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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.

Objectives: To compare the early stage clinical and radiological results of patients suffering from thoracolumbar vertebral fracture, who we operated with the long segment (LS) and short segment (SS+) stabilization techniques, including the fractured vertebra. Materials and Methods: Thirty-eight patients who were operated in our clinic for T11-L2 vertebral fracture between January 2014 and August 2021 were included in the study. The radiological and clinical results obtained retrospectively for two different operating techniques were compared. The visual analogue scale (VAS) was used for evaluating pain intensity. Results: There were 17 female and 21 male patients. The mean age was 40.39 years. Of the patients, 28 were operated due to traffic accidents, 10 due to falls. LS was performed in 20 patients and SS+ was performed in 18 patients. Operation times, blood loss, preoperative local kyphosis angle and corpus anterior height loss, postoperative mobilization time, postoperative VAS, hospital stay, postoperative local kyphosis angle and corpus anterior height loss for LS and SS+ patients were 171-141 min, 400-300 mL, 11.70°-11.11°, 46-45%, 1.7-1.1 day, 4.8-3.3, 6.4-4.6 day, 5.30°-4.89°, and 29.70-30%, respectively. In the SS+ group, there were statistically significant differences in terms of operation times, blood loss, postoperative VAS values, postoperative mobilization time and number of days of hospitalization compared to the LS patients group. There was no difference in radiological measurements. Conclusion: The early stage clinical results of SS+ stabilization including the fractured vertebra may be better than LS stabilization. Further clinical studies are needed on this subject.

Objective The aim of this study is to investigate the biomechanical changes in the sandwich vertebrae (SV), fractured vertebrae, and adjacent vertebrae at the thoracolumbar vertebrae in patients with osteoporotic vertebral compression fracture (OVCF) who underwent several percutaneous vertebroplasties (PVP) with varied cement volumes. Methods The finite element (FE) model of the T10-L2 thoracolumbar vertebral body is established. The augmented vertebrae (AV) of T11 and L1 is simulated and cylindrical bone cement is placed vertically in its center. The models are categorized into four types according to the volume of bone cement, 2mL bone cement group (model A), 4-mL bone cement group (model B), 6-mL bone cement group (model C), and 8-mL bone cement group (model D). By applying 500 N axial load on the upper surface of T10 and fixing the lower surface of L2, the maximum von Mises stress of the vertebrae and the maximum displacement of the sandwich vertebrae are analyzed and compared. Results The maximum von Mises stresses of the T11 and L1 augmented vertebrae of Model C are lower than those of the fractured vertebrae of Models A and B in all directions of activity. The von Mises stresses of the augmented vertebrae of Model C and Model D are similar. The von Mises stresses of the fractured adjacent vertebrae T10 and L2, and the sandwich vertebrae T12 do not change significantly with the change in cement volume. In addition, the von Mises stress of T12 is lower than that of T10 in all four groups. The minimum value of T12 displacement in Model C is 3.0 mm. Conclusion Under the condition of no leakage, the stress distribution of the AV can be optimized by expanding the supporting area of bone cement to about 6 ml, which not only reduces the risk of recurrent fractures of adjacent vertebrae and AV, but also prolongs the service life of the implants by reducing the stress of bone cement, which provides the basis for the appropriate amount of bone cement required for clinical multi-level PVP.

Study design A retrospective study. Purpose Some studies have found the correlation between traumatic vertebral fractures and intervertebral disc vacuum phenomenon (IVP), but the study about relationship between thoracolumbar fractures and IVP at one year after fracture is lacking. Therefore, the purpose of this study was to analyze the prevalence of fracture-associated IVP (FAVP) in patients with thoracolumbar spine fracture at 1 year postoperatively and discover the related factors. Methods This study included patients admitted to the spine surgery department of a university hospital from January 2016 to December 2021 after traumatic single-segment thoracolumbar fractures. IVP was categorized using computed tomography (CT), and the patient’s gender, age, fracture type, trauma mechanism, 1-year postoperative outcome of the intravertebral shell phenomenon (ISP), degree of vertebral repositioning, and LSC score were recorded. The correlation between each factor and FAVP was analyzed by Pearson’s Chi-square and Student’s t test. Results A total of 236 patients with traumatic single-segment thoracolumbar fractures were included in the study. All patients underwent CT scanning preoperatively, within 3 days postoperatively, and about 1 year postoperatively. 71 patients developed IVP at 1 year postoperatively, of which 47 had FAVP and 24 had degeneration-associated IVP (DAVP). There was a significant correlation between age and both FAVP or DAVP ( P  < 0.05). There was a significant correlation between fracture type, LSC score, trauma mechanism, and 1-year postoperative outcome after ISP and FAVP ( P  < 0.05). Conclusion Patients with thoracolumbar fractures have a higher incidence of postoperative FAVP. FAVP is more likely to occur in patients with an enlarged vertebral cavity 1 year after surgery for the ISP. FAVP needs to be taken into consideration when treating patients with high-energy trauma and older burst fractures.

Background Traumatic intervertebral disc injury, while frequently observed in thoracolumbar fractures, is often overlooked in clinical management. This research aimed to investigate how traumatic intervertebral disc injury influences spinal stability and to analyze the risk factors for correction loss after posterior pedicle screw fixation for thoracolumbar fractures. Methods A retrospective analysis was performed on 194 thoracolumbar fracture patients who received pedicle screw fixation. The assessment of disc injury was conducted using magnetic resonance imaging (MRI). Patients were categorized into intervertebral disc injury (IDI) and non-IDI (nIDI) groups. The clinical variables included visual analog scale (VAS) score, and American Spinal Injury Association score. The radiological data, comprising the vertebral wedge angle (VWA), Cobb angle (CA), disc angle, disc height, anterior (AVBHr), midline (MVBHr), and posterior vertebral body height ratio (PVBHr), were compared before surgery, one week after the operation, and at final follow-up. The mean follow-up duration was 12.7 ± 7.0 months. Results The mean VAS score showed significant improvement postoperatively. 22.6% of patients with IDI developed the intervertebral vacuum phenomenon. The IDI group exhibited significantly greater CA and VWA, as well as lower disc height, AVBHr and MVBHr than the non-IDI group at the last follow-up. Age (odds ratio [OR] = 1.038, 95% confidence interval [CI] = 1.011–1.066, P  = 0.005), male (OR = 2.201, 95% CI = 1.107–4.377, P  = 0.025), and IDI (OR = 2.463, 95% CI = 1.105–5.489, P  = 0.028) were statistically significant risk factors for kyphosis correction loss according to multivariate logistic regression analysis. Conclusion Traumatic IDI contributes to loss of correction following thoracolumbar fractures and is closely associated with accelerated disc degeneration. Age, male, and IDI are independent risk factors for postoperative kyphosis recurrence in patients with thoracolumbar fractures.

Measurements of skeletal muscle cross-sectional area, index, and radiation attenuation utilizing clinical computed tomography (CT) scans are used in assessments of sarcopenia, the loss of skeletal muscle mass and function associated with aging. To classify individuals as sarcopenic, sex-specific cutoffs for ‘low’ values are used. Conventionally, cutoffs for skeletal muscle measurements at the level of the third lumbar (L3) vertebra are used, however L3 is not included in several clinical CT protocols. Non-contrast-enhanced CT scans from healthy kidney donor candidates (age 18–40) at Michigan Medicine were utilized. Skeletal muscle area (SMA), index (SMI), and mean attenuation (SMRA) were measured at each vertebral level between the tenth thoracic (T10) and the fifth lumbar (L5) vertebra. Sex-specific means, standard deviations (s.d.), and sarcopenia cutoffs (mean-2 s.d.) at each vertebral level were computed. Associations between vertebral levels were assessed using Pearson correlations and Tukey’s difference test. Classification agreement between different vertebral level cutoffs was assessed using overall accuracy, specificity, and sensitivity. SMA, SMI, and SMRA L3 cutoffs for sarcopenia were 92.2 cm 2 , 34.4 cm 2 /m 2 , and 34.3 HU in females, and 144.3 cm 2 , 45.4 cm 2 /m 2 , and 38.5 HU in males, consistent with previously reported cutoffs. Correlations between all level pairs were statistically significant and high, ranging from 0.65 to 0.95 (SMA), 0.64 to 0.95 (SMI), and 0.63 to 0.95 (SMRA). SMA peaks at L3, supporting its use as the primary site for CT sarcopenia measurements. However, when L3 is not available alternative levels (in order of preference) are L2, L4, L5, L1, T12, T11, and T10. Healthy reference values reported here enable sarcopenia assessment and sex-specific standardization of SMA, SMI, and SMRA in clinical populations, including those whose CT protocols do not include L3.

Background Decision-making regarding nonoperative versus operative treatment of patients with thoracolumbar burst fractures in the absence of neurologic deficits is controversial. Lack of evidence-based practice may result in patients being treated inappropriately and being exposed to unnecessary adverse consequences. Purpose Using meta-analysis, we therefore compared pain (VAS) and function (Roland Morris Disability Questionnaire) in patients with thoracolumbar burst fractures without neurologic deficit treated nonoperatively and operatively. Secondary outcomes included return to work, radiographic progression of kyphosis, radiographic progression of spinal canal stenosis, complications, cost, and length of hospitalization. Methods We searched MEDLINE, EMBASE ® , and the Cochrane Central Register of Controlled Trials for ‘thoracic fractures’, ‘lumbar fractures’, ‘non-operative’, ‘operative’ and ‘controlled clinical trials’. We established five criteria for inclusion. Data extraction and quality assessment were in accordance with Cochrane Collaboration guidelines. The main analyses were performed on individual patient data from randomized controlled trials. Sensitivity analyses were performed on VAS pain, Roland Morris Disability Questionnaire score, kyphosis, and return to work, including data from nonrandomized controlled trials and using fixed effects meta-analysis. We identified four trials, including two randomized controlled trials consisting of 79 patients (41 with operative treatment and 38 with nonoperative treatment). The mean followups ranged from 24 to 118 months. Results We found no between-group differences in baseline pain, kyphosis, and Roland Morris Disability Questionnaire scores. At last followup, there were no between-group differences in pain, Roland Morris Disability Questionnaire scores, and return to work rates. We found an improvement in kyphosis ranging from means of 12.8º to 11º in the operative group, but surgery was associated with higher complication rates and costs. Conclusions Operative management of thoracolumbar burst fractures without neurologic deficit may improve residual kyphosis, but does not appear to improve pain or function at an average of 4 years after injury and is associated with higher complication rates and costs. Level of Evidence Level II, therapeutic study. See the Guidelines for Authors for a complete description of level of evidence.

Background Thoracolumbar injury classification systems such as TLICS and TL AOSIS are widely implemented but offer limited guidance in intermediate score ranges (TLICS = 3–4), where treatment decisions are often uncertain. The modified TLICS (mTLICS) was developed to address this gap by integrating MRI-derived quantitative parameters. Methods This retrospective study included 146 adults with MRI-confirmed thoracolumbar spine injuries (T1–L5) treated at Phu Tho Provincial General Hospital between April 2024 and May 2025. Inclusion required MRI within 7 days of trauma and complete clinical data, including ASIA grade, VAS score, and treatment modality. All cases were classified using TLICS, TL AOSIS, and mTLICS, and managed conservatively, minimally invasively, or surgically. Predictive performance for treatment allocation was assessed using ROC analysis, multinomial logistic regression, and decision curve analysis (DCA). Results mTLICS showed the highest diagnostic accuracy across all treatment comparisons (AUC = 0.94-1.00), particularly in the intermediate-score group (TLICS = 3–4), with AUCs of 0.991 (conservative vs. surgical) and 0.965 (minimally invasive vs. surgical). Multinomial regression identified mTLICS as the sole independent predictor of treatment allocation (OR = 31.2-1338.4; p  < 0.01), while TLICS and TL AOSIS were not statistically significant. DCA demonstrated the highest net clinical benefit for mTLICS, especially within the 0.3–0.6 threshold range. Conclusions The mTLICS demonstrated improved accuracy in stratifying thoracolumbar injuries across three treatment tiers and enhanced clarity in decision-making for intermediate cases. Its MRI-based components support personalized, image-guided management. Nonetheless, as clinicians at the study site were familiar with the mTLICS framework through prior academic exposure, potential incorporation bias cannot be entirely excluded. These findings should therefore be interpreted with caution, as mTLICS scores were calculated retrospectively after treatment completion and were not used prospectively to determine patient management, underscoring the need for prospective, multicenter validation to confirm its generalizability.