Relations of the soft structures of the posterior mediastinum in the scoliotic spine

In 20 dissections of scoliotic cadavers, the changes of the structures in the posterior mediastinum in relation to the spine were found to be as follows. The aorta persistently followed and adhered to the abnormal curves of the spine. The azygos vein and the thoracic duct followed the aorta closely in its changes. The sympathetic trunk and the greater splanchnic nerves likewise followed the changes in the curvature of the scoliotic spine, but they were often disturbed in their course by vertebral osteophytes and by hyperostoses due to arthritis of the costovertebral joints. The esophagus preserved its normal straight course, unaffected by the scoliotic curves.     

Clinico-radiological analysis of surgically treated sciatica cases

An analysis included 187 patients treated surgically for sciatica due to vertebral disk pathologies. Nerve roots compression was noted in all examined patients, including 54% of left-sided compression, 43% of right-sided, and 3% of bilateral compression. Majority of cases involved nerve roots in L5 (51%) and L4 (36%) segments of the spine. Intra-operationally 139 (87%) out of 160 abnormal radiculographies have been confirmed. Disk disease was diagnosed in 11 patients despite the lack of changes in radiculography. It may be explained by the extremely lateral prolapse of the vertebral disk. Long term course of the disease and clinical picture decide on surgery in such cases.     

Capacities of angiography in the imaging of abnormal changes in the cerebral arteries

The study was based on the angiographic examination of 233 patients with prior subarachnoidal hemorrhage. Angiographic study was performed using the Seldinger technique by contrasting both carotid and vertebral arteries. Twenty-three patients in whom arterial aneurysm had been detected by digital subtraction angiography underwent 3D angiography. The authors improved a procedure during which a contrast agent was manually injected into the internal carotid or vertebral artery, by using a 20-ml disposal syringe with controlled maximum developed pressure and flow increase rate up to 2.0 ml/sec for 4-5 sec during rotary scanning and the administration of the radiocontrast medium was stopped when an image appeared on the monitor at 190 degrees (190.0, 200.0) C-arm rotation. This procedure could decrease significantly the volume of the administered contrast agent from 18 to 8 (8.0, 10.0) ml and reduce the time of radiation exposure from 6 to 4 (4.0, 5.0) sec. The improved angiographic modes for the right vertebral and right carotid artery could visualize pathological changes in these arteries and establish a relationship, namely: due to degenerative dystrophic processes of the cervical spine there is a tendency for higher pathological changes in the vertebral arteries with an increased stage of osteochondrosis in the cervical spine (R = 0.95; p = 0.014).     

Severe neurologic manifestations from cervical spine instability in spondylo-megaepiphyseal-metaphyseal dysplasia

Spondylo-megaepiphyseal-metaphyseal dysplasia (SMMD; OMIM 613330) is a dysostosis/dysplasia caused by recessive mutations in the homeobox-containing gene, NKX3-2 (formerly known as BAPX1). Because of the rarity of the condition, its diagnostic features and natural course are not well known. We describe clinical and radiographic findings in six patients (five of which with homozygous mutations in the NKX3-2 gene) and highlight the unusual and severe changes in the cervical spine and the neurologic complications. In individuals with SMMD, the trunk and the neck are short, while the limbs, fingers and toes are disproportionately long. Radiographs show a severe ossification delay of the vertebral bodies with sagittal and coronal clefts, missing ossification of the pubic bones, large round "balloon-like" epiphyses of the long bones, and presence of multiple pseudoepiphyses at all metacarpals and phalanges. Reduced or absent ossification of the cervical vertebrae leads to cervical instability with anterior or posterior kinking of the cervical spine (swan neck-like deformity, kyknodysostosis). As a result of the cervical spine instability or deformation, five of six patients in our series suffered cervical cord injury that manifested clinically as limb spasticity. Although the number of individuals observed is small, the high incidence of cervical spine deformation in SMMD is unique among skeletal dysplasias. Early diagnosis of SMMD by recognition of the radiographic pattern might prevent of the neurologic complications via prophylactic cervical spine stabilization.     

Carpal tunnel syndrome,humeral epicondylitis,and the cervical spine: a study of clinical and dimensional relations.

Forty-three patients with idiopathic carpal tunnel syndrome, confirmed by nerve conduction studies and treated by surgery, were compared clinically and radiologically with 43 age- and sex-matched control patients. Patients with carpal tunnel syndrome had a significantly greater prevalence of lateral humeral epicondylitis (tennis elbow) (33%) than controls (7%). Randomised reading of the cervical spine radiographs in ignorance of the groups to which they belonged showed no significant difference in the prevalence of either intervertebral disc degeneration or intraforaminal osteophyte protruion using conventional grading methods. Measurement of the minimum anteroposterior diameter of the cervical spinal canal, the anteroposterior diameters of the cervical vertebral bodies, and the ratio of intervertebral disc height to adjacent vertebral body height in the cervical spine, however, showed a consistent trend to smaller measurements in the carpal tunnel group. Differences were significant at several vertebral levels in each of these dimensions. The narrowing of the intervertebral discs relative to the vertebral bodies in patients with carpal tunnel syndrome may indicate connective tissue changes, which might also occur in the common extensor origin at the elbow or in the contents of the carpal tunnel.     

20例葡萄球菌感染所致化脓性脊柱炎的临床特征分析

为探讨葡萄球菌感染所致化脓性脊柱炎(pyogenic vertebral osteomyelitis,PVO)的临床及影像学特征,本研究回顾性分析了2009年1月-12月上海交通大学附属第六人民医院感染病科收治的20例葡萄球菌感染所致PVO患者的临床特征、实验室检查指标、影像学资料及治疗效果。结果显示,20例PVO患者中金黄色葡萄球菌感染较为多见,85%患者病变在腰椎,50%患者白细胞计数升高,13例发热(65%),12例(60%)出现椎旁脓肿,所有患者C反应蛋白、红细胞沉降率、铁蛋白均升高。计算机断层扫描(computed tomography,CT)平扫示感染椎体骨质破坏;磁共振成像(magnetic resonance imaging,MRI)示病变椎体及椎间盘破坏区异常信号灶,增强后可见明显强化;单光子发射计算机断层扫描(emission computed tomography,ECT)示病变椎体不均匀放射性摄取增高。金黄色葡萄球菌对青霉素耐药率达77.8%。12例椎旁脓肿患者经CT引导下穿刺置管引流加敏感抗生素治疗,临床结局良好。结果提示,金黄色葡萄球菌是葡萄球菌感染所致PVO的主要致病菌,其对青霉素普遍耐药,炎症指标和影像学检查可用于疗效评估及随访,内科保守治疗对PVO有效。     

A videofluoroscopy-based tracking algorithm for quantifying the time course of human intervertebral displacements

The motions of individual intervertebral joints can affect spine motion, injury risk, deterioration, pain, treatment strategies, and clinical outcomes. Since standard kinematic methods do not provide precise time-course details about individual vertebrae and intervertebral motions, information that could be useful for scientific advancement and clinical assessment, we developed an iterative template matching algorithm to obtain this data from videofluoroscopy images. To assess the bias of our approach, vertebrae in an intact porcine spine were tracked and compared to the motions of high-contrast markers. To estimate precision under clinical conditions, motions of three human cervical spines were tracked independently ten times and vertebral and intervertebral motions associated with individual trials were compared to corresponding averages. Both tests produced errors in intervertebral angular and shear displacements no greater than 0.4° and 0.055 mm, respectively. When applied to two patient cases, aberrant intervertebral motions in the cervical spine were typically found to correlate with patient-specific anatomical features such as disc height loss and osteophytes. The case studies suggest that intervertebral kinematic time-course data could have value in clinical assessments, lead to broader understanding of how specific anatomical features influence joint motions, and in due course inform clinical treatments.     

Comparison of original and modified scoring systems for inflammatory changes in the vertebral column in patients with spondyloarthritis from magnetic resonance imaging data

Magnetic resonance imaging of all sections of the vertebral column was carried out in 90 patients with spondyloarthritis to calculate inflammatory changes, by using various scoring systems. The modified scoring systems were found to significantly increase the detection rate of abnormalities in the lumbar spine as compared to the original Berlin score and that in the thoracic and lumbar sections as compared with the original Canadian score.     

The cerebrospinal venous system: anatomy, physiology, and clinical implications

There is substantial anatomical and functional continuity between the veins, venous sinuses, and venous plexuses of the brain and the spine. The term "cerebrospinal venous system" (CSVS) is proposed to emphasize this continuity, which is further enhanced by the general lack of venous valves in this network. The first of the two main divisions of this system, the intracranial veins, includes the cortical veins, the dural sinuses, the cavernous sinuses, and the ophthalmic veins. The second main division, the vertebral venous system (VVS), includes the vertebral venous plexuses which course along the entire length of the spine. The intracranial veins richly anastomose with the VVS in the suboccipital region. Caudally, the CSVS freely communicates with the sacral and pelvic veins and the prostatic venous plexus. The CSVS constitutes a unique, large-capacity, valveless venous network in which flow is bidirectional. The CSVS plays important roles in the regulation of intracranial pressure with changes in posture, and in venous outflow from the brain. In addition, the CSVS provides a direct vascular route for the spread of tumor, infection, or emboli among its different components in either direction.     

Epidemiology of osteoporotic fractures

Osteoporosis constitutes a major public health problem through its association with age-related fractures. These fractures typically occur at the hip, spine and distal forearm. It has been estimated that the lifetime risk of a hip fracture in white women is 17.5%, with a comparable risk in men of 6%. Hip fractures lead to an overall reduction in survival of about 15% (relative or observed/expected survival at 5 years of 0.83), and the majority of excess deaths occur within the first 6 months following the fracture. Such fractures are also associated with considerable morbidity. Although all vertebral deformities do not come to clinical attention, the lifetime risk of clinically diagnosed vertebral fractures is about 15% in white women. Vertebral fractures tend to be associated with back pain and kyphosis, and also with an impairment of survival, though this is likely to be due to clustering of comorbidity. About one-quarter of clinically diagnosed vertebral deformities result in hospitalization.     

DR全脊柱摄影技术在脊柱侧弯中的应用与优势

目的:探讨数字化X线摄影(DR)全脊柱摄像技术在脊柱侧弯中的应用和优势。方法:收集2012年2月至2013年6月于本院进行治疗的脊柱侧弯病例88例,应用数字化X线摄影(DR)技术对脊柱由上至下进行正位和侧位的扫描,均进行3次曝光,每两次曝光间隔均为9秒,曝光后通过图像拼接技术将患者脊柱图像进行拼接和重叠,形成全景图像,对全部患者的图像质量进行观察和评估。结果:所有入选病例中有84例患者图像清晰显示了脊柱侧弯的方向和角度、椎体和椎间隙、对称的椎弓根、根间距及对脏器的影响程度。其中1例因运动不合作出现伪影,3例曝光不足。全脊柱图像质量正位优秀率为92.43%,侧位优秀率为85.92%;全脊柱图像拼接正位优秀率为83.44%,侧位优秀率为86.58%。结论:数字化X线摄影(DR)技术应用上方便快捷,患者配合时间较短,图像质量较好,能够满足临床医生进行诊断和治疗,有助于患者预后康复情况的评估,值得在临床诊断中推广应用。     

Treatment of osteoporosis with human parathyroid peptide and observations on effect of sodium fluoride.

OBJECTIVE--To evaluate the need for a randomised study of treatment of spinal osteoporosis with human parathyroid peptide in the secondary prevention of crush fractures; to study the effect of human parathyroid hormone peptide 1-34 plus sex hormones on vertebral body cancellous bone; and, separately, to determine the effect of relatively low doses of sodium fluoride plus calcium on spinal bone mineral density. DESIGN--Open study of patients with primary or postmenopausal osteoporosis. All patients had serial bone densitometry of the spine by quantitative computed tomography and dual photon absorptiometry as well as serial densitometry of the radial midshaft (cortical) and radial distal (trabecular) bone by quantitative computed tomography. Changes in the spinal bone not forming the spongiosa of the vertebral bodies ("cortical" bone) were determined from the difference between the two axial measurements, after correction to the same units of measurement. SETTING--Northwick Park Hospital and Medical Research Council Clinical Research Centre. PATIENTS--24 Patients who fulfilled the conventional criteria for type 1 (vertebral) osteoporosis not secondary to recognised causes other than sex hormone deficiency and with at least one crush or wedge vertebral fracture and a spinal bone density (quantitative computed tomography) less than 80 mg/cm3 or two or more fractures. Twelve patients received human parathyroid peptide and 12 sodium fluoride; they were not randomised. MAIN OUTCOME MEASURES--Trends in axial and peripheral bone mass values determined by linear, time dependent regression analyses. RESULTS--The patients receiving the peptide showed a substantial increase in vertebral spongiosa (mean 25.6 mg/cm2 two years after the start of treatment). No significant changes were seen in spinal cortical or radial bone density. The patients receiving sodium fluoride showed roughly equal increases in cancellous and cortical bone over the same period (mean increase in vertebral spongiosa 16.1 mg/cm3). No significant changes were seen in radial bone. CONCLUSIONS--Treatment of postmenopausal women with human parathyroid peptide selectively increases spinal cancellous bone density by amounts that may prove useful in secondary prevention. Peptide treatment should now be tested in a randomised study in which the important end point is prevention of fractures as the usefulness of sodium fluoride in this context is doubtful.     

Increases of calcium and magnesium and decrease of iron in human posterior longitudinal ligaments of the cervical spine with aging

To elucidate compositional changes of ligaments with aging, the authors investigated age-related changes of elements in the posterior longitudinal ligaments (PLLs) by inductively coupled plasma—atomic emission spectrometry. After the ordinary dissection, PLLs were resected from the subjects ranging in age from 65 to 95 yr. The PLLs of the cervical spine were resected between the fourth and fifth cervical vertebrae, the PLLs of the thoracic spine between the fifth and seventh thoracic vertebrae, and the PLLs of the lumbar spine between the second and third lumbar vertebrae. Calcium and magnesium increased progressively with aging in the PLLs of the cervical spine, but they did not increase with aging in the PLLs of the thoracic and lumbar spine. In contrast, iron decreased gradually with aging in the PLLs of the cervical spine. Regarding the relationships among elements, significant correlations were found among the contents of calcium, phosphorus, magnesium, and sodium in the PLLs of the cervical spine.     

The basis for spinal manipulation: Chiropractic perspective of indications and theory

It is reasonable to think that patients responding to spinal manipulation (SM), a mechanically based therapy, would have mechanical derangement of the spine as a critical causal component in the mechanism of their condition. Consequently, SM practitioners routinely assess intervertebral motion, and treat patients on the basis of those assessments. In chiropractic practice, the vertebral subluxation has been the historical raison d'etre for SM. Vertebral subluxation is a biomechanical spine derangement thought to produce clinically significant effects by disturbing neurological function. This paper reviews the putative mechanical features of the subluxation and three theories that form the foundation for much of chiropractic practice. It concludes with discussion of subluxation as an indicator for SM therapy, particularly from the perspective that subluxation may be one contributory cause of ill-health within a "web of causation".     

脊柱微创手术对骨质疏松性椎体骨折的疗效及安全性分析

目的：探究脊柱微创手术对骨质疏松性椎体骨折的疗效及安全性。方法：选取我院骨科于2008年3月-2011年3月收治的72例骨质疏松性椎体压缩骨折进行分组治疗,观察组（n=36）接受脊柱微创手术,对照组（n=36）接受传统保守治疗,对比两组患者术后生活情况、疗效及观察组术后并发症。结果：两组患者治疗前压缩椎体高度/病椎上下椎体高度和之半、椎体后凸Cobb角及骨块侵占椎管比率无明显统计学差异（P〉0.05）,治疗后上述指标均显著改善,观察组改善程度较对照组更为明显（P〈0.05）;观察组治疗优良率91.7%,对照组为58.3%,其中6例患者因症状加重转为手术治疗,观察组治疗效果明显优于对照组（P〈0.05）;观察组患者术后未出现内植物松动、断裂、形成假关节、截瘫等并发症,钉棒内固定系统坚强可靠;两组患者均获得有效随访,平均随访时间（9.7±2.5）个月,观察组平均下地时间（4.1±1.7）d,肌力恢复时间（3.7±0.8）周,Frankel神经功能均恢复E级;对照组平均下地时间（7.4±3.0）d,肌力恢复时间（5.9±1.4）周,Frankel神经功能评分：D级6例,E级30例。结论：脊柱微创手术能够有效改善骨质疏松性椎体骨折患者骨骼力学变化,可有效保证其术后恢复情况,疗效较好,且不会引发严重并发症,值得临床广泛推广。     

Ossification of the posterior longitudinal ligament]

The authors described 21 patients aged 37 to 83 with ossification of the posterior longitudinal ligament (10 with ischemic myelopathy, 6 with aftermaths of a trauma of the cervical spine, and 5 with the radicular syndrome on the basis of vertebral osteochondrosis. X-ray signs of three types of ossification of the posterior longitudinal ligament were defined and specified: linear, curved and mixed. The linear type was more frequently observed in the cervical spine whereas the curved type was more frequent in the lumbar spine.     

Ageing,Neuronal Connectivity and Brain Disorders: An Unsolved Ripple Effect

Cognitive decline associated with ageing and age-related disorders emerges as one of the greatest health challenges in the next decades. To date, the molecular mechanisms underlying the onset of neuronal physiological changes in the central nervous system remain unclear. Functional MRI and PET studies have indicated the decline in working memory performance in older adults. Similarly, age-related disorders, such as Alzheimer’s disease, are associated with changes in the prefontral cortex and related neural circuitry, which underlines the decline of integrative function between different brain regions. This is mainly attributed to the loss of synaptic connectivity, which is a feature commonly observed in neurodegenerative disorders. In humans, the morphological and functional changes in neurons, such as reduction of spine numbers and synaptic dysfunction, precede the first signs of cognitive decline and likely contribute to pathology progression. Thus, a new scenario emerges in which apparently unrelated diseases present common features, such as the remodelling of neuronal circuitries promoted by ageing. For many years, ageing was considered a process of slow deterioration triggered by accidental environmental factors. Conversely, it is now evident that ageing is a biological process tightly controlled by evolutionary highly conserved signalling pathways. Importantly, genetic mutations that enhance longevity significantly delay the loss of synaptic connectivity and, therefore, the onset of age-related brain disorders. Accordingly, tweaking ageing might be an attractive approach to prevent cognitive decline caused by age-related synaptic dysfunction.     

年龄与性别相关的大鼠视皮层树突形态变化

衰老会导致视觉功能的退化,但其潜在的神经机制尚不清楚。通过改良Golgi-Cox染色法,测定了青年雄性、青年雌性及老年雄性与老年雌性4组共20只大鼠视皮层的树突长度和树突棘密度,以研究年龄与性别对视皮层树突形态的影响。结果显示青年雄性大鼠视皮层顶树突、基树突、树突总长度均明显高于青年雌性大鼠,但这种性别差异在老年雌雄组之间并不显著,可能是由于在雄性组之间存在着明显的年龄相关性树突长度减少而在雌性组之间并不存在。青年雄性组的树突棘密度要明显高于青年雌性组,尽管衰老导致了青年雄、雌性组的树突棘密度均明显降低,但老年雄、雌性组的树突棘密度并无显著差异,这可能是由于雄性组的年龄相关性树突密度降低程度要远大于雌性组。由此可见衰老确实能导致视皮层树突形态的退化,这可能是老年性视觉功能衰退的潜在神经机制,但这种退化可能具有一定的性别差异。     

Paleoepidemiology of a central California prehistoric population from Ca-Ala-329: II. Degenerative disease

Degenerative lesions are scored and frequencies of involvement are computed for a skeletal collection from Ca-Ala-329, a prehistoric site on the southeastern side of San Francisco Bay, dating from 500 A.D. up to European contact. A large earthmound site, excavations conducted there by San Jose State University retrieved close to 300 burials. For this epidemiological analysis, reasonably complete and aged skeletons representing 77 adult females and 90 adult males are available. Degenerative changes are scored macroscopically in an ordinal fashion for the large fibro-cartilagenous joints between adjacent vertebral bodies (vertebral osteophytosis) as well as the small apophyseal articulations of the spine. In addition, in the peripheral skeleton degenerative changes are scored in the temporo-mandibular, shoulder, elbow, hip, and knee joints as well as the small articulations of the hands and feet. The most common degenerative changes in the spine are seen between the vertebral bodies of the lower lumbar region. In the peripheral skeleton the highest involvement of degenerative disease is seen in the hands and feet. Compared to other relevant osteological samples, this group of hunting-gathering California Indians shows more degenerative changes than settled agriculturists (from Pecos Pueblo, New Mexico) but substantially less frequent involvement than in arctic hunters (Alaskan Eskimos).     

De novo achondroplasia causing four consecutive unsuccessful pregnancies: a case report

ABSTRACT: INTRODUCTION: The incidence of achondroplasia is very low, and the birth of two or more consecutive babies with achondroplasia to unaffected parents is a rarity. We report a rare case of recurrent achondroplasia in babies of unaffected parents. CASE PRESENTATION: A 29-year-old Nigerian Igbo woman who has had three consecutive dead achondroplastic babies presented at a gestational age of 31 weeks with a two-hour history of drainage of liquor and vaginal bleeding. Neither she nor her husband had features of achondroplasia. Fundal height was compatible with the gestational age. Fetal heart activity was present. An abdominal ultrasound examination showed a viable fetus with short long bones, oligohydramnios, and a fundal placenta with a small retroplacental blood clot. Our patient was stabilized and had an emergency Cesarean section for grade 1 abruptio placentae. A live male baby with Apgar scores of 4 at one minute and 5 at 10 minutes was delivered. The baby had classic features of achondroplasia and died shortly after birth. CONCLUSIONS: To the best of our knowledge, this is the first reported case of recurrent achondroplasia in siblings of unaffected parents in Nigeria. Management is challenging, and the outcomes of future pregnancies appear bleak. However, proper counseling and follow-up are needed. There is also a need to establish preconception clinics and facilities for prenatal genetic diagnosis and gene therapy in developing countries.