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Chen K, Wang T, Tong X, Song Y, Hong J, Sun Y, Zhuang Y, Shen H, Yao XI. Osteoporosis is associated with depression among older adults: a nationwide population-based study in the USA from 2005 to 2020. Public Health 2024; 226:27-31. [PMID: 37988825 DOI: 10.1016/j.puhe.2023.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/27/2023] [Accepted: 10/11/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVES The global prevalence of osteoporosis is rising, yet it is unclear whether people with osteoporosis have a higher risk of depression than those without osteoporosis. STUDY DESIGN A cross-sectional study. METHODS We used nationally representative data from the US National Health and Nutrition Examination Survey (NHANES) in 2005-2006, 2007-2008, 2009-2010, 2013-2014, and 2017-2020. The diagnosis of osteoporosis was based on the bone mineral density of the femoral neck measured by dual-energy X-ray absorptiometry. Depression was assessed by the Patient Health Questionnaire-9 (PHQ-9), with a score ≥5 as depressive symptoms and a score ≥10 as probable depression. We used logistic regression models to evaluate the association between osteoporosis and depressive symptoms and probable depression. RESULTS We included 11,603 adults (aged 50 years and older, 52.3% male) and observed 5.2% of them had osteoporosis. 31.9% of these osteoporotic people had depressive symptoms, and 10.0% had probable depression. Compared to participants without osteoporosis, those with osteoporosis were 1.73 times more likely to experience depressive symptoms (odds ratio [OR] = 1.73, 95% confidence interval [CI] 1.20-2.50) and 1.91 times more likely to experience probable depression (OR = 1.91, 95% CI 1.02-3.59), after adjusting for sex, age, race/ethnicity, education, marital status, family income, body mass index, smoking, physical activity, and alcohol abuse. Moderate-to-vigorous activities mediated the associations between osteoporosis and depression and depressive symptoms. CONCLUSIONS Osteoporosis is an independent risk factor for depression. This study highlights the need to evaluate the mental well-being of patients with osteoporosis in clinical and primary health care.
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Affiliation(s)
- K Chen
- Department of Orthopaedics, The Eighth Affiliated Hospital, Sun Yat-sen University, 3025 Shennan Road, Shenzhen 518000, PR China.
| | - T Wang
- Department of Orthopaedics, The Eighth Affiliated Hospital, Sun Yat-sen University, 3025 Shennan Road, Shenzhen 518000, PR China.
| | - X Tong
- Department of Orthopaedics, The Eighth Affiliated Hospital, Sun Yat-sen University, 3025 Shennan Road, Shenzhen 518000, PR China.
| | - Y Song
- Department of Orthopaedics, The Eighth Affiliated Hospital, Sun Yat-sen University, 3025 Shennan Road, Shenzhen 518000, PR China.
| | - J Hong
- Department of Orthopaedics, The Eighth Affiliated Hospital, Sun Yat-sen University, 3025 Shennan Road, Shenzhen 518000, PR China.
| | - Y Sun
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN 38163, USA.
| | - Y Zhuang
- Department of Orthopaedics, The Eighth Affiliated Hospital, Sun Yat-sen University, 3025 Shennan Road, Shenzhen 518000, PR China.
| | - H Shen
- Department of Orthopaedics, The Eighth Affiliated Hospital, Sun Yat-sen University, 3025 Shennan Road, Shenzhen 518000, PR China; Department of Clinical Research, The Eighth Affiliated Hospital, Sun Yat-sen University, 3025 Shennan Road, Shenzhen 518000, PR China.
| | - X I Yao
- Department of Orthopaedics, The Eighth Affiliated Hospital, Sun Yat-sen University, 3025 Shennan Road, Shenzhen 518000, PR China; Department of Clinical Research, The Eighth Affiliated Hospital, Sun Yat-sen University, 3025 Shennan Road, Shenzhen 518000, PR China.
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Takahashi S, Terai H, Hoshino M, Tsujio T, Kato M, Toyoda H, Suzuki A, Tamai K, Yabu A, Nakamura H. Machine-learning-based approach for nonunion prediction following osteoporotic vertebral fractures. 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; 32:3788-3796. [PMID: 36269421 DOI: 10.1007/s00586-022-07431-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 10/02/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE An osteoporotic vertebral fracture (OVF) is a common disease that causes disabilities in elderly patients. In particular, patients with nonunion following an OVF often experience severe back pain and require surgical intervention. However, nonunion diagnosis generally takes more than six months. Although several studies have advocated the use of magnetic resonance imaging (MRI) observations as predictive factors, they exhibit insufficient accuracy. The purpose of this study was to create a predictive model for OVF nonunion using machine learning (ML). METHODS We used datasets from two prospective cohort studies for OVF nonunion prediction based on conservative treatment. Among 573 patients with acute OVFs exceeding 65 years in age enrolled in this study, 505 were analyzed. The demographic data, fracture type, and MRI observations of both studies were analyzed using ML. The ML architecture utilized in this study included a logistic regression model, decision tree, extreme gradient boosting (XGBoost), and random forest (RF). The datasets were processed using Python. RESULTS The two ML algorithms, XGBoost and RF, exhibited higher area under the receiver operating characteristic curves (AUCs) than the logistic regression and decision tree models (AUC = 0.860 and 0.845 for RF and XGBoost, respectively). The present study found that MRI findings, anterior height ratio, kyphotic angle, BMI, VAS, age, posterior wall injury, fracture level, and smoking habit ranked as important features in the ML algorithms. CONCLUSION ML-based algorithms might be more effective than conventional methods for nonunion prediction following OVFs.
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Affiliation(s)
- Shinji Takahashi
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan.
| | - Hidetomi Terai
- Department of Orthopaedic Surgery, Osaka City General Hospital, 2-15-16, Miyakojima Hon-Dori, Miyakojima-Ku, Osaka, Japan
| | - Masatoshi Hoshino
- Department of Orthopaedic Surgery, Osaka City General Hospital, 2-15-16, Miyakojima Hon-Dori, Miyakojima-Ku, Osaka, Japan
| | - Tadao Tsujio
- Department of Orthopaedic Surgery, Shiraniwa Hospital, 6-10-1. Shiraniwadai, Ikoma City, Nara, Japan
| | - Minori Kato
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan
| | - Hiromitsu Toyoda
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan
| | - Akinobu Suzuki
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan
| | - Koji Tamai
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan
| | - Akito Yabu
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan
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Lee S, Zheng H, Park SM, Kim HJ, Yeom JS. A Randomized Controlled Trial of Vertebral Body Decompression Procedure Versus Conservative Treatment for Painful Vertebral Compression Fracture. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1848. [PMID: 37893566 PMCID: PMC10608657 DOI: 10.3390/medicina59101848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/12/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023]
Abstract
Background: Traditional treatment modalities for vertebral compression fractures (VCFs) include bed rest, pain medications, muscle relaxants, back braces, and physical therapy. In cases where conservative treatment proves ineffective, a new procedure called core decompression of the vertebral body is explored. Core decompression of the vertebral body has the potential to lower and stabilize the intraosseous pressure, resulting in enhanced blood circulation, which contributes to pain reduction. In this trial, we evaluated the efficacy of core decompression of the vertebral body in patients with painful VCFs compared with conventional conservative treatment. Methods: This prospective randomized controlled trial was conducted at a tertiary education hospital between June 2017 and May 2020. The participants were randomly assigned in a 1:1 ratio to one of two treatment groups: the core decompression group and the conservative treatment group. The primary outcome measure was the visual analog scale (VAS) pain score of the back 3 months after the procedure. Secondary outcome measures included the Oswestry Disability Index (ODI) for lumbar disabilities, the European Quality of Life-5 Dimensions (EQ-5D) score for quality of life, and radiographic outcomes such as changes in compression rate. Results: All patients underwent the assigned intervention (48 core decompression and 50 conservative treatments). At both 1 month and 3 months, there were no significant differences between the core decompression group and conservative treatment group in VAS pain score (adjusted treatment effect: -0.1 and 2.0; 95% confidence interval [CI]: -7.5 to 7.3 and -5.6 to 9.6; p = 0.970 and p = 0.601, respectively). In addition, there were no significant inter-group differences in ODI and EQ-5D scores throughout the follow-up period (p = 0.917 and 0.704, respectively). Conclusion: Core decompression of the vertebral body did not demonstrate any significant improvement in pain and disability compared to conventional conservative treatment.
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Affiliation(s)
| | | | - Sang-Min Park
- Spine Center and Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si 13620, Republic of Korea
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Li X, Chen W, Chen Q, Li F, Chen C, Li P, Li F, Guo S, Chen P, Yuan W, Liu D, Wang S, Hu Z. Effects of resistance and balance exercises for athletic ability and quality of life in people with osteoporotic vertebral fracture: Systematic review and meta-analysis of randomized control trials. Front Med (Lausanne) 2023; 10:1135063. [PMID: 36968833 PMCID: PMC10033532 DOI: 10.3389/fmed.2023.1135063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 02/21/2023] [Indexed: 03/11/2023] Open
Abstract
PurposeThis study aimed to use meta-analysis to determine the impact of resistance and balance training on athletic ability and quality of life for patients with osteoporotic vertebral fracture (OVF).MethodsThis study followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) criteria for systematic reviews and meta-analyzes. The PubMed, Web of science, Cochrane, Embase, and CNKI databases were searched for randomized controlled trials (RCTs) up to September 2022. The search strategy was related to the intervention measures, population, and results, and was structured around the search terms: “Exercise,” “Osteoporotic vertebral fracture,” and “activities of function.” Two reviewers strictly implemented the inclusion and exclusion criteria. Subgroup analyzes of age and training duration were performed for the main outcomes.ResultsWe included 12 RCTs (n = 1,289) of resistance and balance training in patients with OVF. Compared with controls, the intervention group showed improvements on the Quality of Life Questionnaire issued by the European Foundation for Osteoporosis, visual analog pain scale, Timed Up and Go, falls efficacy scale international (FES-I), kyphosis, and functional reach. On subgroup analysis, the effect was more significant when training continued >10 weeks.ConclusionResistance and balance exercise training improved function and balance, and reduced fall risk in patients with OVF. We recommend resistance and balance training for at least 10 weeks. Future multicenter, large sample trials are needed for more reliable conclusions.
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Affiliation(s)
- Xuefei Li
- Longhua Clinical Medical College of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wenhua Chen
- School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, China
| | - Qian Chen
- Longhua Clinical Medical College of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Fangfang Li
- Longhua Clinical Medical College of Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chen Chen
- Longhua Clinical Medical College of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Pan Li
- Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Fangyu Li
- Longhua Clinical Medical College of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Suxia Guo
- Longhua Clinical Medical College of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Pinghua Chen
- Shanghai Seventh People's Hospital, Shanghai, China
| | - Weina Yuan
- Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Dan Liu
- Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shiyun Wang
- Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhijun Hu
- Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Zhijun Hu,
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Lu W, Teng Z, Chen J, Shi R, Zou T, Gao M, Li W, Peng Z, Wang L, Zhao Y, Lu S. A Pain That is Easily Overlooked: Referred Pain Caused by OVCF. J Pain Res 2023; 16:961-971. [PMID: 36960463 PMCID: PMC10030002 DOI: 10.2147/jpr.s375966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 02/25/2023] [Indexed: 03/18/2023] Open
Abstract
Purpose The objective of this study was to analyze the clinical characteristics and the therapeutic effects of treatment at our spinal center in OVCF patients associated with referred pain. The underlying goals were to deepen the understanding of referred pain caused by OVCFs, improve the currently low early diagnosis rate of OVCFs, and improve the effectiveness of treatment. Methods The patients who had referred pain from OVCFs and met the inclusion criteria were retrospectively analyzed. All patients were treated with percutaneous kyphoplasty (PKP). Visual analog scale (VAS) scores and Oswestry Disability Index (ODI) were used to evaluate the therapeutic effect at different time points. Results There were 11 males (19.6%) and 45 females (80.4%). Their corresponding mean bone mineral density (BMD) value was -3.3 ± 0.4. The regression coefficient of BMD in the linear regression equation was -4.51 (P<0.001). According to the classification system for referred pain in OVCFs, there were 27 cases of type A (48.2%), 12 cases of type B (21.2%), 8 cases of type C (14.3%), 3 cases of type D (5.4%), and 6 cases of type E (10.7%). All patients were followed up for at least 6 months, and both VAS scores and ODI were found to be significantly better postoperatively than preoperatively (P<0.001). There was no significant difference in VAS scores and ODI between different types preoperatively or 6 months postoperatively (P > 0.05). Within each type, there were significant differences in VAS scores and ODI between the pre- and postoperative timepoints (P < 0.05). Conclusion Attention should be paid to referred pain in OVCF patients, which is not uncommon in clinical practice. Our summary of the characteristics of referred pain caused by OVCFs can improve the early diagnosis rate of OVCFs patients and provide a reference for their prognosis after PKP.
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Affiliation(s)
- Wei Lu
- Yunnan Key Laboratory of Digital Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China
- Department of Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China
- Department of Orthopedics, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, People’s Republic of China
| | - Zhaowei Teng
- Yunnan Key Laboratory of Digital Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China
- Department of Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China
| | - Jiayu Chen
- Yunnan Key Laboratory of Digital Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China
- Department of Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China
- Department of Orthopedics, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, People’s Republic of China
| | - Rongmao Shi
- Department of Orthopedics, Clinical College of the 920th Hospital of Joint Logistics Support Force of Kunming Medical University, Kunming, People’s Republic of China
| | - Tiannan Zou
- Yunnan Key Laboratory of Digital Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China
- Department of Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China
- Department of Orthopedics, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, People’s Republic of China
| | - Ming Gao
- Yunnan Key Laboratory of Digital Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China
- Department of Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China
- Department of Orthopedics, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, People’s Republic of China
| | - Weichao Li
- Yunnan Key Laboratory of Digital Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China
- Department of Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China
- Department of Orthopedics, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, People’s Republic of China
| | - Zhi Peng
- Yunnan Key Laboratory of Digital Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China
- Department of Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China
- Department of Orthopedics, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, People’s Republic of China
| | - Long Wang
- Yunnan Key Laboratory of Digital Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China
- Department of Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China
- Department of Orthopedics, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, People’s Republic of China
| | - Yonghui Zhao
- Yunnan Key Laboratory of Digital Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China
- Department of Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China
- Department of Orthopedics, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, People’s Republic of China
| | - Sheng Lu
- Yunnan Key Laboratory of Digital Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China
- Department of Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China
- Department of Orthopedics, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, People’s Republic of China
- Correspondence: Sheng Lu, Department of Orthopedics, the First People’s Hospital of Yunnan Province, No. 157 Jinbi Road, Kunming, 650032, People’s Republic of China, Tel +86-0871-63633071, Fax +86-0871-63633071, Email
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Matsumoto K, Shah A, Kelkar A, Mumtaz M, Kumaran Y, Goel VK. Sagittal Imbalance May Lead to Higher Risks of Vertebral Compression Fractures and Disc Degeneration-A Finite Element Analysis. World Neurosurg 2022; 167:e962-e971. [PMID: 36064117 DOI: 10.1016/j.wneu.2022.08.119] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Sagittal balance is an important clinical parameter of the spine for its normal function. Maintenance of the sagittal balance is crucial in the clinical management of spinal problems. METHODS Three different finite element models with spinal alignments based on Schwab's classification were developed: (1) Balanced/Normal model (sagittal vertical axis [SVA] = 0 mm, lumbar lordosis [LL] = 50°, thoracic kyphosis [TK] = 25°, pelvic incidence [PI] = 45°, pelvic tilt [PT] = 10°, sacral slope [SS] = 35°); (2) Balanced with compensatory mechanisms/Flatback model (SVA = 50 mm, LL = 20°, TK = 20°, PI = 45°, PT = 30°, SS = 15°); and (3) Imbalanced/Hyperkyphotic model (SVA = 150 mm, LL = -5°, TK = 25°, PI = 45°, PT = 40°, SS = 5°). All 3 models were subjected to the follower loads simulating bodyweight/muscular contractions along with the moments to simulate flexion, extension, lateral bending, and axial rotation. The maximum cortical vertebral stress, annular stress, and intradiscal pressure (IDP) were calculated and compared. RESULTS The results showed that the hyperkyphotic model had higher stresses in the vertebrae (25% higher), the annulus fibrosus (48% higher) and the IDP (8% higher) than the normal models in flexion. The segments near the thoracolumbar junction (T10-L1) showed the highest increase in the vertebral body stress, the annulus fibrosus stress, and the IDP. CONCLUSIONS This study showed that the imbalance in sagittal alignment might be responsible for disc degeneration and atraumatic vertebral fractures at the thoracolumbar regions, supporting clinical findings.
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Affiliation(s)
- Koji Matsumoto
- Engineering Center for Orthopedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, Ohio, USA; Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Anoli Shah
- Engineering Center for Orthopedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, Ohio, USA
| | - Amey Kelkar
- Engineering Center for Orthopedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, Ohio, USA
| | - Muzammil Mumtaz
- Engineering Center for Orthopedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, Ohio, USA
| | - Yogesh Kumaran
- Engineering Center for Orthopedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, Ohio, USA
| | - Vijay K Goel
- Engineering Center for Orthopedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, Ohio, USA.
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Okuwaki S, Funayama T, Ikumi A, Shibao Y, Miura K, Noguchi H, Takahashi H, Koda M, Tatsumura M, Kawamura H, Yamazaki M. Risk factors affecting vertebral collapse and kyphotic progression in postmenopausal osteoporotic vertebral fractures. J Bone Miner Metab 2022; 40:301-307. [PMID: 34773152 DOI: 10.1007/s00774-021-01283-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/18/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION We aimed to investigate the risk factors that affect vertebral deformity 6 months after osteoporotic vertebral fractures (OVFs) at the time of injury. MATERIALS AND METHODS From May 2017 to May 2020, 70 postmenopausal women with OVFs were evaluated for age; body mass index; number of previous OVFs; total 25-hydroxy vitamin D [25(OH)D] levels; posterior wall injury on computed tomography; cross-sectional area (CSA) of the psoas major, erector spinae, and multifidus; fat infiltration; vertebral instability (VI) upon admission; collapse rate (CR); and kyphotic angle (KA) at 6 months after injury. A multiple regression analysis was conducted to identify the risk factors for the CR and KA. RESULTS The CR was correlated with posterior wall injury (r = 0.295, p = 0.022), 25(OH)D levels (r = - 0.367, p = 0.002), and VI (r = 0.307, p = 0.010). In the multiple regression analysis, the 25(OH)D levels (p = 0.032) and VI (p = 0.035) were significant risk factors for the CR at the 6-month follow-up. The KA was correlated with the 25(OH)D levels (r = - 0.262, p = 0.031) and VI (r = 0.298, p = 0.012). In the multiple regression analysis, the CSA of the psoas major (p = 0.011) and VI (p < 0.001) were significant risk factors for the KA at the 6-month follow-up. CONCLUSION In cases with large VI at the time of injury, the CR and KA were significantly higher at 6 months after injury. Moreover, the CR was affected by the 25(OH)D level, while the KA was affected by the CSA of the psoas major upon admission.
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Affiliation(s)
- Shun Okuwaki
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Toru Funayama
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Akira Ikumi
- Department of Orthopedic Surgery and Sports Medicine, University of Tsukuba Hospital Mito Clinical Education and Training Center Mito Kyodo General Hospital, Mito, Ibaraki, Japan
| | - Yosuke Shibao
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Kousei Miura
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hiroshi Noguchi
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hiroshi Takahashi
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Masao Koda
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Masaki Tatsumura
- Department of Orthopedic Surgery and Sports Medicine, University of Tsukuba Hospital Mito Clinical Education and Training Center Mito Kyodo General Hospital, Mito, Ibaraki, Japan
| | - Haruo Kawamura
- Department of Orthopedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital, Takahagi, Ibaraki, Japan
| | - Masashi Yamazaki
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
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Hamad AF, Yang S, Yan L, Leslie WD, Morin SN, Walld R, Roos LL, Lix LM. The association of objectively ascertained sibling fracture history with major osteoporotic fractures: a population-based cohort study. Osteoporos Int 2021; 32:681-688. [PMID: 32935168 DOI: 10.1007/s00198-020-05635-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/08/2020] [Indexed: 11/25/2022]
Abstract
UNLABELLED We investigated the association of objectively ascertained sibling fracture history with major osteoporotic fracture (hip, forearm, humerus, or clinical spine) risk in a population-based cohort using administrative databases. Sibling fracture history is associated with increased major osteoporotic fracture risk, which has implications for fracture risk prediction. INTRODUCTION We aimed to determine whether objectively ascertained sibling fracture history is associated with major osteoporotic fracture (MOF; hip, forearm, humerus, or clinical spine) risk. METHODS This retrospective cohort study used administrative databases from the province of Manitoba, Canada, which has a universal healthcare system. The cohort included men and women 40+ years between 1997 and 2015 with linkage to at least one sibling. The exposure was sibling MOF diagnosis occurring after age 40 years and prior to the outcome. The outcome was incident MOF identified in hospital and physician records using established case definitions. A multivariable Cox proportional hazards regression model was used to estimate the risk of MOF after adjustment for known fracture risk factors. RESULTS The cohort included 217,527 individuals; 91.9% were linked to full siblings (siblings having the same father and mother) and 49.0% were females. By the end of the study period, 6255 (2.9%) of the siblings had a MOF. During a median follow-up of 11 years (IQR 5-15), 5235 (2.4%) incident MOF were identified in the study cohort, including 234 hip fractures. Sibling MOF history was associated with an increased risk of MOF (hazard ratio [HR] 1.67, 95% confidence interval [CI] 1.44-1.92). The risk was elevated in both men (HR 1.57, 95% CI 1.24-1.98) and women (HR 1.74, 95% CI 1.45-2.08). The highest risk was associated with a sibling diagnosis of forearm fracture (HR 1.81, 95% CI 1.53-2.15). CONCLUSION Sibling fracture history is associated with increased MOF risk and should be considered as a candidate risk factor for improving fracture risk prediction.
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Affiliation(s)
- A F Hamad
- Department of Community Health Sciences, University of Manitoba, 753 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada.
| | - S Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - L Yan
- Department of Community Health Sciences, University of Manitoba, 753 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada
| | - W D Leslie
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - S N Morin
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - R Walld
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - L L Roos
- Department of Community Health Sciences, University of Manitoba, 753 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - L M Lix
- Department of Community Health Sciences, University of Manitoba, 753 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada
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9
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Szulc P. Impact of Bone Fracture on Muscle Strength and Physical Performance-Narrative Review. Curr Osteoporos Rep 2020; 18:633-645. [PMID: 33030682 DOI: 10.1007/s11914-020-00623-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Low muscle strength and poor physical performance are associated with high risk of fracture. Many studies assessed clinical and functional outcomes of fractures. Fewer studies analyzed the impact of fractures on muscle strength and physical performance. RECENT FINDINGS Vertebral fractures (especially multiple and severe ones) are associated with back pain, back-related disability, lower grip strength, lower strength of lower limbs, lower gait speed, and poor balance. Patients with hip fracture have slower gait and lower quadriceps strength. Non-vertebral fractures were associated with lower strength of the muscles adjacent to the fracture site (e.g., grip strength in the case of distal radius fracture, knee extensors in the case of patellar fracture) and poor physical function dependent on the muscles adjacent to the fracture site (e.g., limited range of motion of the shoulder in the case of humerus fracture, gait disturbances in the case of the ankle fracture). Individuals with a fracture experience a substantial deterioration of muscle strength and physical performance which exceeds that related to aging and is focused on the period close to the fracture occurrence. After fracture, muscle strength increased and physical performance improved. The rate of normalization depended partly on the therapeutic approach and on the rehabilitation program. A subgroup of patients, mainly the elderly, never returns to the pre-fracture level of physical performance. The permanent decline of physical function after fracture may be related to the limitation of movements due to pain, low physical activity, poor health before the fracture, and reduced efficacy of retraining after immobilization.
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Affiliation(s)
- Pawel Szulc
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France.
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10
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Elderly men have much lower vertebral fracture risk than elderly women even at advanced age: the MrOS and MsOS (Hong Kong) year 14 follow-up radiology results. Arch Osteoporos 2020; 15:176. [PMID: 33159570 DOI: 10.1007/s11657-020-00845-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/20/2020] [Indexed: 02/07/2023]
Abstract
UNLABELLED MrOS MsOS (Hong Kong) studies year 14 follow-up shows for subjects without baseline osteoporotic vertebral deformity, women's incident vertebral fracture (VF) rate was twice that of men. For subjects with vertebral deformity of baseline ≥ 20% height loss, counting subject, women's incident VF rate was three times higher than that of men. INTRODUCTION For MrOS MsOS (Hong Kong) baseline (BL) studies, 2000 men and 2000 women ≥ 65 years were recruited during 2001 to 2003. This study presents the year 14 follow-up (FU). MATERIALS Whole spine MRI was performed in 271 males (mean, 82.8 ± 3.6 years) and 150 females (mean, 82.0 ± 4.29 years). Osteoporotic vertebral deformity (OVD) classification included no OVD (grade 0), and OVDs with < 20%, 20~25%, > 25%~1/3, > 1/3~40%, > 40%~2/3, and > 2/3 height loss (grade 1~6). With an existing VD, a further height loss of ≥ 15% was a VD progression. A new incident VD was a change from grade 0 to ≥ grade 2 or to grade 1 with ≥ 10% height loss. OVD progression and new incident OVD were considered incident VF. RESULTS The proportion of osteoporotic subjects only slightly increased during FU for men but doubled for women. Groupwise, OVD was not associated with back pain in men; but OVD with > 1/3 height loss was associated with back pain in women. For subjects without BL OVD, 7.9% of men and 14.6% of women had incident VF. For subjects with BL OVD of ≥ 20% height loss, men's and women's incident VF were 17.6% and 52.6%, respectively, counting subject and 1.68% and 7.89%, respectively, counting vertebra. CONCLUSION Elderly men with or without existing osteoporotic VD have much lower future VF risk than elderly women.
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11
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Wáng YXJ, Lentle BC. Radiographic osteoporotic vertebral fractures in elderly men: a brief review focusing on differences between the sexes. Quant Imaging Med Surg 2020; 10:1863-1876. [PMID: 32879863 PMCID: PMC7417751 DOI: 10.21037/qims-2020-21] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 06/28/2020] [Indexed: 12/16/2022]
Abstract
Bone loss occurs in both sexes as a result of ageing but is exacerbated in women by the hormonal changes associated with menopause. Unlike in women, secondary osteoporosis occurs in almost half of men diagnosed with osteoporosis. Moreover, vertebral fractures (VFs) seen in elderly men may more likely be the result of high energy trauma. The osteoporotic vertebral fracture (OVF) radiograph diagnosis criteria for women may not be directly applicable for men. Particular attention should be paid to the mid-thoracic level where over-diagnosis commonly occurs. For wedge-shaped vertebral deformities (VDs) or VDs with anterior height reduction only, a diagnosis of OVF requires great caution, as they are poorly correlated to bone mineral density (BMD). For age-matched subjects, it is likely that elderly men's prevalent radiographic OVFs are approximately half of the elderly women's. This male-female ratio is very similar to other clinical fractures such as those occurring at the hip. Even so, the clinical relevance of OVF in elderly men may be less than that of elderly women. On the other hand, for elderly men with hip BMD-based osteoporosis, the OVF risk is as high as that of osteoporotic women. Elderly Chinese men have a lower OVF prevalence than age-matched Caucasian men.
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Affiliation(s)
- Yì Xiáng J. Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Brian C. Lentle
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
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12
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Martin JG, Goldman DT, Dabrowiecki AM, Newsome J, Bercu ZL, Gilliland C. Additional Magnetic Resonance or Nuclear Scintigraphy Imaging Influences Approach to Vertebral Augmentation: A Single Institution Experience. Spine (Phila Pa 1976) 2020; 45:E927-E932. [PMID: 32675605 DOI: 10.1097/brs.0000000000003420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review. OBJECTIVE To ascertain impact of preprocedural magnetic resonance imaging (MRI) or nuclear medicine Tc99m-DMP scintigraphy on the treatment plan when compared with plain films and/or computed tomography prior to vertebral augmentation procedures. SUMMARY OF BACKGROUND DATA Over 1 million vertebral compression fractures (VCFs) occur in the United States annually with over 150,000 individuals hospitalized each year. Physical examination and history are essential to the workup of VCFs, but imaging remains necessary for confirming the diagnosis. VCFs can be imaged with various modalities and there is limited data on the comparative effectiveness of different imaging modalities. METHODS Six hundred fifty consecutive patients treated with vertebral augmentation at a single institution between May of 2013 and April of 2018 were reviewed. Preprocedure imaging of the spine obtained within 30 days prior to the procedure were reviewed. Preprocedure imaging results were cross-referenced against the levels treated by vertebral augmentation to determine whether there was a change in the levels treated after receiving an MRI or NM imaging study. RESULTS Three hundred sixty-three patients had adequate imaging for inclusion. One hundred fifty-four of these 363 patients (42.4%) had an alteration of their treatment plan based upon the MR or NM imaging. Fewer vertebral levels were treated in 33, different levels were treated in 41, and more levels were treated in 80 patients. CONCLUSION MRI or nuclear medicine bone scan imaging prior to vertebral augmentation altered the location and number of levels treated in a large percentage of patients, adding specificity to treatment over findings on radiographs or computed tomography alone. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Jonathan G Martin
- Division of Interventional Radiology, Department of Radiology, Duke University, Durham, NC
| | - Daryl T Goldman
- Division of Interventional Radiology, Department of Radiology, Ichan School of Medicine at Mount Sinai, New York, NY
| | - Alexander M Dabrowiecki
- Division of Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
| | - Janice Newsome
- Division of Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
| | - Zachary L Bercu
- Division of Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
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13
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Chapurlat R, Bui M, Sornay-Rendu E, Zebaze R, Delmas PD, Liew D, Lespessailles E, Seeman E. Deterioration of Cortical and Trabecular Microstructure Identifies Women With Osteopenia or Normal Bone Mineral Density at Imminent and Long-Term Risk for Fragility Fracture: A Prospective Study. J Bone Miner Res 2020; 35:833-844. [PMID: 31821619 PMCID: PMC9328422 DOI: 10.1002/jbmr.3924] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 10/03/2019] [Accepted: 11/03/2019] [Indexed: 12/24/2022]
Abstract
More than 70% of women sustaining fractures have osteopenia or "normal" bone mineral density (BMD). These women remain undetected using the BMD threshold of -2.5 SD for osteoporosis. As microstructural deterioration increases bone fragility disproportionate to the bone loss producing osteopenia/normal BMD, we hypothesized that the structural fragility score (SFS) of ≥70 units, a measure capturing severe cortical and trabecular deterioration, will identify these women. Distal radial images were acquired using high-resolution peripheral quantitative tomography in postmenopausal French women, mean age 67 years (range 42-96 years); 1539 women were followed for 4 years (QUALYOR) and 561 women followed for 8 years (OFELY). Women with osteopenia or normal BMD accounted for ~80% of fractures. Women ≥70 years, 29.2% of the cohort, accounted for 39.2% to 61.5% of fractures depending on follow-up duration. Women having fractures had a higher SFS, lower BMD, and a higher fracture risk assessment score (FRAX) than women remaining fracture-free. In each BMD category (osteoporosis, osteopenia, normal BMD), fracture incidence was two to three times higher in women with SFS ≥70 than <70. In multivariable analyses, associations with fractures remained for BMD and SFS, not FRAX. BMD was no longer, or weakly, associated with fractures after accounting for SFS, whereas SFS remained associated with fracture after accounting for BMD. SFS detected two-to threefold more women having fractures than BMD or FRAX. SFS in women with osteopenia/normal BMD conferred an odds ratio for fracture of 2.69 to 5.19 for women of any age and 4.98 to 12.2 for women ≥70 years. Receiver-operator curve (ROC) analyses showed a significant area under the curve (AUC) for SFS, but not BMD or FRAX for the women ≥70 years of age. Targeting women aged ≥70 years with osteopenia indicated that treating 25% using SFS to allocate treatment conferred a cost-effectiveness ratio < USD $21,000/QALY saved. Quantifying microstructural deterioration complements BMD by identifying women without osteoporosis at imminent and longer-term fracture risk. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
| | - Minh Bui
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | - Roger Zebaze
- Department of Medicine and Endocrinology, Austin Health, University of Melbourne, Melbourne, Australia.,StraxCorp, Melbourne, Australia
| | | | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Ego Seeman
- Department of Medicine and Endocrinology, Austin Health, University of Melbourne, Melbourne, Australia.,StraxCorp, Melbourne, Australia.,Mary MacKillop Institute of Healthy Aging, Australian Catholic University, Melbourne, Australia
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14
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Kuo FC, Liao YY, Lee CH, Liau BY, Pan CC. Posture Stability and Kinematics While Performing a 180° Turning Step in Elderly Individuals With and Without Vertebral Compression Fracture and in Middle-Aged Adults. J Med Biol Eng 2020. [DOI: 10.1007/s40846-020-00508-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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16
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The role of the Fracture Liaison Service (FLS) in subsequent fracture prevention in the extreme elderly. Aging Clin Exp Res 2019; 31:1105-1111. [PMID: 30311093 DOI: 10.1007/s40520-018-1054-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 10/05/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Several guidelines recommend a bone and fall-related osteoporosis risk assessment in all patients with fracture and age > 50 years. In practice, however, there is no consensus whether screening > 85 years is useful. AIM To evaluate the subsequent fracture risk in all patient > 85 years, comparing the two populations of Fracture Liaison Service (FLS) attenders and non-attenders. METHODS All patients > 85 years that presented at the FLS with a non-vertebral fracture were included in the study during a 5-year period (September 2004 and December 2009). Excluded were pathologic fractures, death < 30 days, or patients on osteoporosis treatment. in patients that attended the FLS, assessment of bone mineral density and fall-risk factors were screened. In both the attenders and non-attenders groups, mortality and subsequent fracture rates were scored during a follow-up of 2 years. RESULTS 282 patients fulfilled inclusion criteria for screening, of which 160 (57%) patients did not attend the FLS. 122 patients were screened for osteoporosis and fall-related risk of whom 72 were diagnosed with osteoporosis. Subsequent fracture risk in both groups was 19%. Medical treatment was started in 51 patients, of which 15 patients developed a subsequent fracture. Cox-regression analysis indicated a significantly lower mortality rate, but not a diminished subsequent fracture rate in the FLS screened population compared to the non-attenders. CONCLUSION The advantage of a FLS in reducing subsequent fracture risk in patients > 85 years seems to be limited. In practice a large proportion of these patients are not screened.
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17
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The role of cement augmentation with percutaneous vertebroplasty and balloon kyphoplasty for the treatment of vertebral compression fractures in multiple myeloma: a consensus statement from the International Myeloma Working Group (IMWG). Blood Cancer J 2019; 9:27. [PMID: 30808868 PMCID: PMC6391474 DOI: 10.1038/s41408-019-0187-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 09/09/2018] [Accepted: 10/31/2018] [Indexed: 12/26/2022] Open
Abstract
Multiple myeloma (MM) represents approximately 15% of haematological malignancies and most of the patients present with bone involvement. Focal or diffuse spinal osteolysis may result in significant morbidity by causing painful progressive vertebral compression fractures (VCFs) and deformities. Advances in the systemic treatment of myeloma have achieved high response rates and prolonged the survival significantly. Early diagnosis and management of skeletal events contribute to improving the prognosis and quality of life of MM patients. The management of patients with significant pain due to VCFs in the acute phase is not standardised. While some patients are successfully treated conservatively, and pain relief is achieved within a few weeks, a large percentage has disabling pain and morbidity and hence they are considered for surgical intervention. Balloon kyphoplasty and percutaneous vertebroplasty are minimally invasive procedures which have been shown to relieve pain and restore function. Despite increasing positive evidence for the use of these procedures, the indications, timing, efficacy, safety and their role in the treatment algorithm of myeloma spinal disease are yet to be elucidated. This paper reports an update of the consensus statement from the International Myeloma Working Group on the role of cement augmentation in myeloma patients with VCFs.
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18
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Uzunoglu I, Kaya I, Sucu HK, Kizmazoglu C, Sevin IE, Aydin HE, Rezanko TA, Yuceer N. Evaluation of Incidentally Detected Pathology Results of Patients with Vertebral Fracture Treated by Vertebroplasty and Kyphoplasty: A Retrospective Study. World Neurosurg 2019; 122:e639-e646. [DOI: 10.1016/j.wneu.2018.10.116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 10/16/2018] [Accepted: 10/19/2018] [Indexed: 01/09/2023]
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19
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Ziebart C, Page AD, MacDermid JC. Application of ICF conceptual framework in Osteoporosis. Physiother Theory Pract 2019; 36:1077-1087. [PMID: 30628503 DOI: 10.1080/09593985.2018.1563932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Osteoporosis (OP) is a metabolic bone disease defined by low bone strength and deterioration of bone tissue, which has wide clinical presentations. The World Health Organization's International Classification of Functioning Disability and Health (ICF) provides a common language, classification system, and conceptual framework to describe the consequences of health conditions in terms of body function and structure, activities and participation, environmental and personal factors. Objectives: The ICF conceptual framework was used, in this paper, to integrate OP research-based knowledge into clinical application using clinical vignettes. Results: Body functions and structures, activities and participation, environmental factors and personal factors are described, and the inter-connection among these factors is explored. The vignettes highlight the importance of different components of the ICF framework and to demonstrate how the ICF framework can capture individual differences in how disability can be experienced in OP. Conclusion: The ICF conceptual framework provides a holistic representation of disability by facilitating a critical appraisal of the health status of people with OP. The framework creates an awareness of the broad and multidimensional nature of OP on the health of individual patients, integrates dimensions of functioning, and highlights the complexity of the evaluation and management of OP.
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Affiliation(s)
- Christina Ziebart
- Faculty of Health Science, Rehabilitation Sciences, Western University , London, Ontario, Canada
| | - Allyson D Page
- School of Communication Science and Disorders, Western University , London, Ontario, Canada
| | - Joy C MacDermid
- Physical Therapy and Surgery, Western University , London, Ontario, Canada.,Clinical Research Lab, Hand and Upper Limb Centre, St. Joseph's Health Centre , London, ON, Canada
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20
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Nygård M, Mosti MP, Brose L, Flemmen G, Stunes AK, Sørskår-Venæs A, Heggelund J, Wang E. Maximal strength training improves musculoskeletal health in amphetamine users in clinical treatment. Osteoporos Int 2018; 29:2289-2298. [PMID: 29978257 DOI: 10.1007/s00198-018-4623-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 06/26/2018] [Indexed: 12/01/2022]
Abstract
UNLABELLED Amphetamine use leads to impaired skeletal health and elevated risk of osteoporosis. In the current study, we document that maximal strength training (MST), as a part of clinical treatment, works as a countermeasure, improving muscle force generating capacity, body composition, and skeletal health at sites particularly prone to osteoporotic fractures. INTRODUCTION Amphetamine users have attenuated musculoskeletal health. MST with heavy loads, few repetitions, and emphasis on maximal mobilization in the concentric phase may increase muscle force generating capacity and skeletal health. This study investigated if MST-induced improvements in force generating capacity improved bone mineral density (BMD), trabecular bone score, and body composition in amphetamine users participating in 3-months clinical treatment. METHODS Of 40 randomized patients, 23 completed the study: 11 in the supervised training group (TG; 8 men, 3 women, 34 ± 10 years) and 12 in the control group (CG; 9 men, 3 women, 32 ± 8 years). The TG performed hack-squat MST three times a week for 12 weeks with an intensity of ~90% of one repetition maximum (1RM). Both groups attended conventional clinical treatment. Pre-training and post-training, we assessed hack-squat 1RM and rate of force development (RFD), BMD, body composition and trabecular bone score by dual X-ray absorptiometry, and serum bone metabolism markers. RESULTS MST induced increases in 1RM (70%) and RFD (86%), and resulted in BMD improvements at lumbar spine (3.6%) and total hip (2.4%); all improvements were different from CG (p < 0.05). Both the 1RM and RFD increases were associated with BMD improvements (lumbar spine: r = 0.73 (1RM), r = 0.60 (RFD); total hip: r = 0.61 (1RM); all p < 0.05). No differences were observed in trabecular bone score or bone metabolism markers. CONCLUSIONS MST improved force generating capacity and skeletal health at sites prone to bone loss in amphetamine users, and advocate that MST should be implemented as a clinical strategy to restore the patients' musculoskeletal health.
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Affiliation(s)
- M Nygård
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
- Department of Mental Health, St. Olav's University Hospital, Trondheim, Norway.
| | - M P Mosti
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- St. Olav's University Hospital, Trondheim, Norway
| | - L Brose
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - G Flemmen
- Department of Research and Development, Clinic of Substance Use and Addiction Medicine, St. Olav's University Hospital, Trondheim, Norway
| | - A K Stunes
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- St. Olav's University Hospital, Trondheim, Norway
| | - A Sørskår-Venæs
- Clinic of Substance Use and Addiction Medicine, St. Olav's University Hospital, Trondheim, Norway
| | - J Heggelund
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Mental Health, St. Olav's University Hospital, Trondheim, Norway
| | - E Wang
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Faculty of Health and Social Sciences, Molde University College, Molde, Norway
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
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21
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Kraxenberger M, Schröder C, Geith T, Büttner A, von Schulze-Pellengahr C, Birkenmaier C, Müller PE, Jansson V, Wegener B. Fracture generation in human vertebrae under compression loading: The influence of pedicle preservation and bone mineral density on in vitro fracture behavior. Technol Health Care 2018; 26:155-163. [PMID: 29154300 DOI: 10.3233/thc-171086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Fractured vertebral bodies are a common and wide spread health issue. OBJECTIVE The purpose of this study was to develop a standardized method to experimentally generate compression fractures in vertebral bodies. The influence of the pedicles has been investigated with regards to the fracture behavior. The correlation between bone mineral density (BMD), the cause of fractures and the fracture behavior was investigated. METHODS Twenty-one fresh frozen human lumbar spines were examined for bone mineral density (BMD) by means of quantitative computed tomography (qCT). All soft tissue was removed, vertebrae were carefully separated from each other and the exposed cranial and caudal endplates were covered with a thin layer of resin to generate a plane and homogeneous surface. A total of 80 vertebral bodies were tested until fracture. RESULTS A good positive correlation was found between BMD, fracture compression force and stiffness of the vertebral body. No significant differences were found between the fractures generated in vertebral bodies with and without pedicles, respectively. CONCLUSIONS Our model represents a consolidation of already existing testing devices. The comparative measurement of the BMD and the fracture behavior shows validity. In contrast to other authors, the force was applied to the whole vertebral body. Furthermore the upper and lower plates were not parallelized and therefore the natural anatomic shape was imitated. Fracture behavior was not altered by removing the pedicles.
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Affiliation(s)
- Michael Kraxenberger
- Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich - Campus Grosshadern, Munich, Germany
| | - Christian Schröder
- Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich - Campus Grosshadern, Munich, Germany
| | - Tobias Geith
- Institute for Clinical Radiology, University Hospital, LMU Munich - Campus Grosshadern, Munich, Germany
| | - Andreas Büttner
- Institute of Forensic Medicine, University Medical Center, Rostock, Germany
| | | | - Christof Birkenmaier
- Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich - Campus Grosshadern, Munich, Germany
| | - Peter E Müller
- Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich - Campus Grosshadern, Munich, Germany
| | - Volkmar Jansson
- Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich - Campus Grosshadern, Munich, Germany
| | - Bernd Wegener
- Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich - Campus Grosshadern, Munich, Germany
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22
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Oakley PA, Jaeger JO, Brown JE, Polatis TA, Clarke JG, Whittler CD, Harrison DE. The CBP ® mirror image ® approach to reducing thoracic hyperkyphosis: a retrospective case series of 10 patients. J Phys Ther Sci 2018; 30:1039-1045. [PMID: 30154597 PMCID: PMC6110211 DOI: 10.1589/jpts.30.1039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/07/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To present a case series demonstrating the reduction of thoracic hyperkyphosis
by the Chiropractic BioPhysics® multimodal rehabilitation program.
[Participants and Methods] Ten randomly selected files and corresponding radiographs were
chosen from recent clinic archives of patients who were treated for thoracic
hyperkyphosis. All patients were treated by CBP mirror image® thoracic
extension traction and exercises, as well as spinal manipulative therapy. [Results]
Results demonstrated an average reduction in hyperkyphosis of 11.3° over an average of 25
treatments, over an average of 9 weeks. Patients also experienced a reduction in pain
levels and disability ratings. [Conclusion] Postural hyperkyphosis is a serious
progressive deformity that is related to a plethora of symptoms, syndromes, and early
death. Thoracic hyperkyphosis may be reduced/corrected by posture-specific, thoracic
extension protocols including mirror image extension traction and exercises, as well as
spinal manipulation as part of the CBP multi-modal rehabilitation program.
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Affiliation(s)
- Paul A Oakley
- Private Practice: 11A-1100 Gorham Street, Newmarket, ON, L3Y 8Y8, Canada
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Greven SJ, Bornemann R, Roessler PP, Rommelspacher Y, Frey SP, Jansen TR, Sander K, Wirtz DC, Pflugmacher R. Influence of radiofrequency kyphoplasty on pulmonary function. Technol Health Care 2018; 25:761-769. [PMID: 28482645 DOI: 10.3233/thc-160488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Vertebral compression fractures (VCF) change the natural spinal alignment and inevitably lead to a decreased quality of life. OBJECTIVE The aim of the study was to evaluate changes in pulmonary function after VCF were treated by radiofrequency kyphoplasty (RF-TVA). METHODS Twenty-five patients were treated with RF-TVA and analyzed in 3 subgroups taking into account the spinal location of the VCF. Pain as measured by visual analogue scale (VAS), Oswestry-Disability-Index (ODI), vertebral height, forced expiratory volume in 1 second (FEV1), and peak expiratory flow (PEF) were assessed before, directly after and 30 days after RF-TVA. RESULTS The mean vertebral height was improved in all subgroups, with a minor reduction from one to 30 days postoperatively. The mean VAS and ODI significantly decreased in the main and upper diaphragm groups from baseline to the follow-up after 30 days. Patients treated below the main diaphragm region showed a significant improvement of ODI and a clear trend to significant improvements of VAS. PEF and FEV1 were significantly improved in the main diaphragm group. FEV1 also increased significantly in the upper diaphragm group with a clear trend to significance in the lower diaphragm group. CONCLUSIONS Results indicate that RF-TVA may improve pulmonary function especially in cases where fractures are located in the main spinal region of the diaphragm.
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Ohnishi T, Iwata A, Kanayama M, Oha F, Hashimoto T, Iwasaki N. Impact of spino-pelvic and global spinal alignment on the risk of osteoporotic vertebral collapse. Spine Surg Relat Res 2018; 2:72-76. [PMID: 31440650 PMCID: PMC6698540 DOI: 10.22603/ssrr.2017-0046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 07/24/2017] [Indexed: 11/05/2022] Open
Abstract
Introduction Numerous studies have reported the risk factors of osteoporotic vertebral collapse. However, whether spino-pelvic and global spinal alignments are associated with the occurrence of osteoporotic vertebral collapse remains unclear. This study aimed to investigate the association between spino-pelvic and global spinal alignments and the occurrence of osteoporotic vertebral collapse. Methods A total of 46 consecutive patients who underwent a nonoperative treatment for a single-level fresh osteoporotic thoracolumbar vertebral compression fracture (T10 to L3) were retrospectively reviewed. The parameters evaluated were the pelvic incidence, anterior deviation of the C7 plumb line, distance between the C7 plumb line and the center of the fractured vertebra, and kyphotic wedge angle of the fractured vertebra in a standing whole-spine radiograph at the beginning of the nonoperative treatment. As an outcome measure, the presence or absence of osteoporotic vertebral collapse was radiographically evaluated at the final follow-up. Multiple logistic regression analysis was used to determine significant risk factors of osteoporotic vertebral collapse. Results The mean values for each parameter were as follows: pelvic incidence, 58.0 degrees; anterior deviation of the C7 plumb line, 3.0 cm; distance between the C7 plumb line and the center of the fractured vertebra, 5.7 cm; and kyphotic wedge angle of the fractured vertebra, 14.6 degrees. Multiple logistic regression analysis revealed that the distance between the C7 plumb line and center of the fractured vertebra was a significant risk factor of osteoporotic vertebral collapse (p = 0.012; odds ratio, 1.025). The anterior deviation of the C7 plumb line (p = 0.214), pelvic incidence (p = 0.728), and kyphotic wedge angle of the fractured vertebra (p = 0.07) did not affect the occurrence of osteoporotic vertebral collapse. Conclusions A large distance between the C7 plumb line and center of the fractured vertebra was a significant risk factor of osteoporotic vertebral collapse. The distance approximately represents that of between gravity center of trunk cranial to the fractured vertebra and the fractured vertebra. Accordingly, the large distance may cause larger flexion moment to the fractured site, leading to stress concentration that results in insufficient bone healing.
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Affiliation(s)
- Takashi Ohnishi
- Spine Center, Hakodate Central General Hospital, Hokkaido, Japan.,Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Akira Iwata
- Spine Center, Hakodate Central General Hospital, Hokkaido, Japan.,Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | | | - Fumihiro Oha
- Spine Center, Hakodate Central General Hospital, Hokkaido, Japan
| | | | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
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25
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Wang H, Zhang Z, Liu Y, Jiang W. Percutaneous kyphoplasty for the treatment of very severe osteoporotic vertebral compression fractures with spinal canal compromise. J Orthop Surg Res 2018; 13:13. [PMID: 29343287 PMCID: PMC5773161 DOI: 10.1186/s13018-018-0719-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 01/09/2018] [Indexed: 11/24/2022] Open
Abstract
Background Very severe osteoporotic vertebral compression fractures (vsOVCFs) are osteoporotic vertebral compression fractures with vertebral body collapse to less than one third of their original height. Few data are available about the use of percutaneous kyphoplasty (PKP) in treating vsOVCFs with spinal canal compromise. The aim of this study was to evaluate the safety and efficacy of percutaneous kyphoplasty (PKP) for the treatment of vsOVCFs with spinal canal compromise. Methods Thirty-five patients who suffered vsOVCFs with spinal canal compromise but without neurological deficits were treated by PKP between January 2009 and October 2014. The vertebral height, local kyphotic angle (LKA), visual analogue scale (VAS) and Oswestry Disability Index (ODI) values were assessed before the operation, 1 day after the operation and at the final follow-up. Results Significant improvements on the VAS and ODI were noted 1 day post-operatively (p < 0.01), and these results were preserved at the final follow-up. The vertebral height was restored and the LKA was improved after surgery (p < 0.01). No neurological deterioration was found. Five of 35 vertebrae (14.3%) of cement leakages were all asymptomatic. Four new OVCFs in three patients were identified. Conclusion PKP is a safe and effective procedure for the treatment of vsOVCFs with spinal canal compromise, achieving significant vertebral height restoration and kyphotic angle reduction and leading to a significant pain relief and improvement in function.
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Affiliation(s)
- Heng Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, China
| | - Zongyu Zhang
- Department of Orthopaedic Surgery, Lianyungang Affiliated Hospital of Nanjing University of Chinese Medicine, 148 Chaoyang Road, Lianyungang, China
| | - Yijie Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, China
| | - Weimin Jiang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, China.
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Bettany-Saltikov J, Turnbull D, Ng SY, Webb R. Management of Spinal Deformities and Evidence of Treatment Effectiveness. Open Orthop J 2017; 11:1521-1547. [PMID: 29399227 PMCID: PMC5759105 DOI: 10.2174/1874325001711011521] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 09/02/2017] [Accepted: 09/11/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The review evaluates the up-to-date evidence for the treatment of spinal deformities, including scoliosis and hyperkyphosis in adolescents and adults. MATERIAL AND METHODS The PubMed database was searched for review articles, prospective controlled trials and randomized controlled trials related to the treatment of spinal deformities. Articles on syndromic scoliosis were excluded and so were the articles on hyperkyphosis of the spine with causes other than Scheuermann's disease and osteoporosis. Articles on conservative and surgical treatments of idiopathic scoliosis, adult scoliosis and hyperkyphosis were also included. For retrospective papers, only studies with a follow up period exceeding 10 years were included. RESULTS The review showed that early-onset idiopathic scoliosis has a worse outcome than late-onset idiopathic scoliosis, which is rather benign. Patients with AIS function well as adults; they have no more health problems when compared to patients without scoliosis, other than a slight increase in back pain and aesthetic concern. Conservative treatment of adolescent idiopathic scoliosis (AIS) using physiotherapeutic scoliosis-specific exercises (PSSE), specifically PSSR and rigid bracing was supported by level I evidence. Yet to date, there is no high quality evidence (RCT`s) demonstrating that surgical treatment is superior to conservative treatment for the management of AIS. For adult scoliosis, there are only a few studies on the effectiveness of PSSEs and a conclusion cannot as yet be drawn.For hyperkyphosis, there is no high-quality evidence for physiotherapy, bracing or surgery for the treatment of adolescents and adults. However, bracing has been found to reduce thoracic hyperkyphosis, ranging from 55 to 80° in adolescents. In patients over the age of 60, bracing improves the balance score, and reduces spinal deformity and pain. Surgery is indicated in adolescents and adults in the presence of progression of kyphosis, refractory pain and loss of balance. DISCUSSION The available evidence reviewed has suggested that different approaches are needed towards the management of different spinal deformities. Specific exercises should be prescribed in children and adolescents with a Cobb angle in excess of 15°. In progressive curves, they should be used in conjunction with bracing. Clarity regarding differences and similarities is given as to what makes PSSE and PSSR specific exercises. As AIS is relatively benign in nature, conservative treatment should be tried when the curve is at a surgical threshold, before surgery is considered. Similarly, bracing and exercises should be prescribed for patients with hyperkyphosis, particularly when the lumbar spine is afflicted. Surgery should be considered only when the symptoms cannot be managed conservatively. CONCLUSION There is at present high quality evidence in support of the conservative treatment of AIS. The current evidence supports the use of PSSE, especially those using PSSR, together with bracing in the treatment of AIS. In view of the lack of medical consequences in adults with AIS, conservative treatment should be considered for curves exceeding the formerly assumed range of conservative indications.There is, however a lack of evidence in support of any treatment of choice for hyperkyphosis in adolescents and spinal deformities in adults. Yet, conservative treatment should be considered first. Yet to date, there is no high quality evidence (RCT`s) demonstrating that surgical treatment is superior to conservative treatment for the management of AIS and hyperkyphosis. Additionally, surgery needs to be considered with caution, as it is associated with a number of long-term complications.
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Affiliation(s)
| | | | | | - Richard Webb
- Peacocks Medical Group, Newcastle-upon-Tyne, Newcastle, UK
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27
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Bornemann R, Jansen TR, Otten LA, Sander K, Wirtz DC, Pflugmacher R. Comparison of radiofrequency kyphoplasty and balloon kyphoplasty in combination with posterior fixation for the treatment of vertebral fractures. J Back Musculoskelet Rehabil 2017; 30:591-596. [PMID: 28035907 DOI: 10.3233/bmr-140224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND In case of complex vertebral fractures, posterior fixation is often required for correction of deformity and instability. Fixation is commonly supported by balloon kyphoplasty (BKP) anterior. A development of BKP is radiofrequency-targeted vertebral augmentation (RF-TVA), which leads to comparable results for augmentation and pain relief. OBJECTIVE This prospective study evaluates the outcome of posterior fixation combined with RF-TVA or BKP, respectively. METHODS VAS, ODI, kyphosis angle and vertebral height of 44 patients were evaluated preoperatively, 3 and 12 months postoperatively. RESULTS Both treatments improved vertebral height and kyphosis angle. At 12 months, vertebral height restoration was still significantly better in the BKP group (p < 0.001) and the improvement of kyphosis angle was comparable between both groups (p = 0.71). VAS and ODI improvements were significantly better in the RF-TVA group (p < 0.001). 8% of BKP patients had cement extravasations, compared to 10.5% in the RF-TVA group (p = 1.0). CONCLUSIONS Combining posterior fixation with RF-TVA leads to better results of VAS and ODI, whereas the vertebral height restoration was favorable for patients treated with BKP. Cement leakage was comparable between both groups. It was asymptomatic and within reported ranges. Limitations of this study are the patient number and different stabilization instrumentation.
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Li G, Liu H, Wang Q, Zhong D. Preoperative prone position exercises: a simple and novel method to improve tolerance to kyphoplasty for treatment of single level osteoporotic vertebral compression fractures. BMC Musculoskelet Disord 2017; 18:472. [PMID: 29162076 PMCID: PMC5697054 DOI: 10.1186/s12891-017-1843-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 11/14/2017] [Indexed: 02/05/2023] Open
Abstract
Background The proper choice of anesthesia for kyphoplasty remains controversy. There are only a few clinical studies specially focusing on and giving detailed information about this treatment under local anesthesia with or without conscious sedation. To evaluate the effect of preoperative prone position exercises on patient tolerance to percutaneous kyphoplasty under local anesthesia. Methods Eighty-three patients with single level osteoporotic vertebral compression fractures were nonrandomly assigned to undergo percutaneous kyphoplasty under local anesthesia with preoperative prone position exercises or without. The number of procedure with or without a pause, need for intravenous sedation, and patient satisfactory were recorded and analyzed. Clinical outcomes were assessed using the visual analog scale and the Oswestry Disability Index. The follow-up time was 6 months. Results The baseline characteristics of both groups were comparable. The number of procedure without a pause in the exercises group was more than the control group (30/42 patients and 10/41 patients, respectively, P < 0.001), and fewer patients required intravenous sedation in the exercises group (7/42 and 28/41, respectively, P < 0.001). Patients in the exercises group were more satisfied compared to the control group (41/42 and 32/41, respectively, P < 0.01). There were no significant differences between the two groups with regard to improvement in pain and functional scores at all postoperative intervals. Conclusions Prone position exercises may improve patient tolerance and satisfaction and reduce the need for intravenous sedation for those with single level vertebral compression fracture undergoing kyphoplasty under local anesthesia. We expect large sample size and multi-center randomized controlled trial studies to be conducted.
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Affiliation(s)
- Guangzhou Li
- Department of Spine Surgery, the Affiliated Hospital of South-west Medical University, No.25 Taiping St, Luzhou, Sichuan, 646000, China.,Department of orthopedics, Sichuan University West China Hospital, Sichuan Province, Chengdu, China
| | - Hao Liu
- Department of orthopedics, Sichuan University West China Hospital, Sichuan Province, Chengdu, China.
| | - Qing Wang
- Department of Spine Surgery, the Affiliated Hospital of South-west Medical University, No.25 Taiping St, Luzhou, Sichuan, 646000, China.
| | - Dejun Zhong
- Department of Spine Surgery, the Affiliated Hospital of South-west Medical University, No.25 Taiping St, Luzhou, Sichuan, 646000, China
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Fortner MO, Oakley PA, Harrison DE. Treating 'slouchy' (hyperkyphosis) posture with chiropractic biophysics ®: a case report utilizing a multimodal mirror image ® rehabilitation program. J Phys Ther Sci 2017; 29:1475-1480. [PMID: 28878486 PMCID: PMC5574330 DOI: 10.1589/jpts.29.1475] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 05/24/2017] [Indexed: 12/19/2022] Open
Abstract
[Purpose] To present a case of the non-surgical reduction of ‘slouchy’ hyperkyphosis
posture utilizing the multimodal Chiropractic BioPhysics® rehabilitation
program emphasizing the mirror image® concept. [Subject and Methods] A
27-year-old female presented suffering from neck and back pains, headaches and gait
dysfunction. The patient was treated 30 times over a period of 6-months. Treatment
consisted of anterior thoracic translation, thoracic extension, and head retraction
exercises as well as spinal traction and spinal manipulation. [Results] After 6-months of
treatment the patient displayed a total correction of the posterior thoracic translation
with a significant reduction in thoracic hyperkyphosis. The dramatic correction of her
overall posture and spine alignment corresponded to the significant relief of neck and
back pains, headaches and improvement of various other health issues as demonstrated by
self-report and SF-36. [Conclusion] Poor postures corresponding to poor health can be
changed for the better with multimodal rehabilitation programs that are now showing
consistent postural improvements corresponding with improvements in various health
conditions. We suggest that the postural correction of those with various pain symptoms be
considered as a first line non-pharmalogical, non-surgical rehabilitation approach for
those presenting with poor posture.
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30
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Miller JE, Oakley PA, Levin SB, Harrison DE. Reversing thoracic hyperkyphosis: a case report featuring mirror image ® thoracic extension rehabilitation. J Phys Ther Sci 2017; 29:1264-1267. [PMID: 28744061 PMCID: PMC5509605 DOI: 10.1589/jpts.29.1264] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 04/05/2017] [Indexed: 01/30/2023] Open
Abstract
[Purpose] To present a case of non-surgical reduction of thoracic hyperkyphosis utilizing
a multimodal rehabilitation program emphasizing the mirror image® concept.
[Subject and Methods] A 15-year-old female presented to a rehabilitation office suffering
from back and neck pains and headaches. The patient was treated sporadically over a period
of 13-months. Treatment consisted of anterior thoracic translation and thoracic extension
exercises, spinal traction and spinal manipulation. [Results] After 13-months of treatment
the patient displayed a significant reduction in hyperkyphosis and a dramatic correction
of her overall posture and spine alignment corresponding to the reduction in back/neck
pains, headaches and the simultaneous improvement of various other health issues.
[Conclusion] Thoracic hyperkyphosis can be reduced through a multimodal rehabilitation
program emphasizing mirror image thoracic extension procedures.
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Dynamic corset versus three-point brace in the treatment of osteoporotic compression fractures of the thoracic and lumbar spine: a prospective, comparative study. Aging Clin Exp Res 2017; 29:443-449. [PMID: 27386868 DOI: 10.1007/s40520-016-0602-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 06/23/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The three-point orthosis is the most commonly used brace in the conservative treatment of osteoporotic vertebral fractures. The Spinomed® dynamic orthosis represents an alternative. AIMS We compared efficacy and safety of these two types of brace in treating osteoporotic vertebral fractures. METHODS One hundred forty patients, aged 65-93 years, sustaining osteoporotic vertebral fracture were consecutively recruited and divided into two groups, and treated with either three-point orthosis or dynamic corset. Patients were evaluated with Visual Analogue Scale, Oswestry Low Back Pain Disability Questionnaire, and measurement of forced expiratory volume in the first second. Regional kyphosis angle, Delmas Index, and height of the fractured vertebral body were also measured on full-spine X-rays. Follow-up intervals were 1, 3, and 6 months after trauma. The complications encountered during the 6-month follow-up were recorded. RESULTS At the 3- and 6-month follow-ups, there was a significant difference (p < 0.05) in pain, disability, and respiration in favor of the dynamic orthosis group. At 6-month follow-up, there was no significant difference (p > 0.05) in all the radiological parameters between groups. Complications were reported for 28 patients in the three-point orthosis group, and for eight patients in the dynamic corset group (p < 0.05). DISCUSSION Biofeedback activation of back muscles is probably a key factor in improving functional outcome with dynamic orthosis. CONCLUSIONS Compared to three-point orthosis, patients treated with dynamic orthosis had a greater reduction in pain and a greater improvement in quality of life and respiratory function, with equal effectiveness in stabilizing the fracture, and fewer complications.
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Arima K, Abe Y, Nishimura T, Okabe T, Tomita Y, Mizukami S, Kanagae M, Aoyagi K. Association of vertebral compression fractures with physical performance measures among community-dwelling Japanese women aged 40 years and older. BMC Musculoskelet Disord 2017; 18:176. [PMID: 28454529 PMCID: PMC5410022 DOI: 10.1186/s12891-017-1531-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 04/17/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Numerous reported studies have shown that vertebral compression fractures are associated with impaired function or disability; however, few examined their association with objective measures of physical performance or functioning. METHODS We examined the association of vertebral compression fractures with physical performance measures in 556 Japanese women aged 40-89 years. Lateral spine radiographs were obtained and radiographic vertebral compression fractures were assessed by quantitative morphometry, defined as vertebral heights more than 3 SD below the normal mean. Measures of physical performance included walking speed, chair stand time and functional reach. Adjusted means of performance-based measures according to the number and severity of vertebral compression fractures were calculated using general linear modeling methods. RESULTS After adjusting for age, body mass index, back pain, number of painful joints, number of comorbidities and regular physical activities, the walking speed of women with two or more compression fractures (1.17 m/s) was significantly slower than that of women without compression fracture (1.24 m/s) (p = 0.03). Compared with women without compression fracture, chair stand time was longer in women with two or more compression fractures (p = 0.01), and functional reach was shorter (p = 0.01). No significant differences were observed in walking speed, chair stand time, or functional reach between women with one compression fracture and those without compression fracture. CONCLUSIONS Having multiple vertebral compression fractures affects physical performance in community-dwelling Japanese women. Poor physical functioning may lead to functional dependence, accelerated bone loss, and increased risk for falls, injuries, and fractures. Preventing vertebral compression fracture is considered important for preserving the independence of older adults.
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Affiliation(s)
- Kazuhiko Arima
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.
| | - Yasuyo Abe
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Takayuki Nishimura
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Takuhiro Okabe
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.,Department of Rehabilitation, Nishi-Isahaya Hospital, Isahaya, Japan
| | - Yoshihito Tomita
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.,Department of Rehabilitation, Nishi-Isahaya Hospital, Isahaya, Japan
| | - Satoshi Mizukami
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.,Department of Rehabilitation, Nishi-Isahaya Hospital, Isahaya, Japan
| | - Mitsuo Kanagae
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.,Department of Rehabilitation, Nishi-Isahaya Hospital, Isahaya, Japan
| | - Kiyoshi Aoyagi
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
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Wahlquist TC, Lee JJ, Brunfeldt A, Burns GT, Patel RD, Graziano GP. Biomechanical Analysis of Intervertebral Cement Extravasation in Vertebral Motion Segments. Orthopedics 2017; 40:e300-e304. [PMID: 27925638 DOI: 10.3928/01477447-20161128-05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 10/10/2016] [Indexed: 02/03/2023]
Abstract
Kyphoplasty is a therapeutic option for pain relief in the setting of compression fractures. Cement extravasation into adjacent disks is a common occurrence. The biomechanical and clinical consequences of cement in the disks currently are unknown. This study investigated the biomechanical effects of cement extravasation into the intervertebral disk in a human cadaveric model. Seven thoracolumbar and lumbar embalmed human cadaveric motion segments were evaluated in axial rotation, right and left lateral bending, and flexion and extension. Stiffness was calculated at baseline and following injection of 1 mL of cement into the intervertebral disk. There was a 13.4% (P=.041) increase in stiffness in axial rotation compared with preinjection motion segments. No significant difference was observed in lateral bending or flexion and extension. In this model, cement extravasation into the disk space increased stiffness in axial rotation. [Orthopedics. 2017; 40(2):e300-e304.].
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Dmytriw AA, Talla K, Smith R. Percutaneous sacroplasty for the management of painful pathologic fracture in a multiple myeloma patient: Case report and review of the literature. Neuroradiol J 2016; 30:80-83. [PMID: 27888274 DOI: 10.1177/1971400916678642] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Percutaneous kyphoplasty has a well-established role in the treatment of pathologic fractures in patients with multiple myeloma. Despite this, there is a scarcity of literature surrounding its use and efficacy in the sacrum. We present a case of successful symptom resolution in a patient with painful sacral fracture following sacroplasty, and review the existing literature. An 81-year-man with multiple myeloma presented to the hematology/oncology clinic with a history of excruciating pain while seated. The impact of this pain on his quality of life subjectively was rated to be particularly high. Computed tomography of the sacrum confirmed the presence of pathologic fracture within the S1 and S2 vertebrae. Under fluoroscopic guidance, polymethyl methacrylate (PMMA) bone cement was injected via 11-gauge needles using an anterior-oblique approach. No immediate post-procedural complications occurred, such as foraminal extravasation or venous injection. The patient reported himself to be pain-free 1 day following the procedure, and this remains the case to date at 2 years of follow-up. Sacroplasty is technically feasible and can provide durable relief of symptoms in patients with painful pathologic fractures of the sacrum. It is likely underused and can offer tremendous benefit to myeloma patients.
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Affiliation(s)
- A A Dmytriw
- 1 Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.,2 Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - K Talla
- 1 Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - R Smith
- 2 Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
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35
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Kwon HM, Lee SP, Baek JW, Kim SH. Appropriate Cement Volume in Vertebroplasty: A Multivariate Analysis with Short-Term Follow-Up. Korean J Neurotrauma 2016; 12:128-134. [PMID: 27857921 PMCID: PMC5110902 DOI: 10.13004/kjnt.2016.12.2.128] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 08/25/2016] [Accepted: 09/20/2016] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE The optimal threshold of the infusion volume of cement has been a continuous subject in percutaneous vertebroplasty (PVP). This study verifies a causal relationship between the cement volume and the clinical outcome, and suggests the parameters of the appropriate volume of cement in PVP. METHODS This is a retrospective study. One hundred nine patients, who underwent PVP between 2012 and 2015, were included in the study. Various factors such as patients' fracture levels, fracture types, fracture body volumes, fracture rates, bone mineral densities, and infused cement volumes were analyzed. Cement infusion ratios were calculated, using total amount of infused cement and fractured body volume. Follow up was done after one-week, one-month and three-months, postoperatively. Changes in the middle body height and the cement leakage levels were monitored and clinical outcomes were evaluated using a visual analogue scale. RESULTS Among the variables, the infusion ratio (r=-0.320, p=0.003, Pearson's correlation) was the only index that showed a significant cause and effect relationship with favorable clinical outcome, except the group with a T-score of higher than -2.5, and the group with a upper thoracic vertebral level. The patients with a cement infusion ratio of 27.8% or more of the fractured body volume had favorable results. CONCLUSION This study showed that high cement infusion ratio revealed favorable outcome in the vertebroplasty of the osteoporotic compression fractures. Infusion ratio of more than 27.8% to osteoporotic compressed vertebrae is optimal for rapid recovery after PVP.
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Affiliation(s)
- Hyun Mook Kwon
- Departement of Neurosurgery, Cheju Halla General Hospital, Jeju, Korea
| | - Sang Pyung Lee
- Departement of Neurosurgery, Cheju Halla General Hospital, Jeju, Korea
| | - Jin Wook Baek
- Departement of Neurosurgery, Cheju Halla General Hospital, Jeju, Korea
| | - Seong Hwan Kim
- Departement of Neurosurgery, Cheju Halla General Hospital, Jeju, Korea
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Szulc P, Feyt C, Chapurlat R. High risk of fall, poor physical function, and low grip strength in men with fracture-the STRAMBO study. J Cachexia Sarcopenia Muscle 2016; 7:299-311. [PMID: 27239407 PMCID: PMC4864191 DOI: 10.1002/jcsm.12066] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 06/22/2015] [Accepted: 07/31/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Several studies assessed the association of prevalent fractures with muscle mass, strength, and physical capacity in men. Clinical impact of these associations is not clear, and they could be influenced by confounders. Our aim was to assess the association of the prevalent fractures with muscle strength, physical function, and the risk of subsequent falls in older men after adjustment for muscle mass and potential confounders. METHODS In a cohort of 890 men aged 50 and older, we assessed appendicular skeletal muscle mass (ASM) by DXA, grip strength, physical function (chair stands, static, and dynamic balance). Relative ASM (RASM) was calculated as ASM / (height)(2). Then, 813 men aged 60 and over were followed up prospectively for 5 years and 144 sustained >1 incident falls. All the analyses were adjusted for lifestyle factors, co-morbidities, and hormones known to influence muscle and physical function. RESULTS Low leisure physical activity, very high occupational physical activity, Parkinson's disease, diabetes mellitus, low apparent free testosterone concentration (AFTC), as well as Grade 2 and 3 vertebral fractures and multiple fractures were associated with lower grip strength when adjusted for confounders including upper limb RASM. Low leisure physical activity, very high occupational physical activity, diabetes mellitus, prior stroke, low AFTC and 25-hydroxycholecalciferol, high C-reactive protein, vertebral fractures, and non-vertebral fractures were associated with poor physical function (lowest quintile of the score of tests) when adjusted for confounders including lower limb RASM. Grade 2 and 3 and multiple vertebral fractures were associated with twofold higher risk of multiple falls after adjustment for confounders. Men having multiple fractures had a twofold higher risk of multiple falls after adjusting for confounders. In multivariable models, risk of falls increased proportionally to the increasing severity and number of vertebral fractures as well as to the increasing number of all fractures. CONCLUSIONS In older men, Grade 2 and 3 vertebral fractures and multiple vertebral and non-vertebral fractures are associated with lower grip strength, poor physical function, and higher risk of multiple falls after adjustment for multiple confounders. This suggests a real direct association. One fracture can initiate a vicious circle leading to another fracture; thus, patients with fractures need physical therapy regardless of their general health status.
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Affiliation(s)
- Pawel Szulc
- INSERM UMR 1033 Hôpital Edouard Herriot University of Lyon Lyon France
| | - Clément Feyt
- INSERM UMR 1033 Hôpital Edouard Herriot University of Lyon Lyon France
| | - Roland Chapurlat
- INSERM UMR 1033 Hôpital Edouard Herriot University of Lyon Lyon France
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James AW, Chiang M, Asatrian G, Shen J, Goyal R, Chung CG, Chang L, Shrestha S, Turner AS, Seim HB, Zhang X, Wu BM, Ting K, Soo C. Vertebral Implantation of NELL-1 Enhances Bone Formation in an Osteoporotic Sheep Model. Tissue Eng Part A 2016; 22:840-9. [PMID: 27113550 DOI: 10.1089/ten.tea.2015.0230] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Vertebral compression fractures related to osteoporosis greatly afflict the aging population. One of the most commonly used therapy today is balloon kyphoplasty. However, this treatment is far from ideal and is associated with significant side effects. NELL-1, an osteoinductive factor that possesses both pro-osteogenic and anti-osteoclastic properties, is a promising candidate for an alternative to current treatment modalities. This study utilizes the pro-osteogenic properties of recombinant human NELL-1 (rhNELL-1) in lumbar spine vertebral defect model in osteoporotic sheep. METHODS Osteoporosis was induced through ovariectomy, dietary depletion of calcium and vitamin D, and steroid administration. After osteoporotic induction, lumbar vertebral body defect creation was performed. Sheep were randomly implanted with the control vehicle, comprised of hyaluronic acid (HA) with hydroxyapatite-coated β-tricalcium phosphate (β-TCP), or the treatment material of rhNELL-1 protein lyophilized onto β-TCP mixed with HA. Analysis of lumbar spine defect healing was performed by radiographic, histologic, and computer-simulated biomechanical testing. RESULTS rhNELL-1 treatment significantly increased lumbar spine bone formation, as determined by bone mineral density, % bone volume, and mean cortical width as assessed by micro-computed tomography. Histological analysis revealed a significant increase in bone area and osteoblast number and decrease in osteoclast number around the implant site. Computer-simulated biomechanical analysis of trabecular bone demonstrated that rhNELL-1-treatment resulted in a significantly more stress-resistant composition. CONCLUSION Our findings suggest rhNELL-1-based vertebral implantation successfully improved cortical and cancellous bone regeneration in the lumbar spine of osteoporotic sheep. rhNELL-1-based bone graft substitutes represent a potential new local therapy.
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Affiliation(s)
- Aaron W James
- 1 Departments of Surgery and Orthopaedic Surgery, Orthopaedic Hospital Research Center, UCLA and Orthopedic Hospital , Los Angeles, California.,2 Division of Growth and Development and Section of Orthodontics, Dental and Craniofacial Research Institute, School of Dentistry, University of California , Los Angeles, Los Angeles, California.,3 Department of Pathology and Laboratory Medicine, University of California , Los Angeles, Los Angeles, California
| | - Michael Chiang
- 2 Division of Growth and Development and Section of Orthodontics, Dental and Craniofacial Research Institute, School of Dentistry, University of California , Los Angeles, Los Angeles, California
| | - Greg Asatrian
- 2 Division of Growth and Development and Section of Orthodontics, Dental and Craniofacial Research Institute, School of Dentistry, University of California , Los Angeles, Los Angeles, California
| | - Jia Shen
- 1 Departments of Surgery and Orthopaedic Surgery, Orthopaedic Hospital Research Center, UCLA and Orthopedic Hospital , Los Angeles, California.,2 Division of Growth and Development and Section of Orthodontics, Dental and Craniofacial Research Institute, School of Dentistry, University of California , Los Angeles, Los Angeles, California
| | - Raghav Goyal
- 2 Division of Growth and Development and Section of Orthodontics, Dental and Craniofacial Research Institute, School of Dentistry, University of California , Los Angeles, Los Angeles, California
| | - Choon G Chung
- 2 Division of Growth and Development and Section of Orthodontics, Dental and Craniofacial Research Institute, School of Dentistry, University of California , Los Angeles, Los Angeles, California
| | - Le Chang
- 1 Departments of Surgery and Orthopaedic Surgery, Orthopaedic Hospital Research Center, UCLA and Orthopedic Hospital , Los Angeles, California.,2 Division of Growth and Development and Section of Orthodontics, Dental and Craniofacial Research Institute, School of Dentistry, University of California , Los Angeles, Los Angeles, California
| | - Swati Shrestha
- 1 Departments of Surgery and Orthopaedic Surgery, Orthopaedic Hospital Research Center, UCLA and Orthopedic Hospital , Los Angeles, California.,2 Division of Growth and Development and Section of Orthodontics, Dental and Craniofacial Research Institute, School of Dentistry, University of California , Los Angeles, Los Angeles, California
| | - A Simon Turner
- 4 Department of Veterinary Sciences, Colorado State University , Fort Collins, Colorado
| | - Howard B Seim
- 4 Department of Veterinary Sciences, Colorado State University , Fort Collins, Colorado
| | - Xinli Zhang
- 1 Departments of Surgery and Orthopaedic Surgery, Orthopaedic Hospital Research Center, UCLA and Orthopedic Hospital , Los Angeles, California.,2 Division of Growth and Development and Section of Orthodontics, Dental and Craniofacial Research Institute, School of Dentistry, University of California , Los Angeles, Los Angeles, California
| | - Benjamin M Wu
- 5 Departments of Bioengineering and Material Sciences, University of California , Los Angeles, Los Angeles, California
| | - Kang Ting
- 1 Departments of Surgery and Orthopaedic Surgery, Orthopaedic Hospital Research Center, UCLA and Orthopedic Hospital , Los Angeles, California.,2 Division of Growth and Development and Section of Orthodontics, Dental and Craniofacial Research Institute, School of Dentistry, University of California , Los Angeles, Los Angeles, California
| | - Chia Soo
- 1 Departments of Surgery and Orthopaedic Surgery, Orthopaedic Hospital Research Center, UCLA and Orthopedic Hospital , Los Angeles, California.,6 Division of Plastic and Reconstructive Surgery, Department of Surgery, David Geffen School of Medicine, University of California , Los Angeles, Los Angeles, California
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Liang L, Chen X, Jiang W, Li X, Chen J, Wu L, Zhu Y. Balloon kyphoplasty or percutaneous vertebroplasty for osteoporotic vertebral compression fracture? An updated systematic review and meta-analysis. Ann Saudi Med 2016; 36:165-74. [PMID: 27236387 PMCID: PMC6074542 DOI: 10.5144/0256-4947.2016.165] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Both kyphoplasty (KP) and vertebroplasty (VP) are effective for patients with osteoporotic vertebral compression fracture (OVCF), but which approach might be more effective remains unclear, so we decided to update earlier systematic reviews. OBJECTIVE Review and analyze studies published as of August 2015 that compared clinical outcomes and complications of KP versus VP. DESIGN Systematic review and meta-analysis. SEARCH METHOD Published reports up to August 2015 were found in PubMed, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL). SELECTION CRITERIA Randomized controlled trials (RCTs) and prospective and retrospective cohort stud.ies comparing KP and VP in patients with OVCF. DATA COLLECTION AND ANALYSIS Two authors independently assessed the studies and extracted data. RESULTS Thirty-two studies involving 3274 patients fulfilled the inclusion criteria. There were significant differences between the two groups in short- and long-term postoperative changes in measures of pain intensity and dysfunction (P < .01), in anterior and middle height (P < .01), kyphotic angle (P < .01), and time to injury, but not in posterior height (P=.178). There were no significant differences in the rate of postoperative fractures including adjacent and total fractures, but cement leakage to the intraspinal space was greater in the VP group (P=.035). KP surgery took longer and required a greater volume of injected cement. CONCLUSIONS KR resulted in better pain relief, improvements in Oswestry dysfunction and radiographic outcomes with less cement leakage, but further RCTs are needed to verify this conclusion. LIMITATIONS Only four RCTs with a certain of risk of bias. Most studies were observational.
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Affiliation(s)
| | | | | | | | | | | | - Yangyi Zhu
- Prof. Yangyi Zhu, Department of Orthopaedics,, Shangyu People's Hospital, University,, No. 899 Pinghai Road, Suzhou 215006, China, Shaoxing 312000, China, F: 86057581266120, , ORCID ID: orcid.org/0000-0002-2654-8360
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Clinical comparison of postoperative results of balloon kyphoplasty (BKP) versus radiofrequency-targeted vertebral augmentation (RF-TVA): a prospective clinical study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2015; 26:67-75. [DOI: 10.1007/s00590-015-1711-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 10/03/2015] [Indexed: 10/22/2022]
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Ailon T, Shaffrey CI, Lenke LG, Harrop JS, Smith JS. Progressive Spinal Kyphosis in the Aging Population. Neurosurgery 2015; 77 Suppl 4:S164-72. [DOI: 10.1227/neu.0000000000000944] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Sangtarash F, Manshadi FD, Sadeghi A. The relationship of thoracic kyphosis to gait performance and quality of life in women with osteoporosis. Osteoporos Int 2015; 26:2203-8. [PMID: 25994904 DOI: 10.1007/s00198-015-3143-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 04/19/2015] [Indexed: 11/25/2022]
Abstract
UNLABELLED Thoracic kyphosis angle (TKA) increases with osteoporosis. This study aimed to investigate the relationship between magnitude of TKA and quality of life and gait performance in 34 osteoporotic women. Our results suggest that increasing TKA is significantly associated with decreasing quality of life (r = -0.48, p < 0.005) and gait performance (r = -0.74, p < 0.0005). INTRODUCTION Osteoporosis and its related effects are threatening health and quality of life especially in postmenopausal women. Increased thoracic kyphosis angle (TKA), as one of the most common adverse musculoskeletal changes, could be regarded as a quantitative index for osteoporotic patients' assessment. Dual digital inclinometer (DDI) is one of the latest tools for non-invasive TKA measurement. The main purpose of this study was to determine whether a relationship existed between the magnitude of TKA, gait performance, and quality of life in a group of osteoporotic women. METHODS Thirty-four osteoporotic women, aged 50-68, participated in this descriptive analytic study. The magnitude of TKA measured by using DDI and expressed as the kyphosis index (KI). Quality of life and gait performance were assessed using short form 36 (SF36) questionnaire and functional gait assessment test, respectively. Back extension range of motion (ROM) and back extensor strength were also assessed. Pearson's correlation test was used to analyze the data, with the significance level of p < 0.05. RESULTS The findings revealed a statistically significant negative correlation between KI and quality of life (r = -0.48, p < 0.005) and KI and gait performance (r = -0.74, p < 0.0005). There was also a significantly negative relation between KI and back extension ROM and back extensor strength (p < 0.05). CONCLUSION The results of this study demonstrated that increased thoracic kyphosis negatively affects gait performance and quality of life. This finding could be regarded as an important implication for therapist to pay more attention to the magnitude of thoracic kyphosis angle and its changes, when selecting appropriate therapeutic methods to improve gait performance and quality of life in osteoporosis women.
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Affiliation(s)
- F Sangtarash
- Rehabilitation Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
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Evaluation of the quality of life after vertebroplasty to treat compressive osteoporotic fractures. Rev Bras Ortop 2015; 49:477-81. [PMID: 26229848 PMCID: PMC4487787 DOI: 10.1016/j.rboe.2014.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 07/29/2013] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE with increasing life expectancy around the world, fractures due to osteoporosis have become more common and the expenditure for treating them has also increased. The aim here was to evaluate the improvement in pain and quality of life among patients with compressive osteoporotic vertebral fractures undergoing vertebroplasty. METHODS eighteen patients with 27 fractured vertebrae underwent vertebroplasty and were evaluated using the Oswestry 2.0 limitations questionnaire before the operation and 24 h and six months after the operation. RESULTS there was a 75% improvement in pain and quality of life, going from a mean preoperative Oswestry of 40% to 10% 24 h after the operation and 9% six months after the operation (p ≤ 0.05). CONCLUSION vertebroplasty is effective in managing compressive osteoporotic vertebral fractures, with improvement in pain and quality of life in the immediate postoperative period and over the medium term.
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Okamoto Y, Murakami H, Demura S, Kato S, Yoshioka K, Hayashi H, Sakamoto J, Kawahara N, Tsuchiya H. The effect of kyphotic deformity because of vertebral fracture: a finite element analysis of a 10° and 20° wedge-shaped vertebral fracture model. Spine J 2015; 15:713-20. [PMID: 25450655 DOI: 10.1016/j.spinee.2014.11.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 10/18/2014] [Accepted: 11/21/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Kyphotic deformity associated with vertebral fracture is believed to be a significant risk factor for additional vertebral fractures. However, previously published research is limited. PURPOSE The purpose of this study was to estimate the biomechanical stresses that kyphotic deformity, with an initial vertebral fracture, place on adjacent vertebrae using three-dimensional finite element (FE) of the spine, head, and ribs. STUDY DESIGN This study is based on the basic science. METHODS Total Human Model for Safety, a three-dimensional FE model of the human body, was used and adjusted to represent an elderly osteoporotic woman. The 12th thoracic vertebra (T12), which is a frequent site of osteoporotic vertebral fractures, was transformed to a wedge shape at 0°, 10°, and 20° to create a normal model, a 10° kyphosis model, and a 20° kyphosis model. Additionally, compensated postures were created for the 10° and 20° kyphosis models. Thus, five models were created: (A) a normal model, (B) a 10° kyphosis model, (C) a 20° kyphosis model, (D) a 10° kyphosis model with compensated posture, and (E) a 20° kyphosis model with compensated posture. Compressive principal stresses (CPSs) on T1-L5 in each model were calculated. RESULTS The highest CPS value was 7.78 MPa placed on the anterior part of the T10 vertebra in the 20° kyphosis model. In the 20° kyphosis model, the higher CPS values showed bimodal peaks at T6 and T7 in the midthoracic spine and at T10 and T11 in the two superior adjacent vertebrae. The maximum CPS values in the A, B, C, D, and E models at T10 were 3.12, 6.74, 7.78, 6.61, and 5.78 MPa. At T11, they were 1.70, 4.41, 6.45, 4.07, and 4.79 MPa. CONCLUSIONS The existence of an initial vertebral fracture at T12 caused an increase in stress on adjacent vertebrae. Higher CPS values showed bimodal peaks in midthoracic vertebrae and in two superior adjacent vertebrae when T12 was transformed to a wedge shape in the 20° kyphosis model.
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Affiliation(s)
- Yoshiyuki Okamoto
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa 920-8641, Japan.
| | - Hideki Murakami
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa 920-8641, Japan
| | - Satoru Demura
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa 920-8641, Japan
| | - Satoshi Kato
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa 920-8641, Japan
| | - Katsuhito Yoshioka
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa 920-8641, Japan
| | - Hiroyuki Hayashi
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa 920-8641, Japan
| | - Jiro Sakamoto
- Department of Human and Mechanical System Engineering, Faculty of Engineering, Kanazawa University, Kakumamachi, Kanazawa 920-1192, Japan
| | - Norio Kawahara
- Department of Orthopedic Surgery, Kanazawa Medical University Hospital, 1-1 Uchinadamachi, Kahoku 920-0293, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa 920-8641, Japan
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Yan Y, Xu R, Zou T. Is thoracolumbar fascia injury the cause of residual back pain after percutaneous vertebroplasty? A prospective cohort study. Osteoporos Int 2015; 26:1119-24. [PMID: 25510580 DOI: 10.1007/s00198-014-2972-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 11/16/2014] [Indexed: 02/08/2023]
Abstract
UNLABELLED Some patients with osteoporotic vertebral compression fractures still suffer from back pain after percutaneous vertebroplasty. We have found that osteoporotic vertebral compression fractures with thoracolumbar fascia injury are common and that thoracolumbar fascia injury may account for the residual pain after percutaneous vertebroplasty. PURPOSE Osteoporotic vertebral compression fractures are successfully treated with percutaneous vertebroplasty (PVP). However, some patients still suffer from back pain after the procedure. We hypothesized that there is a relationship between thoracolumbar (TL) fascia injury and residual postoperative pain. METHODS This prospective study included 133 elderly patients (age range 55 - 92 years) with osteoporotic vertebral compression fractures treated with PVP from February 2010 to March 2012 in our hospital. The patients were divided into two groups based on the presence of TL fascia injury. A visual analog scale (VAS) and the Chinese modified Oswestry Disability Index were used to evaluate the pain before and after PVP. RESULTS The mean VAS score and the Chinese modified Oswestry Disability Index in the patients with TL fascia injury were reduced from 9.11 ± 0.76 to 6.4 ± 1.1 and 73.93 ± 1.46% to 44.6 ± 3.1%, respectively, and in the patients without TL fascia injury from 9.26 ± 0.82 to 8.0 ± 1.3 and 73.96 ± 1.38% to 51.7 ± 1.8%, respectively. Pain and disability were reduced more in patients without TL fascia injury than in those with TL fascia injury (both p < 0.05). CONCLUSIONS There may be a relationship between TL fascia injury and residual back pain after PVP.
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Affiliation(s)
- Y Yan
- Department of Orthopaedics, Ningbo No.2 Hospital, Ningbo, 315010, China
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Alkalay RN, Vader D, Hackney D. The degenerative state of the intervertebral disk independently predicts the failure of human lumbar spine to high rate loading: an experimental study. Clin Biomech (Bristol, Avon) 2015; 30:211-8. [PMID: 25579978 PMCID: PMC5938090 DOI: 10.1016/j.clinbiomech.2014.09.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 09/29/2014] [Accepted: 09/30/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND In the elderly, 30%-50% of patients report a fall event to precede the onset of vertebral fractures. The dynamic characteristics of the spine determine the peak forces on the vertebrae in a fall. However, we know little about the effect of intervertebral disk degeneration on the failure of human spines under the high loading rates associated with such falls. We hypothesized that MR estimates of disk hydration and viscoelastic properties will provide better estimates of failure strength than bone density alone. METHODS Seventeen L1-L3 human spine segments were imaged (magnetic resonance imaging, dual-energy X-ray absorptiometry), their dynamic responses quantified using pendulum based impact, and the spines tested to failure under high rate loading simulating a fall event. The spines' stiffness and damping constants were computed (Kelvin-Voigt model) with disk hydration and geometry assessed from T2 and proton density images. FINDINGS Under impact, the spines exhibited a second-order underdamped response with stiffness and damping ranging (17.9-754.5) kN/m and (133.6-905.3) Ns/m respectively. Damping, but not stiffness, was negatively correlated with higher ultimate strength (P<0.05). Higher bone mineral density and MR-estimated disk hydration correlated with higher ultimate strength (P<0.01 for both). No such correlations were observed for the T2 values. Adding disk hydration yielded a 20% increase in the model's association with failure load compared to bone density alone (MANOVA, P<0.001). INTERPRETATION The strong correlation between disk viscoelastic properties and MR-estimated hydration with the spine segments' ultimate strength clearly demonstrates the need to include disk degeneration as part of fracture risk assessment in the elderly spine.
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Affiliation(s)
- Ron Noah Alkalay
- Center for Advanced Orthopedic Studies, Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA, USA
| | - David Vader
- Center for Advanced Orthopedic Studies, Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA, USA
| | - David Hackney
- Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA, USA
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Tobias JH. Clinical features of osteoporosis. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00198-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Maier GS, Seeger JB, Horas K, Roth KE, Kurth AA, Maus U. The prevalence of vitamin D deficiency in patients with vertebral fragility fractures. Bone Joint J 2015; 97-B:89-93. [DOI: 10.1302/0301-620x.97b1.34558] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Hypovitaminosis D has been identified as a common risk factor for fragility fractures and poor fracture healing. Epidemiological data on vitamin D deficiency have been gathered in various populations, but the association between vertebral fragility fractures and hypovitaminosis D, especially in males, remains unclear. The purpose of this study was to evaluate serum levels of 25-hydroxyvitamin D (25-OH D) in patients presenting with vertebral fragility fractures and to determine whether patients with a vertebral fracture were at greater risk of hypovitaminosis D than a control population. Furthermore, we studied the seasonal variations in the serum vitamin D levels of tested patients in order to clarify the relationship between other known risk factors for osteoporosis and vitamin D levels. We measured the serum 25-OH D levels of 246 patients admitted with vertebral fractures (105 men, 141 female, mean age 69 years, sd 8.5), and in 392 orthopaedic patients with back pain and no fractures (219 men, 173 female, mean age 63 years, sd 11) to evaluate the prevalence of vitamin D insufficiency. Statistical analysis found a significant difference in vitamin D levels between patients with vertebral fragility fracture and the control group (p = 0.036). In addition, there was a significant main effect of the tested variables: obesity (p < 0.001), nicotine abuse (p = 0.002) and diabetes mellitus (p < 0.001). No statistical difference was found between vitamin D levels and gender (p = 0.34). Vitamin D insufficiency was shown to be a risk factor for vertebral fragility fractures in both men and women. Cite this article: Bone Joint J 2015;97-B:89–93.
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Affiliation(s)
| | | | - K. Horas
- ANZAC Research Institute , University
of Sydney, Australia
| | - K. E. Roth
- Johannes-Gutenberg-University, Mainz, Germany
| | - A. A. Kurth
- Themistocles Gluck Hospital, Ratingen, Germany
| | - U. Maus
- University Hospital of Orthopaedic Surgery, Pius-Hospital, Oldenburg, Germany
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Ribom EL, Kindmark A, Ljunggren Ö. Hyperkyphosis and back pain are not associated with prevalent vertebral fractures in women with osteoporosis. Physiother Theory Pract 2014; 31:182-5. [PMID: 25495768 DOI: 10.3109/09593985.2014.989295] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Vertebral fractures (VFs) are the clinical consequence of spinal osteoporosis and may be associated with back pain and aggravated kyphosis. However, the relative importance of VFs as an underlying cause of kyphosis and chronic back pain is not known. The aim of this study was to investigate the relationship between prevalent VFs and the size of kyphosis, and back pain in osteoporotic women. Thirty-six women, aged 74.6 ± 8.3 years, were consecutively recruited from the osteoporosis unit at Uppsala University Hospital. The patients had 1-9 radiographic verified VFs. Tragus wall distance (TWD) and numeric rating scale were used to measure kyphosis and pain. All patients had a hyperkyphosis (TWD ≥ 10 cm). Notably, there were no associations between numbers or location of VFs versus size of kyphosis (ρ = 0.15, p = 0.4; ρ = -0.27, p = 0.12) or severity of back pain (ρ = -0.08, p = 0.66; ρ = 0.16, p = 0.35). Furthermore, no association was evident between kyphosis and back pain (ρ = -0.02, p = 0.89). There was, however, an association between size of kyphosis and age (R = 0.44, p = 0.008). In conclusion, these data suggest that prevalent VFs are not significantly associated with kyphosis or chronic back pain, in patients with manifest spinal osteoporosis.
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Affiliation(s)
- Eva L Ribom
- Department of Surgical Sciences, Section of Orthopaedics, Uppsala University , Uppsala , Sweden
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Gan M, Zou J, Song D, Zhu X, Wang G, Yang H. Is balloon kyphoplasty better than percutaneous vertebroplasty for osteoporotic vertebral biconcave-shaped fractures? Acta Radiol 2014; 55:985-91. [PMID: 24280137 DOI: 10.1177/0284185113511603] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Osteoporotic vertebral biconcave-shaped fractures are not commonly seen in clinical practice. Some articles have been published showing the outcome of vertebroplasty (PV) and balloon kyphoplasty (BKP), but few comparative studies have been performed. PURPOSE To compare the effect and safety of PV and BKP in treating osteoporotic vertebral biconcave-shaped fractures. MATERIAL AND METHODS In this retrospective comparative study, 38 patients with osteoporotic vertebral biconcave-shaped fractures were treated by PV, and 41 patients were treated by BKP from May 2005 to July 2011. The heights of the compromised vertebral body and the kyphotic angles were measured. Visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate pain and functional activity, respectively. The occurrence of refracture and cement leakage were determined, and the costs were recorded. RESULTS The mean VAS and ODI scores significantly improved for both procedures at postsurgical measurements (P < 0.05), and the improvement sustained at the final follow-up. In both groups, there were no significant differences in terms of restoration of the anterior vertebral height and correction of the kyphotic deformity. However, BKP was more effective in restoring the middle vertebral height than PV. Cement leakages were observed in nine (23.7%) treated vertebral bodies in PV group and in three (7.4%) treated vertebral bodies in BKP group, which was a statistically significant difference (P < 0.05). There were four new osteoporotic vertebral fractures in the PV group and two in the BKP group during the follow-up period. The mean cost in the BKP group (6200 ± 122.1 USD) was higher than the PV group (2100 ± 112.5 USD) (P < 0.05). CONCLUSION Both PV and BKP achieved similar improvements in pain and functional outcomes for the treatment of osteoporotic vertebral biconcave-shaped fractures. BKP had a significant advantage over PV in terms of the restoration of the middle vertebral height and fewer cement leakages than PV.
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Affiliation(s)
- Minfeng Gan
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, PR China
| | - Jun Zou
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, PR China
| | - Dawei Song
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, PR China
| | - Xuesong Zhu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, PR China
| | - Genlin Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, PR China
| | - Huilin Yang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, PR China
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Chen L, Black C, Hirsch JA, Beall D, Munk P, Murphy K. Vertebroplasty trials: the medium is the message. J Vasc Interv Radiol 2014; 25:323-5. [PMID: 24461134 DOI: 10.1016/j.jvir.2013.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 09/04/2013] [Accepted: 10/04/2013] [Indexed: 11/26/2022] Open
Affiliation(s)
- Long Chen
- Department of Radiology, Toronto Western Hospital, University of Toronto, Fitzgerald Building, 150 College St., Room 112, Toronto, Ontario, Canada M5S 3E2
| | - Carl Black
- Utah Valley Regional Medical Center, Provo, Utah
| | - Joshua A Hirsch
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Doug Beall
- Radiology Services, Summit Medical Center, Oklahoma City, Oklahoma
| | - Peter Munk
- Department of Radiology, Vancouver General Hospital, Vancouver BC, Canada
| | - Kieran Murphy
- Department of Radiology, Toronto Western Hospital, University of Toronto, Fitzgerald Building, 150 College St., Room 112, Toronto, Ontario, Canada M5S 3E2
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