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Xu W, Yu H, Liang C, Zhai Y, Cui X, Wang W, Zhang W. [Treatment of osteoporotic vertebral fracture combined with moderate to severe spinal kyphosis by transintervertebral release, bone impaction grafting, and posterior column compressed-closing]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:1406-1413. [PMID: 31650757 DOI: 10.7507/1002-1892.201905009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To explore the safety and preliminary effectiveness of transintervertebral release, bone impaction grafting, and posterior column compressed-closing in the treatment of osteoporotic vertebral fracture combined with moderate to severe spinal kyphosis. Methods The clinical data of 21 elderly patients with osteoporotic vertebral fracture combined with moderate to severe spinal kyphosis were retrospectively analyzed between March 2016 and November 2017. There were 1 male and 20 females, aged 55-75 years, with an average of 64.8 years. The disease duration was 8-24 months, with an average of 13.1 months. The bone density T value ranged from -3.4 to -2.1, with an average of -2.3. Lesion segments: T 11 in 2 cases, T 12 in 6 cases, L 1 in 8 cases, L 2 in 1 case, T 11, 12 in 1 case, T 12, L 1 in 2 cases, and T 12, L 2 in 1 case. Preoperative neurological function was classified according to the American Spinal Injury Association (ASIA): 5 cases of grade D and 16 cases of grade E. All patients underwent transintervertebral release, bone impaction grafting, and posterior column compressed-closing. The effectiveness was evaluated by visual analogue scale (VAS) score and Oswestry dysfunction index (ODI) score before operation, at 3 months after operation, and at last follow-up. The neurological function was assessed by ASIA at last follow-up. Local kyphosis Cobb angle (LKCA), thoracic kyphosis (TK), lumbar lordosis (LL), and sagittal vertebral axis (SVA) were measured on the X-ray films of the full-length lateral spine of the patient before operation, at 1 week after operation, and at last follow-up. Results No complication such as fracture of internal fixator or nerve injury occurred. LKCA, TK, and SVA were significantly improved at 1 week after operation and at last follow-up ( P<0.05). There was no significant difference between at 1 week after operation and at last follow-up ( P>0.05). There was no significant difference in LL before and after operation ( F=3.013, P=0.057). The VAS and ODI scores were significantly improved at 3 months after operation and at last follow-up, and further improved at last follow-up when compared with the scores at 3 months after operation, showing significant differences between time points ( P<0.05). Five patients with ASIA grade D neurological function recovered to grade E at 6 months after operation. Conclusion Transintervertebral release, bone impaction grafting, and posterior column compressed-closing for treating osteoporotic vertebral fracture combined with moderate to severe spinal kyphosis has definite effectiveness, strong orthopaedic ability, and minimal trauma, which can effectively restore the sagittal balance of the spine, alleviate pain, and improve the patients' quality of life.
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Affiliation(s)
- Wenqiang Xu
- Department of Orthopaedics, Fuyang Clinical College, Anhui Medical University, Fuyang Anhui, 236000, P. R. China
| | - Haiyang Yu
- Department of Orthopaedics, Fuyang Clinical College, Anhui Medical University, Fuyang Anhui, 236000, P. R.
| | - Chengmin Liang
- Department of Orthopaedics, Fuyang Clinical College, Anhui Medical University, Fuyang Anhui, 236000, P. R. China
| | - Yunlei Zhai
- Department of Orthopaedics, Fuyang Clinical College, Anhui Medical University, Fuyang Anhui, 236000, P. R. China
| | - Xilong Cui
- Department of Orthopaedics, Fuyang Clinical College, Anhui Medical University, Fuyang Anhui, 236000, P. R. China
| | - Wei Wang
- Department of Orthopaedics, Fuyang Clinical College, Anhui Medical University, Fuyang Anhui, 236000, P. R. China
| | - Wei Zhang
- Department of Orthopaedics, Fuyang Clinical College, Anhui Medical University, Fuyang Anhui, 236000, P. R. China
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Roghani T, Khalkhali Zavieh M, Talebian S, Akbarzadeh Baghban A, Katzman W. Back Muscle Function in Older Women With Age-Related Hyperkyphosis: A Comparative Study. J Manipulative Physiol Ther 2019; 42:284-294. [PMID: 31257003 DOI: 10.1016/j.jmpt.2018.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 11/08/2018] [Accepted: 11/15/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to compare static maximal back extensor muscle force, endurance, and characteristics of flexion relaxation phenomenon (FRP) in older women with and without age-related hyperkyphosis. METHODS Maximum back extensor force and endurance measured in a sitting position with a designed load cell setup; appearance, onset, and offset angles of FRP; and extension relaxation ratio (ERR) during a dynamic flexion-extension task were compared between 24 older women with hyperkyphosis (thoracic kyphosis angle ≥50°), mean age 65 ± 4.4 years, and 24 older women without hyperkyphosis (thoracic kyphosis angle ≪50°), mean age 63 ± 4.3 years. Variables of force, endurance, angles of FRP, and ERR were analyzed using an independent sample t test. A χ2 test was used to identify differences between groups in FRP appearance. RESULTS Static back extensor force and endurance were significantly lower among those with versus those without hyperkyphosis (P ≪ .001). Although the 2 groups did not differ in FRP appearance and ERR in the superficial erector spinal muscles (P ≫ .05), FRP in the hyperkyphosis group started sooner and ended later than in the group without hyperkyphosis (P ≪ .05). CONCLUSION Our study indicates that women with age-related hyperkyphosis had decreased static maximal force and endurance of the back extensor muscles and prolonged myoelectrical silence of the superficial erector spinal muscles. Reduced endurance of the superficial erector spinal muscles may trigger early onset of FRP and prolonged relaxation of these muscles.
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Affiliation(s)
- Tayebeh Roghani
- Musculoskeletal Research Center, Rehabilitation Research Institute and Department of Physical Therapy, Faculty of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Minoo Khalkhali Zavieh
- Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Saeed Talebian
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences and Health Services, Tehran, Iran
| | - Alireza Akbarzadeh Baghban
- Proteomics Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Wendy Katzman
- Department of Physical Therapy and Rehabilitation Sciences, University of California, San Francisco, California
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Senthil P, Sudhakar S, Radhakrishnan R, Jeyakumar S. Efficacy of corrective exercise strategy in subjects with hyperkyphosis. J Back Musculoskelet Rehabil 2017; 30:1285-1289. [PMID: 28968227 DOI: 10.3233/bmr-169668] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Age-related hyperkyphosis causes deleterious effects on health, physical function, and quality of life. Recently, health care providers recognized it as a major health concern. OBJECTIVE To identify the effect of corrective exercise strategy on hyperkyphosis and compare it with that of conventional exercise. METHODS Subjects were randomly categorized into two groups. Each group comprised 30 subjects. Group A received the corrective exercise strategy, and group B received conventional exercises for 8 weeks of the study duration (15 repetitions of each exercise for three sessions/day for a total duration of 45 min and 4 days/week. Pre- and post-interventional hyperkyphosis were analyzed according to posture number using the Posture Pro 8 postural analysis software. In addition, pectoralis minor flexibility was assessed using the ruler scale method in centimeters. RESULTS Both groups showed highly significant postural alteration and changes in pectoralis minor muscle length (p< 0.001)CONCLUSIONS:The corrective exercise strategy seems to promote scapular stability and produce a more upright posture of the upper thoracic spine.
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Affiliation(s)
- P Senthil
- School of Physiotherapy, Vels University, Chennai, Tamilnadu, India.,Department of Musculoskeletal, Mohamed Sathak A.J. College of Physiotherapy, Chennai, Tamilnadu, India
| | - S Sudhakar
- Faculty of Physiotherapy, ACS Medical College and Hospitals, Dr MGR University Educational and Research Institute, Chennai, Tamilnadu, India
| | - R Radhakrishnan
- Department of Musculoskeletal, Mohamed Sathak A.J. College of Physiotherapy, Chennai, Tamilnadu, India
| | - S Jeyakumar
- Department of Physiotherapy, Saveetha University, Chennai, Tamilnadu, India
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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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Affiliation(s)
- W B Katzman
- University of California, 1500 Owens Street, San Francisco, CA, 94158, USA.
| | - E Vittinghoff
- University of California, 550 16th. Street, San Francisco, CA, 94158, USA
| | - F Lin
- University of California, 550 16th. Street, San Francisco, CA, 94158, USA
| | - A Schafer
- University of California, 4150 Clement St, San Francisco, CA, 94121, USA
- San Francisco Veterans Affairs Health Care System, 4150 Clement St, San Francisco, CA, 94121, USA
| | - R K Long
- University of California, 550 16th. Street, San Francisco, CA, 94143, USA
| | - S Wong
- University of California, 1500 Owens Street, San Francisco, CA, 94158, USA
| | - A Gladin
- Kaiser Permanente Northern CA, San Francisco Medical Center, 1635 Divisadero Street, Suite 300, San Francisco, CA, 94115, USA
| | - B Fan
- University of California, 400 Parnassus Avenue, San Francisco, CA, 94117, USA
| | - B Allaire
- Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
| | - D M Kado
- University of California, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - N E Lane
- University of California, 4625 Second Avenue, Suite 2000, Sacramento, CA, 95616, USA
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Study of Hyperkyphosis, Exercise and Function (SHEAF) Protocol of a Randomized Controlled Trial of Multimodal Spine-Strengthening Exercise in Older Adults With Hyperkyphosis. Phys Ther 2016; 96:371-81. [PMID: 26251480 PMCID: PMC4774389 DOI: 10.2522/ptj.20150171] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 08/02/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hyperkyphosis negatively affects health status, physical mobility, and quality of life, but there is no standard protocol for treating people with hyperkyphosis. Treatment options include targeted exercise. OBJECTIVES This single-site randomized controlled trial (RCT) will determine the efficacy of a targeted multimodal spine-strengthening exercise program, compared with no exercise intervention, among community-dwelling men and women aged ≥60 years. DESIGN The RCT is a parallel-group design, with 1:1 randomization to exercise and attentional control groups. SETTING The study will be conducted at one primary site (one academic medical center partnered with one local community medical center). PARTICIPANTS One hundred men and women, aged ≥60 years, with thoracic kyphosis ≥40 degrees will be randomized. INTERVENTION The targeted multimodal spine-strengthening exercise intervention includes exercise and postural training delivered by a physical therapist in a group of 10 participants, 3 times a week for 6 months. Controls receive monthly health education meetings in a group of 10 participants and monthly calls from the study coordinator to monitor physical activity and any adverse events. MEASUREMENTS The primary outcome is change in Cobb angle of kyphosis measured from lateral spine radiographs at baseline and 6 months. Secondary outcomes include change in physical function (assessed with the modified Physical Performance Test, Timed "Up & Go" Test, timed loaded standing, 4-m walk, and Six-Minute Walk Test) and health-related quality of life (assessed with the modified Scoliosis Research Society instrument [SRS-30] self-image domain and Patient Reported Outcomes Measurement Information System [PROMIS] global health and physical function indexes). Additional secondary outcomes include pain, physical activity level, spinal flexion and extension muscle strength, paraspinal extensor muscle density, and adverse events. LIMITATIONS Blinding of the participants and instructors providing the intervention is not possible. CONCLUSIONS The efficacy of a high-quality, adequately powered exercise intervention in men and women with kyphosis ≥40 degrees will be evaluated to determine whether targeted multimodal spine-strengthening exercise reduces hyperkyphosis in older adults and improves important secondary outcomes of physical function and health-related quality of life.
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Claesson A, Toth-Pal E, Piispanen P, Salminen H. District nurses' perceptions of osteoporosis management: a qualitative study. Osteoporos Int 2015; 26:1911-8. [PMID: 25792490 DOI: 10.1007/s00198-015-3086-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 02/20/2015] [Indexed: 01/06/2023]
Abstract
UNLABELLED Underdiagnosis of osteoporosis is common. This study investigated Swedish district nurses' perceptions of osteoporosis management. They perceived the condition as having low priority, and the consequences of this perception were insufficient awareness of the condition and perceptions of bone-specific medication as unsafe. They perceived, though, competency when working with fall prevention. INTRODUCTION Undertreatment of patients with osteoporosis is common. Sweden's medical care strategy dictates prioritisation of various conditions; while guidelines exist, osteoporosis is not prioritised. The aim of this study was to investigate district nurses' perceptions of osteoporosis management within Sweden's primary health care system. METHODS Four semi-structured focus group interviews were conducted with 13 female district nurses. The interviews were analysed using thematic analysis. RESULTS The overall theme was perceiving osteoporosis management as ambiguous. The themes were perceiving barriers and perceiving opportunities. These subthemes were linked to perceiving barriers: (i) insufficient procedures, lack of time and not aware of the condition; (ii) insufficient knowledge about diagnosis and about fracture risk assessment tools; (iii) low priority condition and unclear responsibility for osteoporosis management; and (iv) bone-specific medication was sometimes perceived to be unsafe. These subthemes were linked to perceiving opportunities: (i) professional competency when discussing fall prevention in home visit programs, (ii) willingness to learn more about osteoporosis management, (iii) collaboration with other professionals and (iv) willingness to identify individuals at high risk of fracture. CONCLUSIONS Osteoporosis was reported, by the district nurses, to be a low-priority condition with consequences being unawareness of the condition, insufficient knowledge about bone-specific medications, fracture risk assessment tools and procedures. These may be some of the explanations for the undertreatment of osteoporosis. At the same time, the district nurses described competency performing the home visits, which emerged as an optimal opportunity to discuss fall prevention and to introduce FRAX with the aim to identify individuals at high risk of fracture.
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Affiliation(s)
- A Claesson
- Unit of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden,
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Abstract
This article provides an overview of the current burden of osteoporosis and its complications in today's health care system. The impact of osteoporosis on patients' quality of life and direct financial consequences to the entire health care system are emphasized to highlight the need for increased knowledge and awareness of its complications if left untreated or treated incorrectly. Special attention is given to hip fracture and vertebral compression fracture, stressing the importance of diagnosing osteoporosis before fragility fractures occur. Models for improved care of fragility fractures during follow-up in the outpatient setting and the use of pharmacologic agents are discussed.
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Affiliation(s)
- Matthew A Varacallo
- Penn State Hershey Department of Orthopaedics and Rehabilitation, College of Medicine, 30 Hope Drive, Building A, Hershey, PA 17033, USA.
| | - Ed J Fox
- Penn State Hershey Department of Orthopaedics and Rehabilitation, College of Medicine, 30 Hope Drive, Building A, Hershey, PA 17033, USA
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Katzman WB, Miller-Martinez D, Marshall LM, Lane NE, Kado DM. Kyphosis and paraspinal muscle composition in older men: a cross-sectional study for the Osteoporotic Fractures in Men (MrOS) research group. BMC Musculoskelet Disord 2014; 15:19. [PMID: 24428860 PMCID: PMC4029749 DOI: 10.1186/1471-2474-15-19] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 01/14/2014] [Indexed: 12/11/2022] Open
Abstract
Background The prevalence of hyperkyphosis is increased in older men; however, risk factors other than age and vertebral fractures are not well established. We previously reported that poor paraspinal muscle composition contributes to more severe kyphosis in a cohort of both older men and women. Methods To specifically evaluate this association in older men, we conducted a cross-sectional study to evaluate the association of paraspinal muscle composition and degree of thoracic kyphosis in an analytic cohort of 475 randomly selected participants from the Osteoporotic Fractures in Men (MrOS) study with baseline abdominal quantitative computed tomography (QCT) scans and plain thoracic radiographs. Baseline abdominal QCT scans were used to obtain abdominal body composition measurements of paraspinal muscle and adipose tissue distribution. Supine lateral spine radiographs were used to measure Cobb angle of kyphosis. We examined the linear association of muscle volume, fat volume and kyphosis using loess plots. Multivariate linear models were used to investigate the association between muscle and kyphosis using total muscle volume, as well as individual components of the total muscle volume, including adipose and muscle compartments alone, controlling for age, height, vertebral fractures, and total hip bone mineral density (BMD). We examined these associations among those with no prevalent vertebral fracture and those with BMI < 30 kg/m2. Results Among men in the analytic cohort, means (SD) were 74 (SD = 5.9) years for age, and 37.5 (SD = 11.9) degrees for Cobb angle of kyphosis. Men in the lowest tertile of total paraspinal muscle volume had greater mean Cobb angle than men in the highest tertile, although test of linear trend across tertiles did not reach statistical significance. Neither lower paraspinal skeletal muscle volume (p-trend = 0.08), or IMAT (p-trend = 0.96) was associated with greater kyphosis. Results were similar among those with no prevalent vertebral fractures. However, among men with BMI < 30 kg/m2, those in the lowest tertile of paraspinal muscle volume had greater adjusted mean kyphosis (40.0, 95% CI: 37.8 – 42.1) compared to the highest tertile (36.3, 95% CI: 34.2 – 38.4). Conclusions These results suggest that differences in body composition may potentially influence kyphosis.
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Affiliation(s)
- Wendy B Katzman
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, CA 94158, USA.
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