[Application of the theory of equal emphasis on muscle and bone in percutaneous vertebroplasty of lumbar osteoporotic compression fracture]

OBJECTIVE

To explore the clinical efficacy of percutaneous vertebroplasty(PVP) combined with nerve block in the treatment of lumbar osteoporotic vertebral compression fractures under the guidance of traditional chinese medicine "theory of equal emphasis on muscle and bone".

METHODS

Total of 115 patients with lumbar osteoporotic vertebral compression fractures were treated by percutaneous vertebroplasty from January 2015 to March 2022, including 51 males and 64 females, aged 25 to 86 (60.5±15.9) years. Among them, 48 cases were treated with PVP operation combined with erector spinae block and joint block of the injured vertebral articular eminence (intervention group), and 67 cases were treated with conventional PVP operation (control group). The visual analogue scale(VAS) and Oswestry disability index(ODI) before operation, 3 days, 1 month and 6 months after operation between two groups were evaluated. The operation time, number of punctures and intraoperative bleeding between two groups were compared.

RESULTS

The VAS and ODI scores of both groups improved significantly after operation compared with those before operation(P<0.05). Moreover, the VAS and ODI scores of 3 days and 1 month after operation of the intervention group improved more significantly than that of the control group(P<0.05). The difference of VAS and ODI scores before operation and 6 months after operation between two groups had no statistical significances(P>0.05). There was no statistically significant difference in the number of punctures and intraoperative bleeding between the two groups (P>0.05).

CONCLUSION

Based on the theory of "equal emphasis on muscles and bones", PVP combined with nerve block can effectively relieve paravertebral soft tissue spasm and other "muscle injuries", which can significantly improve short-term postoperative low back pain and lumbar spine mobility compared to conventional PVP treatment, and accelerate postoperative recovery, resulting in satisfactory clinical outcomes.

Correlation of bone mineral density with MRI T2* values in quantitative analysis of lumbar osteoporosis

We found that the MRI T2* value is moderately negatively correlated with the bone mineral density assessed with quantitative computed tomography in evaluating osteoporosis in postmenopausal women and may have some potential in assessing severity of lumbar osteoporosis for scientific research.

PURPOSE

To investigate the T2* quantitative measurement in magnetic resonance imaging (MRI) and its correlation with the bone mineral density (BMD) values evaluated with quantitative computed tomography (QCT) in women with postmenopausal lumbar vertebrae osteoporosis.

MATERIALS AND METHODS

Eighty-seven postmenopausal women were enrolled who had MRI scanning with T1WI, T2WI, and T2* mapping sequences and QCT evaluation of BMD. The T2* value and the BMD were assessed in lumbar vertebral bodies 2-4. Based on the BMD values, the patients were divided into three groups: normal, osteopenia, and osteoporosis.

RESULTS

The inter- and intra-observer intraclass correlation coefficients (ICCs) for T2* were 0.91 (0.87-0.94, 95% CI) and 0.93 (0.88-0.95, 95% CI), respectively. The inter- and intra-observer ICCs for the BMD value were 0.89 (0.83-0.92, 95% CI) and 0.91 (0.86-0.93, 95% CI), respectively. The differences of the T2* values and BMD among the three groups were statistically significant (P < 0.05). The BMD value was greater in the normal group (145.02 ± 18.94 mg/cm³) than the other two groups (97.90 ± 16.18 mg/cm³ for osteopenia and 59.09 ± 18.71 mg/cm³ for osteoporosis). The normal group had a significantly (P < 0.05) smaller T2* value than the other two groups (8.39 ± 4.17 ms in the normal group versus 12.25 ± 3.36 ms in the osteopenia or 15.54 ± 4.9 ms in the osteoporosis). A significant (P < 0.05) difference also existed in the T2* value between the osteopenia and the osteoporosis groups. The correlations of the T2* values with BMD values were significantly (P < 0.05) negative after adjusting for age (r = - 0.33, - 0.45, and - 0.51 for normal, osteopenia, and osteoporosis, respectively).

CONCLUSION

The MRI T2*value is moderately negatively correlated with the bone mineral density assessed with quantitative computed tomography in evaluating osteoporosis in postmenopausal women and may have some potential in assessing severity of lumbar osteoporosis for scientific research.

[Biomechanics changes of lumbar spine caused by foraminotomy via percutaneous transforaminal endoscopic lumbar discectomy]

Objective: To analyze the biomechanics changes of lumbar spine caused by foraminotomy via percutaneous transforaminal endoscopic lumbar discectomy using the finite element method. Methods: Three healthy adult males (aged 35.6 to 42.3 years) without spinal diseases were enrolled in this study and 3D-CT scans were carried out to obtain the parameters of lumbar spine. Mimics software was applied to build a 3D finite element model of lumbar spine. Graded resections (1/4, 2/4, 3/4 and 4/4) of the left superior articular process of L(5) were done via percutaneous transforaminal endoscopic lumbar discectomy. Then, the pressure of the L(4/5) right facets, the pressure of the L(4/5) intervertebral disc and the motion of lumbar spine were recorded after simulating the normal flexion and extension, lateral flexion and rotation of the lumbar spine model during different resections. The data were compared among groups with analysis of variance. Results: Comparing with the normal group, after 1/4 resection of the left superior articular process of L(5), the pressure of the L(4/5) right facets showed significant differences during left lateral flexion and rotation of lumbar spine (q=8.823, 8.248, both P<0.05); and the pressure of L(4/5) intervertebral disc also changed significantly during extension and right rotation of lumbar spine (q=6.918, 6.438, both P<0.05); the motion of lumbar spine showed obvious differences during right lateral flexion and rotation (q=6.845, 7.772, 13.58, all P<0.05). Comparing with the normal group, after 2/4 resection of the left superior articular process of L(5), the pressure of the L(4/5) right facets presented significant differences during all conditions (q=5.670-17.830, all P<0.05); the pressure of L(4/5) intervertebral disc changed significantly during flexion, extension, lateral flexion and right rotation (q=5.260, 17.150, 5.727, 8.890, 15.660, all P<0.05); the motion of lumbar spine also existed differences during extension, lateral flexion and rotation (q=9.106, 5.431, 12.060, 11.160, 17.260, all P<0.05). However, after 3/4 resections, the pressure of the L(4/5) right facets, the pressure of the L(4/5) intervertebral disc and the motion of lumbar spine presented differences during all conditions when compared with those in normal group (q=6.303-25.48, all P<0.05). After 4/4 resections, the pressure of the L(4/5) right facets and the pressure of the L(4/5) intervertebral disc and the motion of lumbar spine showed significant differences during all conditions when compared with those in normal group (q=8.065-45.70, all P<0.05). Conclusions: The biomechanics and the stability of lumbar spine changed partly after 1/4 resection of the superior articular process and obviously after more than 2/4 is resected. The superior articular process should be paid more attention during foraminotomy via percutaneous transforaminal endoscopic lumbar discectomy.