Geriatric spine fractures - Demography, changing trends, challenges and special considerations: A narrative review

Trends and disparities in the surgical management of spinal fractures in Sweden during 2008-2023

BACKGROUND

Spinal fractures are a group of complex injuries whose management varies according to a number of factors. The aim of this study was to analyze trends in the management of spinal fracture surgery in Sweden from 2008 to 2023 with a focus on disparities based on gender, surgery method, age and geographical location. A secondary aim was to predict future incidence of spinal fracture surgeries.

METHODS

Comprehensive open source data was obtained from the Swedish National Board of Health and Welfare. The data was stratified based on gender, surgery method, age and geographical location per year and analyzed for trends. Future trends were projected using regression modeling. The student's T-test was used to compare means.

RESULTS

The incidence of spinal fracture surgery decreased overall from 2008 to 2023 while maintaining an increased incidence for males compared to females. The highest incidence for osteosynthesis was 2.7 per 100 000 inhabitants in 2008 and 1 in 2023. This trend is projected to be reversed in 2030. Several surgery methods have decreased in usage and are projected to reach close to 0 in 2030. The patient group that underwent spinal fracture surgery had a higher mean age in 2023 compared to 2008. The incidence of spinal fracture surgery varied significantly across Sweden where region Östergötland performed 6.3 surgeries per 100 000 inhabitants and region Örebro performed 1.4.

CONCLUSIONS

We found several trends where males may undergo spinal fractures surgery more commonly than females. Probable influencing factors may be increased life-spans and osteoporosis. This may also explain the observed shift towards older age groups in spinal fracture surgery. The decreased use of several surgery methods may reflect changes in operational techniques, demographics, and more standardized care. Geographical disparities may indicate different local health care protocols and uneven healthcare utilization and access.

TRIAL REGISTRATION

Not applicable.

An Automated Multi-scale Feature Fusion Network for Spine Fracture Segmentation Using Computed Tomography Images

Spine fractures represent a critical health concern with far-reaching implications for patient care and clinical decision-making. Accurate segmentation of spine fractures from medical images is a crucial task due to its location, shape, type, and severity. Addressing these challenges often requires the use of advanced machine learning and deep learning techniques. In this research, a novel multi-scale feature fusion deep learning model is proposed for the automated spine fracture segmentation using Computed Tomography (CT) to these challenges. The proposed model consists of six modules; Feature Fusion Module (FFM), Squeeze and Excitation (SEM), Atrous Spatial Pyramid Pooling (ASPP), Residual Convolution Block Attention Module (RCBAM), Residual Border Refinement Attention Block (RBRAB), and Local Position Residual Attention Block (LPRAB). These modules are used to apply multi-scale feature fusion, spatial feature extraction, channel-wise feature improvement, segmentation border results border refinement, and positional focus on the region of interest. After that, a decoder network is used to predict the fractured spine. The experimental results show that the proposed approach achieves better accuracy results in solving the above challenges and also performs well compared to the existing segmentation methods.

Evaluation of perioperative care and drivers of cost in geriatric thoracolumbar trauma

Introduction

As the population of elderly patients continues to rise, the number of these individuals presenting with thoracolumbar trauma is expected to increase.

Research question

To investigate thoracolumbar fusion outcomes for patients with vertebral fractures as stratified by decade. Secondarily, we examined the variability of cost across age groups by identifying drivers of cost of care.

Materials and methods

We queried the United States Nationwide Inpatient Sample(NIS) for adult patients undergoing spinal fusion for thoracolumbar fractures between 2012 and 2017. Patients were stratified by decade 60-69(sexagenarians), 70-79(septuagenarians) and 80-89(octogenarians). Bivariable analysis followed by multivariable regression was performed to assess independent predictors of length of stay(LOS), hospital cost, and discharge disposition.

Results

A total of 2767 patients were included, of which 46%(N = 1268) were sexagenarians, 36% septuagenarians and 18%(N = 502) octogenarians. Septuagenarians and octogenarians had shorter LOS compared to sexagenarians(ß = -0.88 days; p = 0.012) and(ß = -1.78; p < 0.001), respectively. LOS was reduced with posterior approach(-2.46 days[95% CI: 3.73-1.19]; p < 0.001), while Hispanic patients had longer LOS(+1.97 [95% CI: 0.81-3.13]; p < 0.001). Septuagenarians had lower total charges $12,185.70(p = 0.040), while the decrease in charges in octogenarians was more significant, with a decrease of $26,016.30(p < 0.001) as compared to sexagenarians. Posterior approach was associated with a decrease of $24,337.90 in total charges(p = 0.026). Septuagenarians and octogenarians had 1.72 higher odds(p < 0.001) and 4.16 higher odds(p < 0.001), respectively, of discharge to a skilled nursing facility.

Discussion and conclusions

Healthcare utilization in geriatric thoracolumbar trauma is complex. Cost reductions in the acute hospital setting may be offset by unaccounted costs after discharge. Further research into this phenomenon and observed racial/ethnic disparities must be pursued.

Plant-derived natural medicines for the management of osteoporosis: A comprehensive review of clinical trials

Background

Osteoporosis is a chronic and systemic skeletal disease that is defined by low bone mineral density (BMD) along with an increase in bone fragility and susceptibility to fracture. This study aimed to overview clinical evidence on the use of herbal medicine for management of osteoporosis.

Methods

Electronic databases including Pubmed, Medline, Cochrane library, and Scopus were searched until November 2022 for any clinical studies on the efficacy and/or safety of plant-derived medicines in the management of osteoporosis.

Results

The search yielded 57 results: 19 on single herbs, 16 on multi-component herbal preparations, and 22 on plant-derived secondary metabolites. Risk of fracture, bone alkaline phosphatase, BMD, and specific bone biomarkers are investigated outcomes in these studies. Medicinal plants including Acanthopanax senticosus, Actaea racemosa, Allium cepa, Asparagus racemosus, Camellia sinensis, Cissus quadrangularis, Cornus mas, Nigella sativa, Olea europaea, Opuntia ficus-indica, Pinus pinaster, Trifolium pretense and phytochemicals including isoflavones, ginsenoside, Epimedium prenyl flavonoids, tocotrienols are among plant-derived medicines clinically investigated on osteoporosis. It seems that multi-component herbal preparations were more effective than single-component ones; because of the synergistic effects of their constituents. The investigated herbal medicines demonstrated their promising results in osteoporosis via targeting different pathways in bone metabolism, including balancing osteoblasts and osteoclasts, anti-inflammatory, immunomodulatory, antioxidant, and estrogen-like functions.

Conclusion

It seems that plant-derived medicines have beneficial effects on bone and may manage osteoporosis by affecting different targets and pathways involved in osteoporosis; However, Future studies are needed to confirm the effectiveness and safety of these preparations.