Study design: This was a retrospective cohort study. Background: The objective of this study was to investigate the associations between the region of endplate injury and long-term transition outcomes in patients with thoracolumbar spine fractures. Methods: A total of 452 patients with thoracolumbar spine fractures who underwent internal fixation between October 2014 and October 2020 and were examined by preoperative and postoperative CT 3D and MRI were included in this retrospective study. The effect of the region of endplate injury on the transition outcome of patients in terms of long-term spine height, Cobb angle and vertebral morphology was investigated. Result: In the short term the rate of surgical improvement was greater in TE, with no significant difference between IRE and ORE(p>0.05). However, both IRE and TE showed significant loss of intervertebral space height and Cobb angle, while the prognostic outcome of ORE was significantly better than that of IRE and TE in the long-term transition (p<0.05). Conclusion:Injuries to the inner 1/3 of the endplate are more likely to lead to a poor prognosis in patients with thoracolumbar fractures compared to the outer 2/3. However, more relevant studies are needed to confirm this in the future.
Background: Although ACDF is widely used in the treatment of cervical degenerative diseases, it cannot achieve adequate decompression for patients with severe intervertebral space stenosis or osteophyte hyperplasia. This study reports a modified technique of ACDF called anterior intervertebral osteotomy and fusion (AIOF) for the treatment of patients with this type of cervical spondylosis and compares its therapeutic effects with those of ACDF. Methods: A total of 121 patients with symptomatic cervical spondylosis who had failed to respond to conservative treatment at least for 3 months were included in the study. The patients were divided into two groups and treated with AIOF and ACDF, respectively. The effects of surgical treatment were analyzed by JOA score, VAS score, spinal canal area, spinal cord diameter and Cervical lordosis. Result: 54 patients (44.6%) were included in the AIOF group and 67 patients (55.4%) were included in the ACDF group. AIOF group and ACDF group showed no significant differences in age, sex, follow-up period, blood loss. However, the long-term prognosis of patients in AIOF group was significantly better than that in ACDF group in terms of JOA score, VAS score, spinal canal area, diameter of spinal cord and cervical lordosis (p<0.05). Conclusion: The osteotomy of the Luschka joint and posterior edge of the vertebral body in AIOF can achieve the decompression of nerve roots and spinal cord safely and effectively. It is a better choice than ACDF for patients with severe intervertebral space stenosis and osteophyte hyperplasia.
Objectives: To describe a simplified classification scheme for endplate injury morphology based on T2-weighted magnetic resonance imaging and to examine possible associations between endplate injury morphology and vertebral space and other variables such as Type of fracture and disc degeneration in a group of patients with thoracolumbar fractures. Methods: CT and MRI images of 432 patients with thoracolumbar spine fractures were collected and collated. All injury endplates were classified as “mild injury”, “moderate injury” and “severe injury”. The association between the injury morphology of the endplate and the long-term transition outcome of the patients was demonstrated in the studied population. Results: Most moderate injuries to the endplate (fissure-type injury) (77.8%) and severe injuries (irregular depression-type injury, schmorl's node-type injury) (95.3%) resulted in significant disc degeneration in the distant future (p < 0.001). They also showed significant differences in the height of the anterior margin of the injured spine (p < 0.05) and the intervertebral space height index (p < 0.05). The consistency of observers in the present study was expressed as Kappa ≈ 0.84, Preop (ICC,0.855 to 0.988), Postop (ICC,0.822 to 0.981) and F/U (ICC,0.870 to 0.990). Conclusions: The current study shows that although the area of injury of endplate fissure-type injury is small preoperatively, can cause severe degeneration of the disc in long-term transition, resulting in greater impact of the intervertebral space height and angle.
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