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To evaluate the clinical efficacy of ZhuZheng robot-assisted versus C-arm fluoroscopy-guided percutaneous pedicle screw fixation (PPSF) in the treatment of thoracolumbar burst fractures. A retrospective analysis was conducted on 86 patients with thoracolumbar burst fractures treated at our institution between March 2022 and August 2023. The cohort included 46 males and 40 females, aged 27 to 69 years. Patients were assigned to either the robot-assisted group ( n  = 41) or the conventional C-arm fluoroscopy group ( n  = 45) according to intraoperative navigation method. Baseline characteristics, including gender ratio and body mass index (BMI), were comparable between the two groups ( P  > 0.05). All patients underwent segmental fixation. Intraoperative parameters such as fluoroscopy frequency, operative time, and estimated blood loss were recorded. The accuracy of screw placement was assessed using postoperative CT at day 3 and graded according to the Gertzbein-Robbins scale. Pain was evaluated using the Visual Analogue Scale (VAS) preoperatively and at 1 day, 3 days, and 1 month postoperatively. Radiological assessments included Cobb angle and anterior vertebral height ratio at baseline, 3 days, 1 month, and 6 months postoperatively. Statistical analyses were performed using the t-test and Mann-Whitney U test. The robot-assisted group had significantly shorter operative time, reduced intraoperative blood loss, lower radiation dose, and fewer fluoroscopy exposures compared to the conventional group (all P  < 0.05). No perioperative complications occurred in either group during follow-up. The screw placement accuracy (grades A + B) was significantly higher in the robot-assisted group (98.4%, 242/246) than in the conventional group (90.4%, 244/270; P  < 0.05). VAS pain scores at postoperative day 1 and day 3 were significantly lower in the robot-assisted group; no significant difference was observed at 1 month. There were no significant intergroup differences in the postoperative Cobb angle or anterior vertebral height ratio at any time point ( P  > 0.05). Robot-assisted orthopedic surgery demonstrates significant advantages in improving screw placement accuracy, reducing intraoperative blood loss, shortening operative time, and minimizing radiation exposure and fluoroscopy frequency, thereby offering improved clinical outcomes in the management of thoracolumbar burst fractures.

This research was developed to accurately evaluate the unstable fractures of thoracolumbar before and after surgery and discuss the treatment timing and methods. Three-dimensional (3D) finite element method was adopted to construct the T12-L5 segment model of human body. The efficiency of percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP), two commonly used internal fixation procedures, was retrospectively compared. A total of 150 patients with chest fracture who received PKP or PVP surgery in our hospital, and 104 patients with the same symptoms who received conservative treatment were collected and randomly rolled into PVP group (75 cases), PKP group (75 cases), and control group (104 cases). Visual analog scale (VAS) score and Oswestry disability index (ODI) of patients were collected before and after surgery and 2, 12, and 24 months after surgery. Then, the anterior and central height of the patient’s cone and the kyphosis angle were calculated by X-ray. Lumbar minimally invasive fusion system and lumbar pedicle screw rod system were established by computer-aided design (CAD), and the biomechanical characteristics were analyzed. The results showed that there was no substantial difference in VAS score and ODI score between PKP and PVP (P>0.05), but they were higher than those of the control group (P<0.05). The anterior edge and middle height of vertebra in the two groups were higher than those in control group (P<0.05), and the increase in PKP group was more substantial (P<0.05). The kyphosis of the two groups was smaller than that of the control group (P<0.05), and the decrease of the kyphosis of the PKP group was more substantial (P<0.05). In summary, the thoracolumbar segment model established by 3D finite element method was an effective model, and it was verified on patients that both PKP and PVP could achieve relatively satisfactory efficacy. The implantation of the new internal fixation system had no obvious effect on the lumbar movement. This work provided a novel idea and method for the treatment of senile thoracolumbar unstable fracture, as well as experimental data of biomechanics for the operation of senile unstable fracture.

Background: The aim of this study was to determine the effect of interbody cages inserted via the posterior approach on segmental lordosis in the setting of preoperative lordotic versus kyphotic/neutral disc spaces in patients with lumbar degenerative spondylolisthesis (LDS). Methods: Five consecutive years of retrospective data from a Canadian Spine Outcomes and Research Network (CSORN) prospective study on the assessment and management of patients with LDS were collected from 2 contributing centres of consecutively enrolled patients. Patients were analyzed preoperatively and at 12-month follow-up with standing lumbar radiographs. At the spondylolisthesis level, segmental lumbar lordosis (SLL) was measured from the upper end plate of the proximal vertebra to the lower end plate of the distal vertebra. Patients were stratified into 4 groups on the basis of the index level disc angle and the type of procedure performed: preoperative lordotic posterolateral fusion (PLF) (group 1), preoperative neutral/kyphotic PLF (group 2), preoperative lordotic interbody fusion (IF) (group 3) and preoperative neutral/kyphotic IF (group 4). Results: A total of 100 of 111 (90 %) patients completed 1-year follow-up. Twenty-three patients underwent PLF with 18 (18%) in group 1 and only 5 (5%) in group 2. Eighty-eight patients underwent IF, with 40 (40%) in group 3 and 48 in group 4 (48%). Among patients with preoperatively lordotic disc angles, group 3 patients had a greater magnitude of worsening in SLL than group 1 patients, with significant differences persisting at 1 year (mean difference 2.3°, 95% confidence interval 0.3 to 4.3, p = 0.029). Patients in group 4 were more likely to achieve improvement in SLL at 1 year than those in group 3 (67% v. 44%, p = 0.046), with similar mean improvement magnitude between groups 3 and 4 (-1.1, 95% CI -3.7 to 1.6, p = 0.42). Conclusion: In the setting of an index-level preoperative lordotic disc angle, the magnitude of segmental lordosis worsening was more pronounced when an interbody cage was used versus PLF. Patients who have kyphotic or neutral disc space preoperatively are more likely to gain lordosis when an interbody cage is used.

Objectives: Percutaneous vertebroplasty is frequently used to treat osteoporotic vertebral compression fractures (OVCFs) due to its low surgical risks. In this study, we tried to determine the early and late effects of single-pedicle and double-pedicle PVPs on the coronal balance of the vertebrae. Methods: This study evaluated 95 OVCF patients treated with PVP between 2008 and 2023. Of these patients, 36 were treated with bilateral and 59 with unilateral vertebroplasty. The Coronal Cobb angle, coronal segmental Cobb angle, and coronal balance of the vertebrae were measured in preoperative, early postoperative, and 6-month postoperative radiographs. The results were compared between the two groups and the effects of single or double pedicle procedure on these values were analyzed. Results: Two study groups were formed, consisting of a total of 95 patients. The mean age was 69.1 years. Fourty-nine patients were female and 46 were male. No significant difference was detected between the groups regarding gender and age. When the data obtained in the preoperative and early postoperative period in patients who underwent single and double pedicle vertebroplasty were evaluated, no statistically significant difference was obtained in coronal balance, Cobb angle, and segmentary Cobb angle measurements. Conclusions: From the radiographic point of view in the long-term follow-up, we think that bilateral PVP provides an advantage over the unilateral approach in maintaining the coronal balance and stabilization of the coronal Cobb angle in patients with OVCF.

SummaryWe performed a 1-year prospective study to see whether zoledronic acid infusion combined with percutaneous kyphoplasty could provide more benefits in the treatment of T12 or L1 osteoporotic vertebral compression fracture (OVCF).IntroductionTo investigate and analyze the clinical effects of zoledronic acid (ZOL) in combination with percutaneous kyphoplasty (PKP) in the treatment of OVCF in postmenopausal women.MethodsIncluded in this study were 101 postmenopausal women patients with T12 or L1 OVCF who received PKP in our hospital between August 2015 and July 2017. They were randomly assigned to a zoledronic acid (ZOL) group (n = 50) or a control group (n = 51). Patients in ZOL group were treated preoperatively with IV infusion of 5 mg ZOL in combination with 0.25μg/d calcitriol and D3 600 mg/d calcium carbonate for a year. Patients in the control group were treated with the same dose of calcitriol and calcium carbonate D3 without ZOL.ResultsThere was no statistically significant difference in age, height, weight, body mass index (BMI), menopause age, and the fractured vertebral body between the two groups. At 6 and 12 months after treatment, bone mineral density (BMD) in ZOL group was higher than that in the control group (p < 0.01); bone markers (NMID, P1NP, and β-CTX) and the VAS score in ZOL group were significantly lower than those in the control group. No new fracture occurred in ZOL group. The incidence of recompression vertebral fracture (RVF) in the control group was 11.7%, while no RVF was detected in any patient in ZOL group. Mild adverse reactions in ZOL group were significantly higher than those in the control group, but all of them were relieved after symptomatic treatment.ConclusionsZOL IV infusion in combination with PKP is beneficial for the treatment of T12 or L1 OVCF.

BackgroundBoth surgery and conservative management are well established treatments for compression fractures of the thoraco-lumbar spine without neurological compromise. This article aims to compare the outcomes of conservative management to those of vertebroplasty, a relatively safe and simple procedure.Methods102 patients were admitted to our neurosurgical unit between January 2012 and February 2016, presenting with a single-level, post-traumatic A1 or A2 Mager l type fracture, affecting the thoracic-lumbar spine without any neurological deficits. After description of both treatment options, the patients were asked to choose between vertebroplasty or conservative treatment. Accordingly, the patients were allocated into two groups and a prospective non-randomized controlled trial was carried out. The first group (Group A) included 52 patients, treated with bed rest and an orthosis. The second group (Group B) of 50 patients underwent a percutaneous vertebroplasty. Pain intensity (assessed via visual analog scale (VAS)), disability degree (assessed via Oswestry Disability Index), ability to resume work (assessed via Denis work Scale), vertebral body height loss rate, regional kyphosis angle (Cobb’s angle), duration of hospitalization and treatment-associated complications, were prospectively recorded in a database and analyzed. Follow ups were planned at 1, 6, and 12 months after the injury.ResultsGroup B, compared with group A, showed a faster improvement in VAS score as well as functional ability and return to work. Cobb’s angle progression was significantly less in the surgical group. Morbidity, mortality, and complication rate were similar and comparable in both groups without a statistical difference (P<0.05)ConclusionsVertebroplasty is a safe and effective treatment in post-traumatic thoracic-lumbar fractures compared with conservative management.

Short segment posterior fixation is the preferred method for stabilizing thoracolumbar fractures. In case of significant disruption of the anterior column, the simple short segment construct does not ensure adequate stability. In this study, we tried to evaluate the effect of inclusion of the fractured vertebra in short segment fixation of thoracolumbar fractures. In a prospective randomized study, eighty patients with thoracolumbar fractures treated just with posterior pedicular fixation were randomized into two groups receiving either the one level above and one level below excluding the fracture level (bridging group), or including the fracture level (including group). Different clinical and radiological parameters were recorded and followed. A sum of 80 patients (42 patients in group 1 and 38 patients in group 2) were enrolled in the study. The patients in both the groups showed similar clinical outcome. There was a high rate of instrumentation failure in the “bridging” group. The “bridging” group showed a mean worsening (29%) in kyphosis, whereas the “including” group improved significantly by a mean of 6%. The significant effect of the “including” technique on the reduction of kyphotic deformity was most prominent in type C fractures. In conclusion, inclusion of the fracture level into the construct offers a better kyphosis correction, in addition to fewer instrument failures, without additional complications, and with a comparable-if not better-clinical and functional outcome. We recommend insertion of screws into pedicles of the fractured thoracolumbar vertebra when considering a short segment posterior fixation, especially in Magerl type C fractures.

Purpose Dorsal spinal instrumentation with pedicle screw constructs is considered the gold standard for numerous spinal pathologies. Screw misplacement is biomechanically disadvantageous and may create severe complications. The aim of this study was to assess the accuracy of patient-specific template-guided pedicle screw placement in the thoracic and lumbar spine compared to the free-hand technique with fluoroscopy. Methods Patient-specific targeting guides were used for pedicle screw placement from Th2–L5 in three cadaveric specimens by three surgeons with different experience levels. Instrumentation for each side and level was randomized (template-guided vs. free-hand). Accuracy was assessed by computed tomography (CT), considering perforations of <2 mm as acceptable (safe zone). Time efficiency, radiation exposure and dependencies on surgical experience were compared between the two techniques. Results 96 screws were inserted with an equal distribution of 48 screws (50 %) in each group. 58 % ( n  = 28) of template-guided (without fluoroscopy) vs. 44 % ( n  = 21) of free-hand screws (with fluoroscopy) were fully contained within the pedicle ( p  = 0.153). 97.9 % ( n  = 47) of template-guided vs. 81.3 % ( n  = 39) of free-hand screws were within the 2 mm safe zone ( p  = 0.008). The mean time for instrumentation per level was 01:14 ± 00:37 for the template-guided vs. 01:40 ± 00:59 min for the free-hand technique ( p  = 0.013), respectively. Increased radiation exposure was highly associated with lesser experience of the surgeon with the free-hand technique. Conclusions In a cadaver model, template-guided pedicle screw placement is faster considering intraoperative instrumentation time, has a higher accuracy particularly in the thoracic spine and creates less intraoperative radiation exposure compared to the free-hand technique.

SummaryThis study evaluated the use of low-dose chest computed tomography (LDCT) for detecting bone fragility. LDCT-measured vertebral bone attenuation by volumetric methods showed good correlation with bone mineral density (BMD) measured by dual-energy x-ray absorptiometry (DXA, and good diagnostic performance for identifying osteoporosis and compression fractures. The results of this study suggest the feasibility of obtaining comprehensive information on bone health in subjects undergoing LDCT.IntroductionOsteoporosis is a prevalent but underdiagnosed disease that increases fracture risk. This study evaluated the utility of vertebral attenuation derived from low-dose chest computed tomography (LDCT) compared to dual-energy x-ray absorptiometry (DXA) for detecting bone fragility.MethodsA total of 232 subjects (78 men and 154 women) aged above 50 years who underwent both LDCT and DXA within 30 days were evaluated. LDCT-measured bone attenuation in Hounsfield units (HU) of four vertebrae (T4, T7, T10, and L1) was evaluated using volumetric methods for correlation with DXA-measured bone mineral density (BMD) and for the diagnosis of compression fractures, osteoporosis, and low BMD (osteoporosis or osteopenia) in men and women, with DXA measurements as the reference standard.ResultsThe average attenuation of the four vertebrae showed strong correlation with DXA-measured BMD of the lumbar spine (r = 0.726, p < 0.05). In receiver-operating characteristic (ROC) analyses, the area under the curve (AUC) across LDCT-measured thresholds of the average attenuation to distinguish compression fractures was 0.827, and a threshold of 129.5 HU yielded 90.9 % sensitivity and 64.4 % specificity. Similarly, average attenuation showed high AUCs and good diagnostic performance for detecting osteoporosis and low BMD in both men and women. Among 44 subjects with compression fractures, the average bone attenuation showed strong negative correlation with both the worst fracture grade (r = −0.525, p < 0.05) and cumulative fracture grade score (r = −0.633, p < 0.05).ConclusionLDCT-measured bone attenuation by volumetric methods showed good correlation with BMD measured by DXA and good diagnostic performance for identifying bone fragility.