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Related Concept Videos

General Structure of a Vertebra01:30

General Structure of a Vertebra

A typical vertebra, with the exception of the sacrum and coccyx, consists of a body, a vertebral arch, and seven different projections termed processes. The anterior portion of the vertebrae, the body, supports about half the body’s weight. The vertebral bodies progressively increase in size and thickness from the cervical region to the lumbar region of the vertebral column. The intervertebral discs present between the bodies of adjacent vertebrae firmly unites them, forming a continuous column.
Herniated Intervertebral Disc l: Introduction01:29

Herniated Intervertebral Disc l: Introduction

Intervertebral disc herniation refers to the displacement of the nucleus pulposus (the gel-like inner core of the disc) through a tear or weakened area in the annulus fibrosus (the outer fibrous ring). The displaced disc material extends beyond the normal boundaries of the disc space and may compress or irritate nearby spinal nerve roots or, less commonly, the spinal cord.Etiology and Risk FactorsHerniation commonly results from degeneration, in which aging reduces disc hydration and...
Structural Joints: Cartilaginous Joints01:17

Structural Joints: Cartilaginous Joints

As the name indicates, at a cartilaginous joint, the adjacent bones are united by cartilage, a tough but flexible type of connective tissue. Unlike synovial joints, these types of joints lack a joint cavity and involve bones joined together by either hyaline cartilage or fibrocartilage.
There are two types of cartilaginous joints:
Synchondrosis
A synchondrosis ("joined by cartilage") is a cartilaginous joint where bones are connected by hyaline cartilage. Synchondrosis may be temporary or...
Articulations of the Vertebral Column01:28

Articulations of the Vertebral Column

In addition to being held together by the intervertebral discs, adjacent vertebrae also articulate with each other at synovial joints formed between the superior and inferior articular processes called zygapophysial joints (facet joints). These are plane joints that provide for only limited motions between the vertebrae. The orientation of the articular processes at these joints varies in different regions of the vertebral column and serves to determine the types of motions available in each...
Degenerative Disc Disease I: Introduction01:27

Degenerative Disc Disease I: Introduction

Degenerative disc disease is a chronic condition in which intervertebral discs gradually lose structure and function. It is not infectious or autoimmune; rather, it results from age-related biochemical and mechanical changes, influenced by genetic, metabolic, and environmental factors.Structure and Function of DiscsThe spine contains 23 intervertebral discs that absorb load, distribute forces, maintain spacing, and allow flexibility. Each disc consists of a nucleus pulposus, a gel-like core...
Muscles of the Vertebral Column01:27

Muscles of the Vertebral Column

The back muscles that lie deep into the thoracolumbar fascia are called intrinsic or true back muscles. These muscles are divided into four layers: superficial, intermediate, deep, and deepest layers.
Superficial Layer:
The superficial layer consists primarily of the splenius muscles, which include the splenius capitis and splenius cervicis. These muscles are mainly responsible for the head and cervical spine movements, including extension, rotation, and lateral bending. The splenius capitis...

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Related Experiment Video

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C-arm-Free Simultaneous OLIF51 and Percutaneous Pedicle Screw Fixation in a Single Lateral Position
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Occult spinous process fractures associated with interspinous process spacers.

David H Kim1, Mark Tantorski, Jeremy Shaw

  • 1Tufts University School of Medicine, 125 Parker Hill Ave., Boston, MA 02120, USA. dhkim@caregroup.harvard.edu

Spine
|February 24, 2011
PubMed
Summary

Interspinous process spacer surgery is linked to a higher rate of spinous process fractures than previously thought. Computed tomography (CT) is essential for detecting these fractures, which are often missed on plain radiographs.

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Area of Science:

  • Orthopedic surgery
  • Spinal diagnostics
  • Medical imaging

Background:

  • Biomechanical studies suggest spinous process strength is adequate for interspinous process spacers (IPS).
  • Previous reports indicate spinous process fracture rates of 1-5.8% after IPS surgery.
  • Fractures often occur in areas difficult to visualize on plain radiographs due to device design.

Purpose of the Study:

  • To accurately estimate the incidence of acute spinous process fractures following interspinous process spacer surgery.
  • To evaluate the diagnostic efficacy of different imaging modalities for detecting these fractures.

Main Methods:

  • Prospective observational study involving patients undergoing IPS surgery.
  • Preoperative and postoperative lumbar spine imaging including biplanar radiographs and computed tomography (CT).
  • Independent review of all imaging studies by a neuroradiologist and orthopedic spine surgeons.

Main Results:

  • Postoperative CT revealed spinous process fractures in 28.9% of patients (22% of levels).
  • No fractures were identifiable on plain radiographs; CT identified 11 nondisplaced fractures.
  • Fractures were associated with poorer patient outcomes and lower satisfaction rates compared to those without fractures.

Conclusions:

  • Interspinous process spacer surgery is associated with a higher rate of early postoperative spinous process fracture than previously reported.
  • Plain radiographs are inadequate for identifying these fractures; CT imaging is required.
  • Unrecognized spinous process fractures may contribute to unsatisfactory outcomes after IPS surgery.