1/150. Transoral fusion with internal fixation in a displaced hangman's fracture.STUDY DESIGN: A case is reported in which late displacement of a "hangman's fracture" was managed by transoral C2-C3 fusion by using bicortical iliac crest graft and a titanium cervical locking plate. OBJECTIVES: To review the management of unstable fractures of the axis and to study other reports of transoral instrumentation of the cervical spine. SUMMARY OF BACKGROUND DATA: Undisplaced fractures of the axis are considered to be stable injuries. Although late displacement is unusual, it can lead to fracture nonunion with persisting instability and spinal cord dysfunction. In this situation, an anterior fusion of the second and third cervical vertebrae is preferred to a posterior fusion from the atlas to the third cervical vertebra, which would abolish lateral rotation between C1 and C2. methods: The literature on hangman's fractures was reviewed. Clinical and radiographic details of a case of C2 instability were recorded, and the particular problems posed by late displacement were considered. RESULTS: There are no other reports of transoral instrumentation of the cervical spine. A sound fusion of C2-C3 was obtained without infection or other complications. Good neck movement returned by 6 months after surgery. CONCLUSION: Undisplaced fractures of the axis are not always stable. The transoral route allows good access for stabilization of displaced hangman's fractures. In special circumstances, a locking plate may prove useful in securing the bone graft. The cervical spine locking plate can be inserted transorally with no complications and by using standard instrumentation.- - - - - - - - - - ranking = 1keywords = bone (Clic here for more details about this article) |
2/150. Complete rotational burst fracture of the third lumbar vertebra managed by posterior surgery. A case report.STUDY DESIGN: Case report of a young man with rotational burst fracture of the third lumbar vertebra, treated by posterior surgery. OBJECTIVES: To describe the management of a rotational burst fracture of the third lumbar vertebra by posterior surgery consisting of reduction, decompression, fusion, and transpedicular instrumentation. SUMMARY OF BACKGROUND DATA: Surgery is the generally recommended means of managing lumbar burst fractures with neurologic deficit. Some surgeons recommend anterior decompression, fusion, and instrumentation. Posterior surgery with decompression through laminectomy, spongioplasty of the vertebral body, interbody fusion of damaged discs, posterolateral fusion, and transpedicular fixation is also a safe and successful management technique. The combined approach consists of posterior decompression, fusion, transpedicular fixation, and anterior fusion using pelvic autografts. The optimum method of management remains in question. METHOD: An 18-year-old man with complete rotational burst fracture of the third lumbar vertebra was treated by posterior surgery. This surgery consisted of reduction, laminectomy, decompression, structure of dural sac tears, spongioplasty of the vertebral body, interbody fusion of both damaged discs, and the implantation of a transpedicular Socon fixator (Aesculap, Tuttlingen, germany), including a transverse connector. The case was documented by radiographs and computed tomography scans before surgery and after fixator removal 19 months after surgery. RESULTS: The patient healed solidly with no instrumentation failure. The neurologic deficit Frankel Grade B improved to Frankel Grade D. CONCLUSION: Surgery to manage lumbar burst fracture must include reduction, decompression, restoration and fusion of anterior and posterior elements by using autologous pelvic spongious autografts, and anterior or posterior instrumentation. Posterior surgery including suturing of dural sac tears, fusion of damaged structures, and transpedicular fixation is successful in young patients and patients with good bone quality.- - - - - - - - - - ranking = 1keywords = bone (Clic here for more details about this article) |
3/150. Extension of phenotype associated with structural mutations in type I collagen: siblings with juvenile osteoporosis have an alpha2(I)Gly436 --> Arg substitution.Mutations in the type I collagen genes have been identified as the cause of all four types of osteogenesis imperfecta (OI). We now report a mutation that extends the phenotype associated with structural abnormalities in type I collagen. Two siblings presented with a history of back pain and were diagnosed with juvenile osteoporosis, based on clinical and radiological examination. Radiographs showed decreased lumbar bone density and multiple compression fractures throughout the thoracic and lumbar spines of both patients. One child has moderate short stature and mild neurosensory hearing loss. However, neither child has incurred the long bone fractures characteristic of OI. Protein studies demonstrated electrophoretically abnormal type I collagen in samples from both children. Enzymatic cleavage of rna:rna hybrids identified a mismatch in type I collagen alpha2 (COL1A2) mRNA. dna sequencing of COL1A2 cDNA subclones defined the mismatch as a single-base mutation (1715G --> A) in both children. This mutation predicts the substitution of arginine for glycine at position 436 (G436R) in the helical domain of the alpha2(I) chain. Analysis of genomic dna identified the mutation in the asymptomatic father, who is presumably a germ-line mosaic carrier. The presence of the same heterozygous mutation in two siblings strongly suggests that the probands display the full phenotype. Taken together, the clinical, biochemical, and molecular findings of this study extend the phenotype associated with type I collagen mutations to cases with only spine manifestations and variable short stature into adolescence.- - - - - - - - - - ranking = 2keywords = bone (Clic here for more details about this article) |
4/150. pregnancy-associated osteoporosis with elevated levels of circulating parathyroid hormone-related protein: a report of two cases.Two lactating women who had complained of back pain developed spontaneous vertebral fractures with low bone mineral density (BMD) several months postpartum. The back pain and biochemical abnormalities presented as hypercalcemia and elevated plasma levels of the parathyroid hormone-related protein (PTH-rP) that returned to normal indices with increasing BMD after weaning. The increased circulating PTH-rP might contribute to the pregnancy-associated osteoporosis in women who probably are already osteopenic.- - - - - - - - - - ranking = 1keywords = bone (Clic here for more details about this article) |
5/150. Pathologic odontoid fracture and benign fibrous histiocytoma of bone.We present the case of a 44-year-old female patient, who sustained an odontoid fracture after a minor trauma (uncomplicated fall). The radiologic evaluation revealed a skeletal tumor of the second cervical vertebra together with a fracture line at the base of the odontoid process of the axis. The patient underwent surgery, the tumor was resected and the odontoid was stabilised using an autologous cortico-cancellous bone graft and a halo fixator. Histologic examination revealed benign fibrous histiocytoma, which is reported to be a very rare skeletal tumor.- - - - - - - - - - ranking = 5keywords = bone (Clic here for more details about this article) |
6/150. magnetic resonance imaging in the diagnosis of sacral stress fracture.Low back and buttock pain in athletes can be a source of frustration for the athlete and a diagnostic dilemma for the doctor. Sacral stress fractures have been increasingly recognised as a potential cause of these symptoms. As plain radiographs are often normal and the radiation load of an isotope bone scan is substantial, the alternative use of magnetic resonance imaging in the diagnosis of a sacral stress fracture is highlighted in this case report.- - - - - - - - - - ranking = 1keywords = bone (Clic here for more details about this article) |
7/150. Mitochondrial dna deletion associated oxidative stress and severe male osteoporosis.We have screened the mitochondrial genome of 15 men with symptomatic vertebral fractures (median age 62 years, range 27-72 years) and 17 male control subjects (median age 61 years, range 40-73 years) for the presence of mitochondrial dna (mtDNA) deletions in peripheral monocyte dna. polymerase chain reaction analysis provided evidence of a common age-related (4.9 kb) mtDNA deletion situated between nucleotides 8470 and 13.460 of the genomic sequence in 5 of the 17 controls (29%) and 9 of the 15 patients (60%) investigated. Southern blotting and polymerase chain reaction revealed a novel 3.7 kb deletion in 2 patients. One of the affected patients, a 27-year-old man with severe osteoporosis (lumbar spine bone mineral density (BMD) 0.381 g/cm(2); Z-score -6.45) was found to harbor deletion in almost 50% of the mitochondria. The patient had a blood lactic acid level (4.6 nM) that was over 3 times the upper reference range (0-1.3 mM), thus confirming the presence of systemic oxidative stress. Further analysis by modified primer shift polymerase chain reaction showed the 5' breakpoint to be between the nucleotides 10.63 kb and 10.80 kb of the mtDNA. The second patient harboring the 3.7 kb deletion was older (62 years) with less severe osteoporosis (lumbar spine BMD 0.727/cm(2); Z-score -2.58) and the proportion of affected mitochondria was lower (25%). The significance of these findings is discussed and the possible relation between oxidative stress and accelerated bone loss is examined.- - - - - - - - - - ranking = 2keywords = bone (Clic here for more details about this article) |
8/150. Relationship between structural parameters, bone mineral density and fracture load in lumbar vertebrae, based on high-resolution computed tomography, quantitative computed tomography and compression tests.Different noninvasive techniques for the assessment of the individual fracture risk in osteoporosis are introduced, and the relation between structural properties of high-resolution computed tomography (HR-CT) images of vertebral bodies, their bone mineral density (BMD) and the fracture load is analyzed. In 24 unfractured lumbar vertebrae with different degrees of demineralization from six specimens, the trabecular and cortical BMD was determined using quantitative CT. A lateral X-ray image revealed the number of fractures in the entire spine. A structural analysis of spongy and cortical bone was performed based on the HR-CT images. In the spongiosa, the fractal dimension was calculated as a function of the threshold value. In the cortical shell, the maximum number of clusters of low BMD was determined at varying threshold values. After the CT measurements the vertebrae were excised and compressed until fractured. On the basis of the spongiosa BMD and the number of fractures, 3 cases were found to be severely osteoporotic; the other 3 cases showed osteopenia. The average fracture loads were determined as 3533 N for the non-osteoporotic cases (range 2602-5802 N) and 1725 N for the osteoporotic cases (range 1311-2490 N). The parameters were determined as follows: average spongiosa BMD 115.2 mg/ml (101.8-135.3 mg/ml) for the non-osteoporotic cases, 46.2 mg/ml (34.8-57.6 mg/ml) for the osteoporotic cases; average cortical BMD 285.1 mg/ml (216.4-361.9 mg/ml) for the non-osteoporotic cases, 136. 1 mg/ml (142.5-215.2 mg/ml) for the osteoporotic cases; spongiosa structure: average 0.5 (range 0.32-0.75) for the non-osteoporotic cases, average 1.05 (range 0.87-1.24) for the osteoporotic cases; cortical structure: average 81 (range 55-104) for the non-osteoporotic cases), average 136 (range 102-159) for the osteoporotic cases. Single parameters (BMD and structure) and weighted sums of these parameters were correlated with the fracture load, resulting in correlation coefficients of r(sBMD) = 0.82 (spongiosa BMD), r(cBMD) = 0.82 (cortical BMD), r(sStr) = -0.75 (spongiosa structure) and r(cStr) = -0.86 (cortical structure). The weighted sum of cortical and spongiosa BMD resulted in r(BMD) = 0.86, of cortical and spongiosa structure in r(Str) = -0.86. A weighted combination of all four parameters correlates with the fracture load at r(4) = 0.89, all correlations being statistically significant (p<0.0001). The four individual parameters show only a slight overlap between non-osteoporotic and osteoporotic subjects. The high correlation of the cortical BMD and the structural parameter in cortical bone indicates the important contribution of the cortical shell to vertebral stability. A weighted sum of multiple parameters results in a higher correlation with the fracture load and does not show an overlap between the two groups. It is best suited to estimate the individual fracture risk. The presented methods are generally applicable in vivo; and allow an improvement of the diagnosis of osteoporosis compared with the measurement of the BMD alone.- - - - - - - - - - ranking = 7keywords = bone (Clic here for more details about this article) |
9/150. Vertebral collapse and normal peripheral blood cell count at the onset of acute lymphatic leukemia in childhood.Acute lymphatic leukemia presenting with bone pain and spine involvement is a recognized clinicopathologic complex that can mimic a wide range of orthopaedic conditions. Bone pain as the presenting complaint is common, with a reported incidence of 27% to 50%. Radiologic abnormalities associated with leukemia in children has been described previously. In the literature, the incidence of spinal involvement is controversial, but there is agreement that the spine is less commonly involved than are the long bones. At the onset of the disease, only 10% of children have normal peripheral blood counts. If the patient has spinal involvement and a normal leukocyte count, the diagnosis is often unclear. Only three of these patients have been described in the literature; this article adds one more patient with acute lymphatic leukemia with back pain as the main symptom, vertebral collapse, and a normal peripheral blood cell count at the time of initial presentation. It illustrates that delay in diagnosis frequently occurs, with the classic features of the disease being uniformly absent.- - - - - - - - - - ranking = 2keywords = bone (Clic here for more details about this article) |
10/150. A case of postpregnancy osteoporosis.A puerperant woman, who was previously healthy and had no disease known to affect bone metabolism, experienced lower back pain and lumbar vertebral fractures during lactation. Both bone formation markers and resorption markers were markedly elevated. Bone mineral density of the lumbar spine as measured by dual energy X-ray absorptiometry was extremely low. She stopped lactation through the use of bromocriptine because of the large volume of milk secretion. After treatment with calcitonin injections and the use of a corset, her back pain gradually disappeared. This case appears to be postpregnancy osteoporosis.- - - - - - - - - - ranking = 2keywords = bone (Clic here for more details about this article) |
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