, and cases that are non-vertebral in origin are rare. We encountered a patient with a relatively rare spinal epidural cavernous hemangioma of the thoracic spine that was non-vertebral in origin. The patient was a 63-year-old man. He had become aware of bilateral leg pain and numbness about 2 months earlier, and gait disturbance appeared gradually thereafter. On MRI, a lesion showing iso-intensity on T1-weighted imaging and high intensity on T2-weighted imaging was detected at the 7th thoracic vertebra. On gadolinium contrast-imaging, the lesion was found to be a homogenously-enhanced dumbbell-shaped extradural spinal neoplasm protruding from the left 7th/8th thoracic intervertebral foramen. A neurogenic tumor was suspected based on myelography and MRI findings, and complete tumorectomy was performed, which improved the lower limb symptoms and gait disturbance. The histopathological diagnosis was cavernous hemangioma. Epidural hemangiomas arise from the vertebra in many cases, and pure spinal epidural cavernous hemangiomas are rare. It is difficult to make a preoperative diagnosis because there are no specific imaging findings that can differentiate these tumors. It may be important to consider this disease before surgery in the differential diagnosis of epidural tumors.

Sternal metastasis-the forgotten column and its effect on thoracic spine stability

Sternal metastases are not studied extensively in the literature. There is a paucity of information on their role in metastatic disease. The concept of the fourth column was described by Berg in 1993, and has been proven in case report, clinically and biomechanical studies. The role of the sternum as a support to the thoracic spine is well documented in the trauma patients, but not much is known about its role in cancer patients. This review examines what is known on the role of the fourth column. Following this we have identified two likely scenarios that sternal metastases may impact management:(1) sternal pathological fracture increases the mobility of the semi-rigid thorax with the loss of the biomechanical support of the sternum-rib-thoracic spine complex; and(2) a sternal metastasis increases the risk of fracture, and while being medical treated the thoracic spine should be monitored for acute kyphosis and neurological injury secondarily to the insufficiency of the fourth column.

ALK-positive anaplastic large cell lymphoma of the thoracic spine occurring in pregnancy: A case report

BACKGROUND Anaplastic large cell lymphoma (ALCL) is a type of non-Hodgkin’s lymphoma (NHL). ALCL is rare as a bone lesion and in pregnancy. CASE SUMMARY We present the first case of anaplastic lymphoma kinase (ALK)+ ALCL of the thoracic spine during pregnancy. A 25-year-old pregnant woman was presented to us at 24 wk’ gestation with severe back pain and weakness in the left lower limb. Imaging examination showed lesions at T10 and T11. She underwent posterior pedicle screw fixation and vertebroplasty. Pathological examination showed ALK+ ALCL. The patient chose to have therapeutic abortion after surgery and received chemotherapy in the hematology department. She now remains disease free with no neurological deficit after 30 mo’ follow-up. CONCLUSION ALK+ ALCL with the thoracic spine involvement is uncommon, especially in pregnancy. Many symptoms can be misunderstood during pregnancy;therefore, when a pregnant patient has persistent back pain or lower limb neurological symptoms, imaging examinations should be performed.

THORACIC SPINE FRACTURES

Objective. To investigate the unique characteristics and treatment of thoracic spine fractures. Methods. Seventy seven patients with thoracic spine fractures were retrospectively reviewed. Of these, there were 37 compression fractures, 34 fracture dislocations, 3 burst fractures and 3 burst dislocations. Twenty six patients had a complete lesion of the spinal cord, 14 sustained a neurologically incomplete injury, and 37 were neurologically intact. Fifty three patients were treated nonoperatively and 24 treated operatively. Results. All patients were followed up for 2～15 years. None of the 26 patients with a complete lesion recovered any significant function. Of 37 neurologically intact patients, 13 had local pain although all of them remained normal function. Two of 14 patients with incomplete paraplegia returned to normal, 7 recovered some function and 5 did not recovered. Conclusions. Because of the unique anatomy and biomechanics of the thoracic spine, the classification commonly applied to thoracolumbar fractures is not suitable for thoracic fractures. Fusion and instrumentation are indicated when the fractures are unstable, while patients with incomplete lesion of the spinal cord may be the candidates for supplemented decompression.

Extradural Hemangioma of Thoracic Spine

A 50-year-old woman presented with mid-thoracic backache and progressive, spastic, paraparesis for 3 months. Magnetic resonance imaging revealed an epidural mass without bone lesion at the level of thoracic vertebrae (T7, T8 and T9). The mass had a paraspinal invasion. The spinal cord was compressed ventrally. The lesion was totally excised through an anterolateral transthoracic approach. Histopathological examination revealed a cavernous hemangioma. The patient improved dramatically after the excision of the lesion. We report this case for its rarity.

Posterior approach to radical resection for thoracic tumor and spine stabilization and reconstruction in one stage

Objective To discuss total vertebrectomy and spine stability and reconstruction by posterior approach for thoracic vertebra tumor and pedicle secrew system fixation and intervertebral fusion. Methods Eighteen patients of 3 males and 15 females of thoracic total vertebral tumor were operated in this group. The age of the group were from 14 to 58 years old, with the average of 23 years. There were 4 aneurysmal bone cysts, 2 hemangiomas,2 osteoblastomas, 1 neurilemomas, 5 giant cell tumro, 1 solitary myeloma and 3 metastatic thoracic vertebra tumors. The locations of the tumors was T4 in 1 case,T5 in 1 case.T6 in 2 cases,T8 in 4 cases, T9 in 3 cases,T10 in 4 cases, T11 in 2 cases and T12 in 1 case respectively. Pre-operative Frankel classification was grade A in 6 cases, B in 7 cases, C in 3 cases and E in 2 cases. Circumferential decompression was performed with total spondylectomy through one-stage posterior approach. Anterior vertebral reconstruction was provided by autograft (ribs or ilium) bone or

Empirical study of transpedicular screw placement assisted by digital navigation templates in the thoracic spines

Objective To investigate the accuracy and feasibility of transpedicular screw placement assisted by the navigation templates in cadaveric thoracic spines.Methods Twenty thoracic cadavers specimens were randomly divided into two

A Case of Thoracic Disc Herniation Extruded to the Dorsal Epidural Space

We encountered a patient with thoracic disc herniation that extruded to the dorsal epidural space. The patient was a 78-year-old man in whom listlessness of the lower limbs developed without an inducer and walking became difficult. The patient was diagnosed as having a thoracic spinal cord tumor on MRI by a physician, and was referred to our hospital. Since ring enhancement was observed on contrast MRI performed at our hospital, the patient was diagnosed with disc herniation and surgery was performed. A hernia continuous with the intervertebral space that extruded to the dorsal epidural space was excised. At the final follow up, 1 year and 4 months after surgery, the patient could walk with a cane. Among thoracic disc herniation cases, hernia extruded to the dorsal epidural space is rare and difficult to diagnose by imaging before surgery, but evaluation using contrast MRI is useful in the diagnosis. When a space-occupying lesion is observed in the spinal canal in the lower thoracic spinal region, it is necessary to evaluate it by contrast MRI in consideration of thoracic disc herniation.

Threatened Aortic Injury by Thoracic Pedicle Screw: A Case Report

Iatrogenic vascular injury during posterior spinal surgery is a rare but potentially serious complication with treatment challenges. We report the case of threatened aortic injury by pedicle screw impingement during posterior fixation of thoracic spine T7 - T8 fracture dislocation. The removal of the conflicting screws was done posteriorly after a visual control of the absence of adventitious break-in by a thoracotomy.

Thoracic Spinal Cord Stab Injury: A Case Report and Literature Review

Thoracic spinal cord stab injuries are rare lesions. A 17-year-old boy was stabbed on his back by his classmate when he bent forward to pick up his cloth from the ground. On admission, he presented with: complete paraplegia with muscle strength of zero on all muscle groups, complete anesthesia from dermatome 10 and below, acute urinary retention, and a four-centimeter wound on the thoracolumbar region from which cerebrospinal fluid mixed with blood was oozing out. A high-dose methylprednisolone protocol was started (30 mg/kg in one hour and then 5.4 mg/kg over 23 hours) an indwelling urinary catheter placed and sterile dressing of the wound done. Antibiotics and analgesics were also administered. The computed tomography scanning revealed a spinal cord transection at T10-T11 level with incarceration of the broken knife blade. An emergency thoracic laminectomy was performed. Removal of the broken knife blade revealed complete spinal cord transection with a compressive hematoma within the spinal cord which was removed by smooth suction. The spinal dura was sutured and the wound closed in many layers. On day 14 after surgery, sensitivity was recovered with 3 on 5 muscle strength in both lower limbs except for both feet where motor function remained null. Urinary retention and fecal incontinence persisted. The patient was discharged from our service for a rehabilitation center. At 32-month follow-up, neurological examination was unchanged although patient noticed a slight improvement of sphincter disturbances.

椎体强化术后恢复高度对邻近椎体的影响:一项有限元分析

背景:椎体压缩骨折是当前骨科领域中常见的疾病,椎体强化术后邻近椎体发生再骨折是一个不可忽视的问题,这对患者的正常生活产生了严重的影响。目的:旨在利用CT图像,建立不同恢复高度的椎体强化后模型。采用有限元分析的方法得出不同恢复高度下邻近椎体的应力情况,并进一步探讨椎体强化术后伤椎高度恢复的重要性。方法:建立并验证了胸腰椎(T_(11)-L3)有限元模型,并在此基础上构建了4种不同恢复高度(100%,80%,60%,40%)的L1术后有限元模型,其中骨水泥容量随着恢复高度的变化而变化。具体模型如下:Model 1为正常恢复高度的术后模型,骨水泥容量为8.3 mL;Model 2为L1前部高度切除20%,后凸角变为10.41°的术后模型,骨水泥容量为6.9 mL;Model 3为L1前部高度切除40%,后凸角变为20.17°的术后模型,骨水泥容量为4.7 mL;Model 4为L1前部高度切除60%,后凸角变为28.85°的术后模型,骨水泥容量为3.6 mL。对术后模型进行评估时,施加了7Nm的力矩和500N的轴向力,记录并分析L2上终板和T12下终板的峰值应力,以及L2和T12松质骨的峰值应力。结果与结论:①L2上终板、T12下终板、L2松质骨、T12松质骨各工况的最高峰值应力都出现在Model 1和Model 4,特别是T12下终板(除后伸工况外),前屈、左右侧弯和左右旋转工况都在Model 4达到了最高峰值应力,应力分别为50.3,33.1,44.9,34.3,31.9 MPa;②根据邻近椎体终板和松质骨的峰值应力,排除Model 1和Model 4两个模型后,大部分工况的最小峰值应力都是出现在Model 2模型上,且Model 2模型出现最小峰值应力的情况占据了66.6%,尤其是在L2的上终板和松质骨(除后伸工况外),最小峰值应力都是出现在了Mode 2上;③因此将恢复高度控制在原高度的100%和40%左右是比较危险的恢复高度,对邻近椎体的影响较大;将恢复高度控制在原高度的80%左右可能是一个较为理想的选择;恢复高度在原高度的80%左右,邻近椎体所承受的应力较小,从而减小了患者发生邻近椎体再骨折的风险。

经皮椎弓根内固定在无神经损伤胸腰椎骨折中的疗效及对脊柱稳定性的影响

目的:探究经皮椎弓根内固定在无神经损伤胸腰椎骨折中的疗效及对脊柱稳定性的影响。方法:将2021年10月—2023年1月汕头市澄海区人民医院收治的82例无神经损伤胸腰椎骨折患者根据随机数字表法分为对照组(n=41)和观察组(n=41)。对照组进行开放椎弓根内固定治疗,观察组进行经皮椎弓根内固定治疗。比较两组优良率、手术时间、切口长度、术中出血量、住院时间、并发症发生率,以及手术前后的疼痛程度[语言分级评分法(VRS)]和脊柱稳定性(伤椎前、后缘高度比、矢状面指数及后凸Cobb角)。结果:两组优良率比较,差异无统计学意义(P>0.05);观察组的手术时间、住院时间及切口长度均显著短于对照组,术中出血量显著少于对照组,并发症发生率显著低于对照组,差异均有统计学意义(P<0.05);术前两组VRS评分及脊柱稳定性指标比较,差异均无统计学意义(P>0.05);术后1、4、12周,观察组的VRS评分均显著低于对照组,差异均有统计学意义(P<0.05);两组术后24周的VRS评分及术后12、24周的脊柱稳定性指标比较,差异均无统计学意义(P>0.05)。结论:经皮椎弓根内固定可减轻手术创伤,有效促进无神经损伤胸腰椎骨折患者的术后恢复,疗效确切,对脊柱稳定性的效果与开放手术相近。

胸腰椎肿瘤整块切除的围术期并发症及危险因素

目的:探讨胸腰椎肿瘤整块切除术后手术围术期并发症的发生情况及危险因素。方法:回顾性分析以胸腰椎肿瘤就诊于我科并行整块切除和前柱重建手术的患者资料。2016年5月~2022年10月,有90例连续患者在我科根据Weinstein-Boriani-Biagini外科分期系统进行整块切除,使用3D打印人工椎体进行前柱重建。收集这些患者的人口学、肿瘤学和手术学数据,依据并发症对康复过程的影响将术中及术后3个月内发生的并发症分为严重并发症和轻微并发症(严重并发症指任何会显著改变患者的预期恢复过程的并发症,余为轻微并发症);依据既往手术史将所有患者分为初术组(n=67)和翻修组(n=23)。比较各组患者在年龄、性别、病理类型、肿瘤累及节段、手术时间、术中失血和围术期并发症等上的区别,并进行回归分析,探索严重和轻微并发症的危险因素。结果:所有患者均按计划完成了整块切除手术,其中全椎切除77例,矢状切除12例,椎体切除1例;平均手术时间553.4min(210~1208min),术中失血1534.1mL(260~5500mL)。共65例(72.2%)患者发生129例次围术期并发症,其中21例(23.3%)患者发生29例严重并发症,2例(2.2%)患者死亡。翻修组比初术组的多节段受累更多(P=0.000),严重并发症发生率更高(P=0.038)。在单变量回归分析中,联合入路(OR=14.778,P=0.001)、总失血量(OR=1.004,P=0.004)、分期手术(OR=5.250,P=0.008)、既往手术史(OR=2.946,P=0.043)、肿瘤累及节段数(OR=1.607,P=0.023)和腰椎肿瘤(OR=3.509,P=0.015)是严重并发症发生的危险因素,其中联合入路(OR=6.375,P=0.036)是严重并发症的独立危险因素。结论:对胸腰椎肿瘤进行整块切除和前柱重建有很高的并发症风险,尤其是需要联合入路时。

Wiltse入路椎弓根螺钉内固定治疗胸腰椎骨折的效果分析

目的:探讨分析Wiltse入路椎弓根螺钉内固定治疗胸腰椎骨折的效果。方法:将苏州市相城人民医院2020年1月—2022年1月收治的60例胸腰椎骨折患者按随机数字表法分为Wiltse入路组(A组,n=30)和后路椎旁入路组(B组,n=30)。比较两组手术总时长、总失血量、术后首次下床活动时间、住院总天数;比较两组术前和术后1周、12个月的视觉模拟评分法(VAS)评分、Oswestry功能障碍指数(ODI)、伤椎前后缘高度比及Cobb角。结果:A组手术总时长、术后首次下床活动时间、住院总天数均较B组更短,总失血量较B组更少(P<0.05)。A组术后1周的VAS评分、ODI均较B组明显更低(P<0.05)。两组术后1周及12个月伤椎前后缘高度比均较治疗前增高,Cobb角均较术前减小(P<0.05),但两组间比较,差异均无统计学意义(P>0.05)。结论:Wiltse入路椎弓根钉内固定治疗胸腰椎骨折具有手术时间短、失血少、损伤小、恢复快的优点。

胸椎结核术中输血量对术后凝血功能的影响

目的 探究胸椎结核术中输血量对术后凝血功能的影响,并对相关性进行研究。方法 筛选2020年5月至2022年10月河北省胸科医院收治的胸椎结核前路手术患者51例作为研究对象进行回顾性分析。按术中输血量分为A组(A≤400 mL,19例)、B组(400 mL<B≤800 mL,23例)、C组(C>800 mL,9例),分别于术前(T0)、术后1 d(T2)、术后7 d(T3)取静脉血,检测血常规、凝血功能和血栓弹力图。对血小板(PLT)、凝血酶原时间(PT)、国际标准化比值(INR)、R值、K值、MA值、α角参数进行方差分析,并对有效参数行LSD检验,比较各组差异,研究相关性变化趋势。结果 术后3组患者R值和K值变小,α角、MA值增大,PLT数量升高,说明术后血液处于高凝状态。T1时3组患者R值、α角、MA值、PLT参数比较,差异有统计学意义(P<0.05)。T2时3组MA值、PLT比较,差异有统计学意义(P<0.05)。T1时3组有效参数两两比较均有统计学意义(P<0.05)。T2时A组与B组MA值差异有统计学意义(P=0.047)。A组与C组PLT、MA值差异有统计学意义(P<0.05)。T1时输血量与PLT、R值、MA值、α角具有相关性(P<0.05)。PLT、MA值、α角与输血量之间正向相关(P<0.05)。R值与输血量之间呈负相关(Rs=-0.371)。T2时PLT、MA值与输血量之间呈正相关(P<0.05)。结论 患者术后凝血功能处于高凝状态,PLT、R值、MA值、α角与术中输血量相关,术中输血量与术后高凝状态呈正相关。即术中输血越多,患者术后发生血栓风险越高。

PERMA下的护理模式在胸腰椎骨折患者护理中的应用

目的分析胸腰椎骨折患者采取PERMA护理模式干预的效果与应用价值。方法选择2022年8月至2023年8月福建省立医院32区急诊外科收治的80例胸腰椎骨折患者作为研究对象,采用随机数字表法将其分作观察组与对照组,各40例。对照组辅以常规模式干预;观察组实施PERMA护理模式干预。对比分析两组患者护理前后焦虑抑郁心理状态、护理后锻炼依从性、护理的总满意度、护理前后生活质量。结果两组患者入院时心理状态评估结果、护理前生活质量评分对比差异无统计学意义(均P>0.05);护理后,观察组患者焦虑、抑郁评分均低于对照组(P<0.05),观察组患者锻炼依从性、护理总满意度、生活质量评分均高于对照组(均P<0.05)。结论胸腰椎骨折患者通过PERMA护理模式干预,可有效改善不良心态,促使患者功能锻炼更加依从,提高生活质量,促进康复。