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Hua Y, Bi R, Zhang Y, Xu L, Guo J, Li Y. Different bone sites-specific response to diabetes rat models: Bone density, histology and microarchitecture. PLoS One 2018; 13:e0205503. [PMID: 30346963 PMCID: PMC6197850 DOI: 10.1371/journal.pone.0205503] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 09/26/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND PURPOSE Diabetes mellitus (DM) is the most common metabolic disorder that is characterized by hyperglycemia, it can be categorized by T1DM and T2DM. T1DM is also reported to cause bone loss. However, most reports regarding this aspect of T1DM have only investigated a single site; a comparison of bone loss from different areas of the body is still lacking. METHODS Thirty-five 12-week-old Sprague Dawley® (SD) rats were separated to seven groups. Five rats were euthanized without any surgery at 0 weeks for histological examination and determination of baseline characteristics. In 15 of the rats, DM was induced via Streptozotocin (STZ)-injection, and they were separated to 3 groups (4 weeks, 8 weeks and 12 weeks after STZ-injection). The remaining 15 rats were used as the control group (4 weeks, 8 weeks and 12 weeks after saline-injection). We tested bone-mass loss at four skeletal sites, the tibia, the femur greater trochanter, the spine, and the mandibular bones using micro-computed tomography (CT) and histological tests. RESULTS Tibia was influenced the most obvious(BV/TV decreased by 27.3%, 52.5%, and 81.2% at 4 weeks, 8 weeks, and 12 weeks, respectively. p<0.05). In contrast, the other three sites were influenced to a lesser extent and bone loss became prominent at a later time point according to the histological and micro-CT tests(Femur: BV/TV did not decrease significantly at the first month or second month. However, and decreased by 49.4% at the third month, P<0.05. Mandible: the BV/TV only decreased by 6.5% at 1 month after STZ-injection. There was still a significant difference between the second and third months. The BV/TV decreased by 47.0% and 68.1% at 2 months and 3 months, respectively, (p<0.05) Spine: the BV/TV only decreased by 6.7%. However, significant change was observed in the spine at the second month and third month after STZ injection. The BV/TV decreased by 45.4% and 64.3%, respectively, p<0.05). CONCLUSION The results indicate that T1DM can severely influence the bone structure of the 4 skeletal sites. Further, areas with dense trabecular bones were influenced less and at a later time point in comparison to the tibial region. CLINICAL RELEVANCE Our research can serve as a guide to help increase the success rate of implant treatment, and help decrease the fracture risk in different bone types with greater accuracy.
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Suh CH, Yun SJ, Jin W, Lee SH, Park SY, Ryu CW. Diagnostic performance of dual-energy CT for the detection of bone marrow oedema: a systematic review and meta-analysis. Eur Radiol 2018; 28:4182-4194. [PMID: 29679212 DOI: 10.1007/s00330-018-5411-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 02/20/2018] [Accepted: 02/23/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this systematic review and meta-analysis was to assess the sensitivity and specificity of dual-energy CT (DECT) for the detection of bone marrow oedema (BME). METHODS An electronic search of the PubMed and EMBASE databases was conducted. Bivariate modelling and hierarchical summary receiver-operating characteristic modelling were performed to evaluate the overall diagnostic performance of DECT for BME. Subgroup analysis was performed according to the assessment type (qualitative vs. quantitative) and anatomical location (spine vs. appendicular skeleton). Meta-regression analyses were performed according to the subject, study, and DECT characteristics. RESULTS Twelve eligible studies (1901 lesions, 450 patients) were included. DECT exhibited a pooled sensitivity of 0.85 [95% confidence interval (CI): 0.78-0.90] and a pooled specificity of 0.97 (95% CI: 0.92-0.98) for BME detection. In addition, the diagnostic performance of qualitative assessment (sensitivity, 0.85; specificity, 0.97) was higher than that of quantitative assessment (sensitivity, 0.84; specificity, 0.88) of DECT findings. The diagnostic performance of DECT for the spine (sensitivity, 0.84; specificity, 0.98) and appendicular skeleton (sensitivity, 0.84; specificity, 0.93) were excellent. According to meta-regression analysis, the use of a tin filter, ≥ 2 image planes, and a slice thickness < 1 mm tended to exhibit higher sensitivity and hyperacute stage BME (< 24 h) tended to exhibit lower sensitivity. CONCLUSIONS These findings indicate that DECT has excellent sensitivity and specificity for BME detection. Qualitative assessment of DECT findings obtained using a tin filter, ≥ 2 image planes, and a 0.5-1-mm slice thickness in the acute stage BME (≥24 h) is recommended for more sensitive diagnosis. KEY POINTS • Overall, DECT is useful for the detection of BME (sensitivity, 85%; specificity-97%). • Qualitative assessment (sensitivity-85%; specificity-97%) is more accurate than quantitative assessment (sensitivity-84%; specificity-88%). • DECT showed excellent diagnostic performance for both the spine/appendicular skeleton (sensitivity-84%/84%; specificity-98%/93%).
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Osella G, Priola AM, Priola SM, Piga A, Longo F, Ventura M, Bentivegna G, Angeli A, Veltri A, Terzolo M. Dual-Energy X-ray Absorptiometry Predictors of Vertebral Deformities in Beta-Thalassemia Major. J Clin Densitom 2018; 21:507-516. [PMID: 28756994 DOI: 10.1016/j.jocd.2017.06.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 06/18/2017] [Accepted: 06/27/2017] [Indexed: 10/19/2022]
Abstract
Vertebral fractures in beta-thalassemia major are increasingly found because of the longer life expectancy of patients, with a major negative impact on their quality of life. We performed a retrospective cross-sectional study to investigate the prevalence of vertebral deformities in thalassemic patients and to identify their best dual-energy X-ray absorptiometry (DXA) predictor among trabecular bone score (TBS), bone mineral density (BMD), and Z-score. Eighty-two outpatients with beta-thalassemia major on regular conventional treatment were studied at a single academic center. All patients underwent plain thoracic-lumbar spine X-rays and lumbar DXA to assess the number and the severity of vertebral deformities (Genant's method), the spinal deformity index, lumbar spine DXA parameters (BMD, TBS, and Z-score), and the presence of platyspondyly. Twenty-nine patients (35%) had vertebral deformities and showed significantly lower TBSs than the remainders (1.141 ± 0.083 vs 1.254 ± 0.072, p < 0.0001). The analysis of variance of the TBS between the group of patients without vertebral deformities (spinal deformity index = 0) and the remaining groups showed a significant difference (p < 0.001). The TBS had better sensitivity (86.2%), specificity (75.5%), and diagnostic accuracy (79.3%) than BMD and Z-score in discriminating patients with and without vertebral deformities. Combining the TBS with the BMD or the Z-score showed that the diagnostic accuracy of the first in discriminating patients with and without vertebral deformities improved from 79.3% to 85.4% and 87.8%, respectively. The presence of platyspondyly was a significant predictor of vertebral deformities in the multivariate model. Vertebral deformities in well-treated patients with beta-thalassemia major are common and are often unrecognized. In our hands, the TBS was better than the BMD and the Z-score in predicting vertebral deformities. Plain X-rays of the spine should be performed also in asymptomatic patients, especially when the TBS is low.
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Wang Y, Jia G, Song J, Kong X, Zhang W, Meng C. Comparative Efficacy of Alendronate upon Vertebral Bone Mineral Density and Fracture Rates in East Asians Versus Non-East Asians with Postmenopausal Osteoporosis: A Systematic Review and Meta-Analysis. Horm Metab Res 2018; 50:738-746. [PMID: 30312984 DOI: 10.1055/a-0741-8300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Bisphosphonates, such as alendronate, have become the most widely used and effective anti-resorptive therapy for postmenopausal osteoporosis. Previous genetic studies suggest that ethnicity may drive differing responses to bisphosphonate therapy in East Asians and non-East Asians. Therefore, the aim of this study was to comparatively evaluate the efficacy of alendronate upon lumbar spinal BMD and vertebral fracture rates in East Asians and non-East Asians with postmenopausal osteoporosis. MEDLINE, EMBASE, and Cochrane CENTRAL were searched for relevant randomized controlled trials (RCTs) comparing the efficacy of alendronate versus placebo (or calcium/mineral and/or Vitamin D or hormone replacement therapy) in primary postmenopausal osteoporotic women. We calculated the weighted mean differences (WMDs) for lumbar spinal BMD and the risk ratios (RRs) for vertebral fracture risk along with their respective 95% confidence intervals (CIs). From an initial set of 445 non-duplicate records, 13 full-text articles were finally included in this meta-analysis consisting of four East Asian RCTs and nine non-East Asian RCTs. Alendronate therapy displayed significant effects in improving lumbar spinal BMD in both East Asians [WMD (95% CI)=5.30 (0.32-10.29), p=0.037] and non-East Asians [WMD (95% CI)=5.73 (3.61-7.85), p=0.000]. Alendronate therapy did not display significant effects upon vertebral fracture risk in East Asians [RR (95% CI)=0.41 (0.06-2.73), p=0.358] but did display a significant effect upon lowering vertebral fracture risk in non-East Asians [RR (95% CI)=0.55 (0.42-0.72), p=0.000]. These findings suggest that ethnicity may affect the efficacy of bisphosphonate therapy in postmenopausal osteoporotic women.
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Liang J, Zhou X, Chen N, Li X, Yu H, Yang Y, Song Y, Du Q. Efficacy of three-dimensionally integrated exercise for scoliosis in patients with adolescent idiopathic scoliosis: study protocol for a randomized controlled trial. Trials 2018; 19:485. [PMID: 30201050 PMCID: PMC6131734 DOI: 10.1186/s13063-018-2834-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 08/02/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Adolescent idiopathic scoliosis (AIS) is one of the most prevalent spinal deformities that may progress sharply during growth. The aim of this study will be to evaluate the efficacy of three-dimensionally integrated exercise on the Cobb angle, angle of trunk rotation, sagittal profile, and quality of life in patients with AIS. METHODS/DESIGN The study is designed as a randomized controlled trial. Participants include 42 patients with AIS aged 10-16 years. Randomly assigned patients will follow a 6-month treatment, either in a control group with standard care of observation following the Scoliosis Research Society criteria or in an experimental group with three-dimensionally integrated exercise for scoliosis. Blinded assessments at baseline and immediately after intervention will include the change of Cobb angle, angle of trunk rotation, sagittal index, and quality of life. DISCUSSION If we find that the intervention is effective in improving Cobb angle, angle of trunk rotation, sagittal profile, and quality of life in patients with AIS, this trial will have a positive impact and warrant a change in clinical practice. TRIAL REGISTRATION ClinicalTrials.gov, NCT03427970 . Registered on February 9, 2018, and revised on July 24, 2018.
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Lian F, Zhou J, Wang Y, Chen D, Xu H, Liang L. Efficiency of dose reduction strategy of etanercept in patients with axial spondyloarthritis. Clin Exp Rheumatol 2018; 36:884-890. [PMID: 29652659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 02/26/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To evaluate the efficacy of different tapering or discontinuation strategies of etanercept in a cohort of axial spondyloarthritis from South China. METHODS We performed a retrospective cohort study. Axial SpA patients who achieved clinical remission for at least 6 months after receiving a standard dose of etanercept therapy were enrolled. Different tapering or discontinuation strategies were compared. RESULTS Altogether, 258 cases were enrolled. No differences were found in baseline characteristics among the three groups. Significantly more patients on discontinuation group (19%) than tapering group (5.4%, p<0.001) relapsed as early as 6 months. Almost all of the patients (103/107, 96.3%) in taper 25% group and more than 80% (71/88, 80.7%) of the patients in taper 50% group maintained low disease activity (LDA) or clinical remission during the first year. At the end of the 2-year follow-up, the percentage of patients maintaining LDA or remission were 28.6% (discontinuation), 55.7% (taper 50%), 84.1% (taper 25%), respectively. Activity indexes were significantly lower in taper 25% group compared to the other two groups. Patients in discontinuation group and tapering 50% group, with longer SpA duration were more likely to relapse, and remission>12 months before discontinuation/tapering helped to reduce relapse. CONCLUSIONS It is feasible to slowly increase the dosing interval and transit to the lowest effective dosing interval for some patients in remission/LDA. Prolonging the time under remission before tapering help to improve the outcome. Tapering 25% of the etanercept dose every 3 months may be a pragmatic approach for more cost-effective use of the drug.
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Slattery C, Verma K. Classification in Brief: SRS-Schwab Classification of Adult Spinal Deformity. Clin Orthop Relat Res 2018; 476:1890-1894. [PMID: 29601382 PMCID: PMC6259802 DOI: 10.1007/s11999.0000000000000264] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 02/26/2018] [Indexed: 01/31/2023]
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Zhao ZH, Bao HD, Tseng CC, Zhu ZZ, Qiu Y, Liu Z. Prediction of respiratory function in patients with severe scoliosis on the basis of the novel individualized spino-pelvic index. INTERNATIONAL ORTHOPAEDICS 2018; 42:2383-2388. [PMID: 29623457 DOI: 10.1007/s00264-018-3877-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 03/05/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Our study aimed to evaluate the pulmonary function of patients with severe scoliosis after correcting standing height with spino-pelvic index (SPI). METHODS Inclusion criteria: (1) with a coronal Cobb angle of more than 90°; (2) diagnosed as congenital (CS) or idiopathic scoliosis (IS); (3) aged between ten and 20 years; (4) with pulmonary function test (PFT) at the primary consultation. Patients with previous surgical intervention, with angular kyphosis, and with neuromuscular disease were excluded. Length of spine (LOS), height of spine (HOS), and height of pelvis (HOP) were measured on coronal films. SPI was defined as the ratio between LOS and HOP. The corrected body height was calculated: corrected body height = body height + (SPI × HOP - HOS). The PFTs included the following parameters: VCmax, FVC, FVC% predicted, FEV1, FEV1% predicted, PEF, and MVV. PFT results were recalculated using the corrected body height. RESULTS Thirty patients were diagnosed as IS and 27 as CS with average Cobb angles of 99.88° ± 11.83 and 98.06° ± 14.27, respectively. Significant differences were observed in VCmax and FVC between IS and CS patients (P < 0.05). All the corrected PFT parameters were significantly lower than the original PFT parameters (P < 0.05). CONCLUSION For the first time, this study proposed a method to predict pulmonary function of patients with severe scoliosis using SPI, as an age-independent parameter in normal adolescents. After body height correction, pulmonary function of patients with severe scoliosis was found to be significantly decreased, indicating that pulmonary function impairment was underestimated in patients with severe scoliosis when evaluating pulmonary function with arm span.
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Xie YF, Szeto G, Madeleine P, Tsang S. Spinal kinematics during smartphone texting - A comparison between young adults with and without chronic neck-shoulder pain. APPLIED ERGONOMICS 2018; 68:160-168. [PMID: 29409630 DOI: 10.1016/j.apergo.2017.10.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 10/27/2017] [Accepted: 10/27/2017] [Indexed: 06/07/2023]
Abstract
To advance our understanding about the association between smartphone use and chronic neck-shoulder pain, the objective of this study was to compare spinal kinematics between different text-entry methods in smartphone users with and without chronic neck-shoulder pain. Symptomatic (n = 19) and healthy participants (n = 18) were recruited and they performed three tasks: texting on a smartphone with one hand, with two hands, and typing on a desktop computer. Three-dimensional kinematics were examined in the cervical, thoracic and lumbar regions for each task. This study suggests that altered kinematics may be associated with pain since significantly increased angles of cervical right side flexion during smartphone texting and greater postural changes in cervical rotation were found during all text-entry tasks in the symptomatic group. Two-handed texting was associated with increased cervical flexion while one-handed texting was correlated with an asymmetric neck posture, indicating both text-entry methods are not favorable in terms of spinal postures.
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Newman M, Newman R, Hughes T, Vadher K, Barker KL. Is the timed loaded standing test a valid measure of back muscle endurance in people with vertebral osteoporosis? Osteoporos Int 2018; 29:893-905. [PMID: 29322223 DOI: 10.1007/s00198-017-4358-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 12/18/2017] [Indexed: 12/17/2022]
Abstract
UNLABELLED Timed loaded standing (TLS) is a suggested measure of back muscle endurance for people with vertebral osteoporosis. Surface electromyography revealed back muscles work harder and fatigue during TLS. The test end-point and total time were associated with back fatigue. The findings help demonstrate the concurrent validity of the TLS test. INTRODUCTION The TLS test is suggested as a measure of back muscle endurance for patients with vertebral osteoporosis. However, to date, no study has demonstrated that TLS does measure back extensor or erector spinae (ES) muscle endurance. We used surface electromyography (sEMG) to investigate the performance of the thoracic ES muscles during TLS. METHODS Thirty-six people with vertebral osteoporosis with a mean age of 71.6 (range 45-86) years participated. sEMG recordings were made of the ES at T3 and T12 bilaterally during quiet standing (QS) and TLS. The relative (%) change in sEMG amplitude between conditions was compared. Fatigue was evaluated by analysing the change in median frequency (MF) of the sEMG signal during TLS, and the correlation between maximal TLS time and rate of MF decline was examined. RESULTS Activity in the ES increased significantly during TLS at all electrode locations. During TLS, the MF declined at a mean rate of -24.2% per minute (95% C.I. -26.5 to -21.9%). The MF slope and test time were strongly correlated (r2 = 0.71), and at test end, the final MF dropped to an average 89% (95% C.I. 85 to 93%) of initial MF. Twenty-eight participants (78%) reported fatigue was the main reason for stopping, and for eight (22%), it was pain. CONCLUSIONS This study demonstrates that TLS challenges the ES muscles in the thoracic region and results in ES fatigue. Endurance time and the point at which the TLS test ends are strongly related to ES fatigue.
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Abstract
BACKGROUND Value-based healthcare models rely on quality measures to evaluate the efficacy of healthcare delivery and to identify areas for improvement. Quality measure research in other areas of health care has generally shown that there is a limited number of available quality measures and that those that exist disproportionately focus on processes as opposed to outcomes. The purpose of this study was to assess the current state of quality measures and candidate quality measures in spine surgery. QUESTIONS/PURPOSES (1) How many quality measures and candidate quality measures are currently available? (2) According to Donabedian domains and National Quality Strategy (NQS) priorities, what aspects or domains of care do the present quality measures and candidate quality measures represent? METHODS We systematically reviewed the National Quality Forum, the Agency for Healthcare Research and Quality, and the Physician Quality Reporting System for quality measures relevant to spine surgery. A systematic search for candidate quality measures was also performed using MEDLINE/PubMed and Embase as well as publications from the American Academy of Orthopaedic Surgeons, Congress of Neurological Surgeons, and the North American Spine Society. Clinical practice guidelines were included as candidate quality measures if their development was in accordance with Institute of Medicine criteria for the development of clinical practice guidelines, they were based on consistent clinical evidence including at least one Level I study, and they carried the strongest possible recommendation by the developing body. Quality measures and candidate quality measures were then pooled for analysis and categorized by clinical focus, NQS priority, and Donabedian domain. Our initial search yielded a total of 3940 articles, clinical practice guidelines, and quality measures, 74 of which met criteria for inclusion in this study. RESULTS Of the 74 measures studied, 29 (39%) were quality measures and 45 (61%) were candidate quality measures. Fifty of 74 (68%) were specific to the care of the spine, and 24 of 74 (32%) were related to the general care of spine patients. The majority of the spine-specific measures were process measures (45 [90%]) and focused on the NQS priority of "Effective Clinical Care" (44 [88%]). The majority of the general care measures were also process measures (14 [58%]), the highest portion of which focused on the NQS priority of "Patient Safety" (10 [42%]). CONCLUSIONS Given the large number of pathologies treated by spine surgeons, the limited number of available quality measures and candidate quality measures in spine surgery is inadequate to support the transition to a value-based care model. Additionally, current measures disproportionately focus on certain aspects or domains of care, which may hinder the ability to appropriately judge an episode of care, extract usable data, and improve quality. Physicians can steward the creation of meaningful quality measures by participating in clinical practice guideline development, assisting with the creation and submission of formal quality measures, and conducting the high-quality research on which effective guidelines and quality measures depend.
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Nikaido T, Sumitani M, Sekiguchi M, Konno S. The Spine painDETECT questionnaire: Development and validation of a screening tool for neuropathic pain caused by spinal disorders. PLoS One 2018; 13:e0193987. [PMID: 29561897 PMCID: PMC5862456 DOI: 10.1371/journal.pone.0193987] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Accepted: 02/22/2018] [Indexed: 12/15/2022] Open
Abstract
Objectives To develop screening tools for neuropathic pain caused by spinal disorders, the Spine painDETECT questionnaire (SPDQ) and its short-form version (SF-SPDQ), by modifying the Japanese version of the painDETECT questionnaire (PDQ-J), and to validate these tools. Methods Using data from patients with neuropathic pain caused by spinal disorders (NeP-SD) and patients with nociceptive pain caused by joint disorders (NocP) as controls, we devised a scoring system for the SPDQ by calculating weighting coefficients for nine PDQ-J items. Simultaneously, we selected some items for the SF-SPDQ. Next, we conducted the validation study primarily using patients with a confirmed diagnosis (a multicenter study) and general patients (a web-based survey). Sensitivity, specificity, and the area under the receiver-operating characteristic curve (AUC), along with additional positive/negative predictive values and positive/negative likelihood ratios, were calculated to assess the diagnostic utility of these tools in each population. Results Data for 85 patients with NeP-SD and 45 patients with NocP were analyzed to develop the SPDQ/SF-SPDQ. The SPDQ had sensitivity of 78.8% and specificity of 75.6% (AUC = 0.77). The SF-SPDQ had 82.4% sensitivity and 66.7% specificity (AUC = 0.75). In the multicenter study (n = 45), both tools had diagnostic utility almost comparable with that demonstrated at development: the SPDQ had sensitivity of 83.3% and specificity of 69.2%, with the SF-SPDQ having 86.2% sensitivity and 68.8% specificity. In the web-based survey (n = 500), while the SPDQ had slightly low sensitivity (74.0%), the SF-SPDQ maintained high sensitivity (84.4%), although specificity was relatively low (61.2%). Conclusions We developed the SPDQ and SF-SPDQ as valid screening tools for neuropathic pain caused by spinal disorders. Both have moderate utility as screening tools, with the SF-SPDQ perhaps being preferable for clinical use. However, physicians should be vigilant about possible false-positive diagnoses.
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Gieysztor EZ, Sadowska L, Choińska AM, Paprocka-Borowicz M. Trunk rotation due to persistence of primitive reflexes in early school-age children. ADV CLIN EXP MED 2018; 27:363-366. [PMID: 29558021 DOI: 10.17219/acem/67458] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The angle of trunk rotation (ATR) is a measurement that allows an objective assessment of a growing child's spine. Early detection of trunk rotation prevents the progression of scoliosis. One of the factors that predispose children to the formation of faulty posture may be primitive reflexes, which should be integrated in the central nervous system (CNS) by the age of one year. If retained, primitive reflexes affect children's physical development as well as their development at school. OBJECTIVES The aim of the study was to determine the prevalence of trunk asymmetry and the persistence of primitive reflexes and their inter-relationships in early school-age children. MATERIAL AND METHODS In this population-based survey, 61 children, average age 6.3 years (SD ±1.43), were examined. The ATR was examined using a scoliometer. The degree of integration of reflexes was assessed using tests developed by S. Goddard to assess the asymmetrical tonic neck reflex (ATNR), symmetrical tonic neck reflex (STNR), and spinal Galant reflex (SGR) on a 0-4 scale. Spearman's rank correlation coefficient and the χ2 test were used in the statistical analysis. RESULTS In almost half of the children body rotation was observed, in most cases toward the right (p = 0.012). This asymmetry was positively correlated with non-integrated Galant reflex on the same side (r = 0.335, p = 0.050). The presence of trunk rotation is associated with sex: There was higher frequency of asymmetry among the girls than among the boys. CONCLUSIONS In the evaluation of scoliosis, it could be useful to examine primitive reflexes as a possible reason for trunk rotation. In the treatment of scoliosis, primitive reflex integration methods should be used in some cases.
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Illien-Juünger S, Palacio-Mancheno P, Kindschuh WF, Chen X, Sroga GE, Vashishth D, Iatridis JC. Dietary Advanced Glycation End Products Have Sex- and Age-Dependent Effects on Vertebral Bone Microstructure and Mechanical Function in Mice. J Bone Miner Res 2018; 33:437-448. [PMID: 29160901 PMCID: PMC5865476 DOI: 10.1002/jbmr.3321] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/20/2017] [Accepted: 10/22/2017] [Indexed: 12/20/2022]
Abstract
Back pain is a leading cause of global disability that can arise from vertebral fracture and osteoporosis. Although poor general health and obesity are among the strongest risk factors for back pain, there is remarkably little known about how diet influences spinal diseases. Advanced glycation end-products (AGEs) are implicated in increased fracture risk, yet no studies investigated how dietary AGEs affect spinal health. We tested the hypothesis that high dietary AGE ingestion will diminish vertebral structure and function in a sex- and age-dependent manner. Female and male mice were fed low-AGE (L-AGE) or high-AGE (H-AGE) isocaloric diets for 6 and 18 months and multiple measurements of bone structure and function were taken. AGE levels in serum and cortical vertebrae were increased only for 6-month-old H-AGE female mice while blood glucose and body weight remained normal for all animals. When fed an H-AGE diet, 6-month-old female mice had inferior vertebral trabecular structure with decreased bone mineral density (BMD) and bone volume fraction. Biomechanical testing and analytical modeling further showed functional deterioration in 6-month-old H-AGE females with reduced shear and compression moduli, and maximum load to failure. At 18 months, H-AGE mice of both sexes had significant but small decreases in cortical BMD and thickness, yet functional biomechanical behaviors were not distinguishable from other aging changes. We conclude that an H-AGE diet, without diabetic or overweight conditions, diminished vertebral microstructure, mechanical behaviors, and fracture resistance in young female mice in a manner suggesting accelerated bone aging. © 2017 American Society for Bone and Mineral Research.
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Fischgrund JS, Rhyne A, Franke J, Sasso R, Kitchel S, Bae H, Yeung C, Truumees E, Schaufele M, Yuan P, Vajkoczy P, DePalma M, Anderson DG, Thibodeau L, Meyer B. Intraosseous basivertebral nerve ablation for the treatment of chronic low back pain: a prospective randomized double-blind sham-controlled multi-center study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:1146-1156. [PMID: 29423885 DOI: 10.1007/s00586-018-5496-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 01/11/2018] [Accepted: 01/24/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of radiofrequency (RF) ablation of the basivertebral nerve (BVN) for the treatment of chronic low back pain (CLBP) in a Food and Drug Administration approved Investigational Device Exemption trial. The BVN has been shown to innervate endplate nociceptors which are thought to be a source of CLBP. METHODS A total of 225 patients diagnosed with CLBP were randomized to either a sham (78 patients) or treatment (147 patients) intervention. The mean age within the study was 47 years (range 25-69) and the mean baseline ODI was 42. All patients had Type I or Type II Modic changes of the treated vertebral bodies. Patients were evaluated preoperatively, and at 2 weeks, 6 weeks and 3, 6 and 12 months postoperatively. The primary endpoint was the comparative change in ODI from baseline to 3 months. RESULTS At 3 months, the average ODI in the treatment arm decreased 20.5 points, as compared to a 15.2 point decrease in the sham arm (p = 0.019, per-protocol population). A responder analysis based on ODI decrease ≥ 10 points showed that 75.6% of patients in the treatment arm as compared to 55.3% in the sham control arm exhibited a clinically meaningful improvement at 3 months. CONCLUSION Patients treated with RF ablation of the BVN for CLBP exhibited significantly greater improvement in ODI at 3 months and a higher responder rate than sham treated controls. BVN ablation represents a potential minimally invasive treatment for the relief of chronic low back pain. These slides can be retrieved under Electronic Supplementary Material.
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Abstract
BACKGROUND Young athletes at the stage of growth acceleration tend to exhibit increased susceptibility to postural abnormalities, especially in the trunk region. The aim of this study was to assess and compare the posture in male adolescent handball players over two years of regular training sessions. METHODS The study group comprised 21 handball players. At the start of the study 15 participants were aged 14 and 6 participants were aged 15 (mean 14.25 ± 0.58). The measurements were repeated three times. Posture was assessed with a photogrammetric method based on the moiré phenomenon. RESULTS The analysis of posture relative to symmetry in the frontal and transverse planes did not reveal any significant differences between posture indicators obtained during the successive measurements. Sagittal plane posture indicators revealed significant changes in torso forward inclination angle and the shape of anteroposterior spinal curvatures. The latter consisted of significant deepening of the upper thoracic curve (angle α) and flattening of the lumbosacral curve (angle γ). CONCLUSIONS A two-year period of handball training did not result in posture asymmetries in young male handball players. The observed changes in the shape of anteroposterior spinal curvatures might be related both to sports training and somatic parameters.
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Bao S, Lin JH. An investigation into four different sit-stand workstation use schedules. ERGONOMICS 2018; 61:243-254. [PMID: 28689467 DOI: 10.1080/00140139.2017.1353139] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 06/29/2017] [Indexed: 06/07/2023]
Abstract
Twelve office workers participated in a study investigating effects of four sit/stand schedules (90-min sit/30-min stand, 80/40, 105/15, and 60/60) via several objective and subjective measures (muscle fatigue, foot swelling, spinal shrinkage, and self-reported discomfort). Results showed that there were no significant differences in shoulder and low back static muscle activities between sitting and standing. Muscle fatigue was developed during workday under all schedules. The longest standing schedule seemed to have a tendency of reducing muscle fatigue. None of the schedules helped or worsened foot swelling and spinal shrinkage. More active break-time activities seemed reducing muscle fatigue and foot swelling. While the self-reported bodily discomfort levels were generally low, the preferred schedules among the participants were varied, although the least standing schedule was the least preferred. We may conclude that effects of using sit-stand workstation to improve musculoskeletal health may be limited but promoting more active break-time activities can help. Practitioner Summary: Sit-stand workstations are used to reduce work-related musculoskeletal disorders. This study shows that office workers prefer sit/stand durations in the range between 1:1 and 3:1. Longer standing may have the potential to reduce muscle fatigue. However, active break-time activities may be more effective in reducing muscle fatigue and foot swelling.
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Goes SM, Trask CM, Boden C, Bath B, Ribeiro DC, Hendrick P, Clay L, Zeng X, Milosavljevic S. Measurement properties of instruments assessing permanent functional impairment of the spine: a systematic review protocol. BMJ Open 2018; 8:e019276. [PMID: 29374671 PMCID: PMC5829857 DOI: 10.1136/bmjopen-2017-019276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Permanent functional impairment (PFI) of the spine is a rating system used by compensation authorities, such as workers compensation boards, to establish an appropriate level of financial compensation for persistent loss of function. Determination of PFI of the spine is commonly based on the assessment of spinal movement combined with other measures of physical and functional impairments; however, the reliability and validity of the measurement instruments used for these evaluations have yet to be established. The aim of this study is to systematically review and synthesise the literature concerning measurement properties of the various and different instruments used for assessing PFI of the spine. METHODS Three conceptual groups of terms (1) PFI, (2) spinal disorder and (3) measurement properties will be combined to search Medline, EMBASE, CINAHL, Web of Science, Scopus, PEDro, OTSeeker and Health and Safety Science Abstracts. We will examine peer-reviewed, full-text articles over the full available date range. Two reviewers will independently screen citations (title, abstract and full text) and perform data extraction. Included studies will be appraised as to their methodological quality using the COnsensus-based Standards for the selection of health Measurement INstruments criteria. Findings will be summarised and presented descriptively, with meta-analysis pursued as appropriate. ETHICS AND DISSEMINATION This review will summarise the current level of evidence of measurement properties of instruments used for assessing PFI of the spine. Findings of this review may be applicable to clinicians, policy-makers, workers' compensation boards, other insurers and health and safety organisations. The findings will likely provide a foundation and direction for future research priorities for assessing spinal PFI. PROSPERO REGISTRATION NUMBER CRD42017060390.
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Benditz A, Auer S, Spörrer JF, Wolkerstorfer S, Grifka J, Suess F, Dendorfer S. Regarding loads after spinal fusion, every level should be seen separately: a musculoskeletal analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:1905-1910. [PMID: 29352353 DOI: 10.1007/s00586-018-5476-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 01/05/2018] [Accepted: 01/12/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The number of spinal fusion surgeries is steadily increasing and biomechanical consequences are still in debate. The aim of this study is to provide biomechanical insights into the sagittal balance of the spine and to compare spinal load before and after spinal fusion. METHOD The joint reaction forces of 52 patients were analyzed in proximo-distal and antero-posterior direction from the levels T12-L1 to L5-S1 using musculoskeletal simulations. RESULTS In 104 simulations, pre-surgical forces were equal to post-surgical. The levels L4-L5 and T12-L1, however, showed increased spinal forces compression forces with higher sagittal displacement. Improved restauration of sagittal balance was accompanied by lower spinal load. AP shear stress, interestingly decreased with sagittal imbalance. CONCLUSION Imbalanced spines have a risk of increased compression forces at Th12-L1. L4-L5 always has increased spinal loads. These slides can be retrieved under Electronic Supplementary Material.
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Yang SC, Liu PH, Tu YK. Pullout evaluation of sawbone experiment in different types of pedicle screws combined with bone cement augmentation for severe osteoporotic spine. Acta Bioeng Biomech 2018; 20:55-64. [PMID: 30220723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE The conventional screw is unable to provide enough screw-bone interface strength for osteoporotic cencellous bone, and complications resulting from loosening or failure of the implants remain a significant clinical problem. Hence, the purpose of this study is to investigate pullout strength and energy in three types of the pedicle screws, including conventional solid pedicle screw, cannulated pedicle screw, and cannulated pedicle screw with a central pin, using osteoporotic sawbone test block with different bone cement volumes through pullout force testing. METHODS The control group (n = 15) of the osteoporotic sawbone test block includes groups A, B, and C to reflect three types of the pedicle screws without bone cement augmentation. The cemented group (n = 45) of the osteoporotic sawbone test block includes groups D1, D2, D3, E1, E2, E3, F1, F2, and F3 to reflect three types of the pedicle screws with PMMA bone cement of 2, 3, and 4 mL augmentation. RESULTS The results showed that the pullout strength and energy in the cemented group were significantly larger than that in the control group. Moreover, the best performances of the pullout strength and energy in the cemented group were evidenced obviously in the case of cannulated pedicle screw with a central pin with 4 mL bone cement augmentation. CONCLUSIONS This study concludes that cement argumentation in the cannulated pedicle screw with a central pin can increase a pullout strength of pedicle screw for severe osteoporotic patients while bone cement of injective volume is limited.
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He C, To MKT, Cheung JPY, Cheung KMC, Chan CK, Jiang WW, Zhou GQ, Lai KKL, Zheng YP, Wong MS. An effective assessment method of spinal flexibility to predict the initial in-orthosis correction on the patients with adolescent idiopathic scoliosis (AIS). PLoS One 2017; 12:e0190141. [PMID: 29267389 PMCID: PMC5739463 DOI: 10.1371/journal.pone.0190141] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 12/10/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Spinal flexibility is an essential parameter for clinical decision making on the patients with adolescent idiopathic scoliosis (AIS). Various methods are proposed to assess spinal flexibility, but which assessment method is more effective to predict the effect of orthotic treatment is unclear. OBJECTIVE To investigate an effective assessment method of spinal flexibility to predict the initial in-orthosis correction, among the supine, prone, sitting with lateral bending and prone with lateral bending positions. METHODS Thirty-five patients with AIS (mean Cobb angle: 28° ± 7°; mean age: 12 ± 2 years; Risser sign: 0-2) were recruited. Before orthosis fitting, spinal flexibility was assessed by an ultrasound system in 4 positions (apart from standing) including supine, prone, sitting with lateral bending and prone with lateral bending. After orthosis fitting, the initial in-orthosis correction was routinely assessed by whole spine standing radiograph. Comparisons and correlation analyses were performed between the spinal flexibility in the 4 positions and the initial in-orthosis correction. RESULTS The mean in-orthosis correction was 41% while the mean curve correction (spinal flexibility) in the 4 studied positions were 40% (supine), 42% (prone), 127% (prone with lateral bending) and 143% (sitting with lateral bending). The correlation coefficients between initial in-orthosis correction and curve correction (spinal flexibility) in the 4 studied positions were r = 0.66 (supine), r = 0.75 (prone), r = 0.03 (prone with lateral bending) and r = 0.04 (sitting with lateral bending). CONCLUSIONS The spinal flexibility in the prone position is the closest to and most correlated with the initial in-orthosis correction among the 4 studied positions. Thus, the prone position could be an effective method to predict the initial effect of orthotic treatment on the patients with AIS.
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Basques BA, McLynn RP, Fice MP, Samuel AM, Lukasiewicz AM, Bohl DD, Ahn J, Singh K, Grauer JN. Results of Database Studies in Spine Surgery Can Be Influenced by Missing Data. Clin Orthop Relat Res 2017; 475:2893-2904. [PMID: 27896677 PMCID: PMC5670041 DOI: 10.1007/s11999-016-5175-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND National databases are increasingly being used for research in spine surgery; however, one limitation of such databases that has received sparse mention is the frequency of missing data. Studies using these databases often do not emphasize the percentage of missing data for each variable used and do not specify how patients with missing data are incorporated into analyses. This study uses the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to examine whether different treatments of missing data can influence the results of spine studies. QUESTIONS/PURPOSES (1) What is the frequency of missing data fields for demographics, medical comorbidities, preoperative laboratory values, operating room times, and length of stay recorded in ACS-NSQIP? (2) Using three common approaches to handling missing data, how frequently do those approaches agree in terms of finding particular variables to be associated with adverse events? (3) Do different approaches to handling missing data influence the outcomes and effect sizes of an analysis testing for an association with these variables with occurrence of adverse events? METHODS Patients who underwent spine surgery between 2005 and 2013 were identified from the ACS-NSQIP database. A total of 88,471 patients undergoing spine surgery were identified. The most common procedures were anterior cervical discectomy and fusion, lumbar decompression, and lumbar fusion. Demographics, comorbidities, and perioperative laboratory values were tabulated for each patient, and the percent of missing data was noted for each variable. These variables were tested for an association with "any adverse event" using three separate multivariate regressions that used the most common treatments for missing data. In the first regression, patients with any missing data were excluded. In the second regression, missing data were treated as a negative or "reference" value; for continuous variables, the mean of each variable's reference range was computed and imputed. In the third regression, any variables with > 10% rate of missing data were removed from the regression; among variables with ≤ 10% missing data, individual cases with missing values were excluded. The results of these regressions were compared to determine how the different treatments of missing data could affect the results of spine studies using the ACS-NSQIP database. RESULTS Of the 88,471 patients, as many as 4441 (5%) had missing elements among demographic data, 69,184 (72%) among comorbidities, 70,892 (80%) among preoperative laboratory values, and 56,551 (64%) among operating room times. Considering the three different treatments of missing data, we found different risk factors for adverse events. Of 44 risk factors found to be associated with adverse events in any analysis, only 15 (34%) of these risk factors were common among the three regressions. The second treatment of missing data (assuming "normal" value) found the most risk factors (40) to be associated with any adverse event, whereas the first treatment (deleting patients with missing data) found the fewest associations at 20. Among the risk factors associated with any adverse event, the 10 with the greatest effect size (odds ratio) by each regression were ranked. Of the 15 variables in the top 10 for any regression, six of these were common among all three lists. CONCLUSIONS Differing treatments of missing data can influence the results of spine studies using the ACS-NSQIP. The current study highlights the importance of considering how such missing data are handled. CLINICAL RELEVANCE Until there are better guidelines on the best approaches to handle missing data, investigators should report how missing data were handled to increase the quality and transparency of orthopaedic database research. Readers of large database studies should note whether handling of missing data was addressed and consider potential bias with high rates or unspecified or weak methods for handling missing data.
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Norheim EP, Black MH, Ngor EW, Shi JM, Safran MR, Navarro RA. Cervical spine disease in surgeons performing arthroscopy or laparoscopy. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2017; 74:206-214. [PMID: 29035681 DOI: 10.1080/19338244.2017.1392277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 10/06/2017] [Indexed: 06/07/2023]
Abstract
Minimal research exists regarding cervical spine disorders in surgeons who perform endoscopy. A confidential on-line survey regarding neck pain (NP), spine disease (SD), and radiculopathy/myelopathy (R/M) was sent to 722 surgeons from a managed, group-based health care system. 415 responded. 361 had endoscopy experience, of whom 24.4% had NP, 20.8% SD, and 3.9% R/M. Most respondents were less than 50 years of age (62.3%), and male (65.7%). Significant risk factors for NP included older age and female, whereas OB/Gyn specialty, increased age and job stress were for SD. After adjusting for age and gender, significant risk factors for NP and SD included greater surgeon experience. After also adjusting for job stress, significant risk factors for SD included increased surgeon experience and higher frequency of endoscopies. No association was found between use of digital OR. Endoscopy appears to place surgeons at higher risk of cervical disease. Level of Evidence: Level 3.
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Taniguchi M, Tateuchi H, Ibuki S, Ichihashi N. Relative mobility of the pelvis and spine during trunk axial rotation in chronic low back pain patients: A case-control study. PLoS One 2017; 12:e0186369. [PMID: 29040298 PMCID: PMC5645112 DOI: 10.1371/journal.pone.0186369] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 09/29/2017] [Indexed: 12/03/2022] Open
Abstract
Background Trunk axial rotation is a risk factor for chronic low back pain (CLBP). The characteristics of rotational mobility in the pelvis and spine among CLBP patients are not fully understood. Purpose The purpose of this study was to examine three-dimensional kinematic changes, and to compare the differences of rotational mobility and coupled motion, in patients with and without CLBP. Methods Fifteen patients with CLBP and 15 age and sex matched healthy subjects participated in this study. Each subject performed trunk rotation to maximum range of motion (ROM) in a standing position. The kinematics data was collected using a three-dimensional motion analysis system. The outcomes measured were the rotational ROM and the spine/pelvis ratio (SPR) in transvers plane at both maximum and 50% rotation position. The coupled angles in sagittal and frontal planes were also measured. Results No significant differences in rotational ROM of the thorax, pelvis, and spine were observed between two groups at maximum rotation position. However, there was a significant interaction between groups and rotational ROM of pelvis and spine (F = 4.57, p = 0.04), and the SPR in CLBP patients was significantly greater than that of the healthy subjects (CLBP; 0.50 ± 0.10 Control; 0.41 ± 0.12, p = 0.04). The results at 50% rotation position were similar to that at maximum rotation. This indicates a relative increase in spinal rotation in the CLBP patients during trunk rotation. Moreover, the CLBP patients exhibited a significantly higher anterior tilt of the pelvis and extension of the spine in the sagittal plane coupled with rotation. Conclusions CLBP patients had relative hyper rotational mobility of the spine as well as excessive spinal extension coupled with trunk rotation. These results suggest that uncoordinated trunk rotation might be a functional failure associated with CLBP.
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Katzman WB, Vittinghoff E, Lin F, Schafer A, Long RK, Wong S, Gladin A, Fan B, Allaire B, Kado DM, Lane NE. Targeted spine strengthening exercise and posture training program to reduce hyperkyphosis in older adults: results from the study of hyperkyphosis, exercise, and function (SHEAF) randomized controlled trial. Osteoporos Int 2017; 28:2831-2841. [PMID: 28689306 PMCID: PMC5873977 DOI: 10.1007/s00198-017-4109-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 05/31/2017] [Indexed: 01/01/2023]
Abstract
A 6-month randomized controlled trial of spine-strengthening exercise and posture training reduced both radiographic and clinical measures of kyphosis. Participants receiving the intervention improved self-image and satisfaction with their appearance. Results suggest that spine-strengthening exercise and postural training may be an effective treatment option for older adults with hyperkyphosis. INTRODUCTION The purpose of the present study is to determine in a randomized controlled trial whether spine-strengthening exercises improve Cobb angle of kyphosis in community-dwelling older adults. METHODS We recruited adults ≥60 years with kyphosis ≥40° and enrolled 99 participants (71 women, 28 men), mean age 70.6 ± 0.6 years, range 60-88, with baseline Cobb angle 57.4 ± 12.5°. The intervention included group spine-strengthening exercise and postural training, delivered by a physical therapist, 1-h, three times weekly for 6 months. Controls received four group health education meetings. The primary outcome was change in the gold standard Cobb angle of kyphosis measured from standing lateral spine radiographs. Secondary outcomes included change in kyphometer-measured kyphosis, physical function (modified Physical Performance Test, gait speed, Timed Up and Go, Timed Loaded Standing, 6-Min Walk), and health-related quality of life (HRQoL) (PROMIS global health and physical function indexes, SRS-30 self-image domain). ANCOVA was used to assess treatment effects on change from baseline to 6 months in all outcomes. RESULTS There was a -3.0° (95% CI -5.2, -0.8) between-group difference in change in Cobb angle, p = 0.009, favoring the intervention and approximating the magnitude of change from an incident vertebral fracture. Kyphometer-measured kyphosis (p = 0.03) and SRS-30 self-esteem (p < 0.001) showed favorable between-group differences in change, with no group differences in physical function or additional HRQoL outcomes, p > 0.05. CONCLUSIONS Spine-strengthening exercise and posture training over 6 months reduced kyphosis compared to control. Our randomized controlled trial results suggest that a targeted kyphosis-specific exercise program may be an effective treatment option for older adults with hyperkyphosis. TRIAL REGISTRATION NUMBER AND NAME OF TRIAL REGISTER ClinicalTrials.gov; identifier NCT01751685.
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