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Deng S, Xie J, Niu T, Wang J, Han G, Xu J, Liu H, Li Z. Association of modic changes and postoperative surgical site infection after posterior lumbar spinal fusion. 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 2024; 33:3165-3174. [PMID: 38816538 DOI: 10.1007/s00586-024-08329-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/21/2024] [Accepted: 05/23/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE Postoperative surgical site infection is one of the most serious complications following spine surgery. Previous studies have reported Modic changes (MC) represent a subclinical infection. This study aims to investigate the relation between Modic changes and surgical site infection after posterior lumbar fusion surgery. METHODS We retrospectively reviewed the records of 424 patients who received posterior lumbar fusion. Preoperative clinical and radiological parameters were recorded. Primary outcome was the rate of postoperative surgical site infection. Covariates included age, body mass index (BMI), sex, hypertension, diabetes mellitus, chronic heart failure, Pfirrmann classification, fused levels, and operation duration. The presence of Modic changes was used as an exposition variable, and adjusted for other risk factors in multivariate analyses. RESULTS Of the 424 patients, 30 (7%) developed an acute surgical site infection. Infection had no relation to age, sex, BMI, and comorbidities. There were 212 (50%) patients with MC, and 23 (10.8%) had a surgical site infection, compared to 212 (50%) patients without MC in which there were 7 (3.3%) surgical site infections. MC was associated with surgical site infection in univariate analysis (odds ratio [OR] = 3.56, 95% confidence interval [CI]: 1.49-8.50, p = 0.004) and multivariate logistic regression analysis (OR = 3.05, 95% CI: 1.26-7.37, p = 0.013). There was statistically significant between specific type (p = 0.035) and grade of MCs (p = 0.0187) and SSI. CONCLUSIONS MCs may be a potential risk factor for SSI following posterior lumbar spinal intervertebral fusion. Type I and grade C MCs showed a higher infection rate compared with other MC types and grades.
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Affiliation(s)
- Siping Deng
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Jiahua Xie
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
- Department of Spine Surgery, The Seventh Affiliated Hospital of Southern Medical University, Foshan, 528244, China
| | - Tianzuo Niu
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Jianru Wang
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Guowei Han
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Jinghui Xu
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Hui Liu
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China.
| | - Zemin Li
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China.
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Cai K, Jiang G, Lu B, Zhang K, Luo K. Bone cement distribution may significantly affect the efficacy of percutaneous vertebroplasty in treating symptomatic Schmorl's nodes. BMC Musculoskelet Disord 2023; 24:473. [PMID: 37296434 DOI: 10.1186/s12891-023-06575-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
PURPOSE Percutaneous vertebroplasty(PVP) has been widely used in treating symptomatic Schmorl's nodes(SNs). However, there were still some patients with poor pain relief. At present, there is a lack of research to analyze the reasons for poor efficacy. METHODS Review the SNs patients treated with PVP in our hospital from November 2019 to June 2022, collect their baseline data. Reverse reconstruction software was used to calculate the filling rate of bone edema ring(Rf). NRS score was used to evaluate pain and ODI to evaluate function. The patients were divided into remission group(RG) and non remission group(n-RG) according to symptom. In addition, according to the Rf, they were divided into excellent, good and poor groups. Differences between groups were investigated. RESULTS A total of 26 vertebrae were included in 24 patients. When grouped according to symptoms, patients in n-RG were older, and surgical segments were tend to locate in lower lumbar spine. The proportion of Poor distribution was significantly higher. When grouped according to the cement distribution, the preoperative NRS and ODI of the three groups were comparable, but the NRS and ODI of Poor group were significantly worse than the Excellent and Good groups postoperatively and at the last follow-up. CONCLUSIONS The cement distribution may significantly affect the efficacy of PVP in treating symptomatic SNs. We suggest that the bone edema ring should be filled as fully as possible to ensure the efficacy. In addition, advanced age and low lumbar lesions are also adverse factors for clinical outcomes.
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Affiliation(s)
- Kaiwen Cai
- Department of Orthopaedic, The First Hospital Of Ningbo University, No. 247, Renmin Road, Jiangbei District, Ningbo, Zhejiang, People's Republic of China
- Institute of Orthopaedics, Ningbo University, No. 247, Renmin Road, Jiangbei District, Ningbo, Zhejiang, People's Republic of China
| | - Guoqiang Jiang
- Department of Orthopaedic, The First Hospital Of Ningbo University, No. 247, Renmin Road, Jiangbei District, Ningbo, Zhejiang, People's Republic of China
- Institute of Orthopaedics, Ningbo University, No. 247, Renmin Road, Jiangbei District, Ningbo, Zhejiang, People's Republic of China
| | - Bin Lu
- Department of Orthopaedic, The First Hospital Of Ningbo University, No. 247, Renmin Road, Jiangbei District, Ningbo, Zhejiang, People's Republic of China
- Institute of Orthopaedics, Ningbo University, No. 247, Renmin Road, Jiangbei District, Ningbo, Zhejiang, People's Republic of China
| | - Kai Zhang
- Department of Orthopaedic, The First Hospital Of Ningbo University, No. 247, Renmin Road, Jiangbei District, Ningbo, Zhejiang, People's Republic of China
- Institute of Orthopaedics, Ningbo University, No. 247, Renmin Road, Jiangbei District, Ningbo, Zhejiang, People's Republic of China
| | - Kefeng Luo
- Department of Orthopaedic, The First Hospital Of Ningbo University, No. 247, Renmin Road, Jiangbei District, Ningbo, Zhejiang, People's Republic of China.
- Institute of Orthopaedics, Ningbo University, No. 247, Renmin Road, Jiangbei District, Ningbo, Zhejiang, People's Republic of China.
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Ekşi MŞ, Orhun Ö, Demir YN, Kara M, Berikol G, Özcan-Ekşi EE. Are serum thyroid hormone, parathormone, calcium, and vitamin D levels associated with lumbar spine degeneration? A cross-sectional observational clinical 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 2023; 32:1561-1574. [PMID: 36976340 DOI: 10.1007/s00586-023-07673-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 03/11/2023] [Accepted: 03/18/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE Low back pain (LBP) impairs the quality of life and rises healthcare costs. The association of spine degeneration and LBP with metabolic disorders have been reported, previously. However, metabolic processes related with spine degeneration remained unclear. We aimed to analyze whether serum thyroid hormones, parathormone, calcium, and vitamin D levels were associated with lumbar intervertebral disc degeneration (IVDD), Modic changes, and fatty infiltration in the paraspinal muscles. METHODS We cross-sectionally analyzed a retrospective database. Patients who visited internal medicine outpatient clinics with suspect of endocrine disorders and chronic LBP were searched. Patients with biochemistry results within 1 week before lumbar spine magnetic resonance imaging (MRI) were included. Age- and gender-matched cohorts were made-up and analyzed. RESULTS Patients with higher serum free thyroxine levels were more likely to have severe IVDD. They were also more likely to have fattier multifidus and erector spinae at upper lumbar levels, less fatty psoas and less Modic changes at lower lumbar levels. Higher PTH levels were observed in patients with severe IVDD at L4-L5 level. Patients with lower serum vitamin D and calcium levels had more Modic changes and fattier paraspinal muscles at upper lumbar levels. CONCLUSION Serum hormone, vitamin D, and calcium levels were associated with not only IVDD and Modic changes but also with fatty infiltration in the paraspinal muscles, mainly at upper lumbar levels in patients with symptomatic backache presenting to a tertiary care center. Complex inflammatory, metabolic, and mechanical factors present in the backstage of spine degeneration.
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Affiliation(s)
- Murat Şakir Ekşi
- Associate Professor of Neurosurgery, FSM Training and Research Hospital, Neurosurgery Clinic, Göztepe Mah. Mesire Sok. Tütüncü Mehmet Efendi Cad. No: 3/34 Kadıkoy, Istanbul, Turkey.
| | - Ömer Orhun
- School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Yaren Nur Demir
- School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Müjdat Kara
- Endocrinology Unit, Department of Internal Medicine, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Gürkan Berikol
- Neurosurgery Clinic, Taksim Training and Research Hospital, Istanbul, Turkey
| | - Emel Ece Özcan-Ekşi
- Department of Physical Medicine and Rehabilitation, School of Medicine, Bahçeşehir University, Istanbul, Turkey
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Zhao X, Ma H, Han H, Zhang L, Tian J, Lei B, Zhang Y. Precision medicine strategies for spinal degenerative diseases: Injectable biomaterials with in situ repair and regeneration. Mater Today Bio 2022; 16:100336. [PMID: 35799898 PMCID: PMC9254127 DOI: 10.1016/j.mtbio.2022.100336] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/16/2022] [Accepted: 06/18/2022] [Indexed: 11/23/2022]
Abstract
As the population ages, spinal degeneration seriously affects quality of life in middle-aged and elderly patients, and prevention and treatment remain challenging for clinical surgeons. In recent years, biomaterials-based injectable therapeutics have attracted much attention for spinal degeneration treatment due to their minimally invasive features and ability to perform precise repair of irregular defects. However, the precise design and functional control of bioactive injectable biomaterials for efficient spinal degeneration treatment remains a challenge. Although many injectable biomaterials have been reported for the treatment of spinal degeneration, there are few reviews on the advances and effects of injectable biomaterials for spinal degeneration treatment. This work reviews the current status of the design and fabrication of injectable biomaterials, including hydrogels, bone cements and scaffolds, microspheres and nanomaterials, and the current progress in applications for treating spinal degeneration. Additionally, registered clinical trials were also summarized and key challenges and clinical translational prospects for injectable materials for the treatment of spinal degenerative diseases are discussed.
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Percutaneous Lumbar Interbody Fusion and Cortoss Cement Bone Augmentation In Osteoporotic Patients With Anterolisthesis: A Technical Note. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Lambrechts MJ, Brush P, Issa TZ, Toci GR, Heard JC, Syal A, Schilken MM, Canseco JA, Kepler CK, Vaccaro AR. Evaluating the Impact of Modic Changes on Operative Treatment in the Cervical and Lumbar Spine: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191610158. [PMID: 36011795 PMCID: PMC9408205 DOI: 10.3390/ijerph191610158] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 05/11/2023]
Abstract
Modic changes (MCs) are believed to be potential pain generators in the lumbar and cervical spine, but it is currently unclear if their presence affects postsurgical outcomes. We performed a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All studies evaluating cervical or lumbar spine postsurgical outcomes in patients with documented preoperative MCs were included. A total of 29 studies and 6013 patients with 2688 of those patients having preoperative MCs were included. Eight included studies evaluated cervical spine surgery, eleven evaluated lumbar discectomies, nine studied lumbar fusion surgery, and three assessed lumbar disc replacements. The presence of cervical MCs did not impact the clinical outcomes in the cervical spine procedures. Moreover, most studies found that MCs did not significantly impact the clinical outcomes following lumbar fusion, lumbar discectomy, or lumbar disc replacement. A meta-analysis of the relevant data found no significant association between MCs and VAS back pain or ODI following lumbar discectomy. Similarly, there was no association between MCs and JOA or neck pain following ACDF procedures. Patients with MC experienced statistically significant improvements following lumbar or cervical spine surgery. The postoperative improvements were similar to patients without MCs in the cervical and lumbar spine.
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Conger A, Smuck M, Truumees E, Lotz JC, DePalma MJ, McCormick ZL. Vertebrogenic Pain: A Paradigm Shift in Diagnosis and Treatment of Axial Low Back Pain. PAIN MEDICINE (MALDEN, MASS.) 2022; 23:S63-S71. [PMID: 35856329 PMCID: PMC9297155 DOI: 10.1093/pm/pnac081] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/22/2022] [Accepted: 05/01/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Aaron Conger
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA
| | - Matthew Smuck
- Department of Orthopaedics, Stanford University, Redwood City, CA, USA
| | - Eeric Truumees
- The University of Texas Dell Medical School, Ascension Texas Spine and Scoliosis, Austin, TX, USA
| | - Jeffrey C Lotz
- Department of Orthopaedics, University of California San Francisco, San Francisco, CA, USA
| | | | - Zachary L McCormick
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA
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Cai K, Zhang Z, Luo K, Cao F, Lu B, Wu Y, Wang H, Zhang K, Jiang G. Biomechanical comparison of vertebral augmentation and cement discoplasty for the treatment of symptomatic Schmorl's node: a finite element analysis. Comput Methods Biomech Biomed Engin 2022; 25:1744-1756. [PMID: 35230207 DOI: 10.1080/10255842.2022.2036979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Percutaneous vertebral augmentation (PVA) and percutaneous cement discoplasty (PCD) are two relatively new minimally invasive surgeries for symptomatic Schmorl's reported in recent decade. However, the clinical evidence for the effectiveness of these two surgeries is insufficient. The purpose of this study was to compare the biomechanical benefits and risks of the two surgeries in order to analyze their biomechanical differences and effectiveness. We reconstructed Five lumbar finite element models via computed tomography data, including control model, PVA-ideal model, PVA-nonideal model, PCD-ideal model, and PCD-nonideal model. The stress and strain of Schmorl's nodes, bone marrow edema zone (BMEZ), affected endplate, and the overall stability of segment were analyzed and compared. The validity of our models was confirmed. As a result, the PVA-ideal model can significantly reduce the stress of Schmorl's node and the strain of BMEZ, while this effect is inappreciable in PVA-nonideal model. The PCD-ideal model significantly reduced the strain of Schmorl's nodes and BMEZ, and significantly improve segmental stability, but also resulted in a significant increase in the stress of Schmorl's nodes, BMEZ and endplates. The PCD-nonideal model not only lacks blocking effect, but also sharply increases the strain of Schmorl's nodes and BMEZ. Thus, We recommend that both PVA and PCD surgeries in ideal distribution facilitated a more stable paranodular biomechanical microenvironment. However, due to the possibility of poor biomechanical outcomes caused by the non-ideal cement distribution, the non-ideal distribution of bone cement needs to be remedied in practice.
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Affiliation(s)
- Kaiwen Cai
- Department of Orthopaedic, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, PR China.,Institute of Orthopaedics, Ningbo University, Ningbo, PR China
| | - Zhang Zhang
- Department of Rheumatology, Ningbo Yinzhou No. 2 Hospital, Ningbo, PR China
| | - Kefeng Luo
- Department of Orthopaedic, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, PR China.,Institute of Orthopaedics, Ningbo University, Ningbo, PR China
| | - Feng Cao
- Department of Orthopaedic, No. 906 Hospital of Chinese People's Liberation Army Joint Logistic Support Force, Ningbo, PR China
| | - Bin Lu
- Department of Orthopaedic, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, PR China.,Institute of Orthopaedics, Ningbo University, Ningbo, PR China
| | - Yuanhua Wu
- Department of Radiology, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, PR China
| | - Hongxia Wang
- Operating room, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, PR China
| | - Kai Zhang
- Department of Orthopaedic, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, PR China.,Institute of Orthopaedics, Ningbo University, Ningbo, PR China
| | - Guoqiang Jiang
- Department of Orthopaedic, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, PR China.,Institute of Orthopaedics, Ningbo University, Ningbo, PR China
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Applebaum A, Nessim A, Cho W. Modic Change: An Emerging Complication in the Aging Population. Clin Spine Surg 2022; 35:12-17. [PMID: 33769981 DOI: 10.1097/bsd.0000000000001168] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 02/24/2021] [Indexed: 01/04/2023]
Abstract
STUDY DESIGN This was a literature review. OBJECTIVE The objective of this study was to review the pathogenesis, prevalence, clinical associations, diagnostic modalities, and treatment options for patients with lower back pain (LBP) associated with Modic change (MC). SUMMARY OF BACKGROUND DATA Vertebral body endplates are located between the intervertebral disk and adjacent vertebral body. Despite their crucial roles in nutrition and biomechanical stability, vertebral endplates are extremely susceptible to mechanical failure. Studies examining the events leading to disk degeneration have shown that failure often begins at the endplates. Endplate degeneration with subchondral bone marrow changes were originally noticed on magnetic resonance imaging. These magnetic resonance imaging signal changes were classified as MC. METHODS A literature review was conducted on the history, etiology, risk factors, diagnostic modalities, and treatment of LBP with MC. RESULTS Type 1 MC refers to the presence of increased vascularization and bone marrow edema within the vertebral body. Type 2 MC involves fatty marrow replacement within the vertebral body. Type 3 MC reflects subchondral bone sclerosis. Despite the original classification, research has supported the notion that MCs possess a transitional nature. Furthermore, type 1 MCs have been strongly associated with inflammation and severe LBP, while types 2 and 3 tend to be more stable and demonstrate less refractory pain. With a strong association to LBP, understanding the etiology of MC is crucial to optimal treatment planning. Various etiologic theories have been proposed including autoimmunity, mechanics, infection, and genetic factors. CONCLUSIONS With the aging nature of the population, MC has emerged as an extremely prevalent issue. Research into the pathogenesis of MC is important for planning preventative and therapeutic strategies. Such strategies may include rehabilitation, surgical fixation, stabilization, steroid or cement injection, or antibiotics. Improved diagnostic methods in clinical practice are thus critical to properly identify patients suffering from MC, plan early intervention, and hasten return to functioning.
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Affiliation(s)
- Ariella Applebaum
- Department of Orthopedic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
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Chiocchi M, Pugliese L, D'Errico F, Di Tosto F, Cerimele C, Pasqualetto M, De Stasio V, Presicce M, Spiritigliozzi L, Di Donna C, Benelli L, Sbordone FP, Grimaldi F, Cammalleri V, De Vico P, Muscoli S, Romeo A, Vanni G, Romeo F, Floris R, Garaci FG, Di Luozzo M. Transcatheter aortic valve implantation in patients with unruptured aortic root pseudoaneurysm: an observational study. J Cardiovasc Med (Hagerstown) 2021; 23:185-190. [PMID: 34506346 DOI: 10.2459/jcm.0000000000001253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Unruptured aortic root pseudoaneurysm (UARP) is a rare complication of aortic valve endocarditis. Infectious spread to the valvular annulus or myocardium can cause septic complications that manifest as wall thickening, and spontaneous abscess drainage leads to pseudoaneurysm formation. We report the first patient series in which transcatheter aortic valve implantation (TAVI) using a single valve-resolved aortic valvulopathy associated with UARP was performed. METHODS At our center, from December 2017 to October 2019, 138 patients underwent TAVI for aortic valve stenosis and/or regurgitation, 20 of whom (12 female patients, 8 male patients) had associated incidental UARP and were considered as our study population. The average age of these patients was 76.9 ± 5.2 years. All patients were assessed using preprocedural and postprocedural multimodality imaging, including transthoracic echocardiography, transesophageal echocardiography, and cardiac computed tomography angiography (CCTA). RESULTS In all cases, the final angiographic examination showed correct valve positioning with complete coverage of the false aneurysm. Post-TAVI CCTA showed presence of total or subtotal UARP thrombosis. The mean follow-up period was 17.5 months (12-23 months). During follow-up, imaging showed normal prosthetic valve function, no significant leakage (trace or mild), and complete UARP exclusion in all patients, without any complications. CONCLUSION In conclusion, percutaneous valve positioning can simultaneously solve pseudoaneurysm complications by excluding the sac and promoting thrombosis.
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Affiliation(s)
- Marcello Chiocchi
- Radiology Division, Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy Cardiology Division, University Department of Medical Sciences Department of Emergency and Acceptance, Unit of Anesthesia, Policlinico Tor Vergata Unit of Cardiology, Ospedale Santo Spirito in Sassia, ASL RM Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
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11
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De Stasio V, Cavallo AU, Spiritigliozzi L, Pugliese L, Presicce M, Di Donna C, Di Tosto F, Pasqualetto M, D'Errico F, Benelli L, Sbordone FP, Grimaldi F, Cerimele C, Vanni G, Romeo F, Floris R, Garaci F, Chiocchi M. Relationship between septo-valvular angle and risk of pacemaker implantation after transcatheter aortic valve implantation: a preliminary study. J Cardiovasc Med (Hagerstown) 2021; 22:716-722. [PMID: 34074895 DOI: 10.2459/jcm.0000000000001181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIM Pre-transcatheter aortic valve implantation (TAVI) computed tomography (CT) has proven to be crucial in identifying pre- and post-procedural predicting factors predisposing the onset of major arrhythmias that require permanent pacemaker (PPM) implantation caused by the compressive effects of the prostheses on the conduction system at the membranous septum (MS) and the muscular crest of the interventricular septum.Our analysis aims to verify if the pre-TAVI assessment of the angle between the MS and the aortic annulus (SVA) might be a predictive factor for the onset of arrhythmias that requires PPM. METHODS Two cardiovascular specialist radiologists retrospectively and double-blind evaluated a randomized list of preprocedural CT of 57 patients who underwent TAVI with a self-expandable valve from April 2019 to February 2020. Two anatomical features were measured by readers: width of the SVA and MS length (MSL). RESULTS A PPM was implanted in 18 patients (31%) after the procedure. There was no significant difference in the anatomical measurements performed between the two observers, regarding both anatomical measurements (intraclass correlation coefficient was 0.944 for the SVA and 0.774 for the MSL]. Receiver-operating characteristic curves (ROC) performed for both measurements have documented: for the SVA sensitivity 94% and Negative predictive value (NPV) 96% (area under the curve: 0.77; 95% confidence interval 0.66-0.90). The MSL ROC was not significant. The mean SVA value stratified for patients who did not undergo PPM implantation and patients who did resulted as significant (P < 0.005). CONCLUSION Measurement of the SVA performed in preprocedural CT scans has proven to be related to the onset of major arrhythmias after TAVI requiring permanent pacemaker implantation with high sensitivity (94%) and NPV (96%).
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Affiliation(s)
- Vincenzo De Stasio
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Radiology Division
| | - Armando U Cavallo
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Radiology Division
| | - Luigi Spiritigliozzi
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Radiology Division
| | - Luca Pugliese
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Radiology Division
| | - Matteo Presicce
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Radiology Division
| | - Carlo Di Donna
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Radiology Division
| | - Federica Di Tosto
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Radiology Division
| | - Monia Pasqualetto
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Radiology Division
| | - Francesca D'Errico
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Radiology Division
| | - Leonardo Benelli
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Radiology Division
| | - Francesco P Sbordone
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Radiology Division
| | - Francesco Grimaldi
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Radiology Division
| | - Cecilia Cerimele
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Radiology Division
| | - Gianluca Vanni
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | | | - Roberto Floris
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Radiology Division
| | - Francesco Garaci
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Radiology Division
| | - Marcello Chiocchi
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Radiology Division
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Baranes D, Kurtzman GM. Biphasic Calcium Sulfate as an Alternative Grafting Material in Various Dental Applications. J ORAL IMPLANTOL 2019; 45:247-255. [PMID: 31042446 DOI: 10.1563/aaid-joi-d-18-00306] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Various grafting materials have been used in oral and periodontal surgeries to augment and rebuild bone intraorally. Calcium sulfate, a synthetic material, also known as an alloplast, has been used for decades in orthopedics, plastic surgery, and oncologic and maxillofacial surgeries for the treatment of osseous deficiencies caused by trauma or inflammation. Biphasic calcium sulfate provides benefits as a short-term space maintainer. Use of biphasic calcium sulfate as the sole material are limited to relatively small osseous defects surrounded by at least 3 bony walls (eg, extraction sockets). Thus, for augmenting large and more complex bone deficiencies Bond Apatite, a composite graft formulation, is indicated. This work will review the various clinical applications of Bond Apatite as an alternative to other graft materials.
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Kavanagh L, Byrne C, Kavanagh E, Eustace S. Vertebroplasty in the treatment of recalcitrant lower back pain attributed to Modic 1 changes. BJR Case Rep 2018; 4:20170092. [PMID: 30363161 PMCID: PMC6159118 DOI: 10.1259/bjrcr.20170092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 01/09/2018] [Accepted: 01/11/2018] [Indexed: 11/18/2022] Open
Abstract
Vertebroplasty is a recognised treatment for osteoporotic and pathological compression fractures. We present the case of TF, a 70-year-old male patient with a history of poor left ventricular function presenting with refractory lower back pain, thought to be secondary to Modic Type1 changes in the L2 and L3 vertebrae, accompanying L2–L3 degenerative disc disease. He was treated conservatively for approximately 9 months without success. Following recent suggestions that vertebroplasty may provide pain relief in patients with degenerative disc change and coexistent Modic 1 changes not responding to conservative treatment, we proceeded to vertebroplasty of the affected levels. This resulted in rapid resolution of pain and return to his pre low back pain level of activity. At 1-year follow-up the patient remains pain free. We review the causes of Modic 1 change, its relationship to low back pain and a rarely used but highly effective treatment option, percutaneous cement vertebroplasty, when it is unresponsive to traditional treatment options.
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Affiliation(s)
- Liam Kavanagh
- Department of Radiology, Cappagh National Orthopaedic Hospital of Ireland, Finglas, Dublin, Ireland
| | - Caoimhe Byrne
- Department of Radiology, Cappagh National Orthopaedic Hospital of Ireland, Finglas, Dublin, Ireland
| | - Eoin Kavanagh
- Department of Radiology, Cappagh National Orthopaedic Hospital of Ireland, Finglas, Dublin, Ireland
| | - Stephen Eustace
- Department of Radiology, Cappagh National Orthopaedic Hospital of Ireland, Finglas, Dublin, Ireland
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Tomasian A, Wallace AN, Jennings JW. Benign Spine Lesions: Advances in Techniques for Minimally Invasive Percutaneous Treatment. AJNR Am J Neuroradiol 2017; 38:852-861. [PMID: 28183835 DOI: 10.3174/ajnr.a5084] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Minimally invasive percutaneous imaging-guided techniques have been shown to be safe and effective for the treatment of benign tumors of the spine. Techniques available include a variety of tumor ablation technologies, including radiofrequency ablation, cryoablation, microwave ablation, alcohol ablation, and laser photocoagulation. Vertebral augmentation may be performed after ablation as part of the same procedure for fracture stabilization or prevention. Typically, the treatment goal in benign spine lesions is definitive cure. Painful benign spine lesions commonly encountered in daily practice include osteoid osteoma, osteoblastoma, vertebral hemangioma, aneurysmal bone cyst, Paget disease, and subacute/chronic Schmorl node. This review discusses the most recent advancement and use of minimally invasive percutaneous therapeutic options for the management of benign spine lesions.
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Affiliation(s)
- A Tomasian
- From the Department of Radiology (A.T.), University of Southern California, Los Angeles, California
| | - A N Wallace
- Mallinckrodt Institute of Radiology (A.N.W., J.W.J.), St Louis, Missouri
| | - J W Jennings
- Mallinckrodt Institute of Radiology (A.N.W., J.W.J.), St Louis, Missouri
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Marcia S, Saba L, Marras M, Suri JS, Calabria E, Masala S. Percutaneous stabilization of lumbar spine: a literature review and new options in treating spine pain. Br J Radiol 2016; 89:20150436. [PMID: 27351691 DOI: 10.1259/bjr.20150436] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Vertebral fracture (VF) is a common condition with >160,000 patients affected every year in North America and most of them with affected lumbar vertebrae. The management of VF is well known and defined by many protocols related to associated clinical neurological symptoms, especially in case of the presence or absence of myelopathy or radicular deficit. In this article, we will explore the percutaneous stabilization of the lumbar spine by showing the newest approaches for this condition.
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Affiliation(s)
- Stefano Marcia
- 1 Department of Radiology, SS Trinità Hospital, Cagliari, Italy
| | - Luca Saba
- 2 Department of Radiology, Azienda Ospedaliero, Universitaria (AOU) di Cagliari-Polo di Monserrato, Cagliari, Italy
| | | | - Jasjit S Suri
- 4 Diagnostic and Monitoring Division, AtheroPoint™ LLC, Roseville, CA, USA.,5 Department of Biomedical Engineering, University of Idaho (Affiliated), ID, USA
| | - Eros Calabria
- 6 Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiation Therapy, University of Rome Tor Vergata, Rome, Italy
| | - Salvatore Masala
- 6 Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiation Therapy, University of Rome Tor Vergata, Rome, Italy
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Huang ZY, Xu HC, Lei T, Li QL, Wu AM, Ni WF. The location of Modic changes in the lumbar spine: a meta-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 2016; 25:3746-3759. [DOI: 10.1007/s00586-016-4456-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 02/06/2016] [Accepted: 02/07/2016] [Indexed: 12/29/2022]
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[Does treatment of patients with chronic back pain and proven Modic type 1 alterations using vertebroplasty make sense?]. Radiologe 2016; 55:281-4. [PMID: 25773114 DOI: 10.1007/s00117-015-2844-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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