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Fracture of l5 transverse

Jarosław Dzierżanowski, Monika Skotarczyk, Zuzanna Baczkowska-Waliszewska, Mateusz Krakowiak, Marek Radkowski, Piotr Łuczkiewicz, Piotr Czapiewski, Tomasz Szmuda, Paweł Słoniewski, Edyta Szurowska, Paweł J Winklewski, Urszula Demkow, Arkadiusz Szarmach
Transpedicular stabilization is a frequently used spinal surgery for fractures, degenerative changes, or neoplastic processes. Improper screw fixation may cause substantial vascular or neurological complications. This study seeks to define detailed morphometric measurements of the pedicle (height, width, and surface area) in the aspects of screw length and girth selection and the trajectory of its implantation, i.e., sagittal and transverse angle of placement. The study was based on CT examinations of 100 Caucasian patients (51 women and 49 men) aged 27-75 with no anatomical, degenerative, or post-traumatic spine changes...
January 26, 2019: Advances in Experimental Medicine and Biology
Armaun J Emami, Chrisoula A Toupadakis, Stephanie M Telek, David P Fyhrie, Clare E Yellowley, Blaine A Christiansen
The most reliable predictor of future fracture risk is a previous fracture of any kind. The etiology of this increased fracture risk is not fully known, but it is possible that fracture initiates systemic bone loss, leading to greater fracture risk at all skeletal sites. In this study, we investigated systemic bone loss and recovery after femoral fracture in young (3-month-old) and middle-aged (12-month-old) mice. Transverse femur fractures were created using a controlled impact, and whole-body bone mineral density (BMD), trabecular and cortical microstructure, bone mechanical properties, bone formation and resorption rates, mouse voluntary movement, and systemic inflammation were quantified at multiple time points post-fracture...
September 6, 2018: Journal of Bone and Mineral Research: the Official Journal of the American Society for Bone and Mineral Research
Neus Roca-Ayats, Pei Ying Ng, Natàlia Garcia-Giralt, Maite Falcó-Mascaró, Mónica Cozar, Josep Francesc Abril, José Manuel Quesada Gómez, Daniel Prieto-Alhambra, Xavier Nogués, James E Dunford, R Graham Russell, Roland Baron, Daniel Grinberg, Susana Balcells, Adolfo Díez-Pérez
Atypical femoral fractures (AFFs) are a rare but potentially devastating event, often but not always linked to bisphosphonate (BP) therapy. The pathogenic mechanisms underlying AFFs remain obscure, and there are no tests available that might assist in identifying those at high risk of AFF. We previously used exome sequencing to explore the genetic background of three sisters with AFFs and three additional unrelated AFF cases, all previously treated with BPs. We detected 37 rare mutations (in 34 genes) shared by the three sisters...
September 5, 2018: Journal of Bone and Mineral Research: the Official Journal of the American Society for Bone and Mineral Research
M Winkelmann, M Lopez Izquierdo, J-D Clausen, E Liodakis, P Mommsen, R Blossey, C Krettek, C Zeckey
Aims: This study aimed to analyze the correlation between transverse process (TP) fractures of the fourth (L4) and fifth (L5) lumbar vertebrae and biomechanical and haemodynamic stability in patients with a pelvic ring injury, since previous data are inconsistent. Patients and Methods: The study is a retrospective matched-pair analysis of patients with a pelvic fracture according to the modified Tile AO Müller and the Young and Burgess classification who presented to a level 1 trauma centre between January 2005 and December 2014...
September 2018: Bone & Joint Journal
Ryan Adams, Sarah Herrera-Nicol, Arthur L Jenkins
Background  Advancements in radiological imaging and diagnostic criteria enable doctors to more accurately identify lumbosacral transitional vertebrae (LSTV) and their association with back and L5 distribution leg pain. It is considered the most common congenital anomaly of the lumbosacral spine with an incidence between 4 and 35%, 3 although many practitioners describe 10 to 12% overall incidence. LSTVs include sacralization of the L5 vertebral body and lumbarization of the S1 segment while demonstrating varying morphology, ranging from broadened transverse processes to complete fusion...
July 2018: Journal of Neurological Surgery Reports
John D Koerner, Dessislava Z Markova, Greg D Schroeder, Brian P Calio, Anuj Shah, Corbin W Brooks, Alexander R Vaccaro, D Greg Anderson, Christopher K Kepler
BACKGROUND CONTEXT: The systemic response regarding cytokine expression after the application of recombinant human bone morphogenetic protein-2 (rhBMP-2) in a rat spinal fusion model has recently been defined, but the local response has not been defined. Defining the local cytokine and growth factor response at the fusion site will help explain the roles of these molecules in the fusion process, as well as that of rhBMP-2. Our hypothesis is that the application of rhBMP-2 to the fusion site will alter the local levels of cytokines and growth factors throughout the fusion process, in a manner that is different from the systemic response, given the tissue-specific effects of rhBMP-2...
August 2018: Spine Journal: Official Journal of the North American Spine Society
S P Mohanty, M Pai Kanhangad, S N Bhat, S Chawla
PURPOSE: To assess the pedicle morphology in the lower thoracic and lumbar spine in an Indian population and to determine the causes of pedicle wall violation by pedicle screws. METHODS: Computerised tomographic scans of 135 consecutive patients with thoracolumbar and lumbar spine fractures were prospectively analysed to determine the pedicle morphology. The transverse pedicle angle, pedicle diameter and screw path length at 527 uninjured levels were measured. Post-operative CT scans of 117 patients were analysed to determine the accuracy of 468 pedicle screws at 234 vertebrae...
December 2018: Musculoskeletal Surgery
Nicolas Newell, A Phillip Pearce, Edward Spurrier, Iain Gibb, Claire E Webster, Jonathan C Clasper, Spyros D Masouros
BACKGROUND: Personnel have sustained a range of devastating blast injuries during recent conflicts. Previous studies have focused on severe injuries, including to the spine; however, no study has specifically focused on the most common spinal injury-transverse process (TP) fractures. Although their treatment usually requires limited intervention, analysis of TP fractures may help determine injury mechanisms. METHODS: Data were collected from victims with spinal fractures who were injured in improvised explosive device attacks, from the UK's Joint Theatre Trauma Registry...
July 2018: Journal of Trauma and Acute Care Surgery
Hazem Nasef, Ahmed Elhessy, Faris Abushaban, Abduljabbar Alhammoud
PURPOSE: Stable or unstable pelvic ring fractures are sometimes associated with L5 transverse process (TP) fractures. This review aimed to determine the effect of L5 TP fractures on pelvic ring fracture stability. METHODS: We searched electronic databases (including MEDLINE, Google Scholar, and SCOPUS) and performed hand searching of English orthopedics journals and conference abstracts until May 2017. We pooled data from five studies, with a total of 278 patients...
July 2018: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Yoshihiro Katsuura, Eileen Lorenz, Warren Gardner
PURPOSE: To analyze the morphometric parameters of the dorsal sacral lamina and pedicles to determine if there is adequate bony architecture to support plate osteosynthesis. METHODS: Two reviewers performed measurements on 98 randomly selected high-resolution CT scans of the pelvis to quantify the bony anatomy of the sacral lamina. Measurements included the depths of the lamina at each sacral level, the trajectory and depth of the sacral pedicles from the sacral lamina, and the width of the sacral canal...
May 2018: Surgical and Radiologic Anatomy: SRA
André Luiz Loyelo Barcellos, Vinícius M da Rocha, João Antonio Matheus Guimarães
INTRODUCTION: Spondylopelvic dissociation is an uncommon and complex injury that results from high-energy trauma with axial overloading through the sacrum. Due to the life-threatening nature of these injuries, standard Advanced Trauma Life Support® (ATLS) protocol must be used in the trauma setting as part of the initial management of these patients. The key to diagnosis is a good physical exam coupled with high level of suspicion. Radicular neurological deficits commonly are present in spondylopelvic dissociation (L5's roots) and should be documented for future evaluations...
November 2017: Injury
Stefan Piltz, Bianka Rubenbauer, Wolfgang Böcker, Heiko Trentzsch
PURPOSE: U-shaped sacral fractures are extremely rare injuries that usually occur as a result of falls from considerable heights. Almost all treatment methods described to date aim solely at stabilizing the fracture but do not contribute to supporting the reduction of such fractures. Using existing implants the purpose of this study is to present a surgical technique that facilitates both the reduction and the stabilization of these injuries. The presented technique was evaluated in a series of three cases...
December 2018: European Spine Journal
Siddharth N Aiyer, Ajoy Prasad Shetty, Rishi Kanna, Srikanth Reddy, Shanmuganathan Rajasekaran
Delayed presentations have been reported following gunshot wounds (GSW) with retained intraspinal bullets due to migration of projectile or lead intoxication. We report on the rare occurrence of delayed pyogenic spondylodiscitis and neurological dysfunction following injury from low velocity GSW to the spine with a retained projectile. A 55-year-old male presented 4 months following GSW to the abdomen which resulted in colonic injury and L5 fracture. The patient was treated initially with ileo-transverse anastomosis, antibiotics, without retrieval of the bullet...
December 2016: Journal of Spine Surgery (Hong Kong)
Thomas Noh, Mokbel K Chedid
BACKGROUND: Transverse fractures of the sacrum are rare, and surgical treatment for these fractures ranges from conservative to challenging. Transverse stress fractures of the sacrum after placement of lumbar-to-sacral instrumentation have been previously described. We report a new technique to repair a transverse Type-2 Roy-Camille fracture with spondylolisthesis of S1 over S2 in a previously fused instrumented high-grade L4-L5, L5-S1 spondylolisthesis. CASE DESCRIPTION: A 64-year-old female who previously had an L4-L5, L5-S1 fusion for spondylolisthesis presented with excruciating lower back pain and radiculopathy for over 6 months...
2016: Surgical Neurology International
Kun Soo Jang, Hyeun Sung Kim
Complex regional pain syndrome (CRPS) type II is a syndrome that develops after nerve injury. Symptoms may be severe, and vary depending on the degree of sympathetic nerve involvement. As yet, there is no satisfactory treatment. We report the case of a female patient who had an L5 left transverse process fracture and an S2 body fracture, who developed symptoms of CRPS type II in her left lower leg that were aggravated during ambulation in spite of absolute bed rest for one month after the trauma. Several treatments, including bed rest, medication, and numerous nerve blocks were attempted, but the pain persisted...
September 2016: Journal of Korean Neurosurgical Society
Daniel Wagner, Lukas Kamer, Takeshi Sawaguchi, R Geoff Richards, Hansrudi Noser, Pol M Rommens
BACKGROUND: Fragility fractures of the sacrum are increasing in prevalence due to osteoporosis and epidemiological changes and are challenging in their treatment. They exhibit specific fracture patterns with unilateral or bilateral fractures lateral to the sacral foramina, and sometimes an additional transverse fracture leads to spinopelvic dissociation. The goal of this study was to assess sacral bone mass distribution and corresponding changes with decreased general bone mass. METHODS: Clinical computed tomography (CT) scans of intact pelves in ninety-one individuals (mean age and standard deviation, 61...
April 6, 2016: Journal of Bone and Joint Surgery. American Volume
Carmine Zoccali, Jesse Skoch, Apar S Patel, Christina M Walter, Mauricio J Avila, Nikolay L Martirosyan, Silvio Demitri, Ali A Baaj
OBJECTIVE: The anatomic area delineated medially by the lateral part of the L4-L5 vertebral bodies, distally by the anterior-superior surface of the sacral wing, and laterally by an imaginary line joining the base of the L4 transverse process to the proximal part of the sacroiliac joint, is of particular interest to spine surgeons. We are referring to this area as the lumbo-sacro-iliac triangle (LSIT). Knowledge of LSIT anatomy is necessary during approaches for L5 vertebral and sacral fractures, sacral and iliac tumors, and extraforaminal decompression of the L5 nerve roots...
April 2016: World Neurosurgery
Pui Kit Suen, Tracy Y Zhu, Dick Ho Kiu Chow, Le Huang, Li-Zhen Zheng, Ling Qin
We investigated the systemic effect of sclerostin monoclonal antibody (Scl-Ab) treatment on intact non-operated bones in an open osteotomy male Sprague Dawley (SD) rat model. Six-month-old male SD rats were subjected to transverse osteotomy at the right femur mid-shaft. Rats were injected subcutaneously with vehicle or Scl-Ab (25 mg/kg, 2 times per week) treatment for 9 weeks. Compared with vehicle control, Scl-Ab treatment significantly improved trabecular and cortical bone mass and microarchitecture at L5 vertebrae and left femora by micro-CT at week 6 and 9...
2015: Scientific Reports
Milka Marinova, Bob Edon, Karsten Wolter, Barbara Katsimbari, Hans H Schild, Holger M Strunk
OBJECTIVE: Evaluation of computed tomography (CT) attenuation measurements for assessing bone mineral density (BMD) and predicting osteoporosis in thoracic and abdominal CT scans for various clinical indications using dual-energy X-ray absorptiometry (DXA) as reference standard. RESEARCH DESIGN AND METHODS: A total of 234 patients (147 women, 87 men) undergoing DXA and CT were examined retrospectively. Mean time between both studies was 0.5 years. CT-attenuation values in Hounsfield units (HU) were measured at the thoracic and lumbar spine (T1, T6, T12, L1-L5), at the femoral neck, and then assigned to their corresponding DXA scores...
2015: Current Medical Research and Opinion
Sithombo Maqungo, Mwangi Kimani, Dilesh Chhiba, Graham McCollum, Steve Roche
BACKGROUND: The presence of a L5 transverse process fracture is reported in many texts to be a marker of pelvis fracture instability. There is paucity of literature to support this view. Only two previous studies have been performed on this subject with statistical analysis. METHODS: We conducted a retrospective cross-sectional review of all abdominopelvic CT scans performed for blunt abdominal trauma in a Level 1 Trauma Unit between January 2012 and August 2013...
August 2015: Injury
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