Journal of Spine

Objectives: To evaluate the feasibility, efficacy and safety of percutaneous vertebroplasty (PVP), minimally invasive decompression and partial tumor resection combined with percutaneous pedicle screws fixation (PPS) for surgical treatment of thoracic metastasis with neurologic compression.

Methods: Twenty patients with 1-level thoracic vertebral metastasis and neurologic compression were treated with the procedure of PVP and PPS combined with minimally invasive neurologic decompression and partial tumor resection through mini posterior midline approach. The prognostic score was evaluated according to Tomita scoring system before operation. VAS score and ASIA grade were also recorded before and after operation. Cobb angles, central and anterior vertebral body height were measured on the lateral X-rays.

Results: The mean prognostic score of Tomita was 7 (range, 6-7 points). The mean follow-up of 13.8 (12-15) months was available for 17 patients and other 3 patients died more than half one year after operation. There were no complications and no death due to complications of the procedure itself. The VAS significantly dropped from 9 (range, 7-10) preoperatively to 3 (range, 2-4) (p<0.001) immediately after surgery and to 1 (range, 0-1) (p<0.001) at the 1-year follow-up. All patients got improvement of paraplegia after operation. At the 3-month follow-up, 3 of 5 patients with complete motor paralysis improved from ASIA scale B to D, 11 of 15 patients with incomplete motor paralysis from C or D to E. Eleven of 17 surviving patients got ASIA scale E at the 1-year follow-up. Spine stability was observed in all of the surviving patients during the follow-up.

Conclusion: PVP, minimally invasive decompression and partial tumor resection combined with PPS is a good choice of surgical treatment for thoracic metastatic tumors with neurologic compression.

Background: Treatments for low back pain (LBP) vary widely. In Africa, the most common forms of therapy include rest and pain medications. However, a novel conservative therapy for LBP is the non-surgical spinal decompression (NSD) (with Intervertebral Differential Dynamics (IDD)) even though considered investigational, improves LBP. This study was aimed to investigate the outcome of chronic LBP with or without radiculopathy using NSD amidst other conservative treatment.

Method: Patients were treated with an average number of 10 sessions within 2 months of NSD therapy, in addition to spinal mobilisation, cervical and lumbo-pelvic muscles re-education programme, soft-tissue therapy, low-level laser therapy, hot or cold application and home exercise programme if indicated. Pre- and post-intervention scores of pain intensity of each treatment session on a Numerical Pain Rating Scale (NPRS) were compared using a paired t-test to determine statistical significance.

Results and Main findings: One hundred and twenty-five patients (73 males, 52 females) were analysed. The mean age and weight of the patients were 54.70 ± 14.07 years and 192.10 ± 35.91 lbs (87.14 ± 16.29 kg) respectively. The mean starting pain intensity score was 4.98 ± 1.86 whereas the mean ending pain intensity score was 4.11 ± 1.84 on a 10-point NPRS. The mean ending pain intensity score was less and also, statistically significant (p=0.000).

Conclusion: Statistically significant improvement in LBP could be achieved using NSD and other traditional conservative management. Long-term follow up post NSD is needful.

Back pain continues to be a leading cause of disability in the United States and is one of the most common reasons for seeking consultation with a physician Nonsurgical interventions remain the first-line of therapy; however, many patients eventually progress to a level of severity that requires surgical treatments such as spinal fusion. Spinal fusion has accounted for the highest total cost among the surgical procedures. The Medicare program reported reimbursing US hospitals $3.2 billion for spinal fusion procedures in fiscal year 2011, making it the third largest CMS Centers for Medicare & Medicaid Services expenditure behind total knee replacement and heart failure. It has also been the focus of attention in investigations to contain hospital costs. The increase in surgical procedures for the management of chronic pain and consequent escalation of healthcare costs has prompted the attention of policy makers as well.

Background: This retrospective study aimed to investigate a correlation between computed tomography (CT) imaging obtained opportunistically during screening for lumbar spine fractures and dual-energy x-ray absorptiometry (DEXA) scans.

Methods: A total of 159 patients over a 5-year study period who had undergone CT scan to investigate for a lumbar spine fracture and a DEXA scan within 12-months of each other were included in the study. Measurements of the region of interest (ROI) through the first 4 lumbar vertebrae were performed to establish Hounsfield unit (HU) values. Measurements for each level were made at three separate locations: mid-vertebral body, and just above and below the inferior and superior endplates, respectively. The HU values were correlated with T-scores obtained from DEXA scans and were further analyzed according to age and gender.

Results: There was a statistically significant correlation between HU values with T-score. Using the Pearson correlation coefficients, a moderate correlation of HU value to hip DEXA for T-score. There was a moderate-strong correlation between DEXA lumbar spine with mid-vertebral body HU, with L3 having the strongest correlation (r²=0.7269). The normal group had a mean HU value of 139.3 (95% CI 119–159.2), the osteopenic group had a mean of 105.9 (95% CI 90.4–123.4), and the osteoporotic group had a mean of 72.4 (95% CI 60.1–81.7).

Conclusion: This current study demonstrated that opportunistic CT imaging can be utilized to infer bone quality and provide information about the presence of osteoporosis and subsequently fracture risk without the need for additional imaging, radiation exposure, cost, or patient time.