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Kitzen J, Jacobs E, Buckley R. Should a spinal orthosis be used for thoracolumbar fractures that are minimally displaced and stable? Injury 2024; 55:111752. [PMID: 39088926 DOI: 10.1016/j.injury.2024.111752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2024]
Affiliation(s)
- Joep Kitzen
- Dept. of Orthopedic Surgery, Maasstad Medical Center, P.O. Box 9100, Rotterdam, 3001 AC, Netherlands
| | - Eva Jacobs
- Masstricht University Medical Center, P.O. Box 5800, 6202 AZ Masstricht, Netherlands
| | - Richard Buckley
- University of Calgary, 0490 McCaig Tower, Foothills Hospital, 3134 Hospital Drive NW Calgary, Alberta, T2N 5A1, Canada.
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Veiskarami M, Aboutorabi A, Mohammadi R, Gholami M, Khamesi E. The effect of elderly-specific spinal orthoses on muscle function and kyphosis angle in elderly subjects: systematic review and meta-analysis. Disabil Rehabil 2024:1-15. [PMID: 38989896 DOI: 10.1080/09638288.2024.2374495] [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: 06/21/2023] [Accepted: 06/24/2024] [Indexed: 07/12/2024]
Abstract
PURPOSE Age-related postural hyper-kyphosis is an exaggerated anterior curvature of the thoracic spine, that impairs balance and increases the risk of falls and fractures in elderly subjects. Our objectives are to review the effect of elderly-specific spinal orthoses on muscle function and kyphosis angle in this subjects. MATERIALS AND METHODS We searched PubMed, Scopus, ISI web of Knowledge, ProQuest and Cochrane library to identify relevant studies that assessed efficacy of spinal orthoses on muscle function and kyphosis angle of elderly subjects with elderly with hyper-kyphosis. Quality assessment was implemented using the Downs and Black scale. RESULTS Results for 709 individuals were described in 18 articles which 12 studies involved RCT. There was significant difference for kyphosis angle after use of orthosis of 148 participants (SMD: -3.79, 95% CI -7.02 to -0.56, p < 0.01). Except one study, all of studies showed significantly increased on the back muscle strength when the participants wore the spinal orthosis and this effect was significantly better in long-term follow up (MD: 84.73; 95% CIs, 23.24 to 146.23; p < 0.01). In the outcome of pain, the efficacy brought by orthosis was large and significant (SMD: -1.66; 95% CIs, -2.39 to 0.94; p < 0.01). CONCLUSIONS Spinal orthosis may be an effective treatment for elderly hyper-kyphosis. However, the small number, and heterogeneity of the included studies, indicate that higher-quality studies should be conducted to verify the effectiveness and orthosis in hyper-kyphosis.
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Affiliation(s)
- Masoumeh Veiskarami
- Department of Physiotherapy, School of Allied Medical Sciences, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Atefeh Aboutorabi
- Department of Orthotics and Prosthetics, School of Rehabilitation, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Rasool Mohammadi
- Social Determinants of Health Research Center, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mehrdad Gholami
- Department of Medical Physics, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Ebrahim Khamesi
- Department of Neurosurgery, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
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Nakatoh S, Fujimori K, Ishii S, Tamaki J, Okimoto N, Ogawa S, Iki M. Association between pharmacotherapy and secondary vertebral fracture managed with a brace in a real-world setting: A nationwide database study in Japan. Geriatr Gerontol Int 2024; 24:390-397. [PMID: 38475987 DOI: 10.1111/ggi.14853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 02/09/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024]
Abstract
AIM This retrospective cohort study assessed the association between the incidence of secondary vertebral fracture managed with a brace (SVF) and pharmacotherapy. METHODS The association between the incidence of SVF and the presence, type, and medication possession ratio (MPR) of pharmacotherapy was investigated using medical insurance data acquired from the National Database of Health Insurance Claims and Specific Health Checkups of Japan. RESULTS The data of female patients (n = 637 303) were analyzed. The 2-year incidence of SVF was 73.5 per 10 000 patients (n = 4687). Approximately 0.73% of patients without medications and 0.74% with medications had SVF. Patients taking bisphosphonates (0.87), denosumab (0.77), and selective estrogen receptor modulators (0.88) had significantly lower standardized incidence ratios (SIRs) than patients not taking medications after the occurrence of primary fracture; meanwhile, patients taking parathyroid hormone medications had considerably higher SIRs than those not taking medications. The non-SVF group (59.1%) had a significantly higher mean MPR than the SVF group (55.5%). Patients taking denosumab in the non-SVF group (68.2%) had the highest mean MPR. The proportion of patients taking denosumab with an MPR of ≥80% in the non-SVF group was significantly higher than that in the SVF group. CONCLUSION Patients taking medications were at a lower risk of developing SVF than those not taking medications. Although this study did not compare the medications' SVF prevention effects, patients taking denosumab had a 0.77 SIR of SVF in Japan. The effect of pharmacotherapy on SVF prevention might be affected by the MPR of each medication. Geriatr Gerontol Int 2024; 24: 390-397.
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Affiliation(s)
- Shinichi Nakatoh
- Department of Orthopedic Surgery, Asahi General Hospital, Toyama, Japan
- Department of Public Health, National Database Japan-Osteoporosis Management Study Group, Kindai University Faculty of Medicine, Osaka, Japan
| | - Kenji Fujimori
- Department of Public Health, National Database Japan-Osteoporosis Management Study Group, Kindai University Faculty of Medicine, Osaka, Japan
- Department of Health Administration and Policy, Tohoku University School of Medicine, Sendai, Japan
| | - Shigeyuki Ishii
- Department of Public Health, National Database Japan-Osteoporosis Management Study Group, Kindai University Faculty of Medicine, Osaka, Japan
- Department of Regulatory Science, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Junko Tamaki
- Department of Public Health, National Database Japan-Osteoporosis Management Study Group, Kindai University Faculty of Medicine, Osaka, Japan
- Department of Hygiene & Public Health, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Nobukazu Okimoto
- Department of Public Health, National Database Japan-Osteoporosis Management Study Group, Kindai University Faculty of Medicine, Osaka, Japan
- Okimoto Clinic, Hiroshima, Japan
| | - Sumito Ogawa
- Department of Public Health, National Database Japan-Osteoporosis Management Study Group, Kindai University Faculty of Medicine, Osaka, Japan
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masayuki Iki
- Department of Public Health, National Database Japan-Osteoporosis Management Study Group, Kindai University Faculty of Medicine, Osaka, Japan
- Department of Public Health, Kindai University Faculty of Medicine, Osaka, Japan
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Huysmans SM, Senden R, Jacobs E, Willems PJ, Marcellis RG, Boogaart MVD, Meijer K, Willems PC. Gait alterations in patients with adult spinal deformity. NORTH AMERICAN SPINE SOCIETY JOURNAL 2024; 17:100306. [PMID: 38293567 PMCID: PMC10825775 DOI: 10.1016/j.xnsj.2023.100306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/18/2023] [Accepted: 12/26/2023] [Indexed: 02/01/2024]
Abstract
Background Adult spinal deformity patients (ASD) experience altered spinal alignment affecting spatiotemporal parameters and joint kinematics. Differences in spinal deformity between patients with symptomatic idiopathic scoliosis (ID-ASD) and patients with "de novo" scoliosis (DN-ASD) may affect gait characteristics differently. This study aims to compare gait characteristics between ID-ASD, DN-ASD, and asymptomatic healthy matched controls. Methods In this observational case-control study, ID-ASD (n = 24) and DN-ASD (n = 26) patients visiting the out-patient spine clinic and scheduled for long-segment spinal fusion were included. Patients were matched, based on age, gender, leg length and BMI, with asymptomatic healthy controls. Gait was measured at comfortable walking speed on an instrumented treadmill with 3D motion capture system. Trunk, pelvic and lower extremities range of motion (ROM) and spatiotemporal parameters (SPT) are presented as median (first and thirds quartile). Independent t-test or Mann-Whitney U test was used to compare ID-ASD, DN-ASD and controls. Statistical Parametric Mapping (independent t-test) was used to compare 3D joint kinematics. Results DN-ASD patients walk with increased anterior trunk tilt during the whole gait cycle compared with ID-ASD patients and controls. ID-ASD walk with decreased trunk lateroflexion compared with DN-ASD and controls. DN-ASD showed decreased pelvic obliquity and -rotation, increased knee flexion, and decreased ankle plantar flexion. ID-ASD and DN-ASD displayed decreased trunk, pelvic and lower extremity ROM compared with controls, but increased pelvic tilt ROM. ID-ASD patients walked with comparable SPT to controls, whereas DN-ASD patients walked significantly slower with corresponding changes in SPT and wider steps. Conclusions DN-ASD patients exhibit distinct alterations in SPT and kinematic gait characteristics compared with ID-ASD and controls. These alterations seem to be predominantly influenced by sagittal spinal malalignment and kinematic findings in ASD patients should not be generalized as such, but always be interpreted with consideration for the nature of the ASD.
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Affiliation(s)
- Stephanie M.D. Huysmans
- Department of Orthopedic Surgery and Research School CAPHRI (Care and Public Health Research Institute), Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands
| | - Rachel Senden
- Department of Physiotherapy, Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands
| | - Eva Jacobs
- Department of Orthopedic Surgery and Research School CAPHRI (Care and Public Health Research Institute), Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands
| | - Paul J.B. Willems
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism (MUMC+), the Netherlands
| | - Rik G.J. Marcellis
- Department of Physiotherapy, Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands
| | - Mark van den Boogaart
- Department of Orthopedic Surgery and Research School CAPHRI (Care and Public Health Research Institute), Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands
| | - Kenneth Meijer
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism (MUMC+), the Netherlands
| | - Paul C. Willems
- Department of Orthopedic Surgery and Research School CAPHRI (Care and Public Health Research Institute), Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands
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Sawada R, Shinoda Y, Ohki T, Ishibashi Y, Kobayashi H, Matsubayashi Y, Tanaka S, Haga N. End-of-life walking ability in cancer patients with spinal metastases. Jpn J Clin Oncol 2024; 54:81-88. [PMID: 37815145 DOI: 10.1093/jjco/hyad138] [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: 07/20/2023] [Accepted: 09/21/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Even terminal cancer patients desire to walk to the toilet by themselves until the very last day. This study aimed to describe the walking ability of patients with spinal metastases at the end-of-life stage and identify the factors affecting this ability. METHODS Among 527 patients who first visited our multidisciplinary team for bone metastasis between 2013 and 2016, 56 patients who had spinal metastases with a Spinal Instability Neoplastic Score ≥7 and died during follow-up were included. We collected general clinical data, performance status, Frankel classification, epidural spinal cord compression scale and Spinal Instability Neoplastic Score at the first consultation. Patients' last day of walking and date of death were also examined. Univariate analyses (chi-squared tests) were performed to identify the factors that impacted walking ability 30 and 14 days before patients' death. RESULTS A total of 56 patients were extracted, and 57.1% (32/56) and 32.7% (16/49) of patients were ambulatory 30 and 14 days before death, respectively. Their performance status (P = 0.0007), Frankel grade (P = 0.012) and epidural spinal cord compression grade (P = 0.006) at the first examination, and administration of bone modifying agents during follow-up period (P = 0.029) were significantly related to walking ability 30 days before death. Among ambulatory patients 30 days before death, those with Spinal Instability Neoplastic Score ≥10 (P = 0.005), especially with high scores of collapse (P = 0.002) and alignment (P = 0.002), were less likely to walk 14 days before death. The walking period in the last month of their life was significantly longer in patients with total Spinal Instability Neoplastic Score 7-9 (P = 0.009) and in patients without collapse (P = 0.040) by the Wilcoxon test. CONCLUSION The progression of spinal metastasis, especially neurological deficit, at the initial consultation were associated with walking ability 30 days before death, and spinal stability might be crucial for preserving walking ability during the last month. Early diagnosis and implementation of appropriate bone management might be important for the end-of-life walking ability.
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Affiliation(s)
- Ryoko Sawada
- Department of Rehabilitation Medicine, The University of Tokyo Hospital, Tokyo, Japan
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yusuke Shinoda
- Department of Rehabilitation Medicine, The University of Tokyo Hospital, Tokyo, Japan
- Department of Rehabilitation Medicine, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Takahiro Ohki
- Department of Rehabilitation Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Yuki Ishibashi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Kobayashi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshitaka Matsubayashi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobuhiko Haga
- Department of Rehabilitation Medicine, The University of Tokyo Hospital, Tokyo, Japan
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Varma S, Tsang K, Peck G. Thoraco-lumbar-sacral orthoses in older people - A narrative literature review. Injury 2023; 54:110986. [PMID: 37579687 DOI: 10.1016/j.injury.2023.110986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 06/20/2023] [Accepted: 08/05/2023] [Indexed: 08/16/2023]
Abstract
Fractures in the thoracolumbar region have a bimodal distribution, with an increasing number of older people presenting with acute vertebral fractures after atraumatic or low energy mechanisms of injury. In the absence of neurological compromise and significant vertebral instability, thoracolumbar fractures are often managed conservatively and bracing is widely recommended. However, in older cohorts, bracing is often ill fitting and poorly tolerated with non-compliance leading to prolonged immobilization. Systematic reviews and meta-analyses have challenged the motive of bracing, but as evidence quality is low, the role of exploratory analysis has been limited. This descriptive review summarises and examines the current evidence that underpins the use of spinal orthoses, specific to older patients, in an effort to streamline its judicious use in clinical practice and identify scope to direct further research.
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Affiliation(s)
- Surabhi Varma
- Major Trauma Center, St. Mary's hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, U.K
| | - Kevin Tsang
- Major Trauma Center, St. Mary's hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, U.K
| | - George Peck
- Major Trauma Center, St. Mary's hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, U.K.
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Pieroh P, Spiegl UJA, Völker A, Märdian S, von der Höh NH, Osterhoff G, Heyde CE. Spinal Orthoses in the Treatment of Osteoporotic Thoracolumbar Vertebral Fractures in the Elderly: A Systematic Review With Quantitative Quality Assessment. Global Spine J 2023; 13:59S-72S. [PMID: 37084346 PMCID: PMC10177312 DOI: 10.1177/21925682221130048] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES Spinal orthoses are frequently used to non-operatively treat osteoporotic vertebral fractures (OVF), despite the available evidence is rare. Previously systematic reviews were carried out, presenting controversial recommendations. The present study aimed to systematic review the recent and current literature on available evidence for the use of orthoses in OVF. METHODS A systematic review was conducted using PubMed, Medline, EMBASE and CENTRAL databases. Identified articles including previous systematic reviews were screened and selected by three authors. The results of retrieved articles were presented in a narrative form, quality assessment was performed by two authors using scores according to the study type. RESULTS Thirteen studies (n = 5 randomized controlled trials, n = 3 non- randomized controlled trials and n = 5 prospective studies without control group) and eight systematic reviews were analyzed. Studies without comparison group reported improvements in pain, function and quality of life during the follow-up. Studies comparing different types of orthoses favor non-rigid orthoses. In comparison to patients not wearing an orthosis three studies were unable to detect beneficial effects and two studies reported about a significant improvement using an orthosis. In the obtained quality assessment, three studies yielded good to excellent results. Previous reviews detected the low evidence for spinal orthoses but recommended them. CONCLUSION Based on the study quality and the affection of included studies in previous systematic reviews a general recommendation for the use of a spinal orthosis when treating OVF is not possible. Currently, no superiority for spinal orthoses in OVF treatment was found.
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Affiliation(s)
- Philipp Pieroh
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Leipzig, Germany
| | - Ulrich J A Spiegl
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Leipzig, Germany
| | - Anna Völker
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Leipzig, Germany
| | - Sven Märdian
- Centre for Musculoskeletal Surgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Nicolas H von der Höh
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Leipzig, Germany
| | - Georg Osterhoff
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Leipzig, Germany
| | - Christoph-E Heyde
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Leipzig, Germany
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Nourian SMA, Mozafari S, Farzinnia S, Saeidi M, Bahrami M. Evaluation of postoperative bracing on unstable traumatic lumbar fractures after pedicle screw fixation. INTERNATIONAL JOURNAL OF BURNS AND TRAUMA 2022; 12:168-174. [PMID: 36160671 PMCID: PMC9490152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 07/18/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Fractures of the thoracolumbar and lumbar regions are very important. There is still debate on the use of braces after surgical operations. The current study aims to evaluate and report the outcomes of postoperative bracing following pedicle screw fixation in patients with thoracolumbar and lumbar fractures in Iran. METHODS This is a clinical trial performed from 2012 to 2022 on 144 patients diagnosed with lumbar and thoracolumbar fractures. Demographic data of patients including age and gender were obtained. Patients' fractures were classified as Frankel (A to E) in terms of clinical and neurological manifestations. Patient's quality of life (QOL) was measured using the 36-Item Short Form Survey (SF-36). All patients underwent surgical fixation of the fracture. Patients were then randomized into two groups using Random Allocation Software. The first group received post-operation bracing and the second group did not receive braces. Thus, radiographic and clinical evaluation data of 1, 3, and 12 months after surgery were used to determine bone fusion. RESULTS The most common mechanisms of trauma included falling from a height in 99 patients (68.7%), vehicle accidents in 39 patients (27.1%), and the most common fracture sites were the L1 vertebrae in 73 patients (50.7%), 111 patients (77.1%) had burst fractures, and 105 patients (72.3%) had no neurological defects (Frankel E). At the beginning of the study, there were no significant differences between the two groups regarding the mentioned data, patients' QOL, and pain severity. All patients (100%) had early mobilization. Most patients (85.4%) did not report persistent back pain 12 months after surgeries. 90.2% returned to their daily activities and all patients (100%) had full fusion based on radiologic data. The QOL and pain severity of patients improved significantly compared to baseline (P < 0.001 for both). CONCLUSION The use or non-use of braces did not affect the treatment results. As a result, patients who have received pedicle screw fixation for unstable thoracolumbar fractures do not require braces in the postoperative period.
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Affiliation(s)
| | - Safura Mozafari
- Department of Emergency Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | - Saeed Farzinnia
- Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | - Milad Saeidi
- School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | - Mahshid Bahrami
- Assistant Professor, Department of Radiology, Isfahan University of Medical SciencesIsfahan, Iran
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Clinical Effect of Bone Filling Mesh Container Vertebroplasty in Osteoporotic Compression Fracture. DISEASE MARKERS 2022; 2022:5029679. [PMID: 35958282 PMCID: PMC9363223 DOI: 10.1155/2022/5029679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 11/17/2022]
Abstract
Objective To investigate the clinical application of bone filling mesh container vertebroplasty in osteoporotic vertebral compression fractures (OVCFs). Methods Patients with OVCF from October 2018 to April 2020 were selected. Patients in the control and study groups underwent percutaneous kyphoplasty (PKP) and bone filling mesh container vertebroplasty, respectively. The Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA), visual analog scale (VAS) scores before and after surgery, and the incidence of complications were compared between the two groups. Results The operation time and fluoroscopy time of the study group were significantly lower than those of the control group (P < 0.05). There was no significant difference in the injection volume of bone cement between the study group and the control group (P > 0.05). There was no significant difference in Cobb angle between the two groups. Three months after the operation, the height of the anterior edge increased and the Cobb angle decreased in the two groups (P < 0.05), but there was no significant difference in the height of the anterior edge and the Cobb angle between the two groups (P > 0.05). The JOA scores increased, while the ODI and VAS scores decreased in both groups after surgery (P < 0.05). There was no significant difference in the total effective rate between the study group (96.15%) and the control group (92.31%) (P > 0.05). The incidence of complications in the study group (3.85%) was significantly lower than that in the control group (15.38%) (P < 0.05). Conclusions For the treatment of OVCFs, bone filling mesh container vertebroplasty is comparable to PKP in terms of functional recovery, but it can safely reduce operative time, fluoroscopy time, and complication rates.
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Weber A, Huysmans SMD, van Kuijk SMJ, Evers SMAA, Jutten EMC, Senden R, Paulus ATG, van den Bergh JPW, de Bie RA, Merk JMR, Bours SPG, Hulsbosch M, Janssen ERC, Curfs I, van Hemert WLW, Schotanus MGM, de Baat P, Schepel NC, den Boer WA, Hendriks JGE, Liu WY, Kleuver MD, Pouw MH, van Hooff ML, Jacobs E, Willems PCPH. Effectiveness and cost-effectiveness of dynamic bracing versus standard care alone in patients suffering from osteoporotic vertebral compression fractures: protocol for a multicentre, two-armed, parallel-group randomised controlled trial with 12 months of follow-up. BMJ Open 2022; 12:e054315. [PMID: 35613823 PMCID: PMC9125700 DOI: 10.1136/bmjopen-2021-054315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Patients with osteoporosis may suffer from a fracture after minimal trauma. Osteoporotic vertebral compression fractures (OVCFs) are among the most common fractures, often leading to substantial pain. There is a need for evidence-based conservative treatment to aid in the management of OVCFs. The objective of this randomised controlled trial (RCT) is to evaluate the effectiveness and cost-effectiveness of dynamic bracing in addition to standard care for improving quality of life (QoL) in patients suffering from an OVCF. METHODS AND ANALYSIS Ninety-eight postmenopausal women from two academic and four community hospitals with a recent symptomatic thoracolumbar OVCF will be randomised into either the standard care or dynamic bracing group. In the dynamic bracing group, the Spinova Osteo orthosis will be used in addition to standard care. Standard care comprises pain control with analgesics, physical therapy and osteoporosis medication. The primary outcome parameter is QoL 1 year after inclusion, as measured by the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41). Secondary outcome parameters are pain, pain medication used, functional disability, sagittal spinal alignment, recurrence rate of OVCFs and physical activity in daily life. A trial-based economic evaluation consisting of both cost-effectiveness analysis and cost-utility analysis will be performed based on empirical data obtained in the RCT. A process evaluation will assess the feasibility of dynamic bracing. All outcomes will be assessed at baseline, 6 weeks, 3 months, 6 months, 9 months and 12 months. ETHICS AND DISSEMINATION Ethical approval has been granted by the Medical Ethics Committee, University Hospital Maastricht and Maastricht University (METC azM/UM) (NL74552.068.20/METC 20-055). Patients will be included only after verification of eligibility and obtaining written informed consent. Results will be disseminated via the Dutch National Osteoporosis Patient Society and via publications and conferences. TRIAL REGISTRATION NUMBER NL8746.
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Affiliation(s)
- Annemarijn Weber
- Department of Orthopedics and Research School CAPHRI, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Stephanie M D Huysmans
- Department of Orthopedics and Research School CAPHRI, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Silvia M A A Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Trimbos Institute, Utrecht, The Netherlands
| | - Elisabeth M C Jutten
- Department of Orthopedics and Research School CAPHRI, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Rachel Senden
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Aggie T G Paulus
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences (FHML), Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences (FHML), School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
| | - Joop P W van den Bergh
- Department of Internal Medicine, Research School NUTRIM, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
| | - Rob A de Bie
- Department of Epidemiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Johannes M R Merk
- Department of Finance, Maastricht University, Maastricht, The Netherlands
| | - Sandrine P G Bours
- Department of Internal Medicine, Subdivision Rheumatology, CAPHRI Care and Public Health Research Institute, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Mark Hulsbosch
- Department of Orthopedic Surgery, VieCuri Medical Centre, Venlo, The Netherlands
| | - Esther R C Janssen
- Department of Orthopedics and Research School CAPHRI, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Orthopedic Surgery, VieCuri Medical Centre, Venlo, The Netherlands
| | - Inez Curfs
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Wouter L W van Hemert
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Martijn G M Schotanus
- Department of Orthopedics and Research School CAPHRI, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Paul de Baat
- Department of Orthopaedic Surgery and Trauma, Catharina Hospital, Eindhoven, The Netherlands
| | - Niek C Schepel
- Department of Orthopaedic Surgery and Trauma, Catharina Hospital, Eindhoven, The Netherlands
| | - Willem A den Boer
- Department of Orthopaedic Surgery and Trauma, Maxima Medical Centre, Eindhoven, The Netherlands
| | - Johannes G E Hendriks
- Department of Orthopaedic Surgery and Trauma, Maxima Medical Centre, Eindhoven, The Netherlands
| | - Wai-Yan Liu
- Department of Orthopaedic Surgery and Trauma, Catharina Hospital, Eindhoven, The Netherlands
- Department of Orthopaedic Surgery and Trauma, Maxima Medical Centre, Eindhoven, The Netherlands
| | | | - Martin H Pouw
- Department of Orthopedics, Radboudumc, Nijmegen, The Netherlands
| | | | - Eva Jacobs
- Department of Orthopedics and Research School CAPHRI, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Paul C P H Willems
- Department of Orthopedics and Research School CAPHRI, Maastricht University Medical Center+, Maastricht, The Netherlands
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11
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de Sire A, Ammendolia A, Gimigliano A, Tiberi R, Cisari C, Invernizzi M. Spinal Orthoses Prescription for Vertebral Fragility Fractures by Italian Physical and Rehabilitation Medicine Physicians: The SPIN-VER Survey. Healthcare (Basel) 2021; 9:healthcare9070892. [PMID: 34356276 PMCID: PMC8303444 DOI: 10.3390/healthcare9070892] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 01/12/2023] Open
Abstract
Vertebral fragility fractures (VFFs) are the most common type of osteoporotic fractures, related to pain and disability. In this scenario, physical and rehabilitative medicine (PRM) physicians prescribe a patient-tailored rehabilitation plan, including spinal orthoses. However, there is a high heterogeneity in the clinical indications of spinal orthoses. Thus, the aim of this survey was to investigate common clinical practice in terms of the prescription of spinal orthoses. This nationwide cross-sectional survey recruited Italian PRM physicians commonly involved in the management of patients with VFFs. One hundred twenty-six PRM physicians completed the survey. The results showed that most PRM physicians prescribe spinal orthoses in outpatients suffering from VFFs (n = 106; 83.9%). The most prescribed spinal orthosis for acute VFF patients was the three-point rigid orthosis (n = 64; 50.8%), followed by the semirigid thoraco-lumbar orthosis (n: 20; 15.9%). However, most PRM physicians prescribed dynamic orthoses in outpatients with chronic VFFs (n = 66; 52.4%). Albeit that a correct management of VFFs is mandatory to improve pain and reduce disability, our findings highlighted uncertainty in the type of spinal orthosis prescription in both the acute and chronic VFF phase. Therefore, high-quality research trials are warranted to provide clear recommendations for the correct clinical management of VFF.
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Affiliation(s)
- Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
- Correspondence: ; Tel.: +39-096-171-2819
| | - Antonio Ammendolia
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
| | | | - Roberto Tiberi
- MyEvent SRL, Events Organization, Monte Porzio Catone, 00078 Rome, Italy;
| | - Carlo Cisari
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, 28100 Novara, Italy; (C.C.); (M.I.)
| | - Marco Invernizzi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, 28100 Novara, Italy; (C.C.); (M.I.)
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS, Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
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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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Zhu Z, Zhou H, Wang Y, Yao X. Associations between bone turnover markers and bone mineral density in older adults. J Orthop Surg (Hong Kong) 2021; 29:2309499020987653. [PMID: 33480325 DOI: 10.1177/2309499020987653] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To examine the associations between bone turnover markers (BTMs) and bone mineral density (BMD) in older adults aged 60-85 years. METHODS A total of 1124 men (mean age, 69.1 years) and 1203 women (mean age, 70.7 years) from the National Health and Nutrition Examination Survey 1999-2002 were included in this cross-sectional analysis. Independent variables were serum bone-specific alkaline phosphatase (sBAP) and urinary N-telopeptide (uNTx), which are biomarkers of bone formation and resorption, respectively. Outcome variable was lumbar BMD. The associations of sBAP and uNTx levels with lumbar BMD was examined using multivariable linear regression models. RESULTS sBAP was negatively associated with lumbar BMD in each multivariable linear regression model, and this negative association was stable in both men and women men (men: β = -0.0028, 95% CI: -0.0046 to -0.0010; women: β = -0.0039, 95% CI: -0.0054 to -0.0023). On the other hand, uNTx was negatively associated with lumbar BMD after adjustment of relevant covariables (β = -0.0328, 95% CI: -0.0523 to -0.0133). However, in the subgroup analysis stratified by gender, this negative association remained only in older women (β = -0.0491, 95% CI: -0.0751 to -0.0231). CONCLUSION Our study suggested that elevated sBAP and uNTX levels correlated with decreased lumbar BMD, especially in older women. This finding indicated that maintaining BTMs at low levels may be beneficial to bone health for older adults.
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Affiliation(s)
- Zhongxin Zhu
- Department of Osteoporosis Care and Control, Xiaoshan First Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Hongliang Zhou
- Department of Clinical Laboratory, Xiaoshan First Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Yanfei Wang
- Department of Medical Oncology, Xiaoshan First Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Xiaocong Yao
- Department of Osteoporosis Care and Control, Xiaoshan First Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China
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Lu J, Lan J, Li X, Zhu Z. Blood lead and cadmium levels are negatively associated with bone mineral density in young female adults. ACTA ACUST UNITED AC 2021; 79:116. [PMID: 34172083 PMCID: PMC8228926 DOI: 10.1186/s13690-021-00636-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 06/11/2021] [Indexed: 11/15/2022]
Abstract
Background The organ toxicities of lead and cadmium have been extensively studied; however, studies of their toxic effects on bone remain limited, especially in young adults. The objective of this study was to examine the associations of blood lead levels (BLL) and blood cadmium levels (BCL) with bone mineral density (BMD) among young adults. Methods We performed a cross-sectional study using the National Health and Nutrition Examination Survey 2011–2018 database. Because of the skewed distribution, BLL and BCL were Ln-transformed for analysis. Weighted multivariate regressions were performed to evaluate the associations between LnBLL and LnBCL and lumbar BMD. Subgroup analyses were further performed. Results A total of 3234 participants aged 20–35 years were included in this study. No significant association between LnBLL and lumbar BMD was found (β = − 5.6, 95%CI: − 13.5–2.3). However, in the subgroup analysis stratified by sex, this association became negative in women (β = − 18.2, 95%CI: − 29.9– − 6.4). Moreover, this negative association was more prominent in female blacks (β = − 35.5, 95%CI: − 63.4– − 7.6). On the other hand, a negative association between LnBCL and lumbar BMD was found (β = − 7.4, 95%CI: − 14.0– − 0.8). In the subgroup analysis stratified by sex, this negative association only existed in women (β = − 18.7, 95%CI: − 28.0– − 9.5). Moreover, this negative association was more prominent in female whites (β = − 31.1, 95%CI: − 46.2– − 16.1). Conclusions Our finding showed that both BLL and BCL were independently and negatively associated with lumbar BMD among young females, but not among young males.
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Affiliation(s)
- Jianfeng Lu
- Department of Medical Administration, The First People's Hospital of Xiaoshan District, Xiaoshan First Affiliated Hospital of Wenzhou Medical University, Hangzhou, 311200, Zhejiang, China
| | - Ji Lan
- Department of Emergency, The First People's Hospital of Xiaoshan District, Xiaoshan First Affiliated Hospital of Wenzhou Medical University, Hangzhou, 311200, Zhejiang, China
| | - Xiao'e Li
- Department of Hematology, The First People's Hospital of Xiaoshan District, Xiaoshan First Affiliated Hospital of Wenzhou Medical University, Hangzhou, 311200, Zhejiang, China
| | - Zhongxin Zhu
- Department of Osteoporosis Care and Control, The First People's Hospital of Xiaoshan District, Xiaoshan First Affiliated Hospital of Wenzhou Medical University, Hangzhou, 311200, Zhejiang, China.
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Ma X, Xue C, Wang X, Zhao Y, Meng W, Gao H, Pang Z, Liu X. Effect of multi-platform extended care on postoperative self-efficacy and quality of life in patients with osteoporotic vertebral compressive fracture. Am J Transl Res 2021; 13:6945-6951. [PMID: 34306447 PMCID: PMC8290810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/18/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES This study analyzed the effect of multi-platform extended care on postoperative self-efficacy and quality of life in patients with osteoporotic vertebral compressive fracture (OVCF). METHODS 162 OVCF patients who underwent percutaneous vertebroplasty (PVP) or percutanous kyphoplasty (PKP) surgery in our hospital from January 2018 to June 2019 were classified into a control group (n=78) and an observation group (n=84) based on the admission time. The control group was given conventional health guidance and follow-up by telephone, and the observation group got multi-platform extended care. The postoperative incidence of re-fracture, Oswestry dysfunction index (ODI) before and after intervention, self-efficacy and quality of life were compared between the two groups. RESULTS Incidence of re-fracture in the observation group was higher than that of the control group (P<0.05). The ODI scores of the two groups 3, 6, and 12 months after operation were lower than those on discharge (P<0.05), and the observation group had lower OD scores than the control group 6 and 12 months after operation (P<0.05). The self-efficacy scores of the two groups 6 months after discharge were higher than that on discharge (P<0.05), and the index in the observation group was higher than that of the control group (P<0.05). In addition, the scores of all dimensions of quality of life in two groups 6 months of discharge were higher than those on discharge (P<0.05), and the scores in the observation group were higher than those of the control group (P<0.05). CONCLUSION Multi-platform extended care can effectively reduce the risk of postoperative re-fracture in OVCF patients, facilitate the improvement of patients' lumbar function, self-efficacy, and quality of life, and improve the prognosis of patients, which is worthy of clinical promotion.
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Affiliation(s)
- Xiaoxia Ma
- Department of Medical Insurance, Traditional Chinese Medicine HospitalBeichen District, Tianjin 300400, China
| | - Caihong Xue
- Department of Orthopedics, Qingdao Municipal Hospital (GROUP)Qingdao 266000, Shandong, China
| | - Xia Wang
- Department of Nursing, Traditional Chinese Medicine HospitalBeichen District, Tianjin 300400, China
| | - Yueling Zhao
- Department of Science and Education, Traditional Chinese Medicine HospitalBeichen District, Tianjin 300400, China
| | - Weiying Meng
- Department of Nursing, Traditional Chinese Medicine HospitalBeichen District, Tianjin 300400, China
| | - Hong Gao
- Department of Encephalopathy, Traditional Chinese Medicine HospitalBeichen District, Tianjin 300400, China
| | - Zhixi Pang
- Department of Encephalopathy, Traditional Chinese Medicine HospitalBeichen District, Tianjin 300400, China
| | - Xianqiang Liu
- Department of Orthopedics, Traditional Chinese Medicine HospitalBeichen District, Tianjin 300400, China
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16
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Ma X, Zhu X, He X, Yi X, Jin A. The Wnt pathway regulator expression levels and their relationship to bone metabolism in thoracolumbar osteoporotic vertebral compression fracture patients. Am J Transl Res 2021; 13:4812-4818. [PMID: 34150062 PMCID: PMC8205725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/21/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate of the Wnt pathway serum regulator expression levels and their relationship with bone metabolism (BM) in thoracolumbar osteoporotic vertebral compression fracture (OVCF) patients. METHODS In this study, 40 healthy controls (group A), 33 osteoporotic patients (group B), and 47 thoracolumbar OVCF patients (group C) were recruited as the study cohort during the same period. The Wnt pathway serum regulator levels, bone density, BM-related inflammatory cytokines, bone formation markers, and bone resorption markers were compared among the three groups, and the correlation between the Wnt pathway serum regulators and BM was analyzed. RESULTS The β-catenin levels, the BALP, the densities at the femoral neck and lumbar spine, and the PINP, IL-10, OPG and BGP in groups B and C were lower than they were in group A, and the above indices in group C were lower than they were in group B (P < 0.05). Groups B and C showed higher CDKK-1, RANKL, TRACP-5b, β-CTX, IL-2, IL-6, MMP-2, MMP-9, Leptin, and TNF-α levels than group A, and the above indicators in group C were higher than they were in group B (P < 0.05). A Pearson's correlation analysis showed that the MMP-2, MMP-9, RANKL, β-CTX, and TRACP-5b levels were negatively correlated with β-catenin (r < 0, P < 0.05) and were positively correlated with DKK-1 (r > 0, P < 0.05). The BGP, PINP, OPG, and BALP levels were positively correlated with β-catenin (r > 0, P < 0.05) and were negatively correlated with DKK-1 (r < 0, P < 0.05). CONCLUSION Patients with thoracolumbar OVCF have abnormal Wnt pathway serum regulator expression levels, low bone density, and abnormal BM, and the patients' Wnt/β-catenin and DKK-1 levels are closely related to BM, so they may be potential targets for the prevention and treatment of metabolic bone diseases.
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Affiliation(s)
- Xuefeng Ma
- Department of Orthopedics, Zhujiang Hospital, Southern Medical UniversityGuangzhou 510282, Guangdong Province, China
- Department of Spine, Shenzhen Pingle Orthopedics HospitalShenzhen 518000, Guangdong Province, China
| | - Xiaoqi Zhu
- Department of Orthopedics, Baoan People’s Hospital ShenzhenShenzhen 518000, Guangdong Province, China
| | - Xu He
- Department of Spine, Shenzhen Pingle Orthopedics HospitalShenzhen 518000, Guangdong Province, China
| | - Xiaobo Yi
- Department of Spine, Shenzhen Pingle Orthopedics HospitalShenzhen 518000, Guangdong Province, China
| | - Anmin Jin
- Department of Orthopedics, Zhujiang Hospital, Southern Medical UniversityGuangzhou 510282, Guangdong Province, China
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LewandrowskI KU, Muraleedharan N, Eddy SA, Sobti V, Reece BD, Ramírez León JF, Shah S. Feasibility of Deep Learning Algorithms for Reporting in Routine Spine Magnetic Resonance Imaging. Int J Spine Surg 2020; 14:S86-S97. [PMID: 33298549 DOI: 10.14444/7131] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Artificial intelligence is gaining traction in automated medical imaging analysis. Development of more accurate magnetic resonance imaging (MRI) predictors of successful clinical outcomes is necessary to better define indications for surgery, improve clinical outcomes with targeted minimally invasive and endoscopic procedures, and realize cost savings by avoiding more invasive spine care. OBJECTIVE To demonstrate the ability for deep learning neural network models to identify features in MRI DICOM datasets that represent varying intensities or severities of common spinal pathologies and injuries and to demonstrate the feasibility of generating automated verbal MRI reports comparable to those produced by reading radiologists. METHODS A 3-dimensional (3D) anatomical model of the lumbar spine was fitted to each of the patient's MRIs by a team of technicians. MRI T1, T2, sagittal, axial, and transverse reconstruction image series were used to train segmentation models by the intersection of the 3D model through these image sequences. Class definitions were extracted from the radiologist report for the central canal: (0) no disc bulge/protrusion/canal stenosis, (1) disc bulge without canal stenosis, (2) disc bulge resulting in canal stenosis, and (3) disc herniation/protrusion/extrusion resulting in canal stenosis. Both the left and right neural foramina were assessed with either (0) neural foraminal stenosis absent, or (1) neural foramina stenosis present. Reporting criteria for the pathologies at each disc level and, when available, the grading of severity were extracted, and a natural language processing model was used to generate a verbal and written report. These data were then used to train a set of very deep convolutional neural network models, optimizing for minimal binary cross-entropy for each classification. RESULTS The initial prediction validation of the implemented deep learning algorithm was done on 20% of the dataset, which was not used for artificial intelligence training. Of the 17,800 total disc locations for which MRI images and radiology reports were available, 14,720 were used to train the model, and 3560 were used to validate against. The convergence of validation accuracy achieved with the deep learning algorithm for the foraminal stenosis detector was 81% (sensitivity = 72.4.4%, specificity = 83.1%) after 25 complete iterations through the entire training dataset (epoch). The accuracy was 86.2% (sensitivity = 91.1%, specificity = 82.5%) for the central stenosis detector and 85.2% (sensitivity = 81.8%, specificity = 87.4%) for the disc herniation detector. CONCLUSIONS Deep learning algorithms may be used for routine reporting in spine MRI. There was a minimal disparity among accuracy, sensitivity, and specificity, indicating that the data were not overfitted to the training set. We concluded that variability in the training data tends to reduce overfitting and overtraining as the deep neural network models learn to focus on the common pathologies. Future studies should demonstrate the accuracy of deep neural network models and the predictive value of favorable clinical outcomes with intervention and surgery. LEVEL OF EVIDENCE 3. CLINICAL RELEVANCE Feasibility, clinical teaching, and evaluation study.
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Affiliation(s)
- Kai-Uwe LewandrowskI
- Staff Orthopaedic Spine Surgeon Center for Advanced Spine Care of Southern Arizona and Surgical Institute of Tucson, Tucson, Arizona
| | | | | | - Vikram Sobti
- Innovative Radiology, PC, River Forest, Illinois
| | - Brian D Reece
- The Spine and Orthopedic Academic Research Institute, Lewisville, Texas
| | - Jorge Felipe Ramírez León
- Fundación Universitaria Sanitas, Bogotá, Colombia, Research Team, Centro de Columna. Bogotá, Colombia, Centro de Cirugía de Mínima Invasión, CECIMIN-Clínica Reina Sofía, Bogotá, Colombia
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Lena F, Etoom M, Al-Wardat M, Modugno N. Osteoporotic fracture and conservative management in Parkinson's disease and Pisa syndrome: Case report. J Bodyw Mov Ther 2020; 25:170-173. [PMID: 33714491 DOI: 10.1016/j.jbmt.2020.11.011] [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: 05/06/2020] [Revised: 10/18/2020] [Accepted: 11/07/2020] [Indexed: 11/27/2022]
Abstract
Osteoporotic fractures (OF) may occur without major trauma or injury. This case reports present a spine OF in Parkinson's disease (PD) and Pisa syndrome (PS). A 75-years-old woman diagnosed with PD for 19 years and PS has been developed. She recently has acute and severe low back pain. No recent injury or fall. After clinical examination and radiograph imaging, moderate wedge compression OF at L2 was revealed without a spinal cord or nerve compression. A program of conservative treatment was applied include antiosteoporotic supplementary, 6-days of bed rest, spine orthosis, and 10-weeks of exercises. The study adapted to use the following outcomes: visual analogues scale for low back pain, wall goniometer for lateral trunk flexion, and Oswesrty disability index for disability. After the intervention, the outcomes were improved as these values: visual analogues scales 7 points, lateral trunk flexion 20°, and Oswesrty disability index 60%. The case report suggests that the posture deformity as PS in PD may increase the risk of spine OF. The conservative treatment could be beneficial and safe for the OF in PD and PS. Further studies are required to confirm the role of PD postural deformities in OF and the effectiveness of therapeutic interventions.
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Affiliation(s)
- Francesco Lena
- INM, Neuromed, Pozzilli, Via Atinense, Pozilli, Isernia, Italy
| | - Mohammad Etoom
- Allied Medical Sciences Department, Division of Physical Therapy, Aqaba University of Technology, Aqaba, Jordan
| | - Mohammad Al-Wardat
- Allied Medical Sciences Department, Division of Physical Therapy, Aqaba University of Technology, Aqaba, Jordan.
| | - Nicola Modugno
- INM, Neuromed, Pozzilli, Via Atinense, Pozilli, Isernia, Italy
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Comprehensive Analysis of Differentially Expressed Circular RNAs in Patients with Senile Osteoporotic Vertebral Compression Fracture. BIOMED RESEARCH INTERNATIONAL 2020; 2020:4951251. [PMID: 33083467 PMCID: PMC7556071 DOI: 10.1155/2020/4951251] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/18/2020] [Accepted: 08/24/2020] [Indexed: 12/21/2022]
Abstract
Aim Circular RNAs (circRNAs) have been found to contribute to the regulation of many diseases and are abundantly expressed in various organisms. The present study is aimed at systematically characterizing the circRNA expression profiles in patients with senile osteoporotic vertebral compression fracture (OVCF) and predicting the potential functions of the regulatory networks correlated with these differentially expressed circRNAs. Methods The circRNA expression profile in patients with senile OVCF was explored by using RNA sequencing. The prediction of the enriched signaling pathways and circRNA-miRNA networks was conducted by bioinformatics analysis. Real-time quantitative PCR was used to validate the selected differentially expressed circRNAs from 20 patients with senile OVCF relative to 20 matched healthy controls. Results A total of 884 differentially expressed circRNAs were identified, of which 554 were upregulated and 330 were downregulated. The top 15 signaling pathways associated with these differentially expressed circRNAs were predicted. The result of qRT-PCR of the selected circRNAs was consistent with RNA sequencing. Conclusions CircRNAs are differentially expressed in patients with senile OVCF, which might contribute to the pathophysiological mechanism of senile osteoporosis.
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20
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Choo YJ, Chang MC. Effectiveness of orthoses for treatment in patients with spinal pain. Yeungnam Univ J Med 2020; 37:84-89. [PMID: 32204582 PMCID: PMC7142031 DOI: 10.12701/yujm.2020.00150] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 03/17/2020] [Indexed: 12/19/2022] Open
Abstract
Spinal pain is a common patient complaint in clinical practice. Conservative treatment methods include oral medication, physical therapy, injections, and spinal orthoses. The clinical application of orthoses is debated because of potential complications associated with long-term use, such as muscle weakness and joint contracture. We reviewed the orthoses most frequently used to manage spinal pain. We review the use of soft cervical and Philadelphia collars, lumbosacral corsets, and thoracolumbosacral orthosis to manage spinal pain. Spinal orthoses can help reduce pain by protecting the muscles and joints of the injured spinal region, preventing or correcting malformations, and limiting trunk flexion, extension, lateral flexion, and rotation. The short-term use of spinal orthoses is known to improve pain and disability during the treatment period without significant adverse effects. Spinal orthoses are expected to alleviate pain and improve patients’ lifestyle.
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Affiliation(s)
- Yoo Jin Choo
- Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu, Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu, Korea
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Heuchemer L, Emmert D, Bender T, Rasche T, Marinova M, Kasapovic A, Conrad R, Mücke M. [Pain management in osteoporosis]. DER ORTHOPADE 2020; 49:363-376. [PMID: 32193562 DOI: 10.1007/s00132-020-03898-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Osteoporosis is a very common disease all over the world, in which a reduction in bone density can lead to an increased risk of fractures and a diminished physical height. Osteoporosis is also associated with acute and chronic pain, which especially occurs in the back and can significantly reduce the quality of life. To provide sufficient care for affected patients, it is essential to know the particularities of pain management in osteoporosis, such as pharmacological and nonpharmacological treatment options. This article gives a comprehensive review of pain management in osteoporosis and also explains the underlying pathomechanisms, risk factors, and diagnostic procedures.
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Affiliation(s)
- L Heuchemer
- Zentrum für Seltene Erkrankungen (ZSEB), Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - D Emmert
- Zentrum für Seltene Erkrankungen (ZSEB), Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - T Bender
- Zentrum für Seltene Erkrankungen (ZSEB), Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - T Rasche
- Zentrum für Seltene Erkrankungen (ZSEB), Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - M Marinova
- Radiologische Klinik, Universitätsklinikum Bonn, Bonn, Deutschland
| | - A Kasapovic
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - R Conrad
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - M Mücke
- Zentrum für Seltene Erkrankungen (ZSEB), Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
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22
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Heuchemer L, Emmert D, Bender T, Rasche T, Marinova M, Kasapovic A, Conrad R, Mücke M. [Pain management in osteoporosis]. Schmerz 2020; 34:91-104. [PMID: 32065297 DOI: 10.1007/s00482-020-00445-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Osteoporosis is a very common disease all over the world, in which a reduction in bone density can lead to an increased risk of fractures and a diminished physical height. Osteoporosis is also associated with acute and chronic pain, which especially occurs in the back and can significantly reduce the quality of life. To provide sufficient care for affected patients, it is essential to know the particularities of pain management in osteoporosis, such as pharmacological and nonpharmacological treatment options. This article gives a comprehensive review of pain management in osteoporosis and also explains the underlying pathomechanisms, risk factors, and diagnostic procedures.
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Affiliation(s)
- L Heuchemer
- Zentrum für Seltene Erkrankungen (ZSEB), Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - D Emmert
- Zentrum für Seltene Erkrankungen (ZSEB), Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - T Bender
- Zentrum für Seltene Erkrankungen (ZSEB), Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - T Rasche
- Zentrum für Seltene Erkrankungen (ZSEB), Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - M Marinova
- Radiologische Klinik, Universitätsklinikum Bonn, Bonn, Deutschland
| | - A Kasapovic
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - R Conrad
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - M Mücke
- Zentrum für Seltene Erkrankungen (ZSEB), Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
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23
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Alin CK, Frisendahl N, Kronhed ACG, Salminen H. Experiences of using an activating spinal orthosis in women with osteoporosis and back pain in primary care. Arch Osteoporos 2020; 15:171. [PMID: 33123853 PMCID: PMC7595975 DOI: 10.1007/s11657-020-00754-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 05/07/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED Women with osteoporosis and back pain took part in focus group interviews and described their experiences of using and handling an activating spinal orthosis. The women described the back orthosis as being like a "close friend", a support in everyday life and a reminder to maintain a good posture. PURPOSE The purpose of this study was to describe and gain a deeper understanding of the views of older women with osteoporosis and back pain seeking primary care regarding their use and handling of an activating spinal orthosis. METHOD We chose a qualitative method whereby information was gathered via focus group interviews and analysed using inductive content analysis. Women who previously participated in a randomised controlled trial and wore an activating spinal orthosis for 6 months were asked. Out of 31 women, 18 agreed to participate. Five focus group interviews were conducted. RESULTS The analysis resulted in an overall theme in which the experiences of wearing the spinal orthosis were described as follows: "A well-adapted spinal orthosis could develop into a long-lasting friendship that provided support and help in daily life". The overall theme was based on three main categories: impact on daily life, individual adaptation and personal relationship. The main categories were well differentiated from each other but had an interdependency. All three categories involved cases in which the spinal orthosis was perceived as relieving symptoms and making daily life easier, as well as when it was perceived as being hard to manage and provided no symptom relief. CONCLUSION In older women with osteoporosis and back pain, an activating spinal orthosis could be perceived as being a "close friend" and a support in everyday life. To facilitate acceptance of the spinal orthosis, it was important for it to be well adapted and for follow-ups to be carried out regularly.
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Affiliation(s)
- Christina Kaijser Alin
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Solna, Sweden.
| | - Nathalie Frisendahl
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Solna, Sweden
| | - Ann-Charlotte Grahn Kronhed
- Rehab Väst, Local Health Care Services in the West of Östergötland, Mjölby, Sweden
- Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Helena Salminen
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Solna, Sweden
- Academic Primary Health Care Centre Stockholm, Stockholm, Sweden
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