A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of Master of Medicine in the branch of Orthopaedic Surgery Johannesburg, 2017 / Background Unstable Thoracolumbar spinal fractures are conventionally treated by open reduction and internal fixation. This involves extensive mobilization of paraspinal muscles, which in turn leads to long-term disability in the form of chronic backache. One of the reasons fractures are stabilized is to prevent kyphotic deformity. Posterior lumbar stabilization done through a minimally invasive technique can achieve the same result as the open technique at the expense of less mobilization of the paraspinal muscles. Aim of the study The aim of the study was to assess the effectiveness of minimally invasive posterior spinal fixation in unstable Thoraco-lumbar fractures in our setting at Charlotte Maxeke Academic Hospital. Objectives To assess the effectiveness of Minimally Invasive Spine Surgery over a short term of minimum of 12 months regarding: Maintaining the correction of fracture kyphosis, Re-operations and Any serious Adverse Events Methodology This was a prospective interventional pilot study. Fractures were classified according to the AO comprehensive system. AO Comprehensive classification fractures A3, B1, B2, C1 and C2 were considered suitable for this technique. Pre-operative, immediate post-operative and one year follow up Cobb’s angles of fracture kyphosis were measured on plain lateral x-rays. Any Serious Adverse Events (SAE) that may have required re-operations were recorded over the minimum of 12 months follow up. Results Twenty patients met the inclusion criteria for this study. Post-operative follow up ranged between 12 and 22 months. There were 14 males and 6 females. The age ranged between 16 years to 54 years with mean of 33.9 years. L1 was the most commonly fractured vertebra. Eleven out of 20 patients sustained fracture of L1, 6 patients had fracture of L2 whereas 3 patients sustained fracture of T12. The AO classification types included one B1, five B2, seven C1 and seven C2 fractures. The pre-operative Cobb’s angle ranged from 7 degrees to 38 degrees with mean of 21.2 degrees. The immediate post-operative Cobb’s angle ranged between zero degrees to 16 degrees with mean of 8.3 degrees. The last follow up Cobb’s angle ranged between zero degrees to 21 degrees with a mean of 10.7 degrees. The loss of correction of fracture kyphosis ranged between zero degrees to 6 degrees with a mean of 2.4 degrees. The post-operative Cobb’s angle was maintained. There was no deterioration of pre-operative neurological status. There was no serious adverse event requiring a re-operation. Conclusion Minimally Invasive Posterior Spinal stabilization for thoracolumbar fractures had an acceptable outcome in our hands in appropriately selected cases. The average loss of correction of 2.4 degrees was in keeping with that found in open technique as well as MIS at other centers. While the number is less, this procedure can be recommended for well selected patients where skills are available. / MT2017

Posterior pedicle screw and rod fixation has become standard in the treatment of oncological resections requiring stabilization, deformity correction and unstable thoracolumbar fractures. Given the high mechanical stress at the points of highest instability, some clinicians have utilized dual rods on each side to augment the construct. The added advantage of this type of construct has not been previously evaluated in-vitro. The goal of this study is to evaluate the biomechanical advantage of a dual rod construct in the thoracolumbar spine, using a burst fracture cadaveric model. Methods: Seven fresh human cadaveric (T9-L3) spines were tested in normal conditions, after an iatrogenic T12 burst fracture, and successively after laminectomy and standard two rod pedicle screw stabilization (two level above and two below) and two different dual rod overlapping constructs. Pure moment torque was applied quasistatically, while 3D motion was measured optoelectronically. Thoracolumbar range of motion was measured during flexion, extension, left / right lateral bending, and left / right axial rotation. Results: All constructs significantly stabilized the simulated burst fracture in all modes of testing. There was no statistically significant difference, however, in the ability to restrict motion between the 3 different constructs, either from T10-L2, or across the fracture segment of T11-L1. Conclusions: There does not appear to be a biomechanical advantage to using dual rods over standard single rods for immediate fixation in an unstable segment. Whether dual rods protect the construct against long-term failure is not yet known.

No description available.

The purpose of this study was to determine whether magnetic resonance imaging (MRI) accurately predicts surgical findings in dachshund dogs with thoracolumbar intervertebral disc extrusions (TLDE). Sixteen dogs presenting with signs of acute TLDE took part in this investigation. MRI was performed on each dog. This was followed by decompressive surgery with the completion of an intra-operative questionnaire documenting the site of the extrusion and spatial distribution of the disc material for each dog. An independent veterinary radiologist evaluated each MRI study, measured and recorded the same parameters from images, utilising 3 sequences (T1-, T2-weighted and Short T1 Inversion recovery) without knowledge of the surgical findings. The imaging findings were compared with the intra-operative measurements. The specific intervertebral disc (IVD) space from which the material extruded and lateralization of the extruded disc material (EDM) were found to be similar between MRI and surgical observations. Longitudinal distribution of the EDM was described as being cranial, caudal or equally distributed in relation to the affected IVD. A Kappa test showed moderate agreement in longitudinal distribution between MRI and surgery. Circumferential distribution was recorded on transverse images and compared to surgical findings. Recorded distribution only coincided completely in 1 case, although the rest of the cases showed good overlap of findings between the MRI and intraoperative findings.Our results could not demonstrate a statistically significant difference between T1-, T2-weighted or STIR sequences when determining the length of the extruded mass in the vertebral canal. We found that when evaluating the absolute error and range of error for each sequence, that the T2-weighted sequence had a narrower range of errors and was thus more consistent in predicting the size of the lesion pre-surgically. MRI was validated as a very useful imaging modality for neurological disorders in dogs. / Dissertation (MMedVet)--University of Pretoria, 2007. / Companion Animal Clinical Studies / unrestricted

Master of Science / Department of Clinical Sciences / James K. Roush / Objective – To evaluate the value of thermography in a clinical setting for dogs with thoracolumbar disease. Animal Population – Thirteen client-owned short-haired Dachshunds presented to Kansas State University Veterinary Medical Teaching Hospital for paraparesis/paraplegia and diagnosed with thoracolumbar disease via myelogram/CT and confirmed during surgical decompression. Procedures - Thermal images were obtained with a hand-held infrared camera with a focal plane array uncooled microbolometer. Images were obtained after physical exam and client consultation and prior to any pre-anesthetic medications, approximately 30+ minutes after entering the hospital. Additional images were obtained in the same manner at 24 hour intervals following surgery until discharge. Six regions of interest (ROI) were identified and recorded. The ROIs identified were right and left thoracic, lumbar and pelvic regions. From each of these regions average temperatures were taken. Results - Temperatures in the pelvic region were significantly cooler (p< 0.001) over all days as compared to the thoracic and lumbar regions and to the overall mean temperature. The lumbar region temperature was significantly greater on day 0 as compared to thoracic and pelvic regions but was not significantly different on any of the following days. The thoracic temperatures were significantly greater than the lumbar and pelvic regions on day 2 but there was no significant difference on any of the preceding or following days. There was no significant difference between left and right on any of the days. There was a correlation of the pelvic region temperatures on day 3 in relation to the presenting neurological grade. Conclusion - Although there were varied heat patterns detected in dachshunds with IVDD, these patterns did not correlate with neurological grade, lesion site or lateralization of the lesion. Although there was a correlation between neurological grades and the pelvic region temperatures on day 3, this time period is unlikely to provide clinical utility. Clinical Relevance - The results of this study suggest that thermography is not a useful tool for the diagnosis or prognosis of thoracolumbar disease in dogs in a clinical setting.

Aufgrund der Tatsache, dass die Wahl der Therapie bei Wirbelfrakturen der Klasse A3 nach Magerl et al. (1994) weiterhin kontrovers diskutiert wird, wurden in dieser Arbeit die Patientenfälle der Abteilung Orthopädie und Unfallchirurgie der Universitätsmedizin Göttingen betrachtet, die im Zeitraum von 2008 bis 2013 eine Wirbelfraktur im Bereich der Brust- und Lendenwirbelsäule erlitten. Das gesamte Kollektiv umfasst 475 Patienten, von denen 266 männlich und 209 weiblich sind. Es wurden objektive Daten wie GDW, Kyphosewinkel und Wirbelkörperhöhenminderung zu fest definierten Zeitpunkten erhoben. Anhand dieser Daten konnte der Verlauf der Stabilität und sowohl der Korrekturgewinn durch die Therapie als auch der Korrekturverlust während der Nachsorge für die jeweiligen Therapiemethoden erfasst werden. Die Therapiemethoden, die hier verglichen werden, sind die konservative Therapie, die Kyphoplastie, die dorsale und die kombiniert dorsoventrale Stabilisierung. Die in der radiologischen Verlaufskontrolle erhobenen Parameter zeigen, dass bei Frakturen der Klassen A1 und A2, die als stabil gelten, die konservative Therapie zu einem guten Ergebnis führt. Bei A3- Frakturen, bei denen in der internationalen Literatur starke Unstimmigkeit darüber besteht, ob diese Frakturen als stabil oder instabil gelten und wie solche Frakturen im allgemeinen zu behandeln sind, bringt die operative Vorgehensweise klare Vorteile. Zudem können bei kombiniert dorsoventraler Operation noch stabilere Ergebnisse erzielt werden. Für die Rotationsfrakturen stellt sich heraus, dass nach der Entfernung des eingebrachten Osteosynthesematerials ein größerer Korrekturverlust eintritt. Abschließend lässt sich sagen, dass bei isolierten Berstungsfrakturen ohne Beteiligung des Bandapparates die Indikation für die kombiniert dorsoventrale Operation häufiger und frühzeitiger gestellt werden sollte. Außerdem sollte beachtet werden, dass bei instabilen Frakturen die Verlängerung der Tragezeit des Fixateurs einen positiven Einfluss auf den Korrekturerhalt hat.

No description available.

Low back pain is one of the most common and disabling musculoskeletal disorders worldwide and the third most common reason for surgery in the United States. The lower back, or lumbar region, supports most of the body's weight; it controls spinal movement and stability through the interaction between bones, nerves, muscles, ligaments, and fascia within the lumbar region. Any disorder of those tissues could cause low back pain (LBP); emerging evidence indicates that the thoracolumbar fascia (TLF) is the lower back's most pain-sensitive soft tissue structure. TLF consists of dense connective tissue separated by loose connective tissue, allowing TLF layers to pass easily during torso movement. A series of foundational studies found that patients enduring long-term low back pain have different TLF structures than those without LBP. Injuries may result in adhesions and fibrosis, which may cause adjacent dense connective tissue layers to lose independent motion, limiting movement and causing pain. LBP is diagnosed by investigating the patient's medical history to identify symptoms and then examining the patient to determine the cause of the pain. If the pain persists after diagnosis and treatment, further investigation is required; an ultrasound scan is used as the next step. Ultrasound (US) imaging is a non-invasive and instantaneous method to evaluate soft, connective tissue structures such as muscles, tendons, ligaments, and fascia. Even though measuring echo intensity helps evaluate the soft tissues, this method still has limitations in diagnosing LBP; 90 % of all LBP patients are diagnosed with non-specific LBP, referred to as pain with no definitive cause . An in-depth investigation of US images could potentially provide more specificity in identifying sources of LBP. By providing information about soft tissue structure, texture analysis could increase US images' diagnostic power. The texture of an ultrasound image is the variation of pixel intensities throughout the region of interest (ROI) that produces different patterns; texture analysis is an approach that quantifies the characteristic variation of pixel intensities within ROI to describe tissue morphological characteristics. First-order texture analysis, second-order texture analysis, and grey-level run length texture analysis are types of analysis that could be applied to quantify parameters that describe the features of the texture; the grey-level analysis is usually conducted in four directions of the texture. This study has four objectives; the first objective is to use first-order and second-order analysis to determine texture parameters and determine whether those parameters can differentiate between individuals with and without LBP. The second objective is to use grey level run length analysis to quantify texture parameters in four directions (0^°,45^°,90^°,135^°) and examine whether those parameters can differentiate between individuals with and without LBP. The third objective is to determine the correlation between the first, second, and run length parameters. The fourth objective is to explore how first-order, second order and grey level run length parameters are affected by US machine settings. A custom-written MATLAB program was developed to quantify first and second-order texture parameters and grey-level run length parameters. Using JMP software, each parameter was statistically compared between individuals with and without LBP. Among nine first- and second-order texture parameters, four showed statistically significant differences between individuals with and without LBP. Among 44 run-length parameters, 9 showed statistically significant differences between individuals with and without LBP. The current study also revealed some strong correlations between first, second, and run length parameters; it also shows that the US machine setting has minor effects on the three types of parameters. Although the present study was conducted on a relatively small sample size, the results indicate that one direction of grey level run length analysis and first and second-order texture analysis can differentiate between people with and without LBP. / Master of Science / Low back pain (LBP) is one of the most common and disabling musculoskeletal disorders worldwide and the third most common reason for surgery in the United States. Due to LBP's effect on mobility, it is one of the leading causes of absence from work, early retirement, and long-term disability payments. The thoracolumbar fascia (TLF), a connective tissue that stabilizes the trunk, pelvis, and spine, is considered the most sensitive tissue to LBP. LBP diagnosis is based on the patient's medical history to identify symptoms and then on an examination to determine the cause. If the pain persists after diagnosis and treatment, imaging is recommended as the next step. Ultrasound (US) imaging produces a cross-sectional image of the structure and has been used to compare TLF structure in people with and without LBP. Additional analyses must be done to increase US images' ability to diagnose LBP. In the current project, three types of analysis of US images were performed; first-order, second-order, and grey level run length analyses were performed to determine parameters for the images of the two groups of people; selected parameters were noted to distinguish between people with and without LBP.

Fraturas e luxações vertebrais decorrente de trauma consistem afecção neurológica frequente na prática clínica veterinária, sendo a coluna tóraco-lombar a mais comumente afetada em cães, e em muitos casos o tratamento cirúrgico é de eleição. Existem diversas técnicas propostas a realizar estabilização vertebral, entretanto, estudos em coluna tóraco-lombar não foram realizados para avaliar as propriedades biomecânicas de cada técnica. Baseado nisso, nossa pesquisa teve como objetivo fazer uma avaliação biomecânica comparando a força e rigidez promovidas por cinco diferentes técnicas de estabilização em coluna toracolombar (Pinos com Cimento Ósseo, Técnica Segmentar Modificada, Placa Bloqueada e Clamp Rod Internal Fixation utilizando parafusos monocorticais e bicorticais) frente às forças de compressão e flexão. Foram utilizadas 34 colunas tóraco-lombares de cães, divididas em cinco grupos. Para realização dos testes biomecânicos, foi utilizada a máquina de ensaios Kratos (modelo KE3000MP) e célula de carga de 100 kg. Para cada corpo de prova, três testes biomecânicos foram realizados, o controle, no segmento íntegro, após desarticulação de T13/L1 e após realização de uma das técnicas de estabilização propostas. Os dados foram exportados para análise estatística para o programa Statistical Package for the Social Sciences (SPSS) versão 18.0. Os resultados permitiram concluir que, apesar de não haver diferença estatística significativa, a Placa Bloqueada foi a técnica que promoveu maior rigidez e estabilidade nas vértebras lesionadas, seguida do CRIF bicortical, técnica Segmentar Modificada e Pinos e Cimento Ósseo. Estatisticamente, a Placa Bloqueada e o CRIF com parafusos bicorticais apresentaram maior rigidez e estabilidade em T13/L1 quando comparados com a técnica CRIF monocortical, que por sua vez, não alcançou rigidez necessária para adequada estabilização das vértebras. / Spinal fractures and luxations resulting from trauma consist frequent disorder in clinical veterinary practice, being thoracolumbar spine the region that is the most commonly affected in canines, thus in many cases surgical treatment is necessary. There are several proposed techniques of implants to perform spinal stabilization; however, few studies of the thoracolumbar spine were carried out to evaluate the biomechanical properties of each technic. Therefore, the objective of the present study is to analyze biomechanical effects comparing the strength and the stiffness promoted by five different technics of stabilization in the thoracolumbar spine (pin with bone cement, modified segmental stabilization, locking plate and clamp rod internal fixation) under compression and bending forces. In the study, thirty four thoracolumbar dog spines were used, dividing the specimens in five groups. In order to perform the biomechanical tests, it was used a Kratos testing machine (model KE3000MP) and loading cell of 100 Kg. Each body of proof was submitted to three biomechanical tests, the control, in the segment intact, after disarticulation of the T13/L1 and after the realization of one of the proposed technics. Data were exported to statistical analyses to the Statistical Package for the Social Sciences (SPSS) version 18.0. The results led to the conclusion that despite there was no statistically significant difference between the techniques, the Locking Plate was the technique that promoted greater rigidity and stability in the injured vertebrae, followed by the Clamp Rod Internal Fixation bicortical, Modified Segmental Instrumentation and Pins with Bone Cement. Statistically, the locking plate and the Clamp Rod Internal Fixation with bicortical pins showed more stiffness and stability in T13/L1 when compared to the Clamp Rod Internal Fixation monocortical, which did not achieved the adequate rigidity for the stabilization of the vertebrae.

Fraturas e luxações vertebrais decorrente de trauma consistem afecção neurológica frequente na prática clínica veterinária, sendo a coluna tóraco-lombar a mais comumente afetada em cães, e em muitos casos o tratamento cirúrgico é de eleição. Existem diversas técnicas propostas a realizar estabilização vertebral, entretanto, estudos em coluna tóraco-lombar não foram realizados para avaliar as propriedades biomecânicas de cada técnica. Baseado nisso, nossa pesquisa teve como objetivo fazer uma avaliação biomecânica comparando a força e rigidez promovidas por cinco diferentes técnicas de estabilização em coluna toracolombar (Pinos com Cimento Ósseo, Técnica Segmentar Modificada, Placa Bloqueada e Clamp Rod Internal Fixation utilizando parafusos monocorticais e bicorticais) frente às forças de compressão e flexão. Foram utilizadas 34 colunas tóraco-lombares de cães, divididas em cinco grupos. Para realização dos testes biomecânicos, foi utilizada a máquina de ensaios Kratos (modelo KE3000MP) e célula de carga de 100 kg. Para cada corpo de prova, três testes biomecânicos foram realizados, o controle, no segmento íntegro, após desarticulação de T13/L1 e após realização de uma das técnicas de estabilização propostas. Os dados foram exportados para análise estatística para o programa Statistical Package for the Social Sciences (SPSS) versão 18.0. Os resultados permitiram concluir que, apesar de não haver diferença estatística significativa, a Placa Bloqueada foi a técnica que promoveu maior rigidez e estabilidade nas vértebras lesionadas, seguida do CRIF bicortical, técnica Segmentar Modificada e Pinos e Cimento Ósseo. Estatisticamente, a Placa Bloqueada e o CRIF com parafusos bicorticais apresentaram maior rigidez e estabilidade em T13/L1 quando comparados com a técnica CRIF monocortical, que por sua vez, não alcançou rigidez necessária para adequada estabilização das vértebras. / Spinal fractures and luxations resulting from trauma consist frequent disorder in clinical veterinary practice, being thoracolumbar spine the region that is the most commonly affected in canines, thus in many cases surgical treatment is necessary. There are several proposed techniques of implants to perform spinal stabilization; however, few studies of the thoracolumbar spine were carried out to evaluate the biomechanical properties of each technic. Therefore, the objective of the present study is to analyze biomechanical effects comparing the strength and the stiffness promoted by five different technics of stabilization in the thoracolumbar spine (pin with bone cement, modified segmental stabilization, locking plate and clamp rod internal fixation) under compression and bending forces. In the study, thirty four thoracolumbar dog spines were used, dividing the specimens in five groups. In order to perform the biomechanical tests, it was used a Kratos testing machine (model KE3000MP) and loading cell of 100 Kg. Each body of proof was submitted to three biomechanical tests, the control, in the segment intact, after disarticulation of the T13/L1 and after the realization of one of the proposed technics. Data were exported to statistical analyses to the Statistical Package for the Social Sciences (SPSS) version 18.0. The results led to the conclusion that despite there was no statistically significant difference between the techniques, the Locking Plate was the technique that promoted greater rigidity and stability in the injured vertebrae, followed by the Clamp Rod Internal Fixation bicortical, Modified Segmental Instrumentation and Pins with Bone Cement. Statistically, the locking plate and the Clamp Rod Internal Fixation with bicortical pins showed more stiffness and stability in T13/L1 when compared to the Clamp Rod Internal Fixation monocortical, which did not achieved the adequate rigidity for the stabilization of the vertebrae.