AIM: To investigate fat infiltration and volume of spino-pelvic muscles in adults spinal deformity(ASD) with magnetic resonance imaging(MRI) and 3D reconstructions.METHODS: Nineteen female ASD patients(mean age 60 ...AIM: To investigate fat infiltration and volume of spino-pelvic muscles in adults spinal deformity(ASD) with magnetic resonance imaging(MRI) and 3D reconstructions.METHODS: Nineteen female ASD patients(mean age 60 ± 13) were included prospectively and consecutively and had T1-weighted Turbo Spin Echo sequence MRIs with Dixon method from the proximal tibia up to T12 vertebra. The Dixon method permitted to evaluate the proportion of fat inside each muscle(fat-water ratio). In order to investigate the accuracy of the Dixon method for estimating fat vs water, the same MRI acquisition was performed on phantoms of four vials composed of different proportion of fat vs water. With Muscl'X software, 3D reconstructions of 17 muscles or group of muscles were obtained identifying the muscle's contour on a limited number of axial images [Deformation of parametric specific objects(DPSO) Method]. Musclar volume(Vmuscle), infiltrated fat volume(Vfat) and percentage of fat infiltration [Pfat, calculated as follow: Pfat = 100 ×(Vfat/Vmuscle)] were characterized by extensor or flexor function respectively for the spine, hip and knee and theirs relationship with demographic data were investigated. RESULTS: Phantom acquisition demonstrated a non linear relation between Dixon fat-water ratio and the real fat-water ratio. In order to correct the Dixon fatwater ratio, the non linear relation was approximated with a polynomial function of degree three using the phantom acquisition. On average, Pfat was 13.3% ± 5.3%. Muscles from the spinal extensor group had a Pfat significantly greater than the other muscles groups, and the largest variability(Pfat = 31.9% ± 13.8%, P < 0.001). Muscles from the hip extensor group ranked 2nd in terms of Pfat(14% ± 8%), and were significantly greater than those of the knee extensor(P = 0.030). Muscles from the knee extensor group demonstrated the least Pfat(12% ± 8%). They were also the only group with a significant correlation between Vmuscle and Pfat(r =-0.741, P < 0.001), however this correlation was lacking in the other groups. No correlation was found between the Vmuscle total and age or body mass index. Except for the spine flexors, Pfat was correlated with age. Vmuscle and Vfat distributions demonstrated that muscular degeneration impacted the spinal extensors most.CONCLUSION: Mechanisms of fat infiltration are not similar among the muscle groups. Degeneration impacted the spinal and hip extensors most, key muscles of the sagittal alignment.展开更多
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 ass...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.展开更多
Cervical myelopathy is a well-described clinical syndrome that may evolve from a combination of etiological mechanisms. It is traditionally classified by cervical spinal cord and/or nerve root compression which varies...Cervical myelopathy is a well-described clinical syndrome that may evolve from a combination of etiological mechanisms. It is traditionally classified by cervical spinal cord and/or nerve root compression which varies in severity and number of levels involved. The vast array of clinical manifestations of cervical myelopathy cannot fully be explained by the simple concept that a narrowed spinal canal causes compression of the cord, local tissue ischemia, injury and neurological impairment. Despite advances in surgical technology and treatment innovations, there are limited neuro-protective treatments for cervical myelopathy, which reflects an incomplete understanding of the pathophysiological processes involved in this disease. The aim of this review is to provide a comprehensive overview of the key pathophysiological processes at play in the development of cervical myelopathy.展开更多
Odontoid fractures account for 5% to 15% of all cervical spine injuries and 1% to 2% of all spine fractures. Type Ⅱ fractures are the most common fracture pattern in elderly patients. Treatment(rigid and non-rigid im...Odontoid fractures account for 5% to 15% of all cervical spine injuries and 1% to 2% of all spine fractures. Type Ⅱ fractures are the most common fracture pattern in elderly patients. Treatment(rigid and non-rigid immobilization, anterior screw fixation of the odontoid and posterior C1-C2 fusion) remains controversial and represents a unique challenge for the treating surgeon. The aims of treatment in the elderly is to quickly restore pre-injury function while decreasing morbidity and mortality associated with inactivity, immobilization with rigid collar and prolonged hospitalization. Conservative treatment of type Ⅱ odontoid fractures is associated with relatively high rates of non-union and in a few cases delayed instability. Options for treatment of symptomatic non-unions include surgical fixation or prolonged rigid immobilization. In this report we present the case of a 73-year-old woman with post-traumatic odontoid nonunion successfully treated with Teriparatide systemic anabolic therapy. Complete fusion and resolution of the symptoms was achieved 12 wk after the onset of the treatment. Several animal and clinical studies have confirmed the potential role of Teriparatide in enhancing fracture healing. Our case suggests that Teriparatide may have a role in improving fusion rates of C2 fractures in elderly patients.展开更多
In order to reduce the magnitude of the force applied to skull for treatment of acute cervical spine dislocation, we developed a method of skeletal traction based on reduction of friction forces under the patient’s h...In order to reduce the magnitude of the force applied to skull for treatment of acute cervical spine dislocation, we developed a method of skeletal traction based on reduction of friction forces under the patient’s head. Traction force was applied to sculls of five patients with cervical fracture-dislocations. A difference in friction interface between the patient’s head and shoulder girdle was created. The traction weight required for the reduction of the vertebral dislocation was significantly lower than an expected minimal traction weight in the commonly used techniques (p = 0.013). The presented method permits an effective and safe reduction of dislocated cervical vertebra by a relatively low traction force.展开更多
A lower risk of prostate cancer has been reported in men with spinal cord injury (SCI) as compared to that observed in able-bodied subjects. As injury-related consequences can have opposite effects on prostate patho...A lower risk of prostate cancer has been reported in men with spinal cord injury (SCI) as compared to that observed in able-bodied subjects. As injury-related consequences can have opposite effects on prostate pathophysiology, this meta-analysis aimed to (1) establish the existence/quantify the extent of decreased prostate cancer risk following SCI and (2) find out if there is any statistically significant difference in prostate-specific antigen (PSA) levels between SCI and able-bodied subjects. MEDLINE, Cochrane Library, Scopus, CINAHL, and ScienceDirect databases were used. Only studies reporting a prostate cancer diagnosis and/or PSA levels following SCI and in able-bodied controls were included. Five studies provided information about prostate cancer on 35 293 subjects with SCI and 158 140 controls. Six studies were included in PSA analysis which reported information on 391 men with SCI and 1921 controls. Pooled estimates indicated that SCI reduced the prostate cancer risk by approximately 50% as compared to controls, whereas differences in PSA levels were not statistically significant. Funnel plots suggested the presence of publication bias only in PSA analysis. Between-study heterogeneity was established and when, according to meta-regression models, analysis was restricted to studies including men with mean age over 55 years, prostate cancer risk in SCI decreased up to 65.0% than that in controls with no heterogeneity (P= 0.33, Iz = 9%). In conclusion, in men over 55 years old, SCI decreases the prostate cancer risk up to 65.0% than that in controls. The large between-study heterogeneity on PSA confirms its poor reliability as a screening tool for prostate cancer in SCI.展开更多
Worldwide, spinal cord injury (SCI) affects around 500,000 people each year and results in significant morbidity. The primary insult to the spinal cord occurs at the time of the initial injury, which may result from a...Worldwide, spinal cord injury (SCI) affects around 500,000 people each year and results in significant morbidity. The primary insult to the spinal cord occurs at the time of the initial injury, which may result from a contusion, laceration or more rarely a transection. Secondary damage in SCI is more insidious and subacute;it is the result of a combination of an inflammatory response, vascular changes and ionic dysregulation. Early clinical intervention is vital after the acute, primary insult to ensure the best possible outcomes for these patients. Current evidence on the demographics and mechanisms, underlying basic science and management strategies of spinal cord injuries are outlined.展开更多
To evaluate the clinical outcome,effectiveness and safety of the surgical management of traumatic lumbar spondylolisthesis with transforaminal lumbar interbody fusion (TLIF) with short segmental instrumentation fixati...To evaluate the clinical outcome,effectiveness and safety of the surgical management of traumatic lumbar spondylolisthesis with transforaminal lumbar interbody fusion (TLIF) with short segmental instrumentation fixation.A retrospective review of a consecutive series of 24 patients with traumatic lumbar spondylolisthesis treated with TLIF procedure was carried out.Intraoperative spinal cord monitoring was used to confirm the peripheral neural function intact during the reduction of the spondylolisthesis.Preoperative clinical and radiographic evaluation of all cases were originally collected prospectively.Data regarding blood loss,operative time,duration of hospital stay,radiographic fusion,instrumentation failure and clinical result were collected and observed at regular follow-up periods.All patients were engaged in high-energy accidents in the lower back and 16 patients had concomitant injuries.The mean operative time was 124 min,mean blood loss was 350 mL,and mean hospital stay was 6.5 days.There were no complications such as incision infection,cerebrospinal fluide (CSF) leakage and nerve root injury and so on.All patients demonstrated a solid lumbar interbody fusion within 4 months,and no evidence of spondylolisthesis correction loss,instrumentation failure and loosing.They all were completely asymptomatic,with normal neurologic findings,and had resumed their previous level of physical activities on the final follow-up.Meticulous clinical examination and careful imaging assessment could assist an early diagonosis in cases of traumatic lumbar spondylolisthesis.Performing open reduction and the TLIF procedure as soon as possible could restore segmental stability and painless function.The TLIF procedure was a safe,effective technique to treat traumatic lumbar spondylolisthesis.展开更多
基金Supported by International Spine Study Group and ParisTech BiomecAM chair program on subject-specific musculoskeletal modeling,with the support of Proteor,Covea,Société Général,ParisTech and Yves Cotrel Foundation
文摘AIM: To investigate fat infiltration and volume of spino-pelvic muscles in adults spinal deformity(ASD) with magnetic resonance imaging(MRI) and 3D reconstructions.METHODS: Nineteen female ASD patients(mean age 60 ± 13) were included prospectively and consecutively and had T1-weighted Turbo Spin Echo sequence MRIs with Dixon method from the proximal tibia up to T12 vertebra. The Dixon method permitted to evaluate the proportion of fat inside each muscle(fat-water ratio). In order to investigate the accuracy of the Dixon method for estimating fat vs water, the same MRI acquisition was performed on phantoms of four vials composed of different proportion of fat vs water. With Muscl'X software, 3D reconstructions of 17 muscles or group of muscles were obtained identifying the muscle's contour on a limited number of axial images [Deformation of parametric specific objects(DPSO) Method]. Musclar volume(Vmuscle), infiltrated fat volume(Vfat) and percentage of fat infiltration [Pfat, calculated as follow: Pfat = 100 ×(Vfat/Vmuscle)] were characterized by extensor or flexor function respectively for the spine, hip and knee and theirs relationship with demographic data were investigated. RESULTS: Phantom acquisition demonstrated a non linear relation between Dixon fat-water ratio and the real fat-water ratio. In order to correct the Dixon fatwater ratio, the non linear relation was approximated with a polynomial function of degree three using the phantom acquisition. On average, Pfat was 13.3% ± 5.3%. Muscles from the spinal extensor group had a Pfat significantly greater than the other muscles groups, and the largest variability(Pfat = 31.9% ± 13.8%, P < 0.001). Muscles from the hip extensor group ranked 2nd in terms of Pfat(14% ± 8%), and were significantly greater than those of the knee extensor(P = 0.030). Muscles from the knee extensor group demonstrated the least Pfat(12% ± 8%). They were also the only group with a significant correlation between Vmuscle and Pfat(r =-0.741, P < 0.001), however this correlation was lacking in the other groups. No correlation was found between the Vmuscle total and age or body mass index. Except for the spine flexors, Pfat was correlated with age. Vmuscle and Vfat distributions demonstrated that muscular degeneration impacted the spinal extensors most.CONCLUSION: Mechanisms of fat infiltration are not similar among the muscle groups. Degeneration impacted the spinal and hip extensors most, key muscles of the sagittal alignment.
文摘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.
文摘Cervical myelopathy is a well-described clinical syndrome that may evolve from a combination of etiological mechanisms. It is traditionally classified by cervical spinal cord and/or nerve root compression which varies in severity and number of levels involved. The vast array of clinical manifestations of cervical myelopathy cannot fully be explained by the simple concept that a narrowed spinal canal causes compression of the cord, local tissue ischemia, injury and neurological impairment. Despite advances in surgical technology and treatment innovations, there are limited neuro-protective treatments for cervical myelopathy, which reflects an incomplete understanding of the pathophysiological processes involved in this disease. The aim of this review is to provide a comprehensive overview of the key pathophysiological processes at play in the development of cervical myelopathy.
文摘Odontoid fractures account for 5% to 15% of all cervical spine injuries and 1% to 2% of all spine fractures. Type Ⅱ fractures are the most common fracture pattern in elderly patients. Treatment(rigid and non-rigid immobilization, anterior screw fixation of the odontoid and posterior C1-C2 fusion) remains controversial and represents a unique challenge for the treating surgeon. The aims of treatment in the elderly is to quickly restore pre-injury function while decreasing morbidity and mortality associated with inactivity, immobilization with rigid collar and prolonged hospitalization. Conservative treatment of type Ⅱ odontoid fractures is associated with relatively high rates of non-union and in a few cases delayed instability. Options for treatment of symptomatic non-unions include surgical fixation or prolonged rigid immobilization. In this report we present the case of a 73-year-old woman with post-traumatic odontoid nonunion successfully treated with Teriparatide systemic anabolic therapy. Complete fusion and resolution of the symptoms was achieved 12 wk after the onset of the treatment. Several animal and clinical studies have confirmed the potential role of Teriparatide in enhancing fracture healing. Our case suggests that Teriparatide may have a role in improving fusion rates of C2 fractures in elderly patients.
文摘In order to reduce the magnitude of the force applied to skull for treatment of acute cervical spine dislocation, we developed a method of skeletal traction based on reduction of friction forces under the patient’s head. Traction force was applied to sculls of five patients with cervical fracture-dislocations. A difference in friction interface between the patient’s head and shoulder girdle was created. The traction weight required for the reduction of the vertebral dislocation was significantly lower than an expected minimal traction weight in the commonly used techniques (p = 0.013). The presented method permits an effective and safe reduction of dislocated cervical vertebra by a relatively low traction force.
文摘A lower risk of prostate cancer has been reported in men with spinal cord injury (SCI) as compared to that observed in able-bodied subjects. As injury-related consequences can have opposite effects on prostate pathophysiology, this meta-analysis aimed to (1) establish the existence/quantify the extent of decreased prostate cancer risk following SCI and (2) find out if there is any statistically significant difference in prostate-specific antigen (PSA) levels between SCI and able-bodied subjects. MEDLINE, Cochrane Library, Scopus, CINAHL, and ScienceDirect databases were used. Only studies reporting a prostate cancer diagnosis and/or PSA levels following SCI and in able-bodied controls were included. Five studies provided information about prostate cancer on 35 293 subjects with SCI and 158 140 controls. Six studies were included in PSA analysis which reported information on 391 men with SCI and 1921 controls. Pooled estimates indicated that SCI reduced the prostate cancer risk by approximately 50% as compared to controls, whereas differences in PSA levels were not statistically significant. Funnel plots suggested the presence of publication bias only in PSA analysis. Between-study heterogeneity was established and when, according to meta-regression models, analysis was restricted to studies including men with mean age over 55 years, prostate cancer risk in SCI decreased up to 65.0% than that in controls with no heterogeneity (P= 0.33, Iz = 9%). In conclusion, in men over 55 years old, SCI decreases the prostate cancer risk up to 65.0% than that in controls. The large between-study heterogeneity on PSA confirms its poor reliability as a screening tool for prostate cancer in SCI.
文摘Worldwide, spinal cord injury (SCI) affects around 500,000 people each year and results in significant morbidity. The primary insult to the spinal cord occurs at the time of the initial injury, which may result from a contusion, laceration or more rarely a transection. Secondary damage in SCI is more insidious and subacute;it is the result of a combination of an inflammatory response, vascular changes and ionic dysregulation. Early clinical intervention is vital after the acute, primary insult to ensure the best possible outcomes for these patients. Current evidence on the demographics and mechanisms, underlying basic science and management strategies of spinal cord injuries are outlined.
文摘To evaluate the clinical outcome,effectiveness and safety of the surgical management of traumatic lumbar spondylolisthesis with transforaminal lumbar interbody fusion (TLIF) with short segmental instrumentation fixation.A retrospective review of a consecutive series of 24 patients with traumatic lumbar spondylolisthesis treated with TLIF procedure was carried out.Intraoperative spinal cord monitoring was used to confirm the peripheral neural function intact during the reduction of the spondylolisthesis.Preoperative clinical and radiographic evaluation of all cases were originally collected prospectively.Data regarding blood loss,operative time,duration of hospital stay,radiographic fusion,instrumentation failure and clinical result were collected and observed at regular follow-up periods.All patients were engaged in high-energy accidents in the lower back and 16 patients had concomitant injuries.The mean operative time was 124 min,mean blood loss was 350 mL,and mean hospital stay was 6.5 days.There were no complications such as incision infection,cerebrospinal fluide (CSF) leakage and nerve root injury and so on.All patients demonstrated a solid lumbar interbody fusion within 4 months,and no evidence of spondylolisthesis correction loss,instrumentation failure and loosing.They all were completely asymptomatic,with normal neurologic findings,and had resumed their previous level of physical activities on the final follow-up.Meticulous clinical examination and careful imaging assessment could assist an early diagonosis in cases of traumatic lumbar spondylolisthesis.Performing open reduction and the TLIF procedure as soon as possible could restore segmental stability and painless function.The TLIF procedure was a safe,effective technique to treat traumatic lumbar spondylolisthesis.