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Oitment C, Thornley P, Koziarz F, Jentzsch T, Bhanot K. A Review of Strategies to Improve Biomechanical Fixation in the Cervical Spine. Global Spine J 2022; 12:1596-1610. [PMID: 35020520 PMCID: PMC9393983 DOI: 10.1177/21925682211063855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES Review the surgical techniques and construct options aimed at improving the biomechanical strength of cervical constructs. METHODS A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search of the MEDLINE, Embase, and Cochrane Library databases was performed to identify all studies examining biomechanical strategies utilized in the osteoporotic cervical spine. Screening was performed in duplicate for all stages of the review process. RESULTS An initial search returned 3887 articles. After deletion of duplications and review of abstracts and full text, 39 articles met inclusion criteria. Overall, the surgical techniques reviewed aimed at obtaining rigid fixation in the setting of poor bone quality, or dispersing the forces at the bone-implant interface. We identified 6 key techniques to improve biomechanical fixation. These include bicortical fixation, appropriate screw selection (size and trajectory), PMMA augmentation, load sharing techniques, consideration of ancillary fixation around the occipitocervical junction, and supplementing the construct with post-operative collar or halo. CONCLUSION The summation of the literature highlights a framework of modalities available to surgeons to improve biomechanical fixation in the cervical spine. While these may improve construct strength in the setting of osteoporosis, there is a paucity of evidence available to make recommendations in this patient population.
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Affiliation(s)
- Colby Oitment
- Division of Orthopedic Surgery, Hamilton General Hospital, McMaster University, Hamilton, ON, Canada,Dr Colby Oitment, MD, McMaster University, Department of Orthopedic Surgery, Hamilton General HospitalAffiliation, McMaster University, 1200 Main St West, Hamilton, ON L8S 4L8, Canada.
| | - Patrick Thornley
- Division of Orthopedic Surgery, Hamilton General Hospital, McMaster University, Hamilton, ON, Canada
| | - Frank Koziarz
- Department of Graduate Studies, Health Research Methodology (HRM), and Epidemiology, McMaster University, Hamilton, ON, Canada
| | - Thorsten Jentzsch
- Division of Orthopaedic Surgery, St Michael’s Hospital, Toronto, ON, Canada,Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Kunal Bhanot
- Division of Orthopaedic Surgery, St Michael’s Hospital, Toronto, ON, Canada,Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
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Shim J, Kim K, Kim KG, Choi U, Kyung JW, Sohn S, Lim SH, Choi H, Ahn T, Choi HJ, Shin D, Han I. Safety and efficacy of Wharton's jelly-derived mesenchymal stem cells with teriparatide for osteoporotic vertebral fractures: A phase I/IIa study. Stem Cells Transl Med 2021; 10:554-567. [PMID: 33326694 PMCID: PMC7980202 DOI: 10.1002/sctm.20-0308] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/28/2020] [Accepted: 11/17/2020] [Indexed: 12/20/2022] Open
Abstract
Osteoporotic vertebral compression fractures (OVCFs) are serious health problems. We conducted a randomized, open-label, phase I/IIa study to determine the feasibility, safety, and effectiveness of Wharton's jelly-derived mesenchymal stem cells (WJ-MSCs) and teriparatide (parathyroid hormone 1-34) in OVCFs. Twenty subjects with recent OVCFs were randomized to teriparatide (20 μg/day, daily subcutaneous injection for 6 months) treatment alone or combined treatment of WJ-MSCs (intramedullary [4 × 107 cells] injection and intravenous [2 × 108 cells] injection after 1 week) and teriparatide (20 μg/day, daily subcutaneous injection for 6 months). Fourteen subjects (teriparatide alone, n = 7; combined treatment, n = 7) completed follow-up assessment (visual analog scale [VAS], Oswestry Disability Index [ODI], Short Form-36 [SF-36], bone mineral density [BMD], bone turnover measured by osteocalcin and C-terminal telopeptide of type 1 collagen, dual-energy x-ray absorptiometry [DXA], computed tomography [CT]). Our results show that (a) combined treatment with WJ-MSCs and teriparatide is feasible and tolerable for the patients with OVCFs; (b) the mean VAS, ODI, and SF-36 scores significantly improved in the combined treatment group; (c) the level of bone turnover markers were not significantly different between the two groups; (d) BMD T-scores of spine and hip by DXA increased in both control and experimental groups without a statistical difference; and (e) baseline spine CT images and follow-up CT images at 6 and 12 months showed better microarchitecture in the combined treatment group. Our results indicate that combined treatment of WJ-MSCs and teriparatide is feasible and tolerable and has a clinical benefit for fracture healing by promoting bone architecture. Clinical trial registration: https://nedrug.mfds.go.kr/, MFDS: 201600282-30937.
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Affiliation(s)
- JeongHyun Shim
- Department of NeurosurgeryShim Jeong HospitalSeoulSouth Korea
| | - Kyoung‐Tae Kim
- Department of Neurosurgery, School of MedicineKyungpook National UniversityDaeguSouth Korea
- Department of NeurosurgeryKyungpook National University HospitalDaeguSouth Korea
| | - Kwang Gi Kim
- Department of Biomedical Engineering, College of MedicineGachon UniversitySeongnam‐siSouth Korea
- Department of Health Sciences and Technology, Gachon Advanced Institute for Health Sciences and Technology (GAIHST)Gachon UniversitySeongnam‐siSouth Korea
| | - Un‐Yong Choi
- Department of NeurosurgeryCHA University School of Medicine, CHA Bundang Medical CenterSeongnam‐siSouth Korea
| | - Jae Won Kyung
- Department of NeurosurgeryCHA University School of Medicine, CHA Bundang Medical CenterSeongnam‐siSouth Korea
| | - Seil Sohn
- Department of NeurosurgeryCHA University School of Medicine, CHA Bundang Medical CenterSeongnam‐siSouth Korea
| | - Sang Heon Lim
- Department of Biomedical Engineering, College of MedicineGachon UniversitySeongnam‐siSouth Korea
| | - Hyemin Choi
- Department of NeurosurgeryCHA University School of Medicine, CHA Bundang Medical CenterSeongnam‐siSouth Korea
| | - Tae‐Keun Ahn
- Department of Orthopedic SurgeryCHA University School of Medicine, CHA Bundang Medical CenterSeongnam‐siSouth Korea
| | - Hye Jeong Choi
- Department of RadiologyCHA University School of Medicine, CHA Bundang Medical CenterSeongnam‐siSouth Korea
| | - Dong‐Eun Shin
- Department of Orthopedic SurgeryCHA University School of Medicine, CHA Bundang Medical CenterSeongnam‐siSouth Korea
| | - Inbo Han
- Department of NeurosurgeryCHA University School of Medicine, CHA Bundang Medical CenterSeongnam‐siSouth Korea
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Ahn TK, Kim KT, Joshi HP, Park KH, Kyung JW, Choi UY, Sohn S, Sheen SH, Shin DE, Lee SH, Han IB. Therapeutic Potential of Tauroursodeoxycholic Acid for the Treatment of Osteoporosis. Int J Mol Sci 2020; 21:ijms21124274. [PMID: 32560070 PMCID: PMC7349164 DOI: 10.3390/ijms21124274] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/14/2020] [Accepted: 06/15/2020] [Indexed: 02/07/2023] Open
Abstract
Tauroursodeoxycholic acid (TUDCA) is a US FDA-approved hydrophilic bile acid for the treatment of chronic cholestatic liver disease. In the present study, we investigate the effects of TUDCA on the proliferation and differentiation of osteoblasts and its therapeutic effect on a mice model of osteoporosis. Following treatment with different concentrations of TUDCA, cell viability, differentiation, and mineralization were measured. Three-month-old female C57BL/6 mice were randomly divided into three groups (n = 8 mice per group): (i) normal mice as the control group, (ii) ovariectomy (OVX) group (receiving phosphate-buffered saline (PBS) treatment every other day for 4 weeks), and (iii) OVX group with TUDCA (receiving TUDCA treatment every other day for 4 weeks starting 6 weeks after OVX). At 11 weeks post-surgery, serum levels of procollagen type I N-terminal propeptides (PINP) and type I collagen crosslinked C-telopeptides (CTX) were measured, and all mice were sacrificed to examine the distal femur by micro-computed tomography (CT) scans and histology. TUDCA (100 nM, 1 µM) significantly increased the proliferation and viability of osteoblasts and osteoblast differentiation and mineralization when used in vitro. Furthermore, TUDCA neutralized the detrimental effects of methylprednisolone (methylprednisolone-induced osteoblast apoptosis). In the TUDCA treatment group the PINP level was higher and the CTX level was lower, but these levels were not significantly different compared to the PBS treatment group. Micro-CT and histology showed that the TUDCA treatment group preserved more trabecular structures in the distal femur compared to the PBS treatment group. In addition, the TUDCA treatment group increased the percentage bone volume with respect to the total bone volume, bone mineral density, and mice distal femur trabeculae compared with the PBS treatment group. Taken together, our findings suggest that TUDCA may provide a favorable effect on bones and could be used for the prevention and treatment of osteoporosis.
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Affiliation(s)
- Tae-Keun Ahn
- Department of Orthopedic Surgery, CHA Bundang Medical Center, School of Medicine CHA University, Seongnam-si, Gyeonggi-do 13496, Korea; (T.-K.A.); (D.-E.S.)
| | - Kyoung-Tae Kim
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu 41944, Korea;
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu 41944, Korea
| | - Hari Prasad Joshi
- Department of Neurosurgery, CHA University School of medicine, CHA Bundang Medical Center, Seongnam-si, Gyeonggi-do 13496, Korea; (H.P.J.); (J.W.K.); (U.-Y.C.); (S.S.); (S.-H.S.)
| | - Kwang Hwan Park
- Department of Orthopedic Surgery, Yonsei University, Severance Hospital, Seoul 03772, Korea;
| | - Jae Won Kyung
- Department of Neurosurgery, CHA University School of medicine, CHA Bundang Medical Center, Seongnam-si, Gyeonggi-do 13496, Korea; (H.P.J.); (J.W.K.); (U.-Y.C.); (S.S.); (S.-H.S.)
| | - Un-Yong Choi
- Department of Neurosurgery, CHA University School of medicine, CHA Bundang Medical Center, Seongnam-si, Gyeonggi-do 13496, Korea; (H.P.J.); (J.W.K.); (U.-Y.C.); (S.S.); (S.-H.S.)
| | - Seil Sohn
- Department of Neurosurgery, CHA University School of medicine, CHA Bundang Medical Center, Seongnam-si, Gyeonggi-do 13496, Korea; (H.P.J.); (J.W.K.); (U.-Y.C.); (S.S.); (S.-H.S.)
| | - Seung-Hun Sheen
- Department of Neurosurgery, CHA University School of medicine, CHA Bundang Medical Center, Seongnam-si, Gyeonggi-do 13496, Korea; (H.P.J.); (J.W.K.); (U.-Y.C.); (S.S.); (S.-H.S.)
| | - Dong-Eun Shin
- Department of Orthopedic Surgery, CHA Bundang Medical Center, School of Medicine CHA University, Seongnam-si, Gyeonggi-do 13496, Korea; (T.-K.A.); (D.-E.S.)
| | - Soo-Hong Lee
- Department of Medical Biotechnology, Dongguk University-Seoul, Seoul 04620, Korea
- Correspondence: (S.-H.L.); (I.-B.H.); Tel.: +82-2-2260-3114 (S.-H.L.); +82-31-780-1924 (I.-B.H.); Fax: +82-2-2277-1274 (S.-H.L.); +82-31-780-5269 (I.-B.H.)
| | - In-Bo Han
- Department of Neurosurgery, CHA University School of medicine, CHA Bundang Medical Center, Seongnam-si, Gyeonggi-do 13496, Korea; (H.P.J.); (J.W.K.); (U.-Y.C.); (S.S.); (S.-H.S.)
- Correspondence: (S.-H.L.); (I.-B.H.); Tel.: +82-2-2260-3114 (S.-H.L.); +82-31-780-1924 (I.-B.H.); Fax: +82-2-2277-1274 (S.-H.L.); +82-31-780-5269 (I.-B.H.)
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