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Murphy L, Piscitelli N, Solomon J, Szlosek D, Nakamura RK. Vertebral heart size and vertebral left atrial size reference ranges in healthy Miniature Schnauzers. Am J Vet Res 2024; 85:ajvr.24.01.0010. [PMID: 38467109 DOI: 10.2460/ajvr.24.01.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 02/17/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVE The inclusion of vertebral heart score (VHS) and, more recently, the inclusion of the vertebral left atrial size (VLAS) in radiographic evaluation have become important screening tools for identifying dogs with occult cardiac disease. Several recent papers have shown there are interbreed variations in the VHS reference range. Our hypothesis is that the Miniature Schnauzer would also have a higher reference range for its VHS. ANIMALS The electronic medical records of IDEXX Telemedicine Consultants were searched for Miniature Schnauzers undergoing thoracic radiographs between March 1, 2022, and February 28, 2023. METHODS Dogs were included if they had 3 view thoracic radiographs performed and no evidence of cardiopulmonary disease was detected. Dogs with incomplete radiographic studies or cardiac or extracardiac disease were excluded. The VHS and VLAS measurements were performed by 2 board-certified cardiologists independent of one another. RESULTS A total of 1,000 radiographs were obtained of which 272 were included for the study. The overall range for the VHS in this cohort was 9.68 to 12.07 with a median of 10.9. For VLAS measurements, a range of 1.71 to 2.4 was documented with a median of 2.0. CLINICAL RELEVANCE The VHS for Miniature Schnauzers without cardiac disease was confirmed to be higher than the canine reference range.
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Affiliation(s)
- Lisa Murphy
- Department of Cardiology, Univeristy of Madison, Madison, WI
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2
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Moura DL. The role of kyphoplasty and expandable intra vertebral implants in the acute treatment of traumatic thoracolumbar vertebral compression fractures: a systematic review. EFORT Open Rev 2024; 9:309-322. [PMID: 38579781 PMCID: PMC11044091 DOI: 10.1530/eor-23-0190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
Purpose The aim of the study was to assess the role of kyphoplasty and expandable intravertebral implants in the treatment of traumatic vertebral compression fractures. Design This is a systematic review. Methods A bibliographic search was carried out in the PubMed/MEDLINE database according to PRISMA guidelines regarding kyphoplasty and expandable intravertebral implants in the treatment of traumatic thoracolumbar vertebral fractures. Results A total of 611 records were screened. In total, 51 studies were obtained referring to traumatic vertebral fractures treated with kyphoplasty; however, of these, only studies addressing traumatic burst fractures were selected, resulting in 12 studies: 10 about kyphoplasty and 2 regarding armed kyphoplasty. In all studies, there was a statistically significant improvement in clinical and functional parameters, restoration of vertebral height and decreasing of vertebral and segmental kyphosis. Overall, there was only a residual loss of height and a slight increase in kyphosis throughout the follow-up period, while complications consisted essentially of cement leakage, all with no clinical repercussions. Conclusion After the discussion, where we address the concepts of direct and indirect reduction, the association of kyphoplasty with pedicle fixation, the potential advantages of expandable intravertebral implants, as well as the vertebral body type of filling in kyphoplasty, it is concluded that kyphoplasty demonstrates favorable outcomes as a method of posterior percutaneous transpedicular access for reconstruction of the anterior column in burst fractures. It allows for the reconstruction of the vertebral body closer to its original anatomy, carried out in a minimally invasive and safe way, which provides a clinical-functional and imaging improvement maintained at the medium-long term.
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Affiliation(s)
- Diogo Lino Moura
- Spine Unit, Department of Orthopedics, Coimbra University Hospital, Coimbra, Portugal, Coimbra, Portugal
- Anatomy Institute and Orthopedics Department, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Gandhi RS, Bhoge SS, Fating T, Sawalkar RG. Positive Outcomes of Physiotherapy Intervention in a Wedge Compression Fracture of the L1 Vertebra: A Case Report. Cureus 2024; 16:e51774. [PMID: 38322069 PMCID: PMC10844797 DOI: 10.7759/cureus.51774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/06/2024] [Indexed: 02/08/2024] Open
Abstract
The thoracolumbar spine is prone to vertebral compression fractures (VCFs). An injury mechanism known as flexion compression is responsible for thoracolumbar spine compression fractures. Usually, this mechanism affects the longitudinal ligament at the front and the front part of the vertebral body as the first components. Pain is the first and foremost symptom; here we present a case report of a 34-year-old male, who came to the hospital with complaints of back pain, and difficulty in breathing followed by a road traffic accident (RTA). MRI and X-ray investigations were done. The patient was diagnosed with a fracture of the anterolateral aspect of the right fourth and fifth ribs and posterolateral aspect of the sixth rib, acute anterior wedge compression fracture of the L1 vertebra, and bilateral minimal pneumothorax and haemothorax. The patient was managed surgically with post-decompression and spinal fusion at the D12-L2 level. The outcomes used were the Oswestry Low-Back Disability Questionnaire, the numerical pain rating scale, and Manual Muscle Testing (MMT). This case report specifies the physiotherapeutic rehabilitation protocol, mainly focusing on techniques like breathing exercises, and upper limb and lower limb strengthening along with trunk and pelvic floor muscles strengthening.
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Affiliation(s)
- Richa S Gandhi
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shruti S Bhoge
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Tejaswini Fating
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rutuja G Sawalkar
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Marbella Fernández D, Montoya-Alonso JA. Radiographic Left Atrial Size Measurement of Dogs in Different Mitral Valve Disease Stages with Four Different Methods. Animals (Basel) 2023; 13:3835. [PMID: 38136872 PMCID: PMC10741156 DOI: 10.3390/ani13243835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
The left atrial size increases (LAS) in patients with mitral valve disease (MVD) as the disease progresses. The vertebral left atrial size (VLAS), the modified-vertebral left atrial size (M-VLAS), and the radiographic left atrial dimension (RLAD) are methods reported to assess LAS on dogs' radiographs. All these methods transform the LAS into vertebral units. The thoracic inlet (TI) has been used as a reliable reference point to measure the cardiac silhouette of dogs with MVD in different stages. The objective of this study was to assess the clinical utility of measuring a dog LAS on right thoracic X-rays using the TI as a reference and determine whether it could differentiate dogs in different MVD stages. LAS was divided by the TI to obtain the thoracic inlet left atrial score (TILAS). This was a retrospective observational study including 135 apparently healthy dogs performed to assess their LAS with four different methods: VLAS, M-VLAS, RLAD, and TILAS. Thirty-six dogs from the general population were selected and compared to 100 dogs in different MVD stages. The TILAS was significantly different between the control dogs and MVD dogs, increasing with the disease stage: control dogs 0.51 ± 0.08, B1 0.57 ± 0.14, B2 0.75 ± 0.13, and C 0.84 ± 0.18. VLAS, M-VLAS, and RLAD also increased as the disease progressed, as shown in previous studies. The TILAS accuracy to distinguish MVD dogs with cardiac enlargement was comparable to VLAS, M-VLAS, and RLAD (AUC 0.91 vs. 0.93, 0.90, and 0.94 respectively). A TILAS > 0.8 can identify dogs with cardiac enlargement secondary to MVD.
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Affiliation(s)
- David Marbella Fernández
- Faculty of Veterinary Medicine, University of Las Palmas de Gran Canaria, 35413 Las Palmas de Gran Canaria, Spain
- CEU Small Animal Hospital, 46115 Valencia, Spain
| | - Jose Alberto Montoya-Alonso
- Internal Medicine, Faculty of Veterinary Medicine, Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, 35413 Las Palmas de Gran Canaria, Spain;
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Traore WM, Ait Belhaj EM, Compaore BG, Touarsa F, Lahfidi A, Jiddane M. Lipid-poor vertebral hemangioma mimicking a vertebral metastasis of cervical carcinoma. Clin Case Rep 2023; 11:e8195. [PMID: 38033692 PMCID: PMC10682230 DOI: 10.1002/ccr3.8195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/10/2023] [Accepted: 06/24/2023] [Indexed: 12/02/2023] Open
Abstract
Vertebral hemangiomas are classified into typical and atypical forms. On imaging, atypical forms may look like malignant lesions. The confrontation of data from different imaging modalities (MRI; CT; scintigraphy) facilitates the diagnosis.
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Affiliation(s)
| | - El Mahdi Ait Belhaj
- Service of RadiologySpeciality Hospital of Rabat, Mohammed V UniversityRabatMorocco
| | | | - Firdous Touarsa
- Service of RadiologySpeciality Hospital of Rabat, Mohammed V UniversityRabatMorocco
| | - Amal Lahfidi
- Service of RadiologySpeciality Hospital of Rabat, Mohammed V UniversityRabatMorocco
| | - Mohamed Jiddane
- Service of RadiologySpeciality Hospital of Rabat, Mohammed V UniversityRabatMorocco
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Anastasilakis AD, Makras P, Paccou J, Bisbinas I, Polyzos SA, Papapoulos SE. Similarities and Differences in the Management of Patients with Osteoporotic Vertebral Fractures and Those with Rebound-Associated Vertebral Fractures Following Discontinuation of Denosumab. J Clin Med 2023; 12:5874. [PMID: 37762815 PMCID: PMC10532339 DOI: 10.3390/jcm12185874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/31/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Rebound-associated vertebral fractures (RVFx) following denosumab discontinuation are typically multiple, are commonly associated with acute sharp pain, increase the risk of imminent fractures, and are pathogenetically different from common osteoporotic vertebral fractures (VFx). A clinically relevant question is whether patients with RVFx should be managed differently from patients with osteoporotic VFx. To address this question, we performed a systematic search of the PubMed database, and we reviewed current evidence on the optimal management of patients with RVFx. For pain relief of patients with RVFx, potent analgesics, often opioids, are essential. Information on the effectiveness of braces in these patients is scarce. Vertebroplasty and kyphoplasty are strongly contraindicated as they confer a substantial risk for new VFx. Exercise may be helpful, but again evidence is lacking. In contrast to patients with osteoporotic VFx, in whom initial treatment with bone-forming agents is recommended, patients with RVFx should initiate treatment with potent antiresorptives. To summarize, patients who have sustained RVFx following denosumab discontinuation are at a very high risk for new fractures, especially VFx. The management of such patients requires a multidisciplinary approach that should not be restricted to pain relief and administration of antiosteoporotic medication, but should also include back protection, early mobilization, and appropriate exercise.
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Affiliation(s)
| | - Polyzois Makras
- Department of Endocrinology and Diabetes, 251 Hellenic Air Force & VA General Hospital, 115 25 Athens, Greece;
- Department of Medical Research, 251 Hellenic Air Force & VA General Hospital, 115 25 Athens, Greece;
| | - Julien Paccou
- Department of Rheumatology, University of Lille, 59000 Lille, France;
| | - Ilias Bisbinas
- First Department of Orthopaedics, 424 Military General Hospital, 564 29 Thessaloniki, Greece;
| | - Stergios A. Polyzos
- First Laboratory of Pharmacology, School of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece;
| | - Socrates E. Papapoulos
- Department of Medical Research, 251 Hellenic Air Force & VA General Hospital, 115 25 Athens, Greece;
- Center for Bone Quality, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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Truumees E, Alexander J, Chandler C, Singh D, Geck M, Stokes J. Clinical Characteristics of 96 Patients Presenting With Hematogenous Spinal Osteomyelitis- a Retrospective Study. Global Spine J 2023:21925682231188363. [PMID: 37411005 DOI: 10.1177/21925682231188363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/08/2023] Open
Abstract
OBJECTIVE To report clinical characteristics and course of care for patients diagnosed with hematogenous spinal osteomyelitis (HVO). METHODS Medical records of patients presenting to two tertiary care centers with HVO were reviewed. RESULTS 96 consecutive patients with HVO were identified. Mean follow-up was 8.9 months. Most infections occurred in the lumbar region (50.0%). Of the cultures taken, MRSA accounted for 9%; MSSA, 26%; Streptococcus species, 12%; other gram-positive bacteria, 23%; gram-negative, 17%; fungal, 2.6%; and 11.5% of cultures returned no growth. 57 patients underwent surgery. Of these, 79% of the patients had undergone a trial of empiric antibiotics (cefepime and vancomycin) of the day prior to surgery. 44% underwent secondary surgeries, typically due to a heavy wound burden of necrotic tissue and pus. Postoperative antibiotics were prescribed to all patients. 51.6% of the patients were prescribed antibiotic therapy >6 months. Overall mortality rate was 3.8%. Major cause of all deaths was septic shock. Post-infection sequelae occurred in 47.4% of patients. The most common sequelae were persistent or new sites of infection, sepsis, and abscess. CONCLUSIONS Diabetes, hypertension, and renal failure appear to increase the risk of post-infection sequelae and death. While non-operative management was attempted in nearly 47%, ultimately 73% had surgery. This high rate may reflect our population of patients hospitalized in a tertiary care center. Available data suggests that patients presenting with hematogenous osteomyelitis be followed closely as failure of non-operative management, and resulting morbidity, was high.
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Affiliation(s)
- Eeric Truumees
- The University of Texas Dell Medical School, Ascension Texas Spine and Scoliosis, Austin, TX, USA
| | | | - Calvin Chandler
- The University of Texas Dell Medical School, Austin, TX, USA
| | | | - Matthew Geck
- The University of Texas Dell Medical School, Ascension Texas Spine and Scoliosis, Austin TX, USA
| | - John Stokes
- Ascension Texas Spine and Scoliosis, Austin TX, USA
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8
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Van Hoof C, Davis NA, Carrera‐Justiz S, Kahn AD, De Decker S, Grapes NJ, Beasley M, Du J, Pancotto TE, Suñol A, Shinn R, DeCicco B, Burkland E, Cridge H. Clinical features, comparative imaging findings, treatment, and outcome in dogs with discospondylitis: A multi-institutional retrospective study. J Vet Intern Med 2023; 37:1438-1446. [PMID: 37288966 PMCID: PMC10365064 DOI: 10.1111/jvim.16785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/21/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Limited recent data exists regarding discospondylitis in dogs. HYPOTHESIS/OBJECTIVES (i) Describe the signalment, clinical and imaging findings, etiologic agents, treatment, and outcome of dogs with discospondylitis, (ii) determine diagnostic agreement between radiographs, CT, and MRI with regard to the presence of discospondylitis and its location, and (iii) determine risk factors for relapse and progressive neurological deterioration. ANIMALS Three hundred eighty-six dogs. METHODS Multi-institutional retrospective study. Data extracted from medical records were: signalment, clinical and examination findings, diagnostic results, treatments, complications, and outcome. Potential risk factors were recorded. Breed distribution was compared to a control group. Agreement between imaging modalities was assessed via Cohen's kappa statistic. Other analyses were performed on categorical data, using cross tabulations with chi-squared and Fisher's exact tests. RESULTS Male dogs were overrepresented (236/386 dogs). L7-S1 (97/386 dogs) was the most common site. Staphylococcus species (23/38 positive blood cultures) were prevalent. There was a fair agreement (κ = 0.22) between radiographs and CT, but a poor agreement (κ = 0.05) between radiographs and MRI with regard to evidence of discospondylitis. There was good agreement between imaging modalities regarding location of disease. Trauma was associated with an increased risk of relapse (P = .01, OR: 9.0, 95% CI: 2.2-37.0). Prior steroid therapy was associated with an increased risk of progressive neurological dysfunction (P = .04, OR: 4.7, 95% CI: 1.2-18.6). CONCLUSIONS AND CLINICAL IMPORTANCE Radiograph and MRI results could be discrepant in dogs with discospondylitis. Prior trauma and corticosteroids could be associated with relapse and progressive neurological dysfunction, respectively.
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Affiliation(s)
- Cassie Van Hoof
- Department of Small Animal Clinical Sciences, College of Veterinary MedicineMichigan State UniversityEast LansingMichiganUSA
| | - Nicole A. Davis
- Department of Small Animal Clinical Sciences, College of Veterinary MedicineMichigan State UniversityEast LansingMichiganUSA
| | - Sheila Carrera‐Justiz
- Department of Small Animal Clinical Sciences, College of Veterinary MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Alisha D. Kahn
- Department of Small Animal Clinical Sciences, College of Veterinary MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Steven De Decker
- Department of Clinical Science and Services, Royal Veterinary CollegeUniversity of LondonHatfieldUK
| | - Nicholas J. Grapes
- Department of Clinical Science and Services, Royal Veterinary CollegeUniversity of LondonHatfieldUK
| | - Michaela Beasley
- Department of Clinical Sciences, College of Veterinary MedicineMississippi State UniversityStarkvilleMississippiUSA
| | - John Du
- Department of Clinical Sciences, College of Veterinary MedicineMississippi State UniversityStarkvilleMississippiUSA
| | - Theresa E. Pancotto
- Department of Clinical Sciences, College of Veterinary MedicineAuburn UniversityAuburnAlabamaUSA
| | - Anna Suñol
- AniCura Ars Veterinaria HospitalBarcelonaSpain
| | - Richard Shinn
- Department of Small Animal Clinical Sciences, College of Veterinary MedicineVirginia TechBlacksburgVirginiaUSA
| | - Barry DeCicco
- Center for Statistical Training and Consulting (CSTAT)Michigan State UniversityEast LansingMichiganUSA
| | - Erica Burkland
- ACCESS Specialty Animal Hospitals—South BayTorranceCaliforniaUSA
| | - Harry Cridge
- Department of Small Animal Clinical Sciences, College of Veterinary MedicineMichigan State UniversityEast LansingMichiganUSA
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Carsote M, Turturea MR, Valea A, Buescu C, Nistor C, Turturea IF. Bridging the Gap: Pregnancy-And Lactation-Associated Osteoporosis. Diagnostics (Basel) 2023; 13:diagnostics13091615. [PMID: 37175006 PMCID: PMC10177839 DOI: 10.3390/diagnostics13091615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/29/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023] Open
Abstract
Early diagnosis of pregnancy- and lactation-associated osteoporosis (PLO) is mandatory for a good outcome. Standard care is not a matter of conventional guidelines, rather it requires an individualized strategy while true overall incidence and pathogeny remain open issues. This is a narrative review based on full-length English articles, published between January 2021 and March 2023 and accessed via PubMed (no traumatic fractures or secondary osteoporosis are included). Our case-sample-based analysis included 836 females with PLO (the largest cohort based on published cases so far) through 12 studies and 24 single case reports. Except for one survey, these involved retrospective cohorts of small size (6-10 females/study) to medium size (23-47 women/study), and large cohorts with >50 subjects per study (a maximum of 379). Age of diagnosis: from 24 to 40 years for case reports (most subjects being over 30 and primigravida), while original studies indicated an average age between 31 and 34.18 years. Type of fractures underlined a most frequent vertebral phenotype (a mean of 2 to 5.8 vertebral fractures per patient) versus a most severe non-vertebral phenotype (hip and femoral neck fractures mostly requiring surgery). Potential contributors varied: smoking (1/3-1/2 of subjects), family history of osteoporosis (1/3), heparin and glucocorticoid use in pregnancy, low body mass index (majority of cases), hypovitaminosis D; and (with a low level of statistical significance) anti-psychotic medication, gestational diabetes, lupus, thrombophilia, anemia, in vitro fertilization (1/3 in one study), twin pregnancy, tocolysis with MgSO4, and postpartum thyroiditis. Most remarkably, up to 50% of PLO patients harbor mutations of LRP5, WNT1, and COL1A1/A2 (more damaged form with potential benefits from osteoanabolic drugs); gene testing might become the new norm in PLO. The low index of clinical suspicion should be supported by performing magnetic resonance imaging (gold standard in pregnancy) with DXA (in lactation). Low bone mineral density is expected (Z-score varying from -2.2 SD to -4 SD, unless normal which does not exclude PLO). Bone turnover markers might be useful in individuals with normal DXA, in pregnancy when DXA cannot be performed, and in following the response to anti-osteoporosis drugs. Alternatively, microarchitecture damage might be reflected by DXA-trabecular bone score and high-resolution peripheral quantitative computed tomography. Specific medical interventions are currently focused on teriparatide (TPT) use (3 studies; n = 99 females treated with TPT and an additional subgroup of 18 patients from the gene-analysis-based study, thus a total of 117 females) which seems to be the therapy of choice as reflected by these new data: 6-24 months, 20 µg/day, no sequential therapy needed; case selection based on high fracture risk is necessary). The first case using romosozumab was reported in 2022. PAO/LAO remains a challenging condition which is a battle for the wellbeing of two individuals, on one hand, considering maternal-fetal outcomes and taking care of the offspring, but it is a battle for a multidisciplinary team, on the other hand, since a standardized approach is lacking.
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Affiliation(s)
- Mara Carsote
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy & C.I. Parhon National Institute of Endocrinology, 011683 Bucharest, Romania
| | | | - Ana Valea
- Department of Endocrinology, Iuliu Hatieganu University of Medicine and Pharmacy & Clinical County Hospital, 400347 Cluj-Napoca, Romania
| | - Cristian Buescu
- Department of Orthopedics and Traumatology, Cluj Emergency County Hospital, 400347 Cluj-Napoca, Romania
| | - Claudiu Nistor
- Department 4-Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, Carol Davila University of Medicine and Pharmacy & Thoracic Surgery Department, Dr. Carol Davila Central Emergency University Military Hospital, 011683 Bucharest, Romania
| | - Ionut Florin Turturea
- Department of Orthopedics and Traumatology, Cluj Emergency County Hospital, 400347 Cluj-Napoca, Romania
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Stellpflug SJ, Dummer MF, Martin CD, Vera JA, LeFevere RC. Cervical Artery Dissections and Ischemic Strokes Associated with Vascular Neck Compression Techniques (Sportive Chokes). J Emerg Med 2022; 63:49-57. [PMID: 35934648 DOI: 10.1016/j.jemermed.2022.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 01/03/2022] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Strangulation as a fight-finishing maneuver in combat sports, termed "choking" in that context, occurs worldwide millions of times yearly. This activity can be trained safely, but devastating injuries can occur. OBJECTIVE Our aim was to present a case series of cervical artery dissections and ischemic strokes associated with sportive choking. Sharing these cases is meant to draw awareness, to assist emergency physicians in caring for these athletes, and to provide a platform for further research. METHODS Institutional Review Board approval was obtained. Participants consented for medical information transfer and anonymous academic reproduction. The minimum medical record information necessary for inclusion was a report of diagnosis-confirming advanced imaging. Participants were contacted for primary information in addition to what the medical records could provide and to confirm some information in the record (e.g., pertinent medical history, demographic characteristics, choking event description, medical care, and commentary on their current health). Medical records and additional first-hand information were reviewed and participants were included if they had a diagnosed dissection or stroke likely associated with a sportive choke. RESULTS Ten cases met all criteria for inclusion. There were 5 cases of carotid artery dissection, 3 cases of vertebral artery dissection, and 2 cases of ischemic stroke without dissection. Nine of 10 participants survived and 3 of 10 have returned to submission grappling training. CONCLUSIONS Cervical artery dissections and ischemic strokes can occur in association with sportive choking. Emergency physicians must be aware of the widespread nature of this activity and must be vigilant in approaching management of patients with symptoms consistent with these injuries.
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Affiliation(s)
| | - Matthew F Dummer
- Department of Emergency Medicine, Regions Hospital, Saint Paul, Minnesota
| | | | - Joshua A Vera
- Hazel Hawkins Memorial Hospital, Hollister, California
| | - Robert C LeFevere
- Department of Emergency Medicine, Regions Hospital, Saint Paul, Minnesota
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Abstract
One-fifth of strokes occur in the territory of the posterior circulation, but
their management, particularly acute reperfusion therapy and neurointervention
procedures for secondary prevention, has received much less attention than
similar interventions for the anterior circulation. In this review, we overview
the treatment of posterior circulation stroke, including both interventions in
the acute setting and secondary prevention. We focus on areas in which the
management of posterior circulation stroke differs from that of stroke in
general and highlight recent advances. Effectiveness of acute revascularization of posterior circulation strokes remains
in large parts unproven. Thrombolysis seems to have similar benefits and lower
hemorrhage risks than in the anterior circulation. The recent ATTENTION and
BAOCHE trials have demonstrated that thrombectomy benefits strokes with basilar
artery occlusion, but its effect on other posterior occlusion sites remains
uncertain. Ischemic and hemorrhagic space-occupying cerebellar strokes can
benefit from decompressive craniectomy. Secondary prevention of posterior circulation strokes includes aggressive
treatment of cerebrovascular risk factors with both drugs and lifestyle
interventions and short-term dual anti-platelet therapy. Randomized controlled
trial (RCT) data suggest basilar artery stenosis is better treated with medical
therapy than stenting, which has a high peri-procedural risk. Limited data from
RCTs in stenting for vertebral stenosis suggest that intracranial stenosis is
currently best treated with medical therapy alone; the situation for
extracranial stenosis is less clear where stenting for symptomatic stenosis is
an option, particularly for recurrent symptoms; larger RCTs are required in this
area.
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Affiliation(s)
- Hugh S Markus
- Department of Clinical Neurosciences, University of Cambridge, Cambridge UK 2152
| | - Patrik Michel
- Stroke Center, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Switzerland
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12
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Patel S, Chiu RG, Chaker AN, Rosinski CL, Nunna RS, Behbahani M, Mehta AI. Current Trends and Socioeconomic Disparities in the Utilization of Spine Augmentation for Patients With Osteoporotic Vertebral Compression Fracture: A Nationwide Inpatient Sample Analysis From 2012 to 2016. Int J Spine Surg 2022; 16:490-497. [PMID: 35728830 DOI: 10.14444/8262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Osteoporotic vertebral compression fracture (OVCF) is a growing health care problem in today's aging population. Since the advent of kyphoplasty and vertebroplasty, these interventions have been commonly utilized in the treatment of symptomatic OVCF. However, the use of these interventions varies because there is not a standard of care for the management of OVCF. There remain disparities in the use of these procedures as treatment for OVCFs in the United States. METHODS The 2012 to 2016 Nationwide Inpatient Sample was queried for all patients admitted for OVCF. These patients were then grouped based on whether they received conservative vs surgical (kyphoplasty/vertebroplasty) management and compared with respect to various socioeconomic factors including race, insurance coverage, income quartile, hospital control, and geography. Propensity score matching was utilized to control for potential baseline confounders as well as the influence of other endpoints. RESULTS The search criteria identified 35,199 patients admitted with OVCF, of whom 7900 (22.4%) received spine augmentation. Blacks/African Americans (risk ratios [RR] = 0.79, P < 0.001), Hispanics/Latinos (RR = 0.82, P < 0.001), Asians/Pacific Islanders (RR = 0.81, P = 0.048), and unknown/other races (RR = 0.88, P = 0.037) were less likely to receive surgical management than whites/Caucasians. When compared with Medicare patients, those with Medicaid (RR = 0.76, P < 0.001) were less likely to receive surgery while privately insured patients were more likely (RR = 1.06, P = 0.42). Patients in the West (RR = 0.90, P < 0.001) were less likely to receive surgery for OVCF than those in the Northeast. CONCLUSIONS A wide variety of socioeconomic disparities exists in the use of spinal augmentation for the management of OVCF in the United States, limiting patient access to a potentially beneficial procedure. CLINICAL RELEVANCE Retrospective Analysis. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Saavan Patel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Ryan G Chiu
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Anisse N Chaker
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Clayton L Rosinski
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Ravi S Nunna
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Mandana Behbahani
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
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Durgia H, Kamalanathan S, Ramkumar G, Sarkar S, Reddy SVB, Sahoo J, Palui R, Raj H. Effect of 2 mg Versus 4 mg of Intravenous Zoledronic Acid on Bone Mineral Density at the Lumbar Spine in Indian Postmenopausal Women with Osteoporosis: A Double-blind Parallel-arm Randomized Controlled Trial. J Res Pharm Pract 2021; 10:71-77. [PMID: 34527611 PMCID: PMC8420937 DOI: 10.4103/jrpp.jrpp_20_130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 02/12/2021] [Indexed: 11/05/2022] Open
Abstract
Objective: The primary purpose was to compare the effect of 2 mg and 4 mg of intravenous zoledronic acid (ZA) on change in the lumbar spine (LS) bone mineral density (BMD) at the end of 1 year in postmenopausal women with osteoporosis. The secondary objectives were changes in BMD at the total hip and femoral neck, change in bone turnover markers (BTMs), and the incidence of new fractures. Methods: This was a double-blind, parallel-arm, randomized control trial with an allocation ratio of 1:1 done in 70 postmenopausal women with osteoporosis. Findings: The mean (±standard deviation) percentage increase in LS BMD at the end of 1 year was 4.86% ± 3.05% and 5.35% ± 3.73% in the 2 mg and 4 mg group, respectively. The dose of 2 mg ZA proved to be inferior to 4 mg with a noninferiority margin of 0.5%. There was no difference in BMD change at hip and BTMs between the two groups at the end of 1 year. Only one patient in 4 mg group developed two new vertebral fractures during a 12-month follow-up. Acute-phase reactions were the most common (43%) side-effects noted without any difference between the two groups (P = 0.63). Conclusion: This study failed to show the noninferiority of 2 mg ZA compared to 4 mg ZA for change in LS BMD at the end of 1 year.
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Affiliation(s)
- Harsh Durgia
- Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sadishkumar Kamalanathan
- Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Govindarajalou Ramkumar
- Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sonali Sarkar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | | | - Jayaprakash Sahoo
- Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Rajan Palui
- Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Henith Raj
- Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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14
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Moura DL, Gabriel JP. Expandable Intra vertebral Implants: A Narrative Review on the Concept, Biomechanics, and Outcomes in Traumatology. Cureus 2021; 13:e17795. [PMID: 34660005 PMCID: PMC8496495 DOI: 10.7759/cureus.17795] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 01/22/2023] Open
Abstract
Expandable intravertebral implants are self-expanding devices applied percutaneously by the posterior transpedicular approach. These devices introduce the concept of anatomical restoration of vertebral body endplates and direct anatomical reduction performed from the interior of the vertebral body with a compression fracture. This paper aims to provide a narrative review on the concept, indications, biomechanical characteristics, as well as functional and radiographic outcomes of the main expandable intravertebral implants currently available, in terms of their application to thoracolumbar spine traumatology. To this end, we performed a search in July 2021 on the MEDLINE/PubMed platform with the words "expandable intravertebral implant", "armed kyphoplasty", "Vertebral Body Stenting" or "stentoplasty" and "SpineJack". The search yielded 144 papers, and of those, we included 15 in this review. We concluded that percutaneous transpedicular posterior access, the ability to reduce vertebral body fractures, particularly of the vertebral endplates and to maintain the vertebral body height, makes the application of expandable intravertebral implants an attractive option in the treatment of thoracolumbar vertebral compression fractures. However, more prospective, randomized, and large-scale blinded studies are still warranted, especially comparative studies between treatments and about the preferential use of an expansive implant over others, in order to gain definitive insights into the effectiveness and indications of each of these devices.
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Affiliation(s)
- Diogo L Moura
- Spine Surgery, Spine Unit, Orthopedics Department, Coimbra Hospital and University Center, Coimbra, PRT
- Spine Surgery, Spine Institute of Ohio, Grant Medical Center, Columbus, USA
| | - Josue P Gabriel
- Orthopedic Spine Surgery, Spine Institute of Ohio, Grant Medical Center, Columbus, USA
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15
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Pikus HJ, Harbaugh RE. Commentary on: Chiropractic associated vertebral artery dissection: An analysis of 34 patients amongst a cohort of 310. Clin Neurol Neurosurg 2021; 207:106790. [PMID: 34245988 DOI: 10.1016/j.clineuro.2021.106790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 06/19/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Harold J Pikus
- Upper Valley Neurology Neurosurgery, 106 Hanover Street, Lebanon, NH 03766, USA.
| | - Robert E Harbaugh
- Distinguished Department of Neurosurgery, Department of Engineering Science & Mechanics Penn State University, Milton S. Hershey Medical Center, 30 Hope Drive, Hershey, PA 17033, USA.
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16
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Xue F, Shen Z, Wang Y, Kwok SC, Yin J. Microvascular decompression for hemifacial spasm involving the vertebral artery: A modified effective technique using a gelatin sponge with a FuAiLe medical adhesive. CNS Neurosci Ther 2021; 27:857-861. [PMID: 34050606 PMCID: PMC8193698 DOI: 10.1111/cns.13662] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/10/2021] [Accepted: 05/10/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Fei Xue
- Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Zhaoli Shen
- Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | | | - Sze Chai Kwok
- Shanghai Key Laboratory of Brain Functional Genomics, Key Laboratory of Brain Functional Genomics Ministry of Education, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China.,Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, China.,NYU-ECNU Institute of Brain and Cognitive Science at NYU Shanghai, Shanghai, China
| | - Jia Yin
- Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
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Suthar R, Reddy BVC, Malviya M, Sirari T, Attri SV, Patial A, Tageja M, Didwal G, Khandelwal NK, Saini AG, Saini L, Sahu JK, Dayal D, Sankhyan N. Bone density and bone health alteration in boys with Duchenne Muscular Dystrophy: a prospective observational study. J Pediatr Endocrinol Metab 2021; 34:573-581. [PMID: 33838091 DOI: 10.1515/jpem-2020-0680] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 01/14/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Boys with Duchenne Muscular Dystrophy (DMD) are at increased risk for compromised bone health, manifesting as low-impact trauma long bone fractures and vertebral compression fractures. METHODS In a prospective observational study, we studied bone health parameters in North Indian boys with DMD. We consecutively enrolled ambulatory boys with DMD on glucocorticoid therapy. Bone health was evaluated with X-ray spine, Dual-energy X-ray absorptiometry (DXA), serum calcium, vitamin D3 (25[OH]D), 1,25-dihyroxyvitamin D3 (1,25[OH]2D3), serum osteocalcin, osteopontin, and N terminal telopeptide of type 1 collagen (Ntx) levels. RESULTS A total of 76 boys with DMD were enrolled. The median age was 8.5 (interquartile range [IQR] 7.04-10.77) years. Among these, seven (9.2%) boys had long bone fractures, and four (5.3%) had vertebral compression fractures. Fifty-four (71%) boys underwent DXA scan, and among these 31 (57%) had low bone mineral density (BMD, ≤-2 z-score) at the lumbar spine. The mean BMD z-score at the lumbar spine was -2.3 (95% confidence interval [CI] = -1.8, -2.8), and at the femoral neck was -2.5 (95% CI = -2, -2.9). 25(OH)D levels were deficient in 68 (89.5%, n=76) boys, and 1,25(OH)2D3 levels were deficient in all. Mean serum osteocalcin levels were 0.68 ± 0.38 ng/mL (n=54), serum osteopontin levels were 8.6 ± 4.6 pg/mL (n=54) and serum Ntx levels were 891 ± 476 nmol/L (n=54). Boys with low BMD received glucocorticoids for longer duration, in comparison to those with normal BMD (median, IQR [16.9 (6-34) months vs. 7.8 (4.8-13.4) months]; p=0.04). CONCLUSIONS Bone health is compromised in North Indian boys with DMD. BMD at the lumbar spine is reduced in more than half of boys with DMD and nearly all had vitamin D deficiency on regular vitamin D supplements. Longer duration of glucocorticoid therapy is a risk factor for low BMD in our cohort.
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Affiliation(s)
- Renu Suthar
- Pediatric Neurology Unit, Department of Pediatrics, APC, PGIMER, Chandigarh, India
| | - B V Chaithanya Reddy
- Pediatric Neurology Unit, Department of Pediatrics, APC, PGIMER, Chandigarh, India
| | - Manisha Malviya
- Pediatric Neurology Unit, Department of Pediatrics, APC, PGIMER, Chandigarh, India
| | - Titiksha Sirari
- Pediatric Neurology Unit, Department of Pediatrics, APC, PGIMER, Chandigarh, India
| | - Savita Verma Attri
- Pediatric Biochemistry Unit, Department of Pediatrics, APC, PGIMER, Chandigarh, India
| | - Ajay Patial
- Pediatric Biochemistry Unit, Department of Pediatrics, APC, PGIMER, Chandigarh, India
| | - Minni Tageja
- Pediatric Biochemistry Unit, Department of Pediatrics, APC, PGIMER, Chandigarh, India
| | - Gunjan Didwal
- Pediatric Biochemistry Unit, Department of Pediatrics, APC, PGIMER, Chandigarh, India
| | | | - Arushi G Saini
- Pediatric Neurology Unit, Department of Pediatrics, APC, PGIMER, Chandigarh, India
| | - Lokesh Saini
- Pediatric Neurology Unit, Department of Pediatrics, APC, PGIMER, Chandigarh, India
| | - Jitendra K Sahu
- Pediatric Neurology Unit, Department of Pediatrics, APC, PGIMER, Chandigarh, India
| | - Devi Dayal
- Pediatric Endocrinology Unit, Department of Pediatrics, APC, PGIMER, Chandigarh, India
| | - Naveen Sankhyan
- Pediatric Neurology Unit, Department of Pediatrics, APC, PGIMER, Chandigarh, India
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18
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Ellapen TJ, Paul Y, Hammill HV, Swanepoel M. Altered cervical posture kinematics imposed by heavy school backpack loading: A literature synopsis (2009-2019). Afr J Disabil 2021; 10:687. [PMID: 33604266 PMCID: PMC7876943 DOI: 10.4102/ajod.v10i0.687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 10/05/2020] [Indexed: 11/20/2022] Open
Abstract
Background Habitual school backpack carriage causes neuro-musculoskeletal vertebral, shoulder and hand pain; deviated posture compromised cardiopulmonary function and proprioception. Objective Present a novel literature summary of the influence of backpack carriage associated with deviated cervical posture and compromised pulmonary function. Method An electronic literature appraisal adopting the Preferred Reporting Items for Systematic Reviews, using Google Scholar, Science Direct, EMBASE, AMED, OVID, PubMed and Sabinet search engines, was instituted during 2009–2019. Key search words: schoolbag, backpack, carriage, cervical posture and children. The quality of the studies was assessed using the Downs and Black Appraisal Scale. Results 583 records were initially identified which was reduced to 14 experimental and observational studies. A total of 1061 participants were included across the 14 studies, with an average age of 11.5 ± 1.3 years, body mass of 37.8 ± 6.6 kilograms (kg), height of 1.41 ± 0.05 meters (m), backpack mass of 5.2 ± 0.9 kg and percentage backpack mass to child’s body mass of 13.75%. The studies mean rating according to the Downs and Black Appraisal Scale was 76.3%. The average craniovertebral angle (CVA) was 53.9° ± 14.6° whilst standing without carrying a backpack was reduced to 50.4° ± 16.4° when loaded (p < 0.05). Backpack loads carried varied from 5% – 30% of the participant’s body mass that produced a mean CVA decline of 3.5°. Conclusion Backpack carriage alters cervical posture, resulting in smaller CVA and compromised pulmonary function. There is no consensus of the precise backpack mass that initiates postural changes. Girls’ posture begin changes when carrying lighter backpacks as compared to boys of the same age strata.
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Affiliation(s)
- Terry J Ellapen
- Department of Sport and Dental Therapy, Tshwane University of Technology, Tshwane, South Africa
| | - Yvonne Paul
- Department of Sport, Rehabilitation and Dental Therapy, Health Science, Tshwane University of Technology, Tshwane, South Africa
| | - Henriëtte V Hammill
- School of Human Movement Science, Faculty of Health Science, North-West University, Potchefstroom, South Africa
| | - Mariëtte Swanepoel
- School of Human Movement Science, Faculty of Health Science, North-West University, Potchefstroom, South Africa
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Kolb B, Large J, Smurthwaite G. An Innovative System to Facilitate Extension Osteotomy in the Prone Position for Chin-on-Chest Deformity of Ankylosing Spondylitis. Int J Spine Surg 2020; 14:1009-1015. [PMID: 33560262 DOI: 10.14444/7151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND In the presence of chin-on-chest deformity of ankylosing spondylitis, positioning for extension osteotomy of the spine is a challenging endeavor. Conventional prone positioning equipment cannot safely accommodate all patients with advanced deformity where the chin brow angle approaches or exceeds 90°. Issues such as inability to accommodate the head and associated equipment while providing operative stability and venous congestion of the head represent significant perioperative risks. The sitting position has been advocated as an alternative but is suboptimal for surgical access and anesthetic care. We present a technical note for a positioning system developed to facilitate extension osteotomy in the prone position. METHODS A positioning device was designed to accommodate patients with advanced deformity. A series of patients with chin brow angles of up to 89° were positioned using our new system. RESULTS We were able to facilitate safe extension osteotomy in the prone position, for procedures lasting up to 14 hours. All our patients were discharged home without significant complication. CONCLUSIONS Our device is simply constructed and may be easily replicated in other institutions engaging in complex spine surgery. We hope our system provides clinicians with greater freedom to provide optimal perioperative care to their patients.
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Affiliation(s)
- Benjamin Kolb
- Department of Anaesthesia, Salford Royal NHS Foundation Trust, Salford, UK
| | - John Large
- Department of Anaesthesia, Salford Royal NHS Foundation Trust, Salford, UK
| | - Glyn Smurthwaite
- Department of Anaesthesia, Salford Royal NHS Foundation Trust, Salford, UK
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20
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Agbotsou KI, Kombate D, Adigo AMY, Apétsè K, Beschet A, Chan V. Hémangiome vertébral neuro-agressif de révélation tardive: cas cliniqueA clinical case of late-onset aggressive vertebral hemangioma with neurological signs. Pan Afr Med J 2020; 37:218. [PMID: 33520057 PMCID: PMC7821802 DOI: 10.11604/pamj.2020.37.218.24313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 07/02/2020] [Indexed: 11/23/2022] Open
Abstract
Résumé Dans la majorité des cas asymptomatiques, les hémangiomes vertébraux peuvent être, dans de rares cas, symptomatiques avec des manifestations cliniques purement neurologiques. S´ils sont fréquemment observés chez un sujet adulte jeune, ils peuvent exceptionnellement être observés chez un sujet âgé. Nous rapportons un cas d´hémangiome vertébral neuro-agressif de révélation tardive traité par une chirurgie décompressive, une sclérothérapie, une cimentoplastie et suivi d´une évolution favorable. English abstract In the majority of asymptomatic cases, vertebral hemangiomas can be, in rare cases, symptomatic with purely neurological clinical manifestations. They commonly occur in young adults, exceptionally in elderly subjects. We here report a case of late onset aggressive vertebral hemangioma with neurological signs treated with decompressive surgery, sclerotherapy and cementoplasty, with favorable outcome.
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Affiliation(s)
- Komi Ignéza Agbotsou
- Service de Neurologie du Centre Hospitalier de Valence, Valence, France.,Service de Neurologie du Centre Hospitalier Universitaire Campus, Lomé, Togo
| | - Damelan Kombate
- Service de Neurologie du Centre Hospitalier Universitaire Campus, Lomé, Togo
| | | | - Kossivi Apétsè
- Service de Neurologie du Centre Hospitalier Universitaire Campus, Lomé, Togo
| | - Albert Beschet
- Service de Neurologie du Centre Hospitalier de Valence, Valence, France
| | - Victor Chan
- Service de Neurologie du Centre Hospitalier de Valence, Valence, France
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Chiu RG, Patel S, Zhu A, Aguilar E, Mehta AI. Endoscopic Versus Open Laminectomy for Lumbar Spinal Stenosis: An International, Multi-Institutional Analysis of Outcomes and Adverse Events. Global Spine J 2020; 10:720-728. [PMID: 32707015 PMCID: PMC7383785 DOI: 10.1177/2192568219872157] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study and systematic review. OBJECTIVES Endoscopic decompression offers a minimally invasive alternative to traditional, open laminectomy. However, comparison of these surgical techniques has been largely limited to small, single-center studies. In this study, we perform the first international, multicenter comparison of both with regard to their associated rates of mortality, complications, readmissions, and reoperations. METHODS The 2017 American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) database, containing data from over 650 hospitals internationally, was queried to evaluate the effect of endoscopic guidance on adverse events. Operative time, length of stay, readmission and reoperation rates, as well as the incidence of peri- and postoperative complications, were compared between endoscopic and open groups. The PubMed/MEDLINE database was queried for studies comparing the techniques. RESULTS A total of 10 726 single-level lumbar decompression patients were identified and included in this study, 34 (0.32%) of whom were operated upon endoscopically. Apart from 2 (5.88%) readmissions, among which only 1 was unplanned, there were no reported surgical complications within the endoscopic group. The mean length of stay for these patients was 0.86 ± 1.44 days, with procedures lasting an average of 91.89 ± 46.72 minutes. However, these endpoints did not differ significantly from the open group. On literature review, 16 studies met the inclusion criteria, and largely consisted of single-center, retrospective analyses. CONCLUSIONS Endoscopically guided approaches to single-level lumbar decompression did not reduce the incidence of adverse events, length of stay or operative time, perhaps due to advances among certain nonendoscopic techniques, such as microsurgery.
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Affiliation(s)
- Ryan G. Chiu
- University of Illinois at Chicago, Chicago, IL, USA
| | - Saavan Patel
- University of Illinois at Chicago, Chicago, IL, USA
| | - Amy Zhu
- University of Illinois at Chicago, Chicago, IL, USA
| | - Eddy Aguilar
- University of Illinois at Chicago, Chicago, IL, USA
| | - Ankit I. Mehta
- University of Illinois at Chicago, Chicago, IL, USA,Ankit I. Mehta, Department of Neurosurgery, University of Illinois at Chicago, 912 South Wood Street, 4 N NPI, Chicago, IL 60612, USA.
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22
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Aljuboori Z, Meyer K, Ding D. The Utility of Short-Interval Repeat Computed Tomography Angiogram After Blunt Cerebrovascular Injury in Adults. Cureus 2020; 12:e9968. [PMID: 32983672 PMCID: PMC7510510 DOI: 10.7759/cureus.9968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction Blunt cerebrovascular injury (BCVI) can lead to thromboembolic events. The necessity of short-interval noninvasive vascular imaging after the initial diagnosis is controversial. This retrospective cohort assesses the utility of short-interval computed tomography angiography (CTA) after an initial diagnosis of BCVI. Methods We retrospectively reviewed patients with BCVI managed at our institution from 2016 to 2019 who underwent a short-interval (one to three weeks) repeat CTA after initial diagnosis. We excluded patients with age <18 years, penetrating injury, and previous neck irradiation. We collected baseline data and performed logistic regression to identify predictors of BCVI imaging outcomes. Results The study cohort comprised 38 patients with a mean age of 45 years with 68% males. Motor vehicle crash (MVC) was the most common mechanism of 79% injury. Unilateral vertebral artery (VA) was the most common vessel that is 66% injured, and grade I 36% was the most common dissection on initial CTA. Grades III and IV dissection 33% were the most common in the short-interval CTA. Shift analysis showed a significant improvement in Biffl grades I on the short-interval CTA (p = 0.0001). Antiplatelet therapy or anticoagulation (AC) was administered to 82% of patients after the initial diagnosis. The rates of early (<2 weeks) and delayed (two weeks to three months) ischemia were 5% and 0%, respectively, and endovascular stenting was performed in 8%. Conclusion BCVI grades I and II are more frequent than high-grade injuries. Short-interval non-invasive vascular imaging can detect changes of BCVI which can affect the management paradigm. It also can select patients who will benefit from endovascular intervention and avoid stroke. Besides, the short-interval non-invasive vascular imaging will not incur additional cost or increase exposure to radiation.
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Affiliation(s)
- Zaid Aljuboori
- Neurological Surgery, University of Louisville School of Medicine, Louisville, USA
| | - Kimberly Meyer
- Neurological Surgery, University of Louisville, Louisville, USA
| | - Dale Ding
- Neurological Surgery, University of Louisville School of Medicine, Louisville, USA
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Asiry S, Matloob A, Gera S. When accurate cytomorphology directs clinical decision: Colonic adenocarcinoma presents initially with an isolated vertebral bone metastasis. Diagn Cytopathol 2020; 48:1325-1327. [PMID: 32816398 DOI: 10.1002/dc.24590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/11/2020] [Accepted: 08/03/2020] [Indexed: 11/07/2022]
Abstract
Liver is the most common site for metastasis of colonic adenocarcinoma. Other relatively common metastatic locations include: peritoneum, lungs and ovaries. Rare metastatic sites include: central nervous system, testis, uterus, oral cavity and bones. Though it is rare to have an isolated bone metastasis without liver or visceral involvement in colonic adenocarcinoma, it can occur. Our case illustrates the vital role of an accurate cytopathologic diagnosis in directing the proper clinical decision and management in our young patient. Our patient's first presentation was acute on chronic back pain radiating to his lower extremities with clinical suspicion of tuberculosis spondylitis. The correct cytopathologic diagnosis of the fine needle aspiration from the destructive vertebral lesion led to the establishment of an isolated metastatic colonic adenocarcinoma diagnosis initially and directed the clinical management of our patient.
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Affiliation(s)
- Saeed Asiry
- The Leopold G. Koss Division of Cytopathology, Montefiore Hospital and Medical Center/Albert Einstein College of Medicine, New York, New York, USA
| | - Ammar Matloob
- The Leopold G. Koss Division of Cytopathology, Montefiore Hospital and Medical Center/Albert Einstein College of Medicine, New York, New York, USA
| | - Shweta Gera
- The Leopold G. Koss Division of Cytopathology, Montefiore Hospital and Medical Center/Albert Einstein College of Medicine, New York, New York, USA
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Kolb B, Large J, Watson S, Smurthwaite G. An innovative prone positioning system for advanced deformity and frailty in complex spine surgery. J Neurosurg Spine 2020; 32:229-234. [PMID: 31653810 DOI: 10.3171/2019.7.spine19161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 07/31/2019] [Indexed: 11/06/2022]
Abstract
The authors present a technical note for a prone positioning system developed to facilitate cervical extension osteotomy for ankylosing spondylitis in the presence of severe deformity and frailty. Chin-on-chest deformity represents one of the most debilitating changes of ankylosing spondylitis. Where the chin-brow angle approaches or exceeds 90°, prone positioning becomes problematic due to the fixed position of the head. Furthermore, the challenge is compounded where physiological deconditioning leads to frailty, and the side effects of medical therapies decrease muscle mass and skin quality. Conventional prone positioning equipment is not able to cater to all patients. A versatile system was developed using a 3D reconstruction to enable a positioning simulation and verification tool. The tool was used to comprehensively plan the perioperative episode, including spatial orientation and associated equipment. Three-dimensional printing was used to manufacture a bespoke positioning device that precisely matched the contours of the patient, reducing contact pressure and risk of skin injury. The authors were able to safely facilitate surgery for a patient whose deformity and frailty may otherwise have precluded this possibility. The system has potential safety and economic implications that may be of significant utility to other institutions engaging in complex spinal surgery.
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Affiliation(s)
| | | | - Stuart Watson
- 2Medical Physics, Salford Royal NHS Foundation Trust, Salford, United Kingdom
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Koktzoglou I, Huang R, Ong AL, Aouad PJ, Walker MT, Edelman RR. High spatial resolution whole-neck MR angiography using thin-slab stack-of-stars quiescent interval slice-selective acquisition. Magn Reson Med 2020; 84:3316-3324. [PMID: 32521094 DOI: 10.1002/mrm.28339] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/01/2020] [Accepted: 05/03/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE To report a 3D multi-echo thin-slab stack-of-stars (tsSOS) quiescent-interval slice-selective (QISS) strategy for high-resolution magnetic resonance angiography (MRA) of the entire neck in under seven minutes. METHODS The neck arteries of eight subjects were imaged at 3 Tesla. Multi-echo 3D tsSOS QISS using a FLASH readout was compared with 3D tsSOS FLASH, 2D QISS, 2D TOF, and 3D TOF. A root-mean-square (RMS) combination of echo time images was tested. Evaluation metrics included arterial signal-to-noise ratio (SNR), arterial-to-muscle contrast-to-noise ratio (CNR), and image quality. RESULTS 3D multi-echo tsSOS QISS using a RMS combination of echo time images increased SNR and CNR by 60% and 63% with respect to the reconstruction obtained with the shortest echo time. 3D tsSOS QISS showed superior CNR with respect to 3D tsSOS FLASH imaging, and more than 3-fold higher SNR and CNR with respect to 2D radial QISS when normalized for voxel size. 3D tsSOS QISS provided good to excellent image quality that exceeded the image quality of 2D QISS, 2D TOF, and 3D TOF (P < .05). CONCLUSION Whole-neck high-resolution nonenhanced MRA is feasible using 3D tsSOS QISS, and produced image quality that exceeded those of competing nonenhanced MRA protocols at 3 Tesla.
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Affiliation(s)
- Ioannis Koktzoglou
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL, USA.,Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Rong Huang
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL, USA
| | - Archie L Ong
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.,Department of Neurology, NorthShore University HealthSystem, Evanston, IL, USA
| | - Pascale J Aouad
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL, USA.,Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Matthew T Walker
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL, USA.,Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Robert R Edelman
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL, USA.,Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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26
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Ward LM, Weber DR, Munns CF, Högler W, Zemel BS. A Contemporary View of the Definition and Diagnosis of Osteoporosis in Children and Adolescents. J Clin Endocrinol Metab 2020; 105:5684884. [PMID: 31865390 PMCID: PMC7121121 DOI: 10.1210/clinem/dgz294] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 12/19/2019] [Indexed: 01/09/2023]
Abstract
The last 2 decades have seen growing recognition of the need to appropriately identify and treat children with osteoporotic fractures. This focus stems from important advances in our understanding of the genetic basis of bone fragility, the natural history and predictors of fractures in chronic conditions, the use of bone-active medications in children, and the inclusion of bone health screening into clinical guidelines for high-risk populations. Given the historic focus on bone densitometry in this setting, the International Society for Clinical Densitometry published revised criteria in 2013 to define osteoporosis in the young, oriented towards prevention of overdiagnosis given the high frequency of extremity fractures during the growing years. This definition has been successful in avoiding an inappropriate diagnosis of osteoporosis in healthy children who sustain long bone fractures during play. However, its emphasis on the number of long bone fractures plus a concomitant bone mineral density (BMD) threshold ≤ -2.0, without consideration for long bone fracture characteristics (eg, skeletal site, radiographic features) or the clinical context (eg, known fracture risk in serious illnesses or physical-radiographic stigmata of osteoporosis), inappropriately misses clinically relevant bone fragility in some children. In this perspective, we propose a new approach to the definition and diagnosis of osteoporosis in children, one that balances the role of BMD in the pediatric fracture assessment with other important clinical features, including fracture characteristics, the clinical context and, where appropriate, the need to define the underlying genetic etiology as far as possible.
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Affiliation(s)
- Leanne M Ward
- Departments of Pediatrics and Surgery, University of Ottawa, and the Children’s Hospital of Eastern Ontario, Division of Endocrinology and Metabolism, Ottawa, Ontario, Canada
- Correspondence and Reprint Requests: Leanne Ward MD FRCPC, Research Chair in Pediatric Bone Health, Professor of Pediatrics, University of Ottawa, Medical Director, The CHEO Bone Health Clinic, Scientific Director, The Ottawa Pediatric Bone Health Research Group, Room 250H, Children’s Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, Ontario, Canada K1H 8L1. E-mail:
| | - David R Weber
- Golisano Children’s Hospital, University of Rochester, New York
| | - Craig F Munns
- Department of Endocrinology, The Children’s Hospital at Westmead, Westmead, Australia, and Discipline of Paediatrics & Child Health, University of Sydney, Australia
| | - Wolfgang Högler
- Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, Linz, Austria, and the Institute of Metabolism and Systems Research, University of Birmingham, United Kingdom
| | - Babette S Zemel
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, The Children’s Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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27
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Kerut CK, Sheahan C, Sheahan M. Six-year history of intermittent symptomatic bilateral vertebral artery stenosis: Imaging and therapeutic intervention. Echocardiography 2020; 37:784-787. [PMID: 32315466 DOI: 10.1111/echo.14656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 02/23/2020] [Accepted: 03/21/2020] [Indexed: 11/29/2022] Open
Abstract
A 66-year-old man was evaluated for a 6-year history of disabling symptoms of typical intermittent vertebrobasilar (VB) insufficiency. Duplex scanning was "normal," but computed tomographic angiography (CTA) revealed significant bilateral proximal vertebral artery (VA) disease. Angiography with stent placement with the proximal right VA resulted in resolution of symptoms. Symptoms of VB insufficiency may occur from bilateral VA disease, most often involving both proximal segments. Duplex ultrasound has high specificity but relatively low sensitivity for finding hemodynamically significant VA disease. Further imaging with CTA or magnetic resonance angiography (MRA) will help in identification of disease. As with this patient, invasive angiography with percutaneous stenting of the most significantly stenosed VA often results in resolution of symptoms of VB insufficiency.
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Affiliation(s)
- Christian K Kerut
- Franklin College of Arts and Sciences, University of Georgia, Athens, Georgia
| | - Claudie Sheahan
- Division of Vascular Surgery, Department of Surgery, School of Medicine, LSU Health Sciences Center, New Orleans, Louisiana
| | - Malachi Sheahan
- Division of Vascular Surgery, Department of Surgery, School of Medicine, LSU Health Sciences Center, New Orleans, Louisiana
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28
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Jean-Denis L, Orcel P. [Vertebroplasty and balloon kyphoplasty in osteoporotic vertebral fractures]. Rev Prat 2019; 69:708-714. [PMID: 32233308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Laredo Jean-Denis
- Services de radiologie, hôpital Lariboisière et université de Paris, Paris, France
| | - Philippe Orcel
- Service de rhumatologie, hôpital Lariboisière et université de Paris, Paris, France
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Jain N, Tadghare J, Patel A, Varma A. Vertebral Hemangioma an Extremely Rare Cause of Spinal Cord Compression in Children: A Case Report. J Pediatr Neurosci 2019; 13:483-485. [PMID: 30937096 PMCID: PMC6413595 DOI: 10.4103/jpn.jpn_59_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Symptomatic benign vascular tumors of the bone are rare. Vertebral hemangiomas are rare detectable spinal tumors. Those presenting with neurological deficits are extremely rare. Early diagnosis and complete excision of the lesion with decompression of the cord is the definitive management in such cases. Delay in treatment may cause irreversible damage to the cord and may leave patient with lifelong neurological deficit. Here, we report a similar case of a thoracic vertebral hemangioma causing spinal cord compression in a child.
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Affiliation(s)
- Nilesh Jain
- Department of Neurosurgery, Sri Aurobindo Medical College and Postgraduate Institute, Indore, Madhya Pradesh, India
| | - Jitendra Tadghare
- Department of Neurosurgery, Sri Aurobindo Medical College and Postgraduate Institute, Indore, Madhya Pradesh, India
| | - Akhilesh Patel
- Department of General Surgery, Sri Aurobindo Medical College and Postgraduate Institute, Indore, Madhya Pradesh, India
| | - Amit Varma
- Department of Pathology, Sri Aurobindo Medical College and Postgraduate Institute, Indore, Madhya Pradesh, India
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30
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Jing X, Gong Z, Zhang N, Chen G, Li F, Chen Q, Xu Z, Zhang R. Fracture and dislocation of lumbar vertebrae with entrapment of small bowel: A case report and literature review. J Int Med Res 2019; 47:1043-1051. [PMID: 30618309 PMCID: PMC6381458 DOI: 10.1177/0300060518816205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Traumatic incarceration of the small bowel accompanied by vertebral fractures and dislocation is rare and usually misdiagnosed until laparotomy. This report presents a rare case of jejunum entrapment between lumbar spine fractures. A 43-year-old man was clamped between two railway tracks on the upper abdomen and lower back. Following ineffective conservative treatment, he underwent a laparotomy due to the development of guarding and rebound tenderness. Loss of vitality of the jejunal loop, which was incarcerated between the L3 and L4 vertebrae, was observed. The necrotic bowel was removed and end-to-end anastomosis was performed. When his condition was stable, anterior and posterior lumbar fixation surgery was performed. The patient had no abdominal complications and lower limb nerve function deficiency during the follow-up period. A review of the literature since 1979 on incarceration of the bowel associated with lumbar fracture and dislocation identified 12 cases: five patients showed persistent neurological symptoms, but none of the patients died as a result of their injuries. It should be borne in mind that patients with hyperextension or flexion-distraction injury of the lumbar spine could show symptoms of intestinal obstruction and bowel incarceration. Enhanced computed tomography or magnetic resonance imaging will be helpful for diagnosis.
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Affiliation(s)
- Xiaowei Jing
- 1 Department of Orthopaedic Surgery, Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, Zhejiang Province, China
| | - Zhiyuan Gong
- 1 Department of Orthopaedic Surgery, Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, Zhejiang Province, China
| | - Ning Zhang
- 2 Department of Orthopaedic Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Gang Chen
- 2 Department of Orthopaedic Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Fangcai Li
- 2 Department of Orthopaedic Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Qixin Chen
- 2 Department of Orthopaedic Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Zhengkuan Xu
- 2 Department of Orthopaedic Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Rui Zhang
- 1 Department of Orthopaedic Surgery, Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, Zhejiang Province, China
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Kapetanakis S, Chourmouzi D, Gkasdaris G, Katsaridis V, Eleftheriadis E, Givissis P. Functional extra-adrenal paraganglioma of the retroperitoneum giving thoracolumbar spine metastases after a five-year disease-free follow-up: a rare malignant condition with challenging management. Pan Afr Med J 2017; 28:94. [PMID: 29255564 PMCID: PMC5724945 DOI: 10.11604/pamj.2017.28.94.13783] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Accepted: 09/12/2017] [Indexed: 11/11/2022] Open
Abstract
Paragangliomas are benign neoplasms that arise from the autonomic nervous system and the associated paraganglia. Although benign, they have been shown to possess metastatic potential. Extra-adrenal retroperitoneal paraganglioma with vertebral metastasis is considered very uncommon. Here, we present a case of a functional extra-adrenal paraganglioma of the retroperitoneum giving metastasis to T4 vertebra after five years of follow-up in a 48-year-old man who had been initially treated with complete resection of the primary tumor. The condition of the patient improved significantly after radiosurgery and somatostatin analogs treatment, until lumbar spine lesions appeared six months later. Our case demonstrates that retroperitoneal paraganglioma is a rare condition which should be considered in the differential diagnosis of a retroperitoneal mass combined with vertebral lesions. Additionally, increased physician awareness and long-term follow-up is mandatory for all patients with history of retroperitoneal paraganglioma since metastases may occur after long latent intervals from the initial diagnosis.
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Affiliation(s)
- Stylianos Kapetanakis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
| | - Danai Chourmouzi
- Radiology Department, Interbalkan European Medical Center, Thessaloniki, Greece
| | - Grigorios Gkasdaris
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
| | - Vasileios Katsaridis
- Neurosurgery Department, Interbalkan European Medical Center, Thessaloniki, Greece
| | | | - Panagiotis Givissis
- First Orthopaedic Department of 'Aristotle University of Thessaloniki', 'Papanikolaou' Hospital, Exohi, Thessaloniki, Greece
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Shafafy R, Suresh S, Afolayan JO, Vaccaro AR, Panchmatia JR. Blunt vertebral vascular injury in trauma patients: ATLS ® recommendations and review of current evidence. J Spine Surg 2017; 3:217-225. [PMID: 28744503 DOI: 10.21037/jss.2017.05.10] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Blunt cerebrovascular injury (BCVI) encompasses two distinct clinical entities: traumatic carotid artery injury (TCAI) and traumatic vertebral artery injury (TVAI). The latter is the focus of our review. These are potentially devastating injuries which pose a diagnostic challenge in the acute trauma setting. There is still debate regarding the optimal screening criteria, diagnostic imaging modality and treatment methods. In 2012 the American College of Surgeons proposed criteria for investigating patients with suspected TVAI and subsequent treatment methods, caveated with the statement that evidence is limited and still evolving. Here we review the historical evidence and recent literature relating to these recommendations.
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Affiliation(s)
- Roozbeh Shafafy
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
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Hsu WK, Kannan A, Mai HT, Fehlings MG, Smith ZA, Traynelis VC, Gokaslan ZL, Hilibrand AS, Nassr A, Arnold PM, Mroz TE, Bydon M, Massicotte EM, Ray WZ, Steinmetz MP, Smith GA, Pace J, Corriveau M, Lee S, Isaacs RE, Wang JC, Lord EL, Buser Z, Riew KD. Epidemiology and Outcomes of Vertebral Artery Injury in 16 582 Cervical Spine Surgery Patients: An AOSpine North America Multicenter Study. Global Spine J 2017; 7:21S-27S. [PMID: 28451487 PMCID: PMC5400180 DOI: 10.1177/2192568216686753] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN A multicenter retrospective case series was compiled involving 21 medical institutions. Inclusion criteria included patients who underwent cervical spine surgery between 2005 and 2011 and who sustained a vertebral artery injury (VAI). OBJECTIVE To report the frequency, risk factors, outcomes, and management goals of VAI in patients who have undergone cervical spine surgery. METHODS Patients were evaluated on the basis of condition-specific functional status using the Neck Disability Index (NDI), modified Japanese Orthopaedic Association (mJOA) score, the Nurick scale, and the 36-Item Short-Form Health Survey (SF-36). RESULTS VAIs were identified in a total of 14 of 16 582 patients screened (8.4 per 10 000). The mean age of patients with VAI was 59 years (±10) with a female predominance (78.6%). Patient diagnoses included myelopathy, radiculopathy, cervical instability, and metastatic disease. VAI was associated with substantial blood loss (770 mL), although only 3 cases required transfusion. Of the 14 cases, 7 occurred with an anterior-only approach, 3 cases with posterior-only approach, and 4 during circumferential approach. Fifty percent of cases of VAI with available preoperative imaging revealed anomalous vessel anatomy during postoperative review. Average length of hospital stay was 10 days (±8). Notably, 13 of the 14 (92.86%) cases resolved without residual deficits. Compared to preoperative baseline NDI, Nurick, mJOA, and SF-36 scores for these patients, there were no observed changes after surgery (P = .20-.94). CONCLUSIONS Vertebral artery injuries are potentially catastrophic complications that can be sustained from anterior or posterior cervical spine approaches. The data from this study suggest that with proper steps to ensure hemostasis, patients recover function at a high rate and do not exhibit residual deficits.
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Affiliation(s)
- Wellington K. Hsu
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Abhishek Kannan
- Northwestern Memorial Hospital, Chicago, IL, USA,Abhishek Kannan, Northwestern Memorial Hospital, 676 N St, Clair St, #1350, Chicago, IL 60611, USA.
| | | | | | - Zachary A. Smith
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | | | - Ziya L. Gokaslan
- Brown University, Providence, RI, USA,Rhode Island Hospital, Providence, RI, USA,The Miriam Hospital, Providence, RI, USA,Norman Prince Neurosciences Institute, Providence, RI, USA
| | - Alan S. Hilibrand
- Jefferson Medical College, The Rothman Institute, Philadelphia, PA, USA
| | | | | | | | | | - Eric M. Massicotte
- Toronto Western Hospital, Toronto, Ontario, Canada,University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Jonathan Pace
- University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Mark Corriveau
- University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Sungho Lee
- University Hospitals Case Medical Center, Cleveland, OH, USA
| | | | | | | | - Zorica Buser
- University of Southern California, Los Angeles, CA, USA
| | - K. Daniel Riew
- Columbia University, New York, NY, USA,New York-Presbyterian/The Allen Hospital, New York, NY, USA
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Randoll C, Gagnon-Normandin V, Tessier J, Bois S, Rustamov N, O'Shaughnessy J, Descarreaux M, Piché M. The mechanism of back pain relief by spinal manipulation relies on decreased temporal summation of pain. Neuroscience 2017; 349:220-228. [PMID: 28288900 DOI: 10.1016/j.neuroscience.2017.03.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 02/01/2017] [Accepted: 03/02/2017] [Indexed: 12/11/2022]
Abstract
The aim of the present study was to determine whether thoracic spinal manipulation (SM) decreases temporal summation of back pain. The study comprised two controlled experiments including 16 and 15 healthy participants, respectively. Each study included six sessions during which painful or non-painful electrical stimulations were delivered in three conditions: (1) control (2) light mechanical stimulus (MS) or (3) SM. Electrical stimulation was applied on the thoracic spine (T4), in the area where SM and MS were performed. In Experiment 1, electrical stimulation consisted in a single 1-ms pulse while a single or repeated train of ten 1-ms pulses was used in Experiment 2. SM involved articular cavitation while MS was a calibrated force of 25N applied manually for 2s. For the single pulse, changes in pain or tactile sensation in the SM or MS sessions compared with the CTL session were not significantly different (all p's>0.05). In contrast, temporal summation of pain was decreased in the SM session compared with the CTL session for both the single and repeated train (p's<0.05). Changes were not significant for the MS sessions (all p's>0.05) and no effect was observed for the tactile sensation (all p's>0.1). These results indicate that SM produces specific inhibitory effects on temporal summation of back pain, consistent with the involvement of a spinal anti-nociceptive mechanism in clinical pain relief by SM. This provides the first mechanistic evidence of back pain relief by spinal manipulation.
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Affiliation(s)
- Christopher Randoll
- Département de Chiropratique, Université du Québec à Trois-Rivières, 3351 boul. des Forges, C.P. 500, Trois-Rivières, Québec G9A 5H7, Canada; Groupe de recherche en cognition, Neuroscience, Affect et Comportement (CogNAC), Université du Québec à Trois-Rivières, 3351 boul. des Forges, C.P. 500, Trois-Rivières, Québec G9A 5H7, Canada
| | - Vincent Gagnon-Normandin
- Département de Chiropratique, Université du Québec à Trois-Rivières, 3351 boul. des Forges, C.P. 500, Trois-Rivières, Québec G9A 5H7, Canada; Groupe de recherche en cognition, Neuroscience, Affect et Comportement (CogNAC), Université du Québec à Trois-Rivières, 3351 boul. des Forges, C.P. 500, Trois-Rivières, Québec G9A 5H7, Canada
| | - Jessica Tessier
- Département de Chiropratique, Université du Québec à Trois-Rivières, 3351 boul. des Forges, C.P. 500, Trois-Rivières, Québec G9A 5H7, Canada; Groupe de recherche en cognition, Neuroscience, Affect et Comportement (CogNAC), Université du Québec à Trois-Rivières, 3351 boul. des Forges, C.P. 500, Trois-Rivières, Québec G9A 5H7, Canada
| | - Suzie Bois
- Département de Chiropratique, Université du Québec à Trois-Rivières, 3351 boul. des Forges, C.P. 500, Trois-Rivières, Québec G9A 5H7, Canada; Groupe de recherche en cognition, Neuroscience, Affect et Comportement (CogNAC), Université du Québec à Trois-Rivières, 3351 boul. des Forges, C.P. 500, Trois-Rivières, Québec G9A 5H7, Canada
| | - Nabi Rustamov
- Département de Chiropratique, Université du Québec à Trois-Rivières, 3351 boul. des Forges, C.P. 500, Trois-Rivières, Québec G9A 5H7, Canada; Groupe de recherche en cognition, Neuroscience, Affect et Comportement (CogNAC), Université du Québec à Trois-Rivières, 3351 boul. des Forges, C.P. 500, Trois-Rivières, Québec G9A 5H7, Canada
| | - Julie O'Shaughnessy
- Département de Chiropratique, Université du Québec à Trois-Rivières, 3351 boul. des Forges, C.P. 500, Trois-Rivières, Québec G9A 5H7, Canada; Groupe de Recherche sur les Affections Neuromusculosquelettiques (GRAN), Université du Québec à Trois-Rivières, 3351 boul. des Forges, C.P. 500, Trois-Rivières, Québec G9A 5H7, Canada
| | - Martin Descarreaux
- Département des Sciences de l'Activité Physique, Université du Québec à Trois-Rivières, 3351 boul. des Forges, C.P. 500, Trois-Rivières, Québec G9A 5H7, Canada; Groupe de Recherche sur les Affections Neuromusculosquelettiques (GRAN), Université du Québec à Trois-Rivières, 3351 boul. des Forges, C.P. 500, Trois-Rivières, Québec G9A 5H7, Canada
| | - Mathieu Piché
- Département de Chiropratique, Université du Québec à Trois-Rivières, 3351 boul. des Forges, C.P. 500, Trois-Rivières, Québec G9A 5H7, Canada; Groupe de recherche en cognition, Neuroscience, Affect et Comportement (CogNAC), Université du Québec à Trois-Rivières, 3351 boul. des Forges, C.P. 500, Trois-Rivières, Québec G9A 5H7, Canada.
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Abstract
BACKGROUND Percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are effective procedures for the treatment of vertebral compression fractures (VCFs). However, recent studies have reported that secondary VCFs develop in patients after PVP or PKP treatment. This study aimed to investigate the clinical characteristics and management of secondary fractures after PVP or PKP. MATERIALS AND METHODS 599 cases who had vertebral compression fracture and underwent PVP or PKP between September 2008 and June 2014 were enrolled, including 121 males and 478 females. Secondary fractures were observed in 52 cases, including 3 males and 49 females, who were treated by re-operation with PVP or PKP. RESULTS The ratio of secondary fracture after PVP or PKP was 8.68% in all cases. The age ranged from 59 to 92 years (74.41 ± 6.83 average). A composition of 44.44% of the secondary fracture occurred near the initial fracture vertebrae. After re-operation with PVP or PKP, visual analog scale score significantly decreased to 2.72 ± 0.88 or 2.52 ± 1.12, respectively, anterior height of vertebral bodies increased to 24.69 ± 4.59 or 24.54 ± 5.97 mm, respectively, and middle height of vertebral bodies increased to 20.90 ± 3.72 or 20.36 ± 6.33 mm, respectively. CONCLUSIONS There is a high chance of secondary fracture near the initially operated vertebrae after PVP or PKP. Re-operation with PVP or PKP achieves satisfactory outcomes in these patients such as pain relief and the recovery of the vertebrae height.
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Affiliation(s)
- Jiang-jun Zhu
- Department of Orthopaedics, The No. 117 Hospital of PLA, Hangzhou, Zhejiang, China
| | - Dong-sheng Zhang
- Department of Orthopaedics, The No. 117 Hospital of PLA, Hangzhou, Zhejiang, China
| | - Su-liang Lou
- Department of Orthopaedics, The No. 117 Hospital of PLA, Hangzhou, Zhejiang, China
| | - Yong-hong Yang
- Department of Orthopaedics, The No. 117 Hospital of PLA, Hangzhou, Zhejiang, China,Address for correspondence: Dr. Yong-hong Yang, Department of Orthopedics, The No. 117 Hospital of PLA, Tian Cheng Road, Hangzhou, Zhejiang, 310013, China. E-mail:
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Zhang L, Wang J, Feng X, Tao Y, Yang J, Zhang S, Cai J. Multifocal skeletal tuberculosis: A case report. Exp Ther Med 2016; 11:1288-1292. [PMID: 27073438 PMCID: PMC4812510 DOI: 10.3892/etm.2016.3032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 01/11/2016] [Indexed: 11/13/2022] Open
Abstract
Tuberculosis (TB) of the musculoskeletal system is a rare clinical condition. Multifocal bone involvement is extremely rare and difficult to recognize. Thus, due to the diverse and atypical clinical manifestations of multifocal skeletal TB, the disease is easy to misdiagnose. In the present study, a rare case of atypical disseminated multifocal skeletal TB was reported, which exhibited uncommon findings in radiological images that were more suggestive of a hematological malignancy or metastatic disease. In conclusion, the diagnosis of this condition by conventional diagnostic methods is challenging. The importance of CT-guided needle biopsy and open biopsy in the diagnosis of skeletal TB was emphasized.
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Affiliation(s)
- Liang Zhang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Subei People's Hospital of Jiangsu, Yangzhou, Jiangsu 225001, P.R. China
| | - Jingcheng Wang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Subei People's Hospital of Jiangsu, Yangzhou, Jiangsu 225001, P.R. China
| | - Xinmin Feng
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Subei People's Hospital of Jiangsu, Yangzhou, Jiangsu 225001, P.R. China
| | - Yuping Tao
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Subei People's Hospital of Jiangsu, Yangzhou, Jiangsu 225001, P.R. China
| | - Jiandong Yang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Subei People's Hospital of Jiangsu, Yangzhou, Jiangsu 225001, P.R. China
| | - Shenfei Zhang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Subei People's Hospital of Jiangsu, Yangzhou, Jiangsu 225001, P.R. China
| | - Jun Cai
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Subei People's Hospital of Jiangsu, Yangzhou, Jiangsu 225001, P.R. China
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Daou B, Hammer C, Chalouhi N, Starke RM, Jabbour P, Rosenwasser RH, Tjoumakaris S. Dissecting pseudoaneurysms: predictors of symptom occurrence, enlargement, clinical outcome, and treatment. J Neurosurg 2016; 125:936-942. [PMID: 26824374 DOI: 10.3171/2015.10.jns151846] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Dissection of the carotid and vertebral arteries can result in the development of aneurysmal dilations. These dissecting pseudoaneurysms can enlarge and cause symptoms. The objective of this study is to provide insight into the progression of dissecting pseudoaneurysms and the treatments required to manage them. METHODS A review of the electronic medical records was conducted to detect patients with carotid and vertebral artery dissection. An imaging review was conducted to identify patients with dissecting pseudoaneurysms. One hundred twelve patients with 120 dissecting pseudoaneurysms were identified. Univariate and multivariate analyses were conducted to assess the factors associated with undergoing further interventions other than medical treatment, pseudoaneurysm enlargement, pseudoaneurysms resulting in ischemic and nonischemic symptoms, and clinical outcome. RESULTS Overall, 18.3% of pseudoaneurysms were intracranial and 81.7% were extracranial, and the average size was 7.3 mm. The mean follow-up time was 29.3 months; 3.3% of patients had a recurrent transient ischemic attack, no patients had a recurrent stroke, and 14.2% of patients had recurrence of nonischemic symptoms (headache, neck pain, Horner syndrome, or cranial nerve palsy). Follow-up imaging demonstrated that 13.8% of pseudoaneurysms had enlarged, 30.2% had healed, and 56% had remained stable. In total, 20.8% of patients had an intervention other than medical treatment. Interventions included stenting, coiling, flow diversion, and clipping. Predictors of intervention included increasing size, size > 10 mm, location in the C2 (petrous) segment of the internal carotid artery (ICA), younger age, hyperlipidemia, pseudoaneurysm enlargement, and any symptom development. Significant predictors of enlargement included smoking, history of trauma, C2 location, hyperlipidemia, and larger initial pseudoaneurysm size. Predictors of pseudoaneurysm resulting in recurrent ischemic and nonischemic symptoms included increasing size and location in the petrous segment of the ICA. Smoking was a predictor of unfavorable outcome. CONCLUSIONS Dissecting pseudoaneurysms have a benign course and most will not cause symptoms or enlarge on follow-up. Medical treatment can be a sufficient, initial treatment for dissecting pseudoaneurysms.
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Affiliation(s)
- Badih Daou
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Christine Hammer
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Nohra Chalouhi
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Robert M Starke
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Robert H Rosenwasser
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Stavropoula Tjoumakaris
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
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Bible JE, Rihn JA, Lim MR, Brodke DS, Lee JY. Avoiding and Managing Intraoperative Complications During Cervical Spine Surgery. J Am Acad Orthop Surg 2015; 23:e81-90. [PMID: 26519429 DOI: 10.5435/JAAOS-D-14-00446] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 08/03/2015] [Indexed: 02/01/2023] Open
Abstract
The incidence of intraoperative complications in cervical spine surgery is low. However, when they do occur, such complications have the potential for causing considerable morbidity and mortality. Spine surgeons should be familiar with methods of minimizing such complications. Furthermore, if they do occur, surgeons must be prepared to immediately treat each potential complication to reduce any associated morbidity.
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Abstract
Background: Clival chordomas are a rare type of cancer with low metastatic potential and primary metastasize to the lung or bones. Case Description: This case report describes a possible metastatic, paravertebral chordoma at level C4-C5 in a patient with a past medical history of a clival chordoma. Conclusion: Chordomas are unpredictable and may metastasise.
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Affiliation(s)
- R Goes
- Department of Neurosurgery, Maastricht University Medical Center, PO box 5800, 6202AZ Maastricht, The Netherlands
| | - J J van Overbeeke
- Department of Neurosurgery, Maastricht University Medical Center, PO box 5800, 6202AZ Maastricht, The Netherlands
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Martirosyan NL, Skoch JM, Zaninovich O, Zoccali C, Galgiani JN, Baaj AA. A paradigm for the evaluation and management of spinal coccidioidomycosis. Surg Neurol Int 2015; 6:107. [PMID: 26167359 PMCID: PMC4483783 DOI: 10.4103/2152-7806.158979] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 04/24/2015] [Indexed: 12/31/2022] Open
Abstract
Background: Coccidioidomycosis is a fungal infection that is endemic to parts of the Southwestern United States. When infection involves the spine, the treatment strategies can be challenging. We have devised a management protocol for spinal coccidioidomycosis based on a review of the literature and our experience. Methods: The electronic literature search of National Library of Medicine for publications from 1964 to 2014 was performed using the following keywords: Coccidioidomycosis and spine. The search yielded 24 papers. Treatment strategies were summarized into a treatment protocol. Results: A total of 164 cases of spinal coccidioidomycosis were identified, ranging in age from <10 to >80 years. Males (n = 131) and African-Americans (n = 79) were strikingly over-represented. Medical therapy: Once a diagnosis of spinal coccidioidomycosis is established, antifungal therapy should always be started. Antifungal therapy with amphotericin B or azoles like fluconazole. Medical therapy needs to be continued for many years and sometimes indefinitely to reduce disease recurrence or progression. Surgical management is indicated in cases with mechanical instability, neurologic deficit, medically intractable pain, or progression of infection despite antifungal therapy. Conclusions: This work provides a working protocol involving assessment and reassessment for the management of spinal coccidioidomycosis. Medical management with antifungal agents in some cases can provide satisfactory disease control. However, in patients with mechanical instability, neurologic deficit, medically intractable pain or disease progression disease control may only be achieved with surgical debridement and stabilization.
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Affiliation(s)
| | - Jesse M Skoch
- Division of Neurosurgery, University of Arizona, Tucson, Arizona, USA
| | - Orel Zaninovich
- Division of Neurosurgery, University of Arizona, Tucson, Arizona, USA
| | - Carmine Zoccali
- Division of Neurosurgery, University of Arizona, Tucson, Arizona, USA
| | - John N Galgiani
- Valley Fever Center for Excellence, University of Arizona Medical Center, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Ali A Baaj
- Division of Neurosurgery, University of Arizona, Tucson, Arizona, USA
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Lee-Montero I, Navarro A, Negrín-Báez D, Zamorano MJ, Borrell Pichs YJ, Berbel C, Sánchez JA, García-Celdran M, Manchado M, Estévez A, Armero E, Afonso JM. Genetic parameters and genotype-environment interactions for skeleton deformities and growth traits at different ages on gilthead seabream (Sparus aurata L.) in four Spanish regions. Anim Genet 2015; 46:164-74. [PMID: 25662001 DOI: 10.1111/age.12258] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2014] [Indexed: 11/29/2022]
Abstract
One of the most important problems of fish aquaculture is the high incidence of fish deformities, which are mainly skeletal. In this study, genetic parameters on gilthead seabream (Sparus aurata L.) for skeleton deformities at different ages (179, 269, 389, 539 and 689 days) and their correlations with growth traits were estimated, as were as their genotype × environment interactions (G × E) at harvesting age. A total of 4093 offspring from the mass spawning of three industrial broodstocks belonging to the PROGENSA(®) breeding programme were mixed and on-grown by different production systems in four Spanish regions: Canary Islands (tanks and cage), Andalusia (estuary), Catalonia (cage) and Murcia (cage). Parental assignment was inferred using the standardized SMsa1 microsatellite multiplex PCR. From three broodstocks, 139 breeders contributed to the spawn and a total of 297 full-sibling families (52 paternal and 53 maternal half-sibling families) were represented. Heritabilities at different ages were medium for growth traits (0.16-0.48) and vertebral deformities (0.16-0.41), and low for any type of deformity (0.07-0.26), head deformities (0.00-0.05) and lack of operculum (0.06-0.11). The genetic correlations between growth and deformity traits were medium and positive, suggesting that to avoid increasing deformities they should be taken into account in breeding programmes when growth is selected. The G × E interactions among the different facilities were weak for length and deformity and strong for growth rate during this period. These results highlight the potential for the gilthead seabream industry to reduce the prevalence of deformities by genetic improvement tools.
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Affiliation(s)
- I Lee-Montero
- Universidad de Las Palmas de Gran Canaria (ULPGC), Grupo de Investigación en Acuicultura (GIA), Carretera Trasmontaña s/n, 35413, Arucas, Las Palmas, Spain; Centro Acuícola y Pesquero de Investigación Aplicada (CAPIA), Universidad Santo Tomás, Buena Vecindad 101, Puerto Montt, Chile
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Emohare O, Cagan A, Polly DW, Gertner E. Opportunistic computed tomography screening shows a high incidence of osteoporosis in ankylosing spondylitis patients with acute vertebral fractures. J Clin Densitom 2015; 18:17-21. [PMID: 25172008 DOI: 10.1016/j.jocd.2014.07.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 07/23/2014] [Indexed: 11/27/2022]
Abstract
Advanced ankylosing spondylitis is associated with reductions in bone mineral density (BMD), contributing to pain and predisposing to fractures. Quantifying this reduction is complicated because overgrowth of bone and loss of trabecular bone occur concurrently. Traditional methods such as dual-energy X-ray absorptiometry struggle to generate accurate estimates of BMD in these patients. The aim of this study was to evaluate the utility of computed tomography (CT) attenuation in generating estimates of BMD in patients with severe AS who had sustained vertebral fractures. Patients with severe AS and bridging syndesmophytes who presented, with acute fractures of the spine, were reviewed to assess whether they had a CT scan in the 6 mo before or after injury that included an image of the L1 vertebra; if it did, the scans were selected for analysis. A total of 17 patients were evaluated. Using a CT attenuation threshold of 135 HU balanced for sensitivity and specificity, 14 of 17 (82%) patients were osteoporotic. Using a CT attenuation threshold for higher sensitivity (160 HU), 15 of 17 (88%) patients were osteoporotic. Even using the L1 CT attenuation threshold of 110 HU for higher specificity, 14 of 17 (82%) patients were osteoporotic. CT attenuation demonstrates that a high proportion of AS patients who sustain fractures have osteoporosis. This overcomes some of the difficulties that have been encountered with the use of dual-energy X-ray absorptiometry in this group of patients. This simple and accessible method saves on time, cost, and exposure to radiation and can help in the planning of a patient's management.
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Affiliation(s)
- Osa Emohare
- Department of Neurosurgery, Regions Hospital, St Paul, MN, USA.
| | - Amanda Cagan
- HealthPartners Institute for Education and Research, Bloomington, MN, USA
| | - David W Polly
- Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Elie Gertner
- Section of Rheumatology, Regions Hospital, St Paul, MN, USA; Division of Rheumatology, University of Minnesota Medical School, Minneapolis, MN, USA
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Abstract
Chordomas are uncommon neoplasms arising from notochord remnants, most commonly occurring in the axial skeleton. Extraskeletal soft tissue chordomas are rare primary tumors, and primary alimentary tract chordomas have not been reported. Herein we report 24 cases of spontaneous primary intestinal chordomas in zebrafish, as well as 9 spontaneous vertebral chordomas. Both intestinal and vertebral tumors showed invasive behavior, although more commonly in the latter. In all cases of primary intestinal chordomas, there was no axial or peripheral skeletal or other nonvisceral involvement. Although uncommon, intestinal chordomas represent a unique background lesion in aged zebrafish.
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Affiliation(s)
- T K Cooper
- Departments of Comparative Medicine and Pathology, Penn State Hershey Medical Center, Hershey, PA, USA
| | - K N Murray
- Pathology and Health Services, Zebrafish International Resource Center, Eugene, OR, USA
| | - S Spagnoli
- Pathology and Health Services, Zebrafish International Resource Center, Eugene, OR, USA Department of Environmental Health Sciences. Oregon State University, Corvallis, OR, USA
| | - J M Spitsbergen
- Department of Microbiology, Oregon State University, Corvallis, OR, USA
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Owolabi MO, Agunloye AM, Ogunniyi A. The relationship of flow velocities to vessel diameters differs between extracranial carotid and vertebral arteries of stroke patients. J Clin Ultrasound 2014; 42:16-23. [PMID: 23712586 DOI: 10.1002/jcu.22053] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 01/15/2013] [Accepted: 03/27/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Chronic changes in flow rate through arteries produce adjustment of arterial diameters. We compared the relationship between flow velocity and diameter in the carotid and in the vertebral arteries of stroke patients. METHODS Using triplex ultrasonography, the internal diameter and flow velocities of the common carotid, internal carotid, and vertebral arteries of 176 consecutive stroke patients were measured. Correlations were examined with Pearson's statistics at an alpha level of 0.05. RESULTS Mean age of the patients was 59.3 ± 12 years, and 66% had cerebral infarcts. Diameter and blood flow velocities showed significant negative correlations (-0.115 ≥ r ≥ -0.382) in the carotid arteries on both sides, but positive correlations (0.211 ≤ r ≤ 0.320) in the vertebral arteries, even after controlling for age, gender, and blood pressure. CONCLUSIONS Our study demonstrated different diameter/flow relationships in the carotid and the vertebral arteries of stroke patients, which may suggest pathologic changes in the adaptive processes governing vessel diameter and growth, especially in the carotid arteries.
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Affiliation(s)
- Mayowa O Owolabi
- Department of Medicine, University College Hospital, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Darbà J, Pérez-Álvarez N, Kaskens L, Holgado-Pérez S, Racketa J, Rejas J. Cost-effectiveness of bazedoxifene versus raloxifene in the treatment of postmenopausal women in Spain. Clinicoecon Outcomes Res 2013; 5:327-36. [PMID: 23882153 PMCID: PMC3709644 DOI: 10.2147/ceor.s42755] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess the cost-effectiveness of bazedoxifene and raloxifene for prevention of vertebral and nonvertebral fractures among postmenopausal Spanish women aged 55-82 years with established osteoporosis and a high fracture risk. METHODS A Markov model was developed to represent the transition of a cohort of postmenopausal osteoporotic women through different health states, ie, patients free of fractures, patients with vertebral or nonvertebral fractures, and patients recovered from a fracture. Efficacy data for bazedoxifene were obtained from the Osteoporosis Study. The perspective of the Spanish National Health Service was chosen with a time horizon of 27 years. Costs were reported in 2010 Euros. Deterministic results were presented as expected cost per quality-adjusted life-year (QALY), and probabilistic results were represented in cost-effectiveness planes. RESULTS In deterministic analysis, the expected cost per patient was higher in the raloxifene cohort (€13,881) than in the bazedoxifene cohort (€13,436). QALYs gained were slightly higher in the bazedoxifene cohort (14.56 versus 14.54). Results from probabilistic sensitivity analysis showed that bazedoxifene has a slightly higher probability of being cost-effective for all threshold values independent of the maximum that the National Health Service is willing to pay per additional QALY. CONCLUSION Bazedoxifene was shown to be a cost-effective treatment option for the prevention of fractures in Spanish women with postmenopausal osteoporosis and a high fracture risk. When comparing bazedoxifene with raloxifene, it may be concluded that the former is the dominant strategy.
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Affiliation(s)
| | | | - Lisette Kaskens
- BCN Health Economics and Outcomes Research, Barcelona, Spain
| | | | - Jill Racketa
- Global Health Economics and Outcomes Research, Pfizer Inc., Collegeville, PA, USA
| | - Javier Rejas
- Health Economic and Outcomes Research Department, Pfizer Alcobendas, Madrid, Spain
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Houda B, Wafa A, Zoubida TM, Mohamed A, Mohamed A, Hicham H. Vertebral cryptococcosis in an immunocompetent patient--a case report. Pan Afr Med J 2011; 8:42. [PMID: 22121450 PMCID: PMC3201606 DOI: 10.4314/pamj.v8i1.71158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2011] [Accepted: 04/10/2011] [Indexed: 11/17/2022] Open
Abstract
We report an unusual case of 70 years old, immunocompetent woman who was diagnosed with vertebral cryptococcosis. The diagnosis was made on the basis of radiological and histological findings. The outcome was favorable under antifungal treatment.
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Affiliation(s)
- Bachir Houda
- Department of Internal medicine, Avicenne University Hospital, Rabat, Morocco
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Arlot ME, Burt-Pichat B, Roux JP, Vashishth D, Bouxsein ML, Delmas PD. Microarchitecture influences microdamage accumulation in human vertebral trabecular bone. J Bone Miner Res 2008; 23:1613-8. [PMID: 18518771 PMCID: PMC3276353 DOI: 10.1359/jbmr.080517] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2007] [Revised: 05/08/2008] [Accepted: 05/30/2008] [Indexed: 01/23/2023]
Abstract
It has been suggested that accumulation of microdamage with age contributes to skeletal fragility. However, data on the age-related increase in microdamage and the association between microdamage and trabecular microarchitecture in human vertebral cancellous bone are limited. We quantified microdamage in cancellous bone from human lumbar (L(2)) vertebral bodies obtained from 23 donors 54-93 yr of age (8 men and 15 women). Damage was measured using histologic techniques of sequential labeling with chelating agents and was related to 3D microarchitecture, as assessed by high-resolution microCT. There were no significant differences between sexes, although women tended to have a higher microcrack density (Cr.Dn) than men. Cr.Dn increased exponentially with age (r = 0.65, p < 0.001) and was correlated with bone volume fraction (BV/TV; r = -0.55; p < 0.01), trabecular number (Tb.N; r = -0.56 p = 0.008), structure model index (SMI; r = 0.59; p = 0.005), and trabecular separation (Tb.Sp; r = 0.59; p < 0.009). All architecture parameters were strongly correlated with each other and with BV/TV. Stepwise regression showed that SMI was the best predictor of microdamage, explaining 35% of the variance in Cr.Dn and 20% of the variance in diffuse damage accumulation. In addition, microcrack length was significantly greater in the highest versus lowest tertiles of SMI. In conclusion, in human vertebral cancellous bone, microdamage increases with age and is associated with low BV/TV and a rod-like trabecular architecture.
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Affiliation(s)
| | | | - Jean-Paul Roux
- Inserm Research Unit 831, Université de LyonLyon, France
| | - Deepak Vashishth
- Inserm Research Unit 831, Université de LyonLyon, France
- Department of Biomedical Engineering, Center of Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic InstituteTroy, New York, USA
| | - Mary L Bouxsein
- Beth Israel Deaconess Medical CenterBoston, Massachusetts, USA
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Abstract
Long-term exposure to whole-body vibration is known to increase the risk of low back problems. The chain of events leading from repeated loading of the lumbar spine to back complaints and the exact nature of the vibration-induced damage are, however, obscure. Fluid in- and outflow as well as viscoelastic deformation are important aspects of the physiological function of the lumbar disc. Precision measurement of stature, termed 'stadiometry', has previously been applied in healthy subjects to document changes in disc height in relation to the load on the lumbar spine. The purpose of this study was to explore the relation between spinal loading and stature in a cohort of 20 subjects with long-term exposure to whole-body vibration. If the change of stature (and thus the change of disc height) caused by changes in spinal loading differed between exposed and normal subjects, this would point to vibration-induced changes in structure and material properties of the discs. For this purpose, four hypotheses were tested: (1) the viscoelastic deformation and fluid exchange of intervertebral discs during phases of spinal loading and unloading differs from normal; (2) the water content of lumbar discs of subjects exposed to long-term whole-body vibration deviates from normal; (3) the mean disc height of the lumbar spine depends on the total time of vibration exposure; (4) repeated loading influences trabecular bone density of vertebrae in the lumbar spine. A cohort of 20 operators of heavy earth-moving machinery was enrolled. Back complaints suspected to be due to long-term exposure (mean 17.6 +/- 2.1 years) to whole-body vibration and application for early retirement were the selection criteria used. Change of stature during a regular 8-h shift and change of stature in standing, carrying and sitting activities were measured. The stadiometric investigations were supplemented by magnetic resonance imaging (MRI) of the lumbar spine to assess whether the water content of the discs exhibited deviations from normal. In addition, quantitative computed tomography (QCT) was performed to assess whether the trabecular bone density of the third lumbar vertebra deviated from normal. The results showed no significant difference in change of stature while standing, carrying or sitting between exposed machine operators and non-exposed operators. Likewise, MRI examinations revealed no significant differences in the water content of the discs averaged over the lumbar spine. In addition, QCT examinations revealed no significant difference in the trabecular bone density of the third lumbar vertebra. The study thus revealed no significant difference between a cohort with long-term exposure and non-exposed controls with respect to viscoelastic properties of discs as determined by stadiometry, average water content of lumbar discs and trabecular bone density of L3.
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Affiliation(s)
- B. Drerup
- />Institut für experimentelle Biomechanik, Domagkstrasse 11, D-48129 Münster, Germany e-mail: Fax: +49-251-8355 983, , , , DE
| | - M. Granitzka
- />Institut für experimentelle Biomechanik, Domagkstrasse 11, D-48129 Münster, Germany e-mail: Fax: +49-251-8355 983, , , , DE
| | - J. Assheuer
- />Institut für Kernspintomographie, Cologne, Germany, , , , DE
| | - G. Zerlett
- />Rheinbraun AG, Cologne, Germany, , , , DE
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Castel E, Lazennec JY, Chiras J, Enkaoua E, Saillant G. Acute spinal cord compression due to intraspinal bleeding from a vertebral hemangioma: two case-reports. Eur Spine J 1999; 8:244-8. [PMID: 10413354 PMCID: PMC3611171 DOI: 10.1007/s005860050167] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Vertebral hemangiomas can cause acute spinal cord compression either after a minor trauma or during the last 3 months of pregnancy. Failure to recognize the lesion can lead to potentially serious treatment delays. An emergency MRI scan usually establishes the diagnosis of vertebral hemangioma responsible for spinal cord compression requiring laminectomy. We report two cases showing that posterior fixation should be considered: in our experience it prevents vertebral collapse during the interval preceding secondary vertebroplasty, which, if performed, provides highly significant pain relief.
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Affiliation(s)
- E Castel
- Department of Orthopedic and Trauma Surgery, CHU Pitié Salpétriere. Paris, France
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Abstract
Osseous lipomata of vertebral bodies are rare. We present a very unusual case where adjacent vertebrae are involved and the plain radiographic and scintigraphic appearances gave cause for some concern. The findings on plain films, scintigraphy, computed tomography and magnetic resonance imaging are discussed.
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Affiliation(s)
- K C Pande
- Department of Spinal Studies, University Hospital, Queen's Medical Centre, Nottingham, UK
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