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Butnariu AD, Miron I, David B, Visarion DM, Pruna VI, Pruna VM. Postoperative Stroke Following Anterior Cervical Spine Surgery: A Case Report. Cureus 2024; 16:e63846. [PMID: 39099982 PMCID: PMC11297389 DOI: 10.7759/cureus.63846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2024] [Indexed: 08/06/2024] Open
Abstract
Vascular complications succeeding anterior cervical spine surgery are rare, but their consequences represent a major burden for the patient. Cerebral infarction following anterior cervical discectomy and fusion (ACDF) is uncommon. However, screening for risk factors before surgery should become mandatory. We present the case of a patient with no significant medical history who underwent ACDF for a C5/C6 herniated disc with myelopathy. Although the surgery was uneventful, after the surgery, partial right palpebral ptosis and miosis were noted, suggestive of Horner syndrome. On the fifth postoperative day, the patient experienced left hemiplegia and drowsiness. An emergency CT scan and cerebral MRI revealed ischemia in the right middle cerebral artery territory. The patient was transferred to a neurology center for mechanical thrombectomy, which revealed a complete occlusion of the right internal carotid artery. The procedure had to be halted due to blood extravasation at the internal carotid artery bifurcation to prevent further complications. An angio-CT examination of the cervical arteries exposed a soft atheromatous plaque on the right internal carotid artery, immediately after the bifurcation. Despite the patient having no significant medical history, blood tests indicated dyslipidemia. At the two-month follow-up, the patient remained hemiplegic, with mild dysphasia. Performing carotid and vertebral Doppler ultrasound before cervical spine surgery might be useful, whenever possible, to assess high-risk factors for ischemic events and avoid such debilitating complications.
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Affiliation(s)
- Andreea D Butnariu
- Neurosurgery Department, Bagdasar-Arseni Clinical Emergency Hospital, Bucharest, ROU
| | - Ioana Miron
- Neurosurgery Department, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
- Neurosurgery Department, Bagdasar-Arseni Clinical Emergency Hospital, Bucharest, ROU
| | - Bogdan David
- Neurosurgery Department, Bagdasar-Arseni Clinical Emergency Hospital, Bucharest, ROU
| | - Dan M Visarion
- Neurosurgery Department, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
- Neurosurgery Department, Bagdasar-Arseni Clinical Emergency Hospital, Bucharest, ROU
| | - Violeta I Pruna
- Ophthalmology Department, CF2 Clinical Hospital, Bucharest, ROU
| | - Viorel M Pruna
- Neurosurgery Department, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
- Neurosurgery Department, Bagdasar-Arseni Clinical Emergency Hospital, Bucharest, ROU
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Hu TY, Zhang G, Ye H, An CL, Wang K, Xia L, Zhou XX, Zhang SS, Lu YH. Pain Relief and Safety of Microwave Ablation Combined with Percutaneous Vertebroplasty for Vertebral Metastasis: A Pilot Study. J Neurol Surg A Cent Eur Neurosurg 2023; 84:513-520. [PMID: 36495242 DOI: 10.1055/s-0042-1758121] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND We investigate the pain relief and safety of microwave ablation (MWA) combined with percutaneous vertebroplasty (PVP) in the treatment of metastatic vertebral tumors. METHODS This prospective pilot study enrolled patients with metastatic vertebral tumors treated between January 2018 and October 2019. The participants were randomized to the PVP and MWA + PVP groups. Clinical parameters, pain visual analog scale (VAS), analgesic use scores (AUS), and quality-of-life score (QLS) were compared between groups. RESULTS Sixty-seven participants were enrolled (PVP: n = 35; MWA + PVP: n = 32). There were no differences in bone cement injection volume, extravasation, and X-ray exposure time between the two groups (p > 0.05), but treatment costs were higher for the MWA + PVP group (26,418 ± 194 vs. 15,606 ± 148 yuan; p < 0.05). There were no significant improvements in VAS from baseline to 24 hours, 72 hours, 7 days, 1 month, and 3 months in the two groups (p > 0.05); at 6 and 12 months after the operation, the improvement from baseline was significant in the two groups (p < 0.05). The VAS was lower at 6 months (2.7 ± 0.7 vs. 3.2 ± 0.7) and 12 months (3.5 ± 0.8 vs. 4.0 ± 0.7) in the MWA + PVP group (both p < 0.01 vs. PVP). The AUS and QLS were improved with PVP at 6 and 12 months (p < 0.05) and with MWA + PVP at 12 months (p < 0.05). The AUS was lower at 6 and 12 months in the MWA + PVP group (p < 0.05 vs. PVP). CONCLUSION MWA combined with PVP might be a safe and effective palliative treatment for pain from metastatic vertebral tumors.
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Affiliation(s)
- Ting-Ye Hu
- Department of Interventional Vascular Surgery, Affiliated Chuzhou Hospital of Anhui Medical University, Chuzhou, Municipal First People's Hospital, Chuzhou, Anhui, China
| | - Gan Zhang
- Department of General Surgery, Anhui Hanbo Group Hospital, Chuzhou, Anhui, China
| | - Hong Ye
- Department of Orthopedics, Affiliated Chuzhou Hospital of Anhui Medical University, Chuzhou, Municipal First People's Hospital, Chuzhou, Anhui, China
| | - Cheng-Ling An
- Digital Subtraction Angiography, Affiliated Chuzhou Hospital of Anhui Medical University, Chuzhou, Municipal First People's Hospital, Chuzhou, Anhui, China
| | - Kai Wang
- Department of Interventional Vascular Surgery, Affiliated Chuzhou Hospital of Anhui Medical University, Chuzhou, Municipal First People's Hospital, Chuzhou, Anhui, China
| | - Lei Xia
- Department of Interventional Vascular Surgery, Affiliated Chuzhou Hospital of Anhui Medical University, Chuzhou, Municipal First People's Hospital, Chuzhou, Anhui, China
| | - Xiao-Xing Zhou
- Department of Interventional Vascular Surgery, Affiliated Chuzhou Hospital of Anhui Medical University, Chuzhou, Municipal First People's Hospital, Chuzhou, Anhui, China
| | - Shan-Shan Zhang
- Department of Interventional Vascular Surgery, Affiliated Chuzhou Hospital of Anhui Medical University, Chuzhou, Municipal First People's Hospital, Chuzhou, Anhui, China
| | - Yu-He Lu
- Department of Interventional Vascular Surgery, Affiliated Chuzhou Hospital of Anhui Medical University, Chuzhou, Municipal First People's Hospital, Chuzhou, Anhui, China
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Khoo B, Gonzalvo A, Kweh BTS. Spinal orthoses in osteoporotic vertebral fractures of the elderly. JOURNAL OF SPINE SURGERY (HONG KONG) 2023; 9:224-228. [PMID: 37841792 PMCID: PMC10570645 DOI: 10.21037/jss-23-76] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 06/14/2023] [Indexed: 10/17/2023]
Affiliation(s)
- Boyuan Khoo
- Department of Neurosurgery, Austin Hospital, Melbourne, VIC, Australia
| | - Augusto Gonzalvo
- Department of Neurosurgery, Austin Hospital, Melbourne, VIC, Australia
- Department of Surgery, University of Melbourne, Parkville, VIC, Australia
| | - Barry Ting Sheen Kweh
- Department of Neurosurgery, Austin Hospital, Melbourne, VIC, Australia
- National Trauma Research Institute, Melbourne, VIC, Australia
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Patel SK, Khan S, Dasari V, Gupta S. Beyond Pain Relief: An In-Depth Review of Vertebral Height Restoration After Balloon Kyphoplasty in Vertebral Compression Fractures. Cureus 2023; 15:e46124. [PMID: 37900521 PMCID: PMC10612383 DOI: 10.7759/cureus.46124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
This comprehensive review delves into the intricate landscape of vertebral height restoration after balloon kyphoplasty in cases of vertebral compression fractures. With a comprehensive examination of procedural intricacies, radiological evaluations, clinical outcomes, and influential factors, a nuanced comprehension unfolds. Beyond its immediate alleviation of pain, vertebral height restoration emerges as a linchpin in enhancing spinal alignment, fostering functional recuperation, and augmenting the overall quality of life. This review underscores the pivotal role of balloon kyphoplasty, transcending its mere medical utility to become a conduit for renewed independence and well-being among individuals grappling with vertebral compression fractures. The ongoing advancements in medical science and the continued pursuit of research stand poised to amplify the significance of vertebral height restoration, manifesting a promising horizon for individuals seeking respite from pain, a revitalised capacity for movement, and a life unburdened by its constraints.
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Affiliation(s)
- Siddharth K Patel
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sohael Khan
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ventaktesh Dasari
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Suvarn Gupta
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Patel D, Gorrell C, Norris J, Liu J. A narrative review of the pharmaceutical management of osteoporosis. ANNALS OF JOINT 2023; 8:25. [PMID: 38529240 PMCID: PMC10929303 DOI: 10.21037/aoj-23-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 06/05/2023] [Indexed: 03/27/2024]
Abstract
Background and Objective Osteoporosis is a skeletal disorder classified by the loss of bone density in older adults leading to compromised bone strength and an increased risk of fracture. It can be divided into categories based on its etiology: senile, post-menopausal, and secondary osteoporosis. Specific prevention measures and treatments exist for targeting bone loss. Here we review and summarize the literature regarding the presentation of osteoporosis and discuss pharmaceutical therapies. Methods PubMed and Google Scholar were searched for articles published in English between 1980 and 2021. Search terms combined "senile osteoporosis", "osteoporosis treatment", "osteoporosis", "bisphosphonates", "denosumab", types of hormone therapy, and other relevant keywords used in various combinations. Key Content and Findings Osteoporosis affects millions but often goes undiagnosed until a pathologic fracture. Dual-energy X-ray absorptiometry (DEXA) scans evaluate bone mineral density (BMD) and are a diagnostic tool for osteoporosis. Adults over the age of 65, post-menopausal women, and those with risk factors such as previous fractures are recommended to receive DEXA scans every one to two years. Bisphosphonates, denosumab, and hormonal therapies are among the most common pharmacologic treatments for osteoporosis. Conclusions Daily, orally administered bisphosphonates are the first-line therapy for osteoporosis given their efficacy in decreasing fracture risk and favorable safety profile. Denosumab is an alternative that is administered subcutaneously every six months and may be given as initial therapy to select patients. Hormonal therapies are used if patients cannot tolerate bisphosphonates or denosumab or are refractory to these medications. Preventative measures for osteoporosis include tailored exercise and sufficient intake of calcium and vitamin D via diet or supplementation.
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Affiliation(s)
- Devon Patel
- Department of Medical Education, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Courtney Gorrell
- Department of Medical Education, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Jordan Norris
- Department of Medical Education, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Jiayong Liu
- Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, OH, USA
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Abstract
Vertebral compression fractures are the most common complication of osteoporosis, with 700,000 cases reported every year in the United States. Vertebral compression fractures typically present with abrupt-onset low back pain with or without a history of trauma, although more than two-thirds are detected incidentally. Diagnosis is confirmed using plain radiographs, while computed tomography and magnetic resonance imaging may be required to evaluate for a malignant cause or if there are neurological deficits on examination. Magnetic resonance imaging is also the modality of choice to determine if the fracture is acute vs chronic in nature. Patients can be managed with a combination of nonsurgical modalities including medications, bracing, and physical therapy, although when indicated, kyphoplasty or vertebroplasty may be considered to provide symptom relief.
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Patel D, Liu J, Ebraheim NA. Managements of osteoporotic vertebral compression fractures: A narrative review. World J Orthop 2022; 13:564-573. [PMID: 35949707 PMCID: PMC9244957 DOI: 10.5312/wjo.v13.i6.564] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/26/2022] [Accepted: 06/14/2022] [Indexed: 02/06/2023] Open
Abstract
Osteoporotic vertebral compression fractures (OVCFs) are the most common fragility fracture and significantly influence the quality of life in the elderly. Currently, the literature lacks a comprehensive narrative review of the management of OVCFs. The purpose of this study is to review background information, diagnosis, and surgical and non-surgical management of the OVCFs. A comprehensive search of PubMed and Google Scholar for articles in the English language between 1980 and 2021 was performed. Combinations of the following terms were used: compression fractures, vertebral compression fractures, osteoporosis, osteoporotic compression fractures, vertebroplasty, kyphoplasty, bisphosphonates, calcitonin, and osteoporosis treatments. Additional articles were also included by examining the reference list of articles found in the search. OVCFs, especially those that occur over long periods, can be asymptomatic. Symptoms of acute OVCFs include pain localized to the mid-line spine, a loss in height, and decreased mobility. The primary treatment regimens are pain control, medication management, vertebral augmentation, and anterior or posterior decompression and reconstructions. Pain control can be achieved with acetaminophen or nonsteroidal anti-inflammatory drugs for mild pain or opioids and/or calcitonin for moderate to severe pain. Bisphosphonates and denosumab are the first-line treatments for osteoporosis. Vertebroplasty and kyphoplasty are reserved for patients who have not found symptomatic relief through conservative methods and are effective in achieving pain relief. Vertebroplasty is less technical and cheaper than kyphoplasty but could have more complications. Calcium and vitamin D supplementation can have a protective and therapeutic effect. Management of OVCFs must be combined with multiple approaches. Appropriate exercises and activity modification are important in fracture prevention. Medication with different mechanisms of action is a critical long-term causal treatment strategy. The minimally invasive surgical interventions such as vertebroplasty and kyphoplasty are reserved for patients not responsive to conservative therapy and are recognized as efficient stopgap treatment methods. Posterior decompression and fixation or Anterior decompression and reconstruction may be required if neurological deficits are present. The detailed pathogenesis and related targeted treatment options still need to be developed for better clinical outcomes.
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Affiliation(s)
- Devon Patel
- College of Medicine and Life Sciences, University of Toledo, Toledo, OH 43614, United States
| | - Jiayong Liu
- Department of Orthopedic Surgery, University of Toledo Medical Center, Toledo, OH 43614, United States
| | - Nabil A Ebraheim
- Department of Orthopedic Surgery, University of Toledo Medical Center, Toledo, OH 43614, United States
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Marchenkova LA. [Topical issues of rehabilitation of patients with osteoporotic vertebral fractures]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 2022; 99:69-79. [PMID: 35236069 DOI: 10.17116/kurort20229901169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The literature review analyzed 20 Russian and 69 foreign publications on the rehabilitation of elderly patients with osteoporotic vertebral fractures. The article deals in detail with the prevalence, medical and social significance of pathological osteoporotic fractures, including vertebral deformities. The data confirming the importance of osteoporosis for physical and rehabilitation medicine specialists are presented. Changes in the quality of life, functional and gate disorders associated with osteoporotic vertebral fractures are described. Based on the available literature data, the principles of rehabilitation of patients with osteoporotic vertebral compression fractures are formulated, including the effectiveness of various methods of physical therapy, mechanotherapy and apparatus physiotherapy. From the standpoint of evidence-based medicine, the role of orthotics in the complex rehabilitation of such patients is described. Based on the analysis of literature data, it was concluded that the problem of osteoporosis is relevant for physicians working in the field of rehabilitation medicine; osteoporotic vertebral fractures are characterized by a high prevalence over the age of 50 years and are associated with a decrease in the quality of life, motor and functional limitations, and an increased risk of death, and well-planned medical rehabilitation programs including physical exercises, physiotherapy and orthotics can significantly improve patient functionality.
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Affiliation(s)
- L A Marchenkova
- National Medical Research Center of Rehabilitation and Balneology of Ministry of Health of Russian Federation, Moscow, Russia
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Lee Y, Lee HJ, Yoon S, Shin J, Park KC, Lee SY, Lee S. Association Between Overweight Sarcopenic Population and Acute Vertebral Osteoporotic Compression Fractures in Females: Retrospective, Cross-Sectional Study. Front Med (Lausanne) 2021; 8:790135. [PMID: 34926531 PMCID: PMC8678084 DOI: 10.3389/fmed.2021.790135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background: This study aimed to determine whether the prevalence of acute vertebral osteoporotic compression fractures (VOCF) in the elderly population is related to the distribution of muscles and fat in the human body. Methods: Data of acute VOCF and non-VOCF patients presenting at our institution between January 2018 and May 2020 were analyzed. Patients aged 65 years and older, who underwent body composition test and dual-energy X-ray absorptiometry at the same time were enrolled. After applying exclusion criteria, patients were divided into four groups: normal, sarcopenia without obesity, obesity without sarcopenia, and sarcopenic obesity. Body mass index ≥25 kg/m2 was considered obesity, and sarcopenia was defined as skeletal muscle index lower than 7.0 kg/m2 in males and 5.4 kg/m2 in females. The VOCF rate was analyzed between the groups. Discussion: A total of 461 patients were included, of whom 103 were males. Among them, 163 (35.36%) had normal body composition, 151 (32.75%) had sarcopenia without obesity, 110 (23.86%) had obesity without sarcopenia, and 37 (8.03%) had sarcopenic obesity. The sarcopenic obesity group had the highest rate of acute VOCF (37.8%), which was statistically significant. Specifically, females with sarcopenic obesity and sarcopenia without obesity had significantly higher acute VOCF rates compared to those with normal body compositions. Multivariate analysis showed that sarcopenic obesity was significantly associated with acute VOCF rate overall, as well as in females. Conclusion: Sarcopenic obesity is strongly associated with acute VOCF, especially in females, and it could be an essential criterion for the prevention of acute VOCF.
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Affiliation(s)
- Younghun Lee
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
| | - Ho-Jae Lee
- Department of Orthopaedic Surgery, CHA Gumi Medical Center, Gumi, South Korea
| | - Siyeong Yoon
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
| | - Jaeyeon Shin
- Department of Computer Science, College of IT Engineering, SeMyung University, Jecheon, South Korea
| | - Kyung-Chae Park
- Department of Family Medicine, Health Promotion Center, CHA Bundang Medical Center, CHA University School of Medicine, Pocheon, South Korea
| | - So-young Lee
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
| | - Soonchul Lee
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
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Shahrestani S, Chen XT, Ballatori AM, Ton A, Bakhsheshian J, Hah RJ, Wang JC, Buser Z. Complication Trends and Costs of Surgical Management in 11,086 Osteoporotic Patients Receiving Lumbar Fusion. Spine (Phila Pa 1976) 2021; 46:1478-1484. [PMID: 33813581 DOI: 10.1097/brs.0000000000004051] [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 cohort study. OBJECTIVE The aim of this study was to compare different aspects of fusion surgery in patients with osteoporosis with regard to graft subtype and surgical approach. SUMMARY OF BACKGROUND DATA Osteoporosis and chronic lower back pain are common in elderly populations and significantly increase the risk of compression fractures within the spine. METHODS Using the 2016-2017 National Readmission Database we identified 11,086 osteoporotic patients who received lumbar fusion using ICD-10 coding. Information regarding biologic graft type and surgical approach was collected. Patients were stratified by number of levels fused. Perioperative complications were collected at 30-, 90-, and 180-day follow-up intervals. Statistical analysis included univariate testing and multivariate regression modeling, controlling for patient demographics and comorbidities. RESULTS Patients receiving single-level fusion with autologous grafts had higher rates of hardware failure (P = 0.00014) at 30-day follow-up and 90-day follow-up (P < 0.0001) and higher rates of lumbar vertebral fractures at 90-day follow-up (P = 0.045) compared to those treated with nonautologous grafts. Patients receiving lumbar fusion with anterior and posterior approaches had no difference in readmission or infection rates, but the anterior approach was associated with a higher cost. CONCLUSION In this study, osteoporotic patients treated with autologous grafts had higher rates of complications compared to those treated with nonautologous grafts. Anterior and posterior approaches had similar complication rates; however, the anterior approach was associated with a higher total cost.Level of Evidence: 4.
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Affiliation(s)
- Shane Shahrestani
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
- Department of Medical Engineering, California Institute of Technology, Pasadena, CA
| | - Xiao T Chen
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Alexander M Ballatori
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Andy Ton
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Joshua Bakhsheshian
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Raymond J Hah
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Jeffrey C Wang
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Zorica Buser
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
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Analysis on the Effect of Different Surgical Methods on the Treatment of Senile Osteoporotic Spinal Compression Fractures and the Influencing Factors of Complications. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:1599470. [PMID: 34512771 PMCID: PMC8426060 DOI: 10.1155/2021/1599470] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/20/2021] [Indexed: 02/07/2023]
Abstract
Osteoporotic fractures are a common type of fractures in the elderly, among which spinal compression fractures are more common. After the occurrence of fractures, due to the compression and burst of the vertebral body, this will lead to local kyphosis deformity and even affect the balance of the sagittal spine. In the past, conservative treatments were used for osteoporotic spinal compression fractures. Although it can relieve pain symptoms, it can easily lead to complications such as aggravation of osteoporosis and deep vein thrombosis of the lower extremities. At present, percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are the main clinical surgical treatments, both of which are minimally invasive surgery, short operation time, effective pain relief, and rapid postoperative recovery. Although both of them are effective, there is still controversy over the efficacy of both in the treatment of osteoporotic spinal compression fractures. The purpose of this study was to investigate the efficacy of PVP and PKP in the treatment of elderly osteoporotic spinal compression fractures and to analyze the related factors that affect the occurrence of postoperative complications. The results show that both PVP and PKP can effectively improve the pain and dysfunction of elderly patients with osteoporotic spinal compression fracture, restoration of vertebral height, and correct kyphosis, but PKP has better effect and higher safety and is worth promoting. Postoperative complications of patients are related to their age, bone mineral density, use of hormones, and antiosteoporosis treatment.
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12
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Kweh BTS, Lee HQ, Tan T, Rutges J, Marion T, Tew KS, Bhalla V, Menon S, Oner FC, Fisher C, Tee JW. The Role of Spinal Orthoses in Osteoporotic Vertebral Fractures of the Elderly Population (Age 60 Years or Older): Systematic Review. Global Spine J 2021; 11:975-987. [PMID: 32990034 PMCID: PMC8258809 DOI: 10.1177/2192568220948036] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVE Spinal orthoses have been generally used in the management of osteoporotic vertebral fractures in the elderly population with purported positive biomechanical and functional effects. To our knowledge, this is the first systematic review of the literature examining the role of spinal orthoses in osteoporotic elderly patients who sustain low energy trauma vertebral fractures. METHODS A systematic literature review adherent to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted. Methodical searches utilizing MEDLINE, EMBASE, Google Scholar, and Cochrane Databases was performed. RESULTS Of the 2019 articles initially retrieved, 7 published articles (4 randomized controlled trials and 3 prospective cohort studies) satisfied the inclusion criteria. Five studies reported improvement in quantitative measurements of spinal column stability when either a rigid or semirigid orthosis was used, while 1 study was equivocal. The studies also showed the translation of biomechanical benefit into significant functional improvement as manifested by improved postural stability and reduced body sway. Subjective improvement in pain scores and quality of life was also noted with bracing. CONCLUSION The use of spinal orthoses in neurologically intact elderly patients aged 60 years and older with osteoporotic compression vertebral fractures results in improved biomechanical vertebral stability, reduced kyphotic deformity, enhanced postural stability, greater muscular strength and superior functional outcomes.
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Affiliation(s)
- Barry Ting Sheen Kweh
- National Trauma Research Institute, Melbourne, Victoria, Australia,The Alfred Hospital, Melbourne, Victoria, Australia,Barry Ting Sheen Kweh, National Trauma Research Institute, 85-89 Commercial Road, Melbourne, Victoria 3004, Australia.
| | - Hui Qing Lee
- National Trauma Research Institute, Melbourne, Victoria, Australia,The Alfred Hospital, Melbourne, Victoria, Australia
| | - Terence Tan
- National Trauma Research Institute, Melbourne, Victoria, Australia,The Alfred Hospital, Melbourne, Victoria, Australia
| | | | - Travis Marion
- Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | | | | | | | | | - Charles Fisher
- University of British Columbia and Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Jin Wee Tee
- National Trauma Research Institute, Melbourne, Victoria, Australia,The Alfred Hospital, Melbourne, Victoria, Australia
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Wen Z, Mo X, Zhao S, Lin W, Chen Z, Huang Z, Cheung WH, Fu D, Chen B. Comparison of Percutaneous Kyphoplasty and Pedicle Screw Fixation for Treatment of Thoracolumbar Severe Osteoporotic Vertebral Compression Fracture with Kyphosis. World Neurosurg 2021; 152:e589-e596. [PMID: 34129986 DOI: 10.1016/j.wneu.2021.06.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pedicle screw fixation (PSF) has been considered the preferred surgery for the treatment of severe osteoporotic vertebral compression fracture (sOVCF), and sOVCF was traditionally regarded as a relative contraindication to minimally invasive percutaneous kyphoplasty (PKP). Debate has continued regarding the selection of the best surgical method for sOVCF. In the present study, we compared the efficacy and safety between PKP and PSF. METHODS PKP was performed in 376 patients in group 1 and PSF in 121 patients in group 2. The visual analog scale (VAS), Oswestry disability index (ODI), local kyphotic angle, fractured vertebral body height, and complications were evaluated. RESULTS In the immediate postoperative analysis, the mean VAS score for group 1 was 2.4, significantly lower than the VAS score of 4.7 for group 2. The mean ODI score was 44.4% for group 1, lower than the ODI score of 57.1% for group 2. In addition, group 1 had had a significantly better ODI score at 1 year of follow-up. The local kyphotic angle and fractured vertebral body height had recovered better in group 2. In group 1, 113 patients had experienced cement leakage, and 29 patients had undergone PKP for adjacent new vertebral fractures. In group 2, 2 patients had developed wound infections, 4 had developed pneumonia, 2 had developed urinary tract infection, 3 had experienced asymptomatic screw loosening, and 7 had undergone PKP to treat new vertebral fractures and 1 had undergone removal of internal fixation because of back pain. CONCLUSIONS The results of the clinical and radiological evaluations showed that PKP is comparable to PSF for the treatment of sOVCF with kyphosis, with PKP having the advantages of minimal invasion, quick postoperative pain relief, and functional recovery.
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Affiliation(s)
- Zhenxing Wen
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xiaoyi Mo
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Shengli Zhao
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Wei Lin
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Zhipeng Chen
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Zifang Huang
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Wing Hoi Cheung
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Dan Fu
- Department of Orthopedics, Kiang Wu Hospital, Macau, People's Republic of China
| | - Bailing Chen
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.
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Factors Associated With Skeletal Muscle Mass Increase by Rehabilitation in Older Adults With Vertebral Compression Fractures. J Aging Phys Act 2021; 30:12-17. [PMID: 33931573 DOI: 10.1123/japa.2020-0475] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/12/2021] [Accepted: 01/25/2021] [Indexed: 11/18/2022]
Abstract
Age-related sarcopenia and osteoporosis-related fractures are critical health issues. Therefore, this study aimed to assess skeletal muscle mass changes in older patients with vertebral compression fractures undergoing rehabilitation and to evaluate factors associated with muscle increases. This study included 179 patients aged ≥80 years in rehabilitation wards with vertebral compression fractures. Appendicular skeletal muscle index was significantly higher at discharge (5.22 ± 1.04 kg/m2, p < .001) than on admission (5.03 ± 1.00 kg/m2). Multiple logistic regression analysis showed that length of hospital stay was significantly associated with increased skeletal muscle index (odds ratios, 1.020; 95% confidence intervals [1.000, 1.032]), whereas age, sex, body mass index, functional independence measure, protein intake, and exercise therapy duration were not. Participants with vertebral compression fractures aged ≥80 years achieved significantly increased skeletal muscle mass in rehabilitation wards. In addition, length of hospital stay was the factor independently associated with increased skeletal muscle index.
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15
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Jang HD, Kim EH, Lee JC, Choi SW, Kim K, Shin BJ. Current Concepts in the Management of Osteoporotic Vertebral Fractures: A Narrative Review. Asian Spine J 2020; 14:898-909. [PMID: 33373513 PMCID: PMC7788360 DOI: 10.31616/asj.2020.0594] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 11/24/2020] [Indexed: 12/14/2022] Open
Abstract
Vertebral fractures are the most common type of osteoporotic fracture and can increase morbidity and mortality. To date, the guidelines for managing osteoporotic vertebral fractures (OVFs) are limited in quantity and quality, and there is no gold standard treatment for these fractures. Conservative treatment is considered the primary treatment option for OVFs and includes pain relief through shortterm bed rest, analgesics, antiosteoporotic drugs, exercise, and braces. Studies on vertebral augmentation (VA) including vertebroplasty and kyphoplasty have been widely reported, but there is still debate and controversy regarding the effectiveness of VA when compared with conservative treatment, and the routine use of VA for OVF is not supported by current evidence. Although most OVFs heal well, approximately 15%-35% of patients with unstable fractures, chronic intractable back pain, severely collapsed vertebra (leading to neurological deficits and kyphosis), or chronic pseudarthrosis frequently require surgery. Given that there is no single technique for optimizing surgical outcomes in OVFs, tailored surgical techniques are needed. Surgeons need to pay attention to advances in osteoporotic spinal surgery and should be open to novel thoughts and techniques. Prevention and management of osteoporosis is the key element in reducing the risk of subsequent OVFs. Bisphosphonates and teriparatide are mainstay drugs for improving fracture healing in OVF. The effects of bisphosphonates on fracture healing have not been clinically evaluated. The intermittent administration of teriparatide significantly enhanced spinal fusion and fracture healing and reduced mortality risk. Based on the current literature, there is still a lack of standard management strategies for OVF. There is a need for greater efforts through multimodal approaches including conservative treatment, surgery, osteoporosis treatment, and drugs that promote fracture healing to improve the quality of the guidelines.
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Affiliation(s)
- Hae-Dong Jang
- Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Eung-Ha Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jae Chul Lee
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Sung-Woo Choi
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Kyungbum Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Byung-Joon Shin
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
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Abstract
Spinal tumors pose significant treatment challenges for the physicians treating them. Understanding the location of the tumor within the intramedullary, intradural extramedullary, or extradural (epidural) space is not only critical in determining a differential diagnosis but may also provide important information about current and future neurologic deficits. Despite significant advances in the treatment of spinal tumors over the past few decades, these patients may still experience significant symptoms related to the tumor or its treatment, such as pain, weakness, impaired sensation, and bowel and bladder dysfunction. Treatment of spinal tumors should involve a multidisciplinary team of neuro-oncologists, spine surgeons, medical and radiation oncologists, physiatrists, and pain specialists to provide comprehensive oncologic management, while optimizing the patient's functional status and quality of life.
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Affiliation(s)
- Lisa Marie Ruppert
- Rehabilitation Medicine Service, Department of Neurology, Memorial Sloan Kettering Cancer Center; New York, NY.,Department of Rehabilitation Medicine, Weill Cornell Medical Center; New York, NY
| | - Julia Reilly
- Rehabilitation Medicine Service, Department of Neurology, Memorial Sloan Kettering Cancer Center; New York, NY.,Department of Rehabilitation Medicine, Weill Cornell Medical Center; New York, NY
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17
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Coccydynia: Diagnostic and Management Guidance. J Nurse Pract 2020. [DOI: 10.1016/j.nurpra.2020.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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18
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Caitriona C, Mark MG, Elaine H, Claire G, Michelle F, Persson UM, Sherrington C, Blake C. Management of hospitalised osteoporotic vertebral fractures. Arch Osteoporos 2020; 15:14. [PMID: 32078057 DOI: 10.1007/s11657-020-0687-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 01/07/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED Management of hospitalised osteoporotic vertebral fracture patients was explored across all major trauma orthopaedic hospitals in Ireland. Findings, based on a survey of orthopaedic doctors and physiotherapists, indicate a lack of standardised clinical care pathways. This study will inform development of clinical audit mechanisms and health service development for this large and growing fracture population in both Ireland and internationally. PURPOSE To explore the management of hospitalised vertebral fragility fracture (VFF) patients in Ireland. METHODS A cross-sectional survey of orthopaedic doctors (specialist registrar level) and physiotherapists was conducted across all hospitals with major orthopaedic trauma units in Ireland. Data were analysed using descriptive statistics in SPSS (V24). RESULTS Responses were achieved from 100% (n = 16) of the hospitals (42 individual physiotherapists and 47 orthopaedic doctors). Conservative management was usual with both orthopaedic doctors (n = 37, 79%) and physiotherapists (n = 40, 96%) reporting prescription of bracing as common practice despite a lack of underpinning evidence. A majority (87%) of the doctors believed osteoporosis medications should commence prior to discharge from the acute setting, but 68% did not agree that responsibility for coordination and delivery of bone health assessment and fracture risk management rested with them. A majority (72%) of physiotherapists reported an absence or were unsure regarding existence of fracture liaison services. 73% of physiotherapists reported prescribing an inpatient or home (78%) exercise programme, including mobility, strength and balance exercise though detail on dose and adherence remain unknown. Wide variance in referral patterns to multi-disciplinary team (MDT) members existed although 79% of orthopaedic doctors supported an MDT approach. CONCLUSION Clinical care pathways for the hospitalised VFF population lack standardisation in Ireland. Key challenges reported by orthopaedic doctors and physiotherapists relate to pain management, osteoporosis medication prescription, clarity on indications for bracing and a lack of fracture liaison services. Clinical guidelines, defined clinical care pathways and high-quality clinical research trials are required for VFF management.
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Affiliation(s)
- Cunningham Caitriona
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Mc Gowan Mark
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland.,St James's Hospital, James's Street, Dublin 8, Ireland
| | - Hughes Elaine
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland.,Tallaght University Hospital, Tallaght, Dublin 24, Ireland
| | - Gallagher Claire
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland.,City Physio, Chartered Physiotherapy Practice, Vesey Terrace, Lucan, County Dublin, Ireland
| | | | - Ulrik McCarthy Persson
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Cathie Sherrington
- Institute for Musculoskeletal Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Catherine Blake
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland
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Tunér J, Hosseinpour S, Fekrazad R. Photobiomodulation in Temporomandibular Disorders. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2019; 37:826-836. [DOI: 10.1089/photob.2019.4705] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Jan Tunér
- Private Practice, Swedish Laser Medical Society (SLMS), Stockholm, Sweden
| | | | - Reza Fekrazad
- Radiation Sciences Research Center, Laser Research Center in Medical Sciences, AJA University of Medical Sciences, Tehran, Iran
- International Network for Photo Medicine and Photo Dynamic Therapy (INPMPDT), Universal Scientific Education and Research Network (USERN), Tehran, Iran
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20
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Wong SPY, Mok CC. Update on Symptomatic Treatment of Acute Vertebral Compression Fracture. JOURNAL OF CLINICAL RHEUMATOLOGY AND IMMUNOLOGY 2019. [DOI: 10.1142/s2661341719300039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The vertebral column is the most common site of osteoporotic fracture in older individuals and in those using long-term glucocorticoids. Vertebral compression fracture leads to significant morbidities such as acute and chronic pain, spinal deformities and neurological complications, resulting in reduced mobility and quality of life. As a previous vertebral compression fracture is a strong risk factor for further fragility fractures and mortality, it should be treated appropriately. This article reviews the management of osteoporotic vertebral compression fracture and provides evidence-based treatment options.
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Affiliation(s)
| | - Chi Chiu Mok
- Department of Medicine, Tuen Mun Hospital, Hong Kong SAR, China
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Langley PC. A Practice Based Chronic Pain Management Registry (CPMR): Structure and Content of Proposed Patient and Patient/Provider Platforms. Innov Pharm 2019; 10:10.24926/iip.v10i1.1628. [PMID: 34007536 PMCID: PMC7643708 DOI: 10.24926/iip.v10i1.1628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Previous commentaries in the Formulary Evaluation section of INNOVATIONS in Pharmacy have pointed to the difficulties of establishing the credibility of trial-based and modeled claims for therapy interventions. Claims for interventions in the management of chronic pain are no exception. To meet this challenge, the Chronic Pain Management Registry (CPMR) has been designed to provide an evidence base for physician practices and health care decision makers to evaluate the impact of pain management interventions. The purpose of this commentary is to detail the development, structure and content of the CPMR in two versions: (i) a patient response version and (ii) a combined patient/provider response version. The CPMR has a potentially critical role to play in providing a framework for the effective auditing of practice compliance in the prescribing and monitoring of opioids in the management of chronic pain. The CPMR tracks, with on-line input from the patient and the treating physician, the process and outcomes of therapy interventions. These reports cover the overall pain experience of patients as well as pain intensity and functional status by eleven specific pain locations, covering both pharmacological and non-pharmacological interventions. Prior to each practice visit patients complete reports which are entered to the CPMR with a summary transmitted to the physician practice. Over time, these reports track the cumulative response to therapy as well as the perception of the patients as to whether or not the therapy has led to any substantive improvement in activity limitations, symptoms and quality of life. A particular focus of the CPMR is on monitoring and evaluating the experience with, and impact of opioid medications, to include the effectiveness of opioid formulations on reducing pain intensity and improving functional status, including an intensive assessment of the potential for and experience of opioid substance abuse for individual patients. The CPMR can also support monthly reports to the practice to summarize patient throughput, the response to care by target pain patients and profiles of opioid use and abuse. The CPMR can be customized to meet the needs of individual practices.
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Kato T, Inose H, Ichimura S, Tokuhashi Y, Nakamura H, Hoshino M, Togawa D, Hirano T, Haro H, Ohba T, Tsuji T, Sato K, Sasao Y, Takahata M, Otani K, Momoshima S, Tateishi U, Tomita M, Takemasa R, Yuasa M, Hirai T, Yoshii T, Okawa A. Comparison of Rigid and Soft-Brace Treatments for Acute Osteoporotic Vertebral Compression Fracture: A Prospective, Randomized, Multicenter Study. J Clin Med 2019; 8:jcm8020198. [PMID: 30736328 PMCID: PMC6406237 DOI: 10.3390/jcm8020198] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/01/2019] [Accepted: 02/02/2019] [Indexed: 01/10/2023] Open
Abstract
While bracing is the standard conservative treatment for acute osteoporotic compression fracture, the efficacy of different brace treatments has not been extensively studied. We aimed to clarify and compare the preventive effect of the different brace treatments on the deformity of the vertebral body and other clinical results in this patient cohort. This multicenter nationwide prospective randomized study included female patients aged 65–85 years with acute one-level osteoporotic compression fractures. We assigned patients within four weeks of injury to either a rigid-brace treatment or a soft-brace treatment. The main outcome measure was the anterior vertebral body compression percentage at 48 weeks. Secondary outcome measures included scores on the European Quality of Life-5 Dimensions (EQ-5D), visual analog scale (VAS) for lower back pain, and the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ). A total of 141 patients were assigned to the rigid-brace group, whereas 143 patients were assigned to the soft-brace group. There were no statistically significant differences in the primary outcome and secondary outcome measures between groups. In conclusion, among patients with fresh vertebral compression fractures, the 12-week rigid-brace treatment did not result in a statistically greater prevention of spinal deformity, better quality of life, or lesser back pain than soft-brace.
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Affiliation(s)
- Tsuyoshi Kato
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, Tokyo 108-0075, Japan.
- Department of Orthopaedics, Ome Municipal General Hospital, Tokyo 198-0042, Japan.
| | - Hiroyuki Inose
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, Tokyo 108-0075, Japan.
| | - Shoichi Ichimura
- Department of Orthopaedics, Kyorin University, Tokyo 181-8611, Japan.
| | - Yasuaki Tokuhashi
- Department of Orthopaedic Surgery, Nihon University, Tokyo 173-8610, Japan.
| | - Hiroaki Nakamura
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka City University, Osaka 545-8585, Japan.
| | - Masatoshi Hoshino
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka City University, Osaka 545-8585, Japan.
| | - Daisuke Togawa
- Department of Orthopaedic Surgery, Hamamatsu University of Medicine, Shizuoka 431-3192, Japan.
| | - Toru Hirano
- Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, Niigata 951-8520, Japan.
| | - Hirotaka Haro
- Department of Orthopaedic Surgery, University of Yamanashi, Yamanashi 409-3898, Japan.
| | - Tetsuro Ohba
- Department of Orthopaedic Surgery, University of Yamanashi, Yamanashi 409-3898, Japan.
| | - Takashi Tsuji
- Department of Orthopaedic Surgery, Kitasato University Kitasato Institute Hospital, Tokyo 108-8642, Japan.
| | - Kimiaki Sato
- Department of Orthopaedic Surgery, Kurume University School of Medicine, Kurume University, Fukuoka 830-0011, Japan.
| | - Yutaka Sasao
- Department of Orthopaedic Surgery, Graduate School, School of Medicine, St. Marianna University, Kanagawa 216-8511, Japan.
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Hokkaido 060-8638, Japan.
| | - Koji Otani
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan.
| | - Suketaka Momoshima
- Department of Diagnostic Radiology, Center for Preventive Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan.
| | - Ukihide Tateishi
- Department of Diagnostic Radiology, Medical Hospital, Tokyo Medical and Dental University, Tokyo 113-8510, Japan.
| | - Makoto Tomita
- Clinical Research Center, Tokyo Medical and Dental University, Tokyo 113-8510, Japan.
| | - Ryuichi Takemasa
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi 783-8505, Japan.
| | - Masato Yuasa
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, Tokyo 108-0075, Japan.
| | - Takashi Hirai
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, Tokyo 108-0075, Japan.
| | - Toshitaka Yoshii
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, Tokyo 108-0075, Japan.
| | - Atsushi Okawa
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, Tokyo 108-0075, Japan.
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Yuen J, Selbi W, Lee L, Germon T. Usefulness of antero-posterior radiograph and variability of management in non-major thoracolumbar injuries: a single centre pilot study and review of literature. Chin Neurosurg J 2018; 4:29. [PMID: 32922890 PMCID: PMC7398401 DOI: 10.1186/s41016-018-0136-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/06/2018] [Indexed: 11/30/2022] Open
Abstract
Background Most adult trauma protocols suggest that where there has been a dangerous mechanism of injury or the patient exhibits abnormal physiology, CT scan is the primary radiological investigation. Other patients who may have suffered thoraco-lumbar (T-L) trauma initially have antero-posterior (AP) and lateral plain X-rays performed. Our clinical experience suggests AP views are not particularly useful in the management of these relatively low-velocity injuries. This is the first study intended to determine the contribution made by AP X-rays in these cases. Methods Adults with a history of T-L trauma referred to our tertiary spinal service over 20 weeks were reviewed. Those with a CT scan performed prior to X-rays were excluded. Four spine surgeons and four neuroradiologists were independently shown lateral X-rays along with the clinical details and asked to provide a management plan. Then they were shown the AP X-rays and asked if they would like to change their advice. Results Fifty-two patients were identified. Thirty-four sets of supine and 40 sets of erect X-rays were included (four people only had lateral X-rays performed), yielding 1152 film views. Average patient age was 58.3 years with 30 (58%) males. Forty-five (87%) were AO type A (compression-type) fractures. Seven (13%) had been erroneously referred with a diagnosis of acute fracture, which on review was not considered to be the case. Fifty-four percent of fractures were between T11 and L2. Forty-six percent appeared osteoporotic. In no instance did evaluation of the AP X-ray change the management plan which had been suggested following the evaluation of the lateral X-ray alone. However, there was significant variation in advice on further management between consultants. Conclusions Our results suggest AP X-rays do not contribute to the management of low-velocity thoraco-lumbar traumas. Larger studies are required to support these findings, but there appears to be a potential to reduce both cost and radiation exposure. More importantly, it demonstrates there is large variability in the management of such patients due to the lack of evidence-based protocols.
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Combination Therapy of Conventional and Korean Medicine for Multiple Vertebral Compression Fractures Associated with Postpartum Osteoporosis: A Case Report. JOURNAL OF ACUPUNCTURE RESEARCH 2018. [DOI: 10.13045/jar.2018.00241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Lewandrowski KU, Ostergren M, de Carvalho PST. Intradiscal Expandable Balloon Distraction During Transforaminal Decompression for Lumbar Foraminal and Lateral Recess Stenosis. Surg Innov 2018; 25:165-173. [PMID: 29375000 DOI: 10.1177/1553350617753243] [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: 12/13/2022]
Abstract
Advanced videoendoscopic equipment (such as motorized drills, chisels, and rongeurs) facilitates the use of modern decompression tools through the inner working channel of the spinal endoscope using the transforaminal approach. Postoperative dysesthetic leg pain, however, is common because of irritation of the dorsal root ganglion. This article presents a novel surgical technique employing an expandable balloon placed into the hollow intervertebral space in patients without any functional disc tissue to distract the stenotic motion segment. This approach improves visualization, facilitates removal of bone during the decompression, and minimizes intraoperative manipulation of the exiting and traversing nerve roots. In a study of 52 targeted patients with symptomatic spinal stenosis at 60 levels (L2/3-1, L3/4-9, L4/5-28, and L5/S1-22) due to advanced degenerative changes of the intervertebral disc and facet joint complex contributing to both foraminal and lateral recess stenosis, only 2 of the 52 patients complained of postoperative dysesthetic leg pain (3.85%) after undergoing this novel procedure. At the final 2-year follow-up, 80.9% of patients showed Excellent and Good outcomes according to modified Macnab criteria.
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Affiliation(s)
- Kai-Uwe Lewandrowski
- 1 Center for Advanced Spine Care of Southern Arizona, Tucson, AZ, USA.,2 Surgical Institute of Tucson, Tucson, AZ, USA.,3 Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
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