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Yıldız Potter İ, Yeritsyan D, Rodriguez EK, Wu JS, Nazarian A, Vaziri A. Detection and Localization of Spine Disorders from Plain Radiography. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024:10.1007/s10278-024-01175-x. [PMID: 38937344 DOI: 10.1007/s10278-024-01175-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/16/2024] [Accepted: 06/09/2024] [Indexed: 06/29/2024]
Abstract
Spine disorders can cause severe functional limitations, including back pain, decreased pulmonary function, and increased mortality risk. Plain radiography is the first-line imaging modality to diagnose suspected spine disorders. Nevertheless, radiographical appearance is not always sufficient due to highly variable patient and imaging parameters, which can lead to misdiagnosis or delayed diagnosis. Employing an accurate automated detection model can alleviate the workload of clinical experts, thereby reducing human errors, facilitating earlier detection, and improving diagnostic accuracy. To this end, deep learning-based computer-aided diagnosis (CAD) tools have significantly outperformed the accuracy of traditional CAD software. Motivated by these observations, we proposed a deep learning-based approach for end-to-end detection and localization of spine disorders from plain radiographs. In doing so, we took the first steps in employing state-of-the-art transformer networks to differentiate images of multiple spine disorders from healthy counterparts and localize the identified disorders, focusing on vertebral compression fractures (VCF) and spondylolisthesis due to their high prevalence and potential severity. The VCF dataset comprised 337 images, with VCFs collected from 138 subjects and 624 normal images collected from 337 subjects. The spondylolisthesis dataset comprised 413 images, with spondylolisthesis collected from 336 subjects and 782 normal images collected from 413 subjects. Transformer-based models exhibited 0.97 Area Under the Receiver Operating Characteristic Curve (AUC) in VCF detection and 0.95 AUC in spondylolisthesis detection. Further, transformers demonstrated significant performance improvements against existing end-to-end approaches by 4-14% AUC (p-values < 10-13) for VCF detection and by 14-20% AUC (p-values < 10-9) for spondylolisthesis detection.
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Affiliation(s)
| | - Diana Yeritsyan
- Beth Israel Deaconess Medical Center (BIDMC), Carl J. Shapiro Department of Orthopedic Surgery, Harvard Medical School, 330 Brookline Avenue, Stoneman 10, Boston, MA, 02215, USA
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, RN123, USA
| | - Edward K Rodriguez
- Beth Israel Deaconess Medical Center (BIDMC), Carl J. Shapiro Department of Orthopedic Surgery, Harvard Medical School, 330 Brookline Avenue, Stoneman 10, Boston, MA, 02215, USA
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, RN123, USA
| | - Jim S Wu
- Department of Radiology, Massachusetts General Brigham (MGB), Harvard Medical School, 75 Francis Street, Boston, MA, 02215, USA
| | - Ara Nazarian
- Beth Israel Deaconess Medical Center (BIDMC), Carl J. Shapiro Department of Orthopedic Surgery, Harvard Medical School, 330 Brookline Avenue, Stoneman 10, Boston, MA, 02215, USA
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, RN123, USA
- Department of Orthopaedics Surgery, Yerevan State University, 0025, Yerevan, Armenia
| | - Ashkan Vaziri
- BioSensics, LLC, 57 Chapel Street, Newton, MA, 02458, USA
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Choi E, Park D, Son G, Bak S, Eo T, Youn D, Hwang D. Weakly supervised deep learning for diagnosis of multiple vertebral compression fractures in CT. Eur Radiol 2024; 34:3750-3760. [PMID: 37973631 DOI: 10.1007/s00330-023-10394-9] [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: 12/09/2022] [Revised: 08/08/2023] [Accepted: 09/11/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE This study aims to develop a weakly supervised deep learning (DL) model for vertebral-level vertebral compression fracture (VCF) classification using image-level labelled data. METHODS The training set included 815 patients with normal (n = 507, 62%) or VCFs (n = 308, 38%). Our proposed model was trained on image-level labelled data for vertebral-level classification. Another supervised DL model was trained with vertebral-level labelled data to compare the performance of the proposed model. RESULTS The test set included 227 patients with normal (n = 117, 52%) or VCFs (n = 110, 48%). For a fair comparison of the two models, we compared sensitivities with the same specificities of the proposed model and the vertebral-level supervised model. The specificity for overall L1-L5 performance was 0.981. The proposed model may outperform the vertebral-level supervised model with sensitivities of 0.770 vs 0.705 (p = 0.080), respectively. For vertebral-level analysis, the specificities for each L1-L5 were 0.974, 0.973, 0.970, 0.991, and 0.995, respectively. The proposed model yielded the same or better sensitivity than the vertebral-level supervised model in L1 (0.750 vs 0.694, p = 0.480), L3 (0.793 vs 0.586, p < 0.05), L4 (0.833 vs 0.667, p = 0.480), and L5 (0.600 vs 0.600, p = 1.000), respectively. The proposed model showed lower sensitivity than the vertebral-level supervised model for L2, but there was no significant difference (0.775 vs 0.825, p = 0.617). CONCLUSIONS The proposed model may have a comparable or better performance than the supervised model in vertebral-level VCF classification. CLINICAL RELEVANCE STATEMENT Vertebral-level vertebral compression fracture classification aids in devising patient-specific treatment plans by identifying the precise vertebrae affected by compression fractures. KEY POINTS • Our proposed weakly supervised method may have comparable or better performance than the supervised method for vertebral-level vertebral compression fracture classification. • The weakly supervised model could have classified cases with multiple vertebral compression fractures at the vertebral-level, even if the model was trained with image-level labels. • Our proposed method could help reduce radiologists' labour because it enables vertebral-level classification from image-level labels.
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Affiliation(s)
- Euijoon Choi
- Department of Artificial Intelligence, Yonsei University, Seoul, Republic of Korea
| | - Doohyun Park
- School of Electrical and Electronic Engineering, Yonsei University, Seoul, Republic of Korea
| | - Geonhui Son
- School of Electrical and Electronic Engineering, Yonsei University, Seoul, Republic of Korea
| | | | - Taejoon Eo
- School of Electrical and Electronic Engineering, Yonsei University, Seoul, Republic of Korea
| | - Daemyung Youn
- School of Management of Technology, Yonsei University, Seoul, Republic of Korea
| | - Dosik Hwang
- School of Electrical and Electronic Engineering, Yonsei University, Seoul, Republic of Korea.
- Center for Healthcare Robotics, Korea Institute of Science and Technology, 5, Hwarang-Ro 14-Gil, Seongbuk-Gu, Seoul, 02792, Republic of Korea.
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, Seoul, Republic of Korea.
- Department of Radiology and Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, Seoul, Republic of Korea.
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Yıldız Potter İ, Rodriguez EK, Wu J, Nazarian A, Vaziri A. An Automated Vertebrae Localization, Segmentation, and Osteoporotic Compression Fracture Detection Pipeline for Computed Tomographic Imaging. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024:10.1007/s10278-024-01135-5. [PMID: 38717516 DOI: 10.1007/s10278-024-01135-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/30/2024] [Accepted: 05/01/2024] [Indexed: 06/29/2024]
Abstract
Osteoporosis is the most common chronic metabolic bone disease worldwide. Vertebral compression fracture (VCF) is the most common type of osteoporotic fracture. Approximately 700,000 osteoporotic VCFs are diagnosed annually in the USA alone, resulting in an annual economic burden of ~$13.8B. With an aging population, the rate of osteoporotic VCFs and their associated burdens are expected to rise. Those burdens include pain, functional impairment, and increased medical expenditure. Therefore, it is of utmost importance to develop an analytical tool to aid in the identification of VCFs. Computed Tomography (CT) imaging is commonly used to detect occult injuries. Unlike the existing VCF detection approaches based on CT, the standard clinical criteria for determining VCF relies on the shape of vertebrae, such as loss of vertebral body height. We developed a novel automated vertebrae localization, segmentation, and osteoporotic VCF detection pipeline for CT scans using state-of-the-art deep learning models to bridge this gap. To do so, we employed a publicly available dataset of spine CT scans with 325 scans annotated for segmentation, 126 of which also graded for VCF (81 with VCFs and 45 without VCFs). Our approach attained 96% sensitivity and 81% specificity in detecting VCF at the vertebral-level, and 100% accuracy at the subject-level, outperforming deep learning counterparts tested for VCF detection without segmentation. Crucially, we showed that adding predicted vertebrae segments as inputs significantly improved VCF detection at both vertebral and subject levels by up to 14% Sensitivity and 20% Specificity (p-value = 0.028).
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Affiliation(s)
| | - Edward K Rodriguez
- Carl J. Shapiro Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School, 330 Brookline Avenue, Stoneman 10, Boston, MA, 02215, USA
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA, 02215, USA
| | - Jim Wu
- Department of Radiology, Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School, 330 Brookline Avenue, Shapiro 4, Boston, MA, 02215, USA
| | - Ara Nazarian
- Carl J. Shapiro Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School, 330 Brookline Avenue, Stoneman 10, Boston, MA, 02215, USA
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA, 02215, USA
- Department of Orthopaedics Surgery, Yerevan State University, Yerevan, Armenia
| | - Ashkan Vaziri
- BioSensics, LLC, 57 Chapel Street, Newton, MA, 02458, USA
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Silverman B, Shofer F, Bonner K, Hampton S. The Effect of Kyphoplasty on Opioid Use in Patients With Vertebral Compression Fractures. Cureus 2024; 16:e54084. [PMID: 38487151 PMCID: PMC10937115 DOI: 10.7759/cureus.54084] [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: 01/29/2024] [Indexed: 03/17/2024] Open
Abstract
Objective The primary objective of this study was to assess opioid use in the 90 days following kyphoplasty (KP) compared to the period between compression fracture and KP. Methods All patients aged 50-85 who underwent KP following a newly diagnosed vertebral compression fracture (VCF) at a large, urban academic medical center between January 1st, 2015, and January 1st, 2023, were screened for inclusion. Patients were excluded if they had an opioid prescription in the month prior to the compression fracture, had a history of malignancy, or underwent concomitant or other surgical procedures in the 90 days following KP. Opioid measures, including the prescribed amount of morphine milliequivalents (MME) per day, number of opioid days, and total MME (MME per day x number of opioid days), in addition to numerical rating scale (NRS) pain scores, were analyzed pre- and post-KP. Results A total of 27 patients met the eligibility criteria, with a mean age of 69.7 and 59.2% being female. Sixteen patients (59%) had received an opioid prescription between compression fracture and KP (opioid group). The median differences pre- and post-KP in prescribed MMEs per day, number of opioid days, and total MMEs were 17.7 (p=.0009), 11.0 (p=.0004), and 232.5 (p<.0001), respectively. There was a significant difference in NRS pain scores in both the opioid group (6.25, p<.0001) and the non-opioid group (4.36, p<.0001) pre- and post-KP. Conclusion Our findings suggest that KP may be associated with a reduction in both opioid use and pain scores in opioid-naïve patients with VCFs. Larger studies that directly compare KP to conservative management are needed to fully assess the impact of KP on opioid and pain outcome measures.
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Affiliation(s)
- Ben Silverman
- Physical Medicine and Rehabilitation, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Frances Shofer
- Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Kirk Bonner
- Physical Medicine and Rehabilitation, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Stephen Hampton
- Physical Medicine and Rehabilitation, Hospital of the University of Pennsylvania, Philadelphia, USA
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Xiao C, Wang H, Lei Y, Xie M, Li S. Percutaneous kyphoplasty combined with pediculoplasty for the surgical treatment of osteoporotic thoracolumbar burst fractures. J Orthop Surg Res 2024; 19:87. [PMID: 38254114 PMCID: PMC10804617 DOI: 10.1186/s13018-024-04562-w] [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: 08/15/2023] [Accepted: 01/14/2024] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVE This study introduces a minimally invasive technique for efficient three-column reconstruction, augmentation, and stabilization of osteoporotic thoracolumbar burst fractures (OTLBFs). METHODS Sixty-eight patients with OTLBFs and no neurological deficits were included from July 2019 to September 2020. The patients were divided into two groups: the simple percutaneous kyphoplasty (PKP) group (n = 32) and the percutaneous kyphoplasty combined with pediculoplasty (PKCPP) group (n = 36). The clinical and radiological outcomes were assessed during a minimum 1-year follow-up period. Clinical outcomes were assessed via the visual analog scale (VAS) and modified MacNab grading criteria. The radiological outcomes included the Cobb angle (CA), anterior wall height (AWH), and posterior wall height (PWH). The surgery duration, postoperative analgesic dosage, length of hospital stay, and complications were recorded. RESULTS Surgery duration was not significantly different between the two groups (P > 0.05). The PKCPP group had a lower analgesic dosage and shorter hospital stay (P < 0.05). Postoperatively, the PKCPP group exhibited better VAS scores and modified MacNab scale scores (P < 0.05), but the differences at the last follow-up assessment were not significant (P > 0.05). Postoperative CA, AWH, and PWH correction were not significantly different on the first postoperative day (P > 0.05). However, the PKCPP group had significantly less CA and PWH loss of correction at the last follow-up visit (P < 0.05). The PKCPP group had significantly fewer complications (P < 0.05). CONCLUSIONS The PKCPP technique complements simple PKP for OTLBFs. It quickly relieves pain, maintains the vertebral body height and Cobb angle, ensures cement stabilization, and offers more stable three-column support.
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Affiliation(s)
- Changming Xiao
- Spinal Surgery Department, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Haozhong Wang
- Spinal Surgery Department, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Yang Lei
- Spinal Surgery Department, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Mingzhong Xie
- Spinal Surgery Department, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, 646000, Sichuan, China.
| | - Sen Li
- Spinal Surgery Department, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, 646000, Sichuan, China.
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Wang Y, Su F, Lu Q, Zhang W, Liu T, Tao Y, Fu S, Cui L, Lu SB, Chen X, Shi Z. Deep learning-driven diagnosis of multi-type vertebra diseases based on computed tomography images. Quant Imaging Med Surg 2024; 14:800-813. [PMID: 38223021 PMCID: PMC10784083 DOI: 10.21037/qims-23-685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 11/24/2023] [Indexed: 01/16/2024]
Abstract
Background Osteoporotic vertebral compression fractures (OVCFs) are the most common type of fragility fracture. Distinguishing between OVCFs and other types of vertebra diseases, such as old fractures (OFs), Schmorl's node (SN), Kummell's disease (KD), and previous surgery (PS), is critical for subsequent surgery and treatment. Combining with advanced deep learning (DL) technologies, this study plans to develop a DL-driven diagnostic system for diagnosing multi-type vertebra diseases. Methods We established a large-scale dataset based on the computed tomography (CT) images of 1,051 patients with OVCFs from Luhe Hospital and used data of 46 patients from Xuanwu Hospital as alternative hospital validation dataset. Each patient underwent one examination. The dataset contained 11,417 CT slices and 19,718 manually annotated vertebrae with diseases. A two-stage DL-based system was developed to diagnose five vertebra diseases. The proposed system consisted of a vertebra detection module (VDModule) and a vertebra classification module (VCModule). Results The training and testing dataset for the VDModule consisted of 9,135 and 3,212 vertebrae, respectively. The VDModule using the ResNet18-based Faster region-based convolutional neural network (R-CNN) model achieved an area under the curve (AUC), false-positive (FP) rate, and false-negative (FN) rate of 0.982, 1.52%, and 1.33%, respectively, in the testing dataset. The training dataset for VCModule consisted of 14,584 and 47,604 diseased and normal vertebrae, respectively. The testing dataset consisted of 4,489 and 15,122 diseased and normal vertebrae, respectively. The ResNet50-based VCModule achieved an average sensitivity and specificity of 0.919 and 0.995, respectively, in diagnosing four kinds of vertebra diseases except for SN in the testing dataset. In the alternative hospital validation dataset, the ResNet50-based VCModule achieved an average sensitivity and specificity of 0.891 and 0.989, respectively, in diagnosing four kinds of vertebra diseases except for SN. Conclusions Our proposed DL system can accurately diagnose four vertebra diseases and has strong potential to facilitate the accurate and rapid diagnosis of vertebral diseases.
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Affiliation(s)
- Yongjie Wang
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Feng Su
- School of Mechanical Engineering and Automation, Beihang University, Beijing, China
- Peking-Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Qian Lu
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Wenkai Zhang
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Tao Liu
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Yining Tao
- School of Mechanical Engineering and Automation, Beihang University, Beijing, China
| | - Shuai Fu
- School of Mechanical Engineering and Automation, Beihang University, Beijing, China
| | - Libin Cui
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Shi-Bao Lu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xueming Chen
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Zhenyun Shi
- School of Mechanical Engineering and Automation, Beihang University, Beijing, China
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Krishnan S, Brovman EY, Jones MR, Manzi JE, Kim JS, Rao N, Urman RD. Racial and socioeconomic disparities in kyphoplasty among the Medicare population. Pain Pract 2024; 24:76-81. [PMID: 37606504 DOI: 10.1111/papr.13286] [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: 09/12/2022] [Revised: 05/02/2023] [Accepted: 08/04/2023] [Indexed: 08/23/2023]
Abstract
INTRODUCTION Kyphoplasty is a minimally invasive treatment for chronic refractory pain secondary to spinal compression fracture. This study investigates racial and socioeconomic disparities in kyphoplasty among the Medicare population. MATERIALS AND METHODS This study utilized data from the Medicare Limited Data Sets (LDS), a CMS administrative claims database. Patients aged 18 and older with ICD code consistent with spinal pathology and compression fractures were included. Outcome was defined as kyphoplasty by race and socioeconomic status (SES) with low SES defined by dual enrollment in Medicare/Medicaid. RESULTS There was a total of 215,502 patients gathered from CMS data, and 717 (0.33%) of these patients underwent kyphoplasty during the study period. Of these patients, 458 (63.8%) were female, the average age was 76.5 years old, 655 (91.3%) were White, 20 (2.7%) were Black, 9 (1.3%) were Hispanic, and 98 (13.7%) were Medicare/Medicaid dual eligible. White patients (32,317/157,177 [20.6%]) were less likely to be dual enrollment eligible in Medicare and Medicaid than Black (5407/13,522 [39.9%]), Hispanic (2833/3675 [77.1%]), Asian (2087/3312 [63.0%]), or North American Native patients (778/1578 [49.1%]). Multivariate regression (MVR) analysis was performed and showed that Blacks were less likely than Whites to have a kyphoplasty performed (OR 0.46 [95% CI: 0.29-0.72], p-value <0.001). Although Hispanics (OR 0.95 [0.49-1.86]), North American Native (OR 0.82 [0.3-2.19]), and unknown race had a decreased odd of undergoing kyphoplasty, it was not statistically significant. CONCLUSION Our study showed after adjustment for pertinent comorbidities, Medicare/Medicaid dual-eligible patients and Black patients were significantly less likely to receive kyphoplasty than White patients with Medicare.
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Affiliation(s)
- Sindhu Krishnan
- Department of Anesthesiology, Perioperative and Pain Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ethan Y Brovman
- Department of Anesthesiology, Perioperative and Pain Medicine, Tufts Medical Center/Tufts Medical School, Boston, Massachusetts, USA
| | - Mark R Jones
- Pain Medicine of the South, Knoxville, Tennessee, USA
| | - Joseph Emanuele Manzi
- Pain Division, Department of Anesthesiology, Weill Cornell School of Medicine and NewYork-Presbyterian Hospital, New York, New York, USA
| | | | | | - Richard D Urman
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Di Martino A, Villari E, Poluzzi R, Brunello M, Rossomando V, D’Agostino C, Ruta F, Faldini C. Role of biophysical stimulation in multimodal management of vertebral compression fractures. Comput Struct Biotechnol J 2023; 21:5650-5661. [PMID: 38047233 PMCID: PMC10692617 DOI: 10.1016/j.csbj.2023.11.023] [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] [Received: 09/28/2023] [Revised: 11/10/2023] [Accepted: 11/10/2023] [Indexed: 12/05/2023] Open
Abstract
Raised life expectancy and aging of the general population are associated with an increased concern for fragility fractures due to factors such as osteoporosis, reduced bone density, and an higher risk of falls. Among these, the most frequent are vertebral compression fractures (VCF), which can be clinically occult. Once the diagnosis is made, generally thorough antero-posterior and lateral views of the affected spine at the radiographs, a comprehensive workup to assess the presence of a metabolic bone disease or secondary causes of osteoporosis and bone frailty is required. Treatment uses a multimodal management consisting of a combination of brace, pain management, bone metabolism evaluation, osteoporosis medication and has recently incorporated biophysical stimulation, a noninvasive technique that uses induced electric stimulation to improve bone recovery through the direct and indirect upregulation of bone morphogenic proteins, stimulating bone formation and remodeling. It contributes to the effectiveness of the therapy, promoting accelerated healing, supporting the reduction of bed rest and pain medications, improving patients' quality of life, and reducing the risk to undergo surgery in patients affected by VCFs. Therefore, the aim of this review is to outline the fundamental concepts of multimodal treatment for VCF, as well as the present function and significance of biophysical stimulation in the treatment of VCF patients.
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Affiliation(s)
- Alberto Di Martino
- 1st Orthopaedic and Traumatologic Department, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136 Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Eleonora Villari
- 1st Orthopaedic and Traumatologic Department, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136 Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Riccardo Poluzzi
- 1st Orthopaedic and Traumatologic Department, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136 Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Matteo Brunello
- 1st Orthopaedic and Traumatologic Department, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136 Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Valentino Rossomando
- 1st Orthopaedic and Traumatologic Department, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136 Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Claudio D’Agostino
- 1st Orthopaedic and Traumatologic Department, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136 Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Federico Ruta
- 1st Orthopaedic and Traumatologic Department, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136 Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Cesare Faldini
- 1st Orthopaedic and Traumatologic Department, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136 Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
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Li T, Pang S, England R, Gong A, Botros D, Manupipatpong S, Hui FK, Khan M. Clinical Outcomes and Safety Comparison of Vertebroplasty, Balloon Kyphoplasty, and Vertebral Implant for Treatment of Vertebral Compression Fractures. AJNR Am J Neuroradiol 2023; 44:1345-1351. [PMID: 37918938 PMCID: PMC10631528 DOI: 10.3174/ajnr.a8031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 09/14/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND AND PURPOSE Vertebral compression fracture represents a major health burden for the aging populations globally. However, limited studies exist on the relative efficacy and safety of surgical interventions for vertebral compression fracture. Here, we aim to compare clinical and patient-reported outcomes following vertebral augmentation using balloon kyphoplasty, vertebroplasty, and SpineJack vertebral implant. MATERIALS AND METHODS An institutional review board-approved, retrospective, multi-institutional review of patients undergoing vertebral augmentation with kyphoplasty, vertebroplasty, and/or a SpineJack vertebral implant was performed between 2018 and 2021. Primary outcomes included pre- and postprocedural pain ratings and vertebral body height restoration. The secondary outcome was a change in the local kyphotic angle. The Kruskal-Wallis test was used to compare outcomes across 3 treatment options. Complications were reviewed during and 30-90 days after the procedure. RESULTS Vertebral augmentation of 344 vertebral compression fracture levels was performed during the study period. Sixty-seven patients had 79 kyphoplasty procedures (55% women; mean age, 64.2 [SD, 12.3] years). Seventy-four patients underwent a mean of 84 vertebroplasty procedures (51% women; mean age, 63.5 [SD, 12.8] years), and 61 patients had a mean of 67 SpineJack vertebral implant procedures (57.4% women; mean age, 68.3 [SD, 10.6] years). Following kyphoplasty, vertebroplasty, and SpineJack vertebral implant, pain scores improved significantly (P < .001). Resting pain improvement was similar across the 3 procedures, whereas improvement of "worst pain" was significantly better following a SpineJack vertebral implant compared with kyphoplasty and vertebroplasty (P < .001). Patients with a SpineJack vertebral implant had greater improvement in vertebral body height restoration and local kyphotic angle compared with those undergoing kyphoplasty and vertebroplasty. Adjacent level fractures (6.7% incidence) occurred similarly in the 3 procedure types. There were no other peri- or postoperative complications. CONCLUSIONS The SpineJack vertebral implant showed equivalent pain improvement compared with vertebroplasty and kyphoplasty, but it had superior vertebral body height restoration and local kyphotic angle improvement. This study supports the SpineJack vertebral implant as a safe and effective alternative (adjunct) for vertebral augmentation, especially in patients with moderate-to-severe vertebral compression fractures for greater improvement in vertebral body height restoration.
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Affiliation(s)
- Taibo Li
- From the Department of Biomedical Engineering (T.L.), Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Sharon Pang
- Department of Emergency Medicine (S.P.), Massachusetts General Hospital, Boston, Massachusetts
| | - Ryan England
- Russell H. Morgan Department of Radiology and Radiological Science (R.E., F.K.H.), The Johns Hopkins Hospital, Baltimore, Maryland
| | - Anna Gong
- Johns Hopkins School of Medicine (A.G., D.B., S.M.), Baltimore, Maryland
| | - David Botros
- Johns Hopkins School of Medicine (A.G., D.B., S.M.), Baltimore, Maryland
| | | | - Ferdinand K Hui
- Russell H. Morgan Department of Radiology and Radiological Science (R.E., F.K.H.), The Johns Hopkins Hospital, Baltimore, Maryland
- Neurointerventional Surgery Division (F.K.H.), The Queen's Medical Center, Honolulu, Hawaii
| | - Majid Khan
- Non-Vascular Interventional Neuroradiology (M.K.), Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
- Division of Neuroradiology and Division of Interventional Radiology (M.K.), Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, Maryland
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10
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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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11
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Shin JI, Leggett AR, Berg AR, Harris CB, Merchant AM, Vives MJ. Enhanced Risk Stratification for Short-Term Complications Following Vertebral Augmentation for Osteoporotic Vertebral Compression Fractures. Int J Spine Surg 2023; 17:579-586. [PMID: 37460240 PMCID: PMC10478692 DOI: 10.14444/8476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND For patients with back pain from osteoporotic vertebral compression fractures (VCFs), vertebral augmentation remains the most utilized surgical intervention. Previous studies report 30-day readmission and mortality rates of up to 10% and 2%, respectively. These studies, however, have included patients with pathologic fractures and combined patients in different admission settings. We undertook the current study to address such shortcomings, which make risk stratification and appropriate counseling difficult. METHODS Four consecutive years of the National Surgical Quality Improvement Program database were queried. Patients who underwent vertebral augmentation for osteoporotic VCFs were divided into 3 groups: (1) outpatient group (defined as patients with same-day discharge), (2) inpatient group (defined as those who were admitted postoperatively), and (3) preprocedure hospitalized group (defined as those who were already inpatient or were at acute/intermediate care facilities and transferred). Postoperative 30-day complications and readmission rates were compared between different groups and examined using multivariate analyses. RESULTS A total of 1023 patients underwent outpatient surgery; 503 were admitted on the day of surgery; and 149 patients were already in-hospital or were transferred from other facility. Mortality rates were 0.68%, 0.60%, and 2.68%, and readmission rates were 6.26%, 6.76%, and 12.8%, for outpatient, inpatient, and preprocedure hospitalization cohorts, respectively. Multivariate analyses identified preprocedure hospitalization as an independent risk factor for urinary tract infection (UTI; OR = 3.98, 95% CI = 1.41-11.20, P = 0.028), pneumonia (OR = 19.69, 95% CI = 3.81-101.65, P < 0.001), readmission (OR = 1.86, 95% CI = 1.06-3.26, P = 0.032), and mortality (OR = 4.49, 95% CI = 1.22-16.53, P = 0.024). CONCLUSION Our findings suggest that published rates of complications and mortality are substantially impacted by the cohort of patients who are already hospitalized or transferred from other facilities. Such patients are at a higher risk of UTI, pneumonia, readmission, and mortality. Conversely, we show that a relatively healthy patient being offered outpatient same-day augmentation has a readmission risk 40% lower and a mortality risk 3 times lower than previously reported. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- John I Shin
- Department of Orthopaedics, Rutgers University New Jersey Medical School, Newark, NJ, USA
| | - Andrew R Leggett
- Department of Orthopaedics, Rutgers University New Jersey Medical School, Newark, NJ, USA
| | - Ari R Berg
- Department of Orthopaedics, Rutgers University New Jersey Medical School, Newark, NJ, USA
| | - Colin B Harris
- Department of Orthopaedics, Rutgers University New Jersey Medical School, Newark, NJ, USA
| | - Aziz M Merchant
- Department of Surgery, Rutgers University New Jersey Medical School, Newark, NJ, USA
| | - Michael J Vives
- Department of Orthopaedics, Rutgers University New Jersey Medical School, Newark, NJ, USA
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12
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Pakhan AA, Boob MA, Somaiya KJ, Phansopkar P. Holistic Therapeutic Approaches Improve Functional Mobility in Patients With Postoperative Vertebral Compression Fracture (VCF): A Case Report. Cureus 2023; 15:e44032. [PMID: 37746439 PMCID: PMC10517586 DOI: 10.7759/cureus.44032] [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] [Received: 07/23/2023] [Accepted: 08/24/2023] [Indexed: 09/26/2023] Open
Abstract
For an unusual spinal injury that frequently results in a traumatic fracture of the lumbar spine, surgical procedures, including spinal fixation and osteotomies, are commonly needed for the therapy of complicated spinal pathologies to regain stability and relieve pain. A 55-year-old man complained of lower back pain while lifting heavy objects at work. He was taken to Acharya Vinoba Bhave Rural Hospital (AVBRH), where a radiological examination revealed a fracture of the L3 vertebra. He underwent surgery for the fracture, which included an L2-L4 spinal fixation operation and an L3-level osteotomy. The patient was sent to the physiotherapy department for postoperative recovery after the surgery. The rehabilitation program was designed according to the patient's condition. The goals were maximizing functional recovery, better pain management, and improving the participant's health and quality of life. The novel rehabilitation strategy strongly emphasized a multifunctional, patient-centric approach and evidence-based methodologies. The goals of the therapy were to regain full range of motion, gradually increase axial loading, and keep the supporting muscles strong.
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Affiliation(s)
- Arjavi A Pakhan
- Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research (DU), Wardha, IND
| | - Manali A Boob
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research (DU), Wardha, IND
| | - Kamya J Somaiya
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research (DU), Wardha, IND
| | - Pratik Phansopkar
- R&D, RNPC, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research (DU), Wardha, IND
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research (DU), Wardha, IND
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13
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Ryu SM, Lee S, Jang M, Koh JM, Bae SJ, Jegal SG, Shin K, Kim N. Diagnosis of osteoporotic vertebral compression fractures and fracture level detection using multitask learning with U-Net in lumbar spine lateral radiographs. Comput Struct Biotechnol J 2023; 21:3452-3458. [PMID: 37457807 PMCID: PMC10345217 DOI: 10.1016/j.csbj.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 06/18/2023] [Accepted: 06/24/2023] [Indexed: 07/18/2023] Open
Abstract
Recent studies of automatic diagnosis of vertebral compression fractures (VCFs) using deep learning mainly focus on segmentation and vertebral level detection in lumbar spine lateral radiographs (LSLRs). Herein, we developed a model for simultaneous VCF diagnosis and vertebral level detection without using adjacent vertebral bodies. In total, 1102 patients with VCF, 1171 controls were enrolled. The 1865, 208, and 198 LSLRS were divided into training, validation, and test dataset. A ground truth label with a 4-point trapezoidal shape was made based on radiological reports showing normal or VCF at some vertebral level. We applied a modified U-Net architecture, in which decoders were trained to detect VCF and vertebral levels, sharing the same encoder. The multi-task model was significantly better than the single-task model in sensitivity and area under the receiver operating characteristic curve. In the internal dataset, the accuracy, sensitivity, and specificity of fracture detection per patient or vertebral body were 0.929, 0.944, and 0.917 or 0.947, 0.628, and 0.977, respectively. In external validation, those of fracture detection per patient or vertebral body were 0.713, 0.979, and 0.447 or 0.828, 0.936, and 0.820, respectively. The success rates were 96 % and 94 % for vertebral level detection in internal and external validation, respectively. The multi-task-shared encoder was significantly better than the single-task encoder. Furthermore, both fracture and vertebral level detection was good in internal and external validation. Our deep learning model may help radiologists perform real-life medical examinations.
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Affiliation(s)
- Seung Min Ryu
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Department of Biomedical Engineering, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soyoung Lee
- Department of Biomedical Engineering, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Miso Jang
- Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung-Min Koh
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung Jin Bae
- Department of Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seong Gyu Jegal
- Department of Biomedical Engineering, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Keewon Shin
- Department of Biomedical Engineering, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Namkug Kim
- Department of Biomedical Engineering, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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14
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Benditz A, Jerosch J. [Osteoporotic vertebral fractures-From diagnosis to treatment]. Z Rheumatol 2023; 82:18-24. [PMID: 36006473 DOI: 10.1007/s00393-022-01255-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 02/07/2023]
Abstract
The aim of the present work is an overview of current concepts in the treatment of osteoporotic vertebral fractures, risk factors, clinical presentation and conservative and operative management. Osteoporotic vertebral fractures are a widespread problem, affecting between 700,000 and 1.5 million adults annually in the USA alone. Osteoporotic vertebral fractures can cause severe physical impairment, including back pain, dysfunction, and progressive thoracic kyphosis. Mortality after osteoporotic vertebral fractures is still increased compared to age-matched controls. In the reality of care, advocates of purely conservative therapy as well as advocates of surgical treatment can be found all over the world. In summary, understanding the risk factors, appropriate clinical evaluation and treatment strategies are crucial. When surgery is indicated, balloon kyphoplasty shows significantly better pain reduction and lower mortality compared to nonsurgical treatment.
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Affiliation(s)
- Achim Benditz
- Sektion Orthopädie und Wirbelsäulenchirurgie, Klinikum Fichtelgebirge, Schillerhain 1-8, 95615, Marktredwitz, Deutschland.
| | - Jörg Jerosch
- Klinik für Orthopädie, Unfallchirurgie und Sportmedizin, Johanna-Etienne-Krankenhaus, Neuss, Deutschland
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15
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Javed S, Perry K, Mach S, Huh B. Case report: Use of peripheral nerve stimulation for treatment of pain from vertebral plana fracture. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2023; 3:1088097. [PMID: 36713642 PMCID: PMC9878588 DOI: 10.3389/fpain.2022.1088097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/16/2022] [Indexed: 01/13/2023]
Abstract
Vertebral plana fractures are a severe form of compression fractures that can cause significant morbidity due to incapacitating pain. Due to the flattening of the vertebrae in a plana fracture, accessing the vertebral body transpedicularly can be difficult, making traditional vertebral augmentation treatment dangerous. These injuries also typically occur in elderly patients with contraindications to invasive procedures. Peripheral nerve stimulation is a relatively new and minimally invasive treatment that uses electrical stimulation to inhibit pain signals from reaching the somatosensory cortex. Our case describes an 80 Year old female with multiple comorbidities and refractory pain due to a vertebral planar fracture successfully treated with a 60 day course of peripheral nerve stimulation as evidenced by over 50% reduction in symptoms and discontinuation of opioid pain medication use.
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Affiliation(s)
- Saba Javed
- Department of Pain Medicine, University of Texas MD Anderson Cancer Center, Houston, United States
| | - Kenneth Perry
- Department of Anesthesiology, Critical Care and Pain Medicine, University of Texas Health Science Center at Houston, Houston, United States,Correspondence: Kenneth Perry
| | - Steven Mach
- Department of Pain Medicine, University of Texas MD Anderson Cancer Center, Houston, United States
| | - Billy Huh
- Department of Pain Medicine, University of Texas MD Anderson Cancer Center, Houston, United States
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16
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Tartara F, Armocida D, Garbossa D, Meli F, Costantino G, Cofano F, Francaviglia N. Porous titanium microsphere kyphoplasty for augmentation treatment of osteoporotic vertebral fractures: Technical report and case series. Front Surg 2023; 10:1152995. [PMID: 37206353 PMCID: PMC10189281 DOI: 10.3389/fsurg.2023.1152995] [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] [Received: 01/28/2023] [Accepted: 03/14/2023] [Indexed: 05/21/2023] Open
Abstract
Background Vertebral augmentation procedures (VAPs) are used in cases of persistent and unresponsive pain in patients with vertebral compression fractures (VCFs). Although VAPs are considered a safe procedure providing quick pain relief and improved physical function, some postoperative complications can occur, for example, bone cement leakage. The material used in this procedure is almost exclusively polymethyl methacrylate (PMMA), which appears to lack biological activity and osteointegration capabilities. In this study, we introduce a new filling system consisting of cannulas preloaded with titanium microspheres, which stabilizes and consolidates the structure of the vertebral body in treating VCFs after the performance of the kyphoplasty procedure. Methods We report a retrospective case series of six patients affected by osteoporotic vertebral fractures with worsening back pain, neurologic impairment, and failed conservative treatment who underwent the VAP at our institute, for which the SPHEROPLAST [MT ORTHO s.r.l., Aci Sant'Antonio (CT), Italy] system was used. Results The patients had failed an average conservative trial of 3.9 weeks before they presented to us with neurodeficit. There were two men and four women with a mean age of 74.5 years. The average hospital stay was 2 days. There were no reported perioperative complications related to cement injection, such as intraoperative hypoxia, hypotension, pulmonary embolization, myocardial infarction, neurovascular or viscera injury, or death. The VAS score significantly decreased from a mean preoperative of 7.5 (range 6-19) to 3.8 (range 3-5) immediately after surgery and 1.8 (range 1-3). Conclusion We report the first clinical results in a series of six patients treated for VCF using the microsphere system after analyzing the clinical results produced by, and the complications that arose from, this new device. In patients with VCF, the VAP using titanium microspheres appears to be a feasible and safe procedure with a low risk of material leakage.
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Affiliation(s)
- Fulvio Tartara
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Daniele Armocida
- Neurosurgery Division, Human Neurosciences Department, “Sapienza” University, AOU Policlinico Umberto I, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
- Correspondence: Daniele Armocida
| | - Diego Garbossa
- Neurosurgery Division, Department of Neuroscience, A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Francesco Meli
- Neurosurgery Division, Arnas Civico di Cristina, Palermo, Italy
| | | | - Fabio Cofano
- Neurosurgery Division, Department of Neuroscience, A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy
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17
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Purdy GM, Venner CP, Tandon P, McNeely ML. Feasibility of a tailored and virtually supported home exercise program for people with multiple myeloma using a novel eHealth application. Digit Health 2022; 8:20552076221129066. [PMID: 36249481 PMCID: PMC9554139 DOI: 10.1177/20552076221129066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 09/09/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction eHealth exercise interventions have the unique ability to leverage the benefits of in-person programming (tailoring and supervision) with the benefits of home programming (flexibility). There may be a role for eHealth-delivered exercise for people with multiple myeloma (MM), as exercise tailoring and supervision are critical for successful outcomes due to the significant impacts/risks of myeloma-related side effects. The purpose of this study was to determine the safety, feasibility, and preliminary efficacy of a 12-week virtually supported eHealth exercise program. Methods Participants with MM completed a 12-week virtually supported home exercise program involving virtually supervised group workouts, independent workouts, and aerobic exercise. Tailoring was facilitated by the functionality of HEAL-Me, a novel eHealth app. Participants completed virtual fitness assessments and questionnaires at baseline and week 12. Results Twenty-nine participants consented, 26 completed all follow-up testing (90%). Exercise adherence was 90% (group), 83% (independent), and 90% (aerobic). No serious adverse events (grade ≥3) occurred. Significant improvements were found for quality of life and physical fitness. There was a high level of program/app satisfaction: 96% of participants agreed or strongly agreed that the exercise program was beneficial, 93% found it enjoyable, 89% were satisfied or very satisfied with delivery through the HEAL-Me app, and 48% felt that the eHealth program helped them manage cancer-related symptoms and side-effects. Conclusion An eHealth intervention that is individually tailored and includes virtual supervision and active support from the healthcare team is feasible and acceptable to people with MM. The findings from this study warrant investigation using a large-scale randomized controlled trial.
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Affiliation(s)
- Graeme M. Purdy
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada,Margaret L. McNeely, Department of Physical Therapy, Faculty of Rehabilitation Medicine, Department of Oncology, Cross Cancer Institute, University of Alberta, 3-44L Corbett Hall, Edmonton, Alberta, Canada.
| | | | - Puneeta Tandon
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Margaret L. McNeely
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada,Cross Cancer Institute, Edmonton, Canada
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18
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Association between Outpatient Visits and Initiating Medication among Elderly Patients after an Osteoporotic Vertebral Fracture. J Clin Med 2022; 11:jcm11175035. [PMID: 36078965 PMCID: PMC9457431 DOI: 10.3390/jcm11175035] [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: 06/28/2022] [Revised: 08/25/2022] [Accepted: 08/25/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose: A treatment gap exists in vertebral fracture (VF) patients. An outpatient visit is a necessary step to initiate treatment. The study aimed to evaluate factors associated with an outpatient visit following a VF diagnosis, and the association between the interval of an outpatient visit after VF diagnosis and its impact on prescribing of anti-osteoporosis medications (AOMs). Methods: Subjects 65 years and older from Tianliao Township in Taiwan with newly diagnosed VF between 2009 and 2010 were included. Information about outpatient visits and AOMs prescriptions were derived from the National Health Insurance Research database and followed up for 2 years. Factors associated with outpatient visits and the initiation of AOMs were assessed using the multivariable Cox proportional regression model analysis. The receiver operating characteristic curve (ROC curve) was analyzed to determine the predictive effects of the interval between an outpatient visit following the diagnosis of a new VF on initiating AOMs and the potential optimal cutoff point. Results: Of 393 participants, 42.2% had outpatient visits within 2 years after a new VF diagnosis, for which the mean interval was 4.8 ± 4.8 months. Patients who were female and reported a current use of supplements were positively associated with visits after a new VF diagnosis, but the bone mineral density (BMD) T-score was negatively associated with visits. Furthermore, 140 (35.6%) patients had initiated AOMs within 2 years after the diagnosis of a new VF. It was found that a higher BMD T-score and a longer interval between an outpatient visit following diagnosis was negatively associated with initiation of AOMs. The ROC curve analysis showed outpatient visits within 3 months after a VF diagnosis had the highest Youden index and maximum area under the curve. Conclusions: Patients who were female, were currently taking supplements, and those who had a lower BMD T-score were more likely to visit doctors after being diagnosed with a new VF. Furthermore, a lower BMD T-score and a shorter interval, within 3 months and not more than 8 months, between an outpatient visit following the diagnosis of VF increased the likelihood of being prescribed AOMs.
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19
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Systematic Nursing Interventions Combined with Continuity of Care in Patients with a Spinal Fracture Complicated with a Spinal Cord Injury and Its Effect on Recovery and Satisfaction. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:3771144. [PMID: 35966749 PMCID: PMC9374555 DOI: 10.1155/2022/3771144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/25/2022] [Accepted: 06/16/2022] [Indexed: 11/17/2022]
Abstract
Objective. The aim of this study is to examine the application value of systematic nursing interventions combined with continuity of care in cases with a spinal fracture complicated with a spinal cord injury and its effect on recovery and satisfaction. Methods. We identified ninety cases with a spinal fracture complicated with a spinal cord injury who were admitted to local hospital from May 2019 to May 2021 as research subjects and assigned them into an experimental group (systematic nursing combined with continuity of care, n = 45) and a control group (conventional nursing, n = 45) according to their admission order. The level of life of all groups between intervention was evaluated with reference to the Generic Quality of Life Inventory-74 (GQOLI-74) Rating Scale. The Hospital Anxiety and Depression (HAD) scale was used to assess the emotional status of patients before and after intervention. The complication rates, nursing outcomes, nursing satisfaction, and rehabilitation outcomes of all cases were calculated. Results. The GQOLI-74 score of the experimental group was higher than that of another group (
). Lower HAD scores of experimental group were observed than that of another group (
). The experimental group obtained remarkably higher nursing effective rates and higher nursing satisfaction than another group (
). Rehabilitation outcome of the experimental group outperformed that another group (
). Conclusion. The use of systematic nursing intervention combined with continuity of care for cases with spinal fracture complicated with a spinal cord injury can enhance the nursing effect, effectively relieve cases’ psychological pressure, improve patients’ level of life and nursing satisfaction, and contribute to the maintenance of a good nurse-patient relationship, which merits clinical promotion.
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20
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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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21
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Dussault PM, Lazzari AA. Response to letter to the editor. Osteoporos Int 2022; 33:1183-1184. [PMID: 35303114 DOI: 10.1007/s00198-022-06351-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/14/2022] [Indexed: 11/26/2022]
Affiliation(s)
| | - A A Lazzari
- VA Boston Healthcare System, Boston, MA, USA
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22
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Kuriakose C, Cherian KE, Jebasingh F, Kapoor N, Asha HS, Jose A, Thomas N, Paul TV. The prevalence of vertebral fractures among Indian perimenopausal women and its association with ovarian biomarkers. J Bone Miner Metab 2022; 40:142-149. [PMID: 34532782 DOI: 10.1007/s00774-021-01266-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/20/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION There is dearth of data on prevalent vertebral fractures in perimenopausal women in India and limited literature on the utility of FSH, AMH and estradiol in evaluating bone health them. The objective was to study the prevalence of vertebral fractures (VF) and to assess the utility of FSH, estradiol and AMH in predicting them in Indian perimenopausal women MATERIALS AND METHODS: It was a cross-sectional study. Perimenopausal women aged 40-49 years underwent assessment for prevalent vertebral fractures, bone mineral density (BMD) and trabecular bone score (TBS). Utility of serum FSH, estradiol and AMH in predicting prevalent vertebral fractures was also assessed. RESULTS A total of 300 perimenopausal women with mean (SD) age of 43.2 (2.8) years was recruited and 18% had moderate-severe VF. Mean (SD) serum AMH was lower in perimenopausal women with VF as compared to those without fractures [0.752 (0.594) vs 1.023 (0.704) P = 0.006]. AMH showed significant positive correlation with TBS (r = 0.3; P < 0.001) and BMD at the femoral neck (r = 0.2; P < 0.001) and lumbar spine (r = 0.3; P < 0.001).On ROC analysis, AMH demonstrated good performance in predicting prevalent VF with an AUC of 0.800 (95% CI 0.705-0.880) and a sensitivity of 85% and specificity of 60% at a cut-off of 1.12 ng/mL. On an exploratory multivariate logistic regression analysis, AMH significantly predicted prevalent fractures with an adjusted OR (OR) of 1.85 (95% CI: 1.03-3.00; P = 0.04). The performance of FSH and estradiol in predicting prevalent fractures was sub-optimal. CONCLUSION About one-fifth of the study subjects had prevalent vertebral fractures. AMH may be a menstrual cycle independent biomarker and may reflect bone loss in perimenopausal women. Further prospective studies are needed to validate these findings.
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Affiliation(s)
- Cijoy Kuriakose
- Departments of Endocrinology, Christian Medical College and Hospital, Vellore, India
| | | | - Felix Jebasingh
- Departments of Endocrinology, Christian Medical College and Hospital, Vellore, India
| | - Nitin Kapoor
- Departments of Endocrinology, Christian Medical College and Hospital, Vellore, India
| | - Hesarghatta S Asha
- Departments of Endocrinology, Christian Medical College and Hospital, Vellore, India
| | - Arun Jose
- Clinical Biochemistry, Christian Medical College and Hospital, Vellore, India
| | - Nihal Thomas
- Departments of Endocrinology, Christian Medical College and Hospital, Vellore, India
| | - Thomas V Paul
- Departments of Endocrinology, Christian Medical College and Hospital, Vellore, India
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Suri A, Jones BC, Ng G, Anabaraonye N, Beyrer P, Domi A, Choi G, Tang S, Terry A, Leichner T, Fathali I, Bastin N, Chesnais H, Taratuta E, Kneeland BJ, Rajapakse CS. Vertebral Deformity Measurements at MRI, CT, and Radiography Using Deep Learning. Radiol Artif Intell 2022; 4:e210015. [PMID: 35146432 DOI: 10.1148/ryai.2021210015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 09/12/2021] [Accepted: 10/22/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE To construct and evaluate the efficacy of a deep learning system to rapidly and automatically locate six vertebral landmarks, which are used to measure vertebral body heights, and to output spine angle measurements (lumbar lordosis angles [LLAs]) across multiple modalities. MATERIALS AND METHODS In this retrospective study, MR (n = 1123), CT (n = 137), and radiographic (n = 484) images were used from a wide variety of patient populations, ages, disease stages, bone densities, and interventions (n = 1744 total patients, 64 years ± 8, 76.8% women; images acquired 2005-2020). Trained annotators assessed images and generated data necessary for deformity analysis and for model development. A neural network model was then trained to output vertebral body landmarks for vertebral height measurement. The network was trained and validated on 898 MR, 110 CT, and 387 radiographic images and was then evaluated or tested on the remaining images for measuring deformities and LLAs. The Pearson correlation coefficient was used in reporting LLA measurements. RESULTS On the holdout testing dataset (225 MR, 27 CT, and 97 radiographic images), the network was able to measure vertebral heights (mean height percentage of error ± 1 standard deviation: MR images, 1.5% ± 0.3; CT scans, 1.9% ± 0.2; radiographs, 1.7% ± 0.4) and produce other measures such as the LLA (mean absolute error: MR images, 2.90°; CT scans, 2.26°; radiographs, 3.60°) in less than 1.7 seconds across MR, CT, and radiographic imaging studies. CONCLUSION The developed network was able to rapidly measure morphometric quantities in vertebral bodies and output LLAs across multiple modalities.Keywords: Computer Aided Diagnosis (CAD), MRI, CT, Spine, Demineralization-Bone, Feature Detection Supplemental material is available for this article. © RSNA, 2021.
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Affiliation(s)
- Abhinav Suri
- Departments of Radiology and Orthopedics, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104
| | - Brandon C Jones
- Departments of Radiology and Orthopedics, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104
| | - Grace Ng
- Departments of Radiology and Orthopedics, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104
| | - Nancy Anabaraonye
- Departments of Radiology and Orthopedics, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104
| | - Patrick Beyrer
- Departments of Radiology and Orthopedics, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104
| | - Albi Domi
- Departments of Radiology and Orthopedics, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104
| | - Grace Choi
- Departments of Radiology and Orthopedics, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104
| | - Sisi Tang
- Departments of Radiology and Orthopedics, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104
| | - Ashley Terry
- Departments of Radiology and Orthopedics, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104
| | - Thomas Leichner
- Departments of Radiology and Orthopedics, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104
| | - Iman Fathali
- Departments of Radiology and Orthopedics, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104
| | - Nikita Bastin
- Departments of Radiology and Orthopedics, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104
| | - Helene Chesnais
- Departments of Radiology and Orthopedics, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104
| | - Elena Taratuta
- Departments of Radiology and Orthopedics, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104
| | - Bruce J Kneeland
- Departments of Radiology and Orthopedics, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104
| | - Chamith S Rajapakse
- Departments of Radiology and Orthopedics, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104
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Ikeda T, Suzuki T, Takagi M, Murakami M. Effect of Early Rehabilitation Treatment on Activities of Daily Living in Patients Receiving Conservative Treatment for Vertebral Compression Fracture. Prog Rehabil Med 2021; 6:20210049. [PMID: 34963904 PMCID: PMC8652343 DOI: 10.2490/prm.20210049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 11/04/2021] [Indexed: 11/09/2022] Open
Abstract
Objectives : Vertebral compression fractures are common among older people. Currently, knowledge of the effects of early rehabilitation treatment on the recovery of activities of daily living (ADL) in older patients who receive conservative treatment for these fractures is limited. Using the instrumental variable (IV) method, we examined the effects on ADL at discharge of a delay in initiating rehabilitation treatment. Methods In this retrospective cohort study, data from the Japanese Diagnosis Procedure Combination database were analyzed. The subjects were patients with vertebral compression fracture who had undergone rehabilitation treatment during their hospitalization between 2014 and 2019 in one of the 29 acute-care hospitals in Yamagata Prefecture. We analyzed data from 1706 patients (mean age, 82.1 years). The independent variable was the number of days between hospital admission and the start of rehabilitation treatment, and the outcome was the Barthel index (BI) score at discharge. An IV method was applied, with adjustments for covariates, including demographics and functional status at admission. Results Most patients started rehabilitation treatment within 3 days of hospital admission. Our IV method showed that the interval between hospital admission and the start of rehabilitation treatment was significantly associated with the BI score at discharge. The coefficient was -2.71 (95% confidence interval [CI]: -5.06 to -0.35). Conclusions A delay in initiating rehabilitation treatment had a negative effect on ADL at discharge. This result emphasizes the importance of including early rehabilitation treatment in acute care, as recommended by several existing guidelines for the treatment of orthopedic diseases.
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Affiliation(s)
- Takaaki Ikeda
- Department of Health Policy Science, Graduate School of Medical Science, Yamagata University, Yamagata, Japan.,Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Miyagi, Japan
| | - Tomoto Suzuki
- Department of Orthopedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Michiaki Takagi
- Department of Orthopedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Masayasu Murakami
- Department of Health Policy Science, Graduate School of Medical Science, Yamagata University, Yamagata, Japan
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Kelm N, Wasfie T, Volk M, Walker Z, Galovska S, Brock C, Jackson A. Role of Fracture Liaison Service Program in Reducing Refracture Rate in the Elderly Osteoporotic Trauma Patients Presenting With Vertebral Compression Fracture: A Six-Year Study. Am Surg 2021:31348211047512. [PMID: 34551600 DOI: 10.1177/00031348211047512] [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: 01/22/2023]
Abstract
INTRODUCTION As the elderly population of the United States and the world increases, so does the incidence of osteoporotic fragility fractures from a fall or minor injury. This results in a large cost to the health care system. This cost is further increased as more than 50% of individuals will have refractures within the first year. In order to reduce the refracture rate in such patients, we enrolled our elderly trauma patients with vertebral compression fractures and vertebral augmentation in a Fracture Liaison Service (FLS) clinic for two years and reevaluated their refracture rate. METHOD This is a retrospective analysis of 720 patients. 142 patients (Group A) were seen between 2012 and 2014 before establishing the FLS program and 578 patients (Group B) were seen between 2015 and 2020 after implementation of the FLS program. The patients enrolled in the FLS program were followed for two years after sustaining a vertebral compression fracture. The data collected included age, sex, serum calcium and vitamin D levels, dual energy X-ray absorptiometry (DXA) scan, 10-year fracture risk (FRAX) score, pressure measurements in PSI taken during vertebral augmentation, as well as the refracture rate. The data collected were analyzed and compared between the two groups using the Student's t-test and chi-square test. RESULTS There was significant reduction in the refracture rate of pre-FLS vs post-FLS vertebral, as well as other fractures in the FLS group (pre-FLS: 48.9% vs post-FLS: 37.0%; P = .01). There was no significant difference between groups A and B in regard to the mean serum level of calcium (9.44 mg/dL vs 9.53 mg/dL), vitamin D level (35.04 ng/mL vs 41.39 ng/mL), DXA scan for spine (-.52 vs -.76) and for femur (-1.77 vs -1.52), and 10-year refracture risk for osteoporotic major fracture (FRAX score-mean: 22.6% vs 19.2%) and for hip fracture (9.18% vs 7.53%). There was a significant difference in the mean age between the groups (79.5 vs 73.5 years; P = .01). Of those who underwent vertebral augmentation, 235 had Pressure Scale Index (PSI) measurements taken. There was a trend in increasing refracture rate when PSI ≤199 compared with those who had PSI ≥200, although statistical significance was not met (33.9% vs 27.0%, P = .21). CONCLUSION A Fracture Liaison Service program will improve the bone health of geriatric osteoporotic patients presenting to the trauma service with vertebral compression fractures and thus reduces the subsequent refracture rate. Further study is needed to evaluate the best PSI used to impact reduction in refracture rate.
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Affiliation(s)
- Noah Kelm
- Department of Orthopedic, Ascension Genesys Hospital, Grand Blanc, MI, USA
| | - Tarik Wasfie
- Department of Trauma Service, 3577Ascension Genesys Hospital, Grand Blanc, MI, USA
| | - Max Volk
- 12268Michigan State University, College of Human Medicine, East Lansing, MI, USA
| | - Zach Walker
- 12268Michigan State University, College of Human Medicine, East Lansing, MI, USA
| | | | - Cara Brock
- Michigan Neurosurgical Institute, Grand Blanc, MI, USA
| | - Avery Jackson
- Michigan Neurosurgical Institute, Grand Blanc, MI, USA
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26
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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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27
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Missiuna PC, Sarraj M, Bosakhar B, Thornley P, Donnellan J, Kishta W, Darby P, Maizlin ZV. Vertebroplasty for Treatment of Steroid-Induced Osteoporotic Vertebral Compression Fractures in an Adolescent With Duchenne Muscular Dystrophy. HSS J 2021; 17:223-226. [PMID: 34421434 PMCID: PMC8361581 DOI: 10.1177/1556331621990648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 12/23/2020] [Indexed: 12/03/2022]
Affiliation(s)
- Paul C. Missiuna
- Department of Surgery, Division of Orthopedic Surgery, McMaster University Medical Centre, Hamilton, ON, Canada,Paul C. Missiuna, MD, FRCS (C), Department of Surgery, Division of Orthopedic Surgery, McMaster University Medical Centre, Hamilton, ON L8N 3Z5, Canada.
| | - Mohamed Sarraj
- Department of Surgery, Division of Orthopedic Surgery, McMaster University Medical Centre, Hamilton, ON, Canada
| | - Batool Bosakhar
- Department of Surgery, Division of Orthopedic Surgery, McMaster University Medical Centre, Hamilton, ON, Canada
| | - Patrick Thornley
- Department of Surgery, Division of Orthopedic Surgery, McMaster University Medical Centre, Hamilton, ON, Canada
| | - John Donnellan
- Department of Radiology, McMaster University Medical Centre, Hamilton, ON, Canada
| | - Waleed Kishta
- Department of Surgery, Division of Orthopedic Surgery, McMaster University Medical Centre, Hamilton, ON, Canada
| | - Peter Darby
- Department of Anesthesia, McMaster University Medical Centre, Hamilton, ON, Canada
| | - Zeev V. Maizlin
- Department of Radiology, McMaster University Medical Centre, Hamilton, ON, Canada
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Ross BJ, Lee OC, Harris MB, Dowd TC, Savoie FH, Sherman WF. Rates of Osteoporosis Management and Secondary Preventative Treatment After Primary Fragility Fractures. JB JS Open Access 2021; 6:JBJSOA-D-20-00142. [PMID: 34136740 PMCID: PMC8202643 DOI: 10.2106/jbjs.oa.20.00142] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Fragility fractures are often sentinel events in documenting new cases of osteoporosis. Numerous analyses have demonstrated low rates of adequate osteoporosis evaluation and treatment following primary fragility fractures. The purpose of this study was to quantify the incidence of primary fragility fractures in America and the rates of osteoporosis screening and management before and after fracture.
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Affiliation(s)
- Bailey J Ross
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Olivia C Lee
- Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center School of Medicine, New Orleans, Louisiana
| | - Mitchel B Harris
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Thomas C Dowd
- Department of Orthopaedic Surgery, San Antonio Uniformed Services Health Education Consortium Orthopaedic Residency Program, Fort Sam Houston, Texas
| | - Felix H Savoie
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - William F Sherman
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
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Differential diagnosis of benign and malignant vertebral fracture on CT using deep learning. Eur Radiol 2021; 31:9612-9619. [PMID: 33993335 DOI: 10.1007/s00330-021-08014-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To evaluate the performance of deep learning using ResNet50 in differentiation of benign and malignant vertebral fracture on CT. METHODS A dataset of 433 patients confirmed with 296 malignant and 137 benign fractures was retrospectively selected from our spinal CT image database. A senior radiologist performed visual reading to evaluate six imaging features, and three junior radiologists gave diagnostic prediction. A ROI was placed on the most abnormal vertebrae, and the smallest square bounding box was generated. The input channel into ResNet50 network was 3, including the slice with its two neighboring slices. The diagnostic performance was evaluated using 10-fold cross-validation. After obtaining the malignancy probability from all slices in a patient, the highest probability was assigned to that patient to give the final diagnosis, using the threshold of 0.5. RESULTS Visual features such as soft tissue mass and bone destruction were highly suggestive of malignancy; the presence of a transverse fracture line was highly suggestive of a benign fracture. The reading by three radiologists with 5, 3, and 1 year of experience achieved an accuracy of 99%, 95.2%, and 92.8%, respectively. In ResNet50 analysis, the per-slice diagnostic sensitivity, specificity, and accuracy were 0.90, 0.79, and 85%. When the slices were combined to ve per-patient diagnosis, the sensitivity, specificity, and accuracy were 0.95, 0.80, and 88%. CONCLUSION Deep learning has become an important tool for the detection of fractures on CT. In this study, ResNet50 achieved good accuracy, which can be further improved with more cases and optimized methods for future clinical implementation. KEY POINTS • Deep learning using ResNet50 can yield a high accuracy for differential diagnosis of benign and malignant vertebral fracture on CT. • The per-slice diagnostic sensitivity, specificity, and accuracy were 0.90, 0.79, and 85% in deep learning using ResNet50 analysis. • The slices combined with per-patient diagnostic sensitivity, specificity, and accuracy were 0.95, 0.80, and 88% in deep learning using ResNet50 analysis.
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30
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Kim H, Pyo H, Park HC, Lim DH, Yu JI, Park W, Ahn YC, Choi DH, Oh D, Noh JM, Cho WK, Yoo GS, Jung SH, Kim ES, Lee SH, Park SJ, Lee CS. Clinical and dosimetric risk factors for vertebral compression fracture after single-fraction stereotactic body radiation therapy for spine metastases. J Bone Oncol 2021; 28:100368. [PMID: 34026479 PMCID: PMC8131921 DOI: 10.1016/j.jbo.2021.100368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/23/2021] [Accepted: 04/27/2021] [Indexed: 10/31/2022] Open
Abstract
Objectives This analysis was performed to evaluate the incidence of vertebral compression fracture (VCF) and determine the contributing factors for VCF in patients undergoing single-fraction stereotactic body radiotherapy (SBRT) for spinal bone metastases (SBM). Methods A retrospective review of medical records was conducted for patients undergoing SBRT for SBM at our institution between January 2010 and December 2018. Patients who had undergone neither pre-SBRT surgical excision nor post-SBRT prophylactic fixation were included. The effects of clinical and dosimetric parameters were analyzed with respect to VCF risk. The following dosimietric parameters of the planning target volume (PTV) were calculated: mean/minimum/maximum dose, radiation dose to 10-90% volume, and irradiated volume receiving more than 10-25 Gy (PTV_V10 - 25 Gy). Results Among 163 patients (179 vertebrae), 21 (12.8%) experienced VCF. The 1-year and 2-year VCF rates were 12.1% and 13.2%, respectively. Among dosimetric parameters, PTV_V15 Gy was the most significant for VCF prediction. In a univariate analysis, breast or prostate primary, no vertebral body collapse, and PTV_V15 Gy ≤42 cm3 were significantly associated with a lower incidence rate of VCF. In a multivariate analysis, PTV_V15 Gy was the only significant factor for VCF risk. The 1-year VCF rate was 3.8% in patients with PTV_V15 Gy ≤42 cm3, while it was 22.1% in those with PTV_V15 Gy > 42 cm3 (p < 0.01). Conclusions SBRT-related VCF was found in 12% of patients in our institution. The PTV_V15 Gy is a significant factor for VCF prediction.
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Affiliation(s)
- Haeyoung Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hongryull Pyo
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Chul Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Do Hoon Lim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeong Il Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Doo Ho Choi
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dongryul Oh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Myoung Noh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won Kyung Cho
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gyu Sang Yoo
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang Hoon Jung
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun-Sang Kim
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sun-Ho Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Se-Jun Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chong-Suh Lee
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Xu Z, Hao D, Dong L, Yan L, He B. Surgical options for symptomatic old osteoporotic vertebral compression fractures: a retrospective study of 238 cases. BMC Surg 2021; 21:22. [PMID: 33407356 PMCID: PMC7789173 DOI: 10.1186/s12893-020-01013-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 12/14/2020] [Indexed: 12/17/2022] Open
Abstract
Background Symptomatic osteoporotic vertebral compression fractures (OVCF) are increasing, as are acute and chronic pain episodes and progressive spinal deformities. However, there are no clear surgical treatment criteria for patients with these different symptoms. Therefore, this study aims to explore the surgical approaches for the treatment of OVCF with different symptoms and evaluate the feasibility of these surgical approaches. Methods We retrospectively analyzed 238 symptomatic OVCF patients who entered our hospital from June 2013 to 2016. According to clinical characteristics and imaging examinations, these patients were divided into I-V grades and their corresponding surgical methods were developed. I, old vertebral fracture with no apparent instability, vertebral augmentation; II, old vertebral fracture with local instability, posterior reduction fusion internal fixation; III, old fractures with spinal stenosis, posterior decompression and reduction fusion and internal fixation; IV, old vertebral fracture with kyphosis, posterior osteotomy with internal fixation and fusion; V, a mixture of the above types, posterior osteotomy (decompression) with internal fixation and fusion. Postoperative visual analog score (VAS), oswestry disability index (ODI) scores, sagittal index (SI) and ASIA grades of neurological function were observed. Results All 238 patients were followed up for 12–38 months, with an average follow-up of 18.5 months. After graded surgery, the VAS score, ODI score, and vertebral sagittal index SI of 238 patients were significantly improved, and the difference between the last follow-up results and the preoperative comparison was statistically significant (P ˂ 0.05). Besides, the postoperative ASIA grades of 16 patients with nerve injury were improved from 14 patients with preoperative grade C, 2 patients with grade D to 4 patients with postoperative grade D and 12 patients with postoperative grade E. Conclusion In this study, we concluded that graded surgery could better treat symptomatic old OVCF and restore spinal stability. This provides clinical reference and guidance for the treatment of symptomatic old OVCF in the future.
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Affiliation(s)
- Zhengwei Xu
- Department of Spine Sugery, Shanxi, Xi'an Jiaotong University Affiliated Honghui Hospital, No.555, Youyi Road, Beilin District, Xi'an, People's Republic of China
| | - Dingjun Hao
- Department of Spine Sugery, Shanxi, Xi'an Jiaotong University Affiliated Honghui Hospital, No.555, Youyi Road, Beilin District, Xi'an, People's Republic of China
| | - Liang Dong
- Department of Spine Sugery, Shanxi, Xi'an Jiaotong University Affiliated Honghui Hospital, No.555, Youyi Road, Beilin District, Xi'an, People's Republic of China
| | - Liang Yan
- Department of Spine Sugery, Shanxi, Xi'an Jiaotong University Affiliated Honghui Hospital, No.555, Youyi Road, Beilin District, Xi'an, People's Republic of China
| | - Baorong He
- Department of Spine Sugery, Shanxi, Xi'an Jiaotong University Affiliated Honghui Hospital, No.555, Youyi Road, Beilin District, Xi'an, People's Republic of China.
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Ouyang X, Ding Y, Yu L, Xin F, Yang X, Sha P, Tong S, Cheng Q, Xu Y. Effects of BMP-2 compound with fibrin on osteoporotic vertebral fracture healing in rats. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2021; 21:149-156. [PMID: 33657766 PMCID: PMC8020021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To investigate the effects of bone morphogenetic protein-2 (BMP-2) compound with fibrin on osteoporotic vertebral fracture healing in rats. METHODS For the present study 160 Specific-Pathogen Free 32-week-old female Sprague-Dawley rats were used. 120 rats were randomly divided in three groups (experimental, model and sham operation group- n=40 per group) and were ovariectomized to establish the osteoporosis model. 40 rats served as a control group without treatment. The expression of BMP-2 in the fracture zone at the 4th, 6th, 8th, and 12th weeks was detected by qRT-PCR. The expression of BALP and CTX-I in serum at the 12th week was detected by Elisa. RESULTS At week 8, the morphology of the sham operation group was the same and the fracture healing occurred more slowly than in the other groups. At week 12, the expression of BMP-2 in the model group was significantly higher than that in the other three groups (p<0.05). At week 12, the maximum load, maximum strain, and elastic modulus of model group were significantly lower than those of the other three groups. CONCLUSIONS BMP-2 compound with fibrin can enhance the timing and quality of bone fracture healing in rats.
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Affiliation(s)
- Xiao Ouyang
- Department of Orthopedic Surgery, Xuzhou Third Hospital, Affiliated Xuzhou Hospital of Jiangsu University, Xuzhou, China
| | - Yunzhi Ding
- Department of Orthopedic Surgery, Xuzhou Third Hospital, Affiliated Xuzhou Hospital of Jiangsu University, Xuzhou, China
| | - Li Yu
- Department of Orthopedic Surgery, Xuzhou Third Hospital, Affiliated Xuzhou Hospital of Jiangsu University, Xuzhou, China
| | - Feng Xin
- Department of Orthopedic Surgery, Xuzhou Third Hospital, Affiliated Xuzhou Hospital of Jiangsu University, Xuzhou, China
| | - Xiaowei Yang
- Department of Orthopedic Surgery, Xuzhou Third Hospital, Affiliated Xuzhou Hospital of Jiangsu University, Xuzhou, China,Corresponding author: Dr Xiao Ouyang, Department of Orthopedics, Xuzhou Third Hospital, Affiliated Hospital of Jiangsu University,131 Huancheng Road, Xuzhou, Jiangsu 221005, P.R. China E-mail:
| | - Peng Sha
- Department of Orthopedic Surgery, Xuzhou Third Hospital, Affiliated Xuzhou Hospital of Jiangsu University, Xuzhou, China
| | - Songming Tong
- Department of Orthopedic Surgery, Xuzhou Third Hospital, Affiliated Xuzhou Hospital of Jiangsu University, Xuzhou, China
| | - Qi Cheng
- Department of Orthopedic Surgery, Xuzhou Third Hospital, Affiliated Xuzhou Hospital of Jiangsu University, Xuzhou, China
| | - Yiqi Xu
- Department of Orthopedic Surgery, Xuzhou Third Hospital, Affiliated Xuzhou Hospital of Jiangsu University, Xuzhou, China
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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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An Experimental Intervention Study Assessing the Impact of a Thin Silicone Gel Surface Overlay on Interface Pressure. Radiol Res Pract 2020; 2020:3246531. [PMID: 33299607 PMCID: PMC7710438 DOI: 10.1155/2020/3246531] [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: 06/18/2020] [Revised: 09/23/2020] [Accepted: 11/02/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction The incidence of pressure ulcers (PUs) presents a substantial threat to patients, especially geriatric patients, those with restricted mobility, and patients suffering from chronic diseases such as cancer. PUs creates a huge financial burden on healthcare authorities and patients, costing billions to treat and manage. Radiography and radiotherapy patients may experience medical device related (MDR) PUs and studies have shown that high interface pressure (IP) values exist for the head when placed on an X-ray table without a mattress. These high IP values pose a PU risk to patients, especially those accessing prolonged radiography/radiology and radiotherapy procedures. The current study assessed the impact on IP values for the head from using a thin silicone gel surface overlay during radiographic procedures and identified whether this reduced the risk of PUs. Materials and Methods A calibrated XSENSOR pressure mat was used to measure IP for the head on an X-ray table with and without a thin silicone gel surface overlay. Prior to pressure mapping, the silicone gel surface overlay was assessed for its impact on radiation attenuation and image quality. Results Study participants were 14 males (70%) and six females (30%), with an age range of 25-53 years (mean = 34.4 ± 7.0). Paired-samples t-test results indicated that there was a statistically significant decrease in the mean IP for the head on the X-ray table without the silicone gel surface overlay (mean = 83.9 ± 8.2 in mmHg) and the X-ray table with the gel surface overlay (mean = 62.4 ± 6.1 in mmHg), p ≤ 0.001. Paired-samples t-test results indicated that there was a statistically significant decrease in the mean peak pressure index (PPI) for the head on the X-ray table without the silicone gel surface overlay (mean = 205.1 ± 28.2 in mmHg) and the X-ray table with the gel surface overlay (mean = 159.8 ± 26.8 in mmHg), p ≤ 0.001. Conclusions The use of a thin silicone gel surface overlay could reduce IP risk for the head by approximately 25%. The reduction in IP risk could have a significant impact in reducing the risk of developing a PU. To ensure maximum benefit, the silicone gel surface overlay should be evaluated to address the specific needs within radiography and radiotherapy planning and treatment settings.
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TOMA AA, GHINGULEAC IB, GHINGULEAC LA, CALOTĂ N, OPREA Doinița, IONESCU EV, ILIESCU MG, STANCIU LE. Case presentation: The interdisciplinary and rehabilitation treatment of lumbar disc hernia on a patient with corticoterapy dependency and history of lymph node TB. BALNEO RESEARCH JOURNAL 2020. [DOI: 10.12680/balneo.2020.404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction. Disc herniation means the movement of an intervertebral disc. Lumbar disc herniation is an evolutionary phase of lumbar vertebral discopathy , by de Seze classification: phase I (low back pain), phase II (lumbar pain and paravertebral contracture), phase III (discal hernia, with three stages , radicular pain, paresthesias and motor deficiency). Materials and Methods. We are presenting the situation of a female patient, aged 62, from the urban area, with confirmed vices of smoking and sedentary lifestyle, which presented in Emergency Room in Constanta for lumbosciatalgias and paresthesias, impaired walking and presence of antalgic positions that required hospitalization in Neurosurgery section. The patient has a 15 points Glasgow score, with medical history of Hypertension, Rheumatoid Arthritis with corticotherapy, minor stroke and lymph node Tuberculosis. The muscular and osteoarticular system: apparently integral, with difficulty for active movements. The magnetic rezonance examination reveals 2 lumbar disc hernias at level L4. The neurosurgical treatment was applied: discectomy in the L4 disc herniation bilaterally with the removal of the disc fragments. Subsequently, the patient was transferred to the medical rehabilitation department from Techirghiol Sanatorium. The patient was evaluated clinically, functionally in dynamics to track the effectiveness of the neuromotor rehabilitation program. Results. Through the program of early rehabilitation established, the therapeutic yield was significant with the improvement of the clinical symptomatology as well as the marked increase of the functional parameters, assuring the patient a high degree of mobility, of autonomy, but also of reintegration in the social and family life. Conclusions. The peculiarity of this case was the critical condition of the patient at the hospitalization, corticodependence, which makes the surgery but also the medical rehabilitation much complicated by functional osteoporosis and low bone consistency. Neurosurgery together with medical rehabilitation have sounded excellent together with in many cases, with ability to restore strength, functionality as well as better health of patients, which creates an indispensability between the two specializations.
Keywords: corticodependency, lumbar disc herniation, rehabilitation, neurosurgery,
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Affiliation(s)
- Andrei-Alexandru TOMA
- ¹ „Ovidius” University of Constanta, Romania ² St. Andrew Emergency Hospital of Constanta, Romania
| | | | | | - Nicoleta CALOTĂ
- ³ Balneal and Rehabilitation Sanatorium of Techirghiol, Constanta, Romania
| | - OPREA Doinița
- ³ Balneal and Rehabilitation Sanatorium of Techirghiol, Constanta, Romania
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Yehudina ED, Kalashnikova OS. [Physical rehabilitation of patients with osteoporosis]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOĬ FIZICHESKOĬ KULTURY 2020; 97:78-85. [PMID: 32356638 DOI: 10.17116/kurort20209702178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Osteoporosis is one of the most common diseases, which along with cardiovascular pathology, diabetes mellitus and oncological diseases has a leading place in the structure of morbidity and mortality of the population. The combination of pharmacological and non-pharmacological methods is fundamental for the treatment and prevention of osteopenia and osteoporosis. This article presents rehabilitation methods that are of great importance for improving the functioning of the musculoskeletal system, the quality of life of patients with osteoporosis. Physical rehabilitation is aimed at stopping the destruction of bone tissue, strengthening it, eliminating pain, reducing stress from the affected areas and restoring the normal function of joints and bones. The proposed types of physical activity not only increase bone strength and strengthen muscle mass, but also reduce the risk of falling - a leading cause of osteoporotic fractures. Exercise programs designed for patients with osteoporosis should include strength and exercise exercises, as well as exercises for flexibility, posture correction, coordination of movements and balance. Training should be regular, varied and of a certain duration. The article considers the advantages and disadvantages of each type of activity.
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Affiliation(s)
- E D Yehudina
- Dnipropetrovsk Medical Academy, Dnieper, Ukraine
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Prado M, Rezaei A, Giambini H. Density-Dependent Material and Failure Criteria Equations Highly Affect the Accuracy and Precision of QCT/FEA-Based Predictions of Osteoporotic Vertebral Fracture Properties. Ann Biomed Eng 2020; 49:663-672. [PMID: 32820381 DOI: 10.1007/s10439-020-02595-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/11/2020] [Indexed: 11/25/2022]
Abstract
About 700,000 vertebral fractures occur in the US as a result of bone loss. Quantitative computed tomography (QCT)-based finite element analysis (FEA) is a promising tool for fracture risk prediction that is becoming attractive in the clinical setting. The goals of this study were (1) to perform individual and pooled specimen optimization using inverse QCT/FEA modeling to obtain ash density-elastic modulus equations incorporating the whole vertebral body and accounting for all variables used during FE modeling, and (2) to determine the effect of material equations and failure criteria on the accuracy and precision of mechanical properties. Fifty-four (54) human vertebrae were used to optimize material equations based on experimental outcomes and, together with a previously proposed material equation, were implemented in our models using three different failure criteria to obtain fracture loads. Our robust QCT/FEA approach predicted 78% of the failure loads. Material equations resulted in poor accuracy in the predicted stiffness, yet yielded good precision and, more importantly, strong correlations with fracture loads. Both material and fracture criterion equations are equally important in estimating accurate and precise QCT/FEA predictions. Results suggest that both elastic modulus and fracture criterion equations should be validated against experimental outcomes to better explain the response of the tissue under various conditions.
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Affiliation(s)
- Maria Prado
- Department of Biomedical and Chemical Engineering, The University of Texas at San Antonio, San Antonio, TX, 78249, USA
| | - Asghar Rezaei
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Hugo Giambini
- Department of Biomedical and Chemical Engineering, The University of Texas at San Antonio, San Antonio, TX, 78249, USA.
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Rizkalla JM, Hotchkiss W, Clavenna A, Dossett A, Syed IY. Triaging Spine Surgery and Treatment during the COVID-19 Pandemic. J Orthop 2020; 20:380-385. [PMID: 32764857 PMCID: PMC7315976 DOI: 10.1016/j.jor.2020.06.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/18/2020] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE To utilize evidence-based medicine to help determine guidelines for spinal surgery during the Covid-19 era. METHODS A literature review was performed of peer-reviewed articles focused on indications for common procedures in spine surgery. Based on these indications, we sub-categorized these procedures into elective, urgent and emergent categories. Case examples provided. RESULTS Indications for spinal surgery were reviewed based on current literature and categorized. This manuscript presents a decision-making algorithm to help provide a guideline for determining the appropriateness of proceeding with spinal surgery during this COVID-19 time period. CONCLUSIONS Spinal surgery during the COVID-19 pandemic is an intricate challenging decision-making process, involving clinical, sociologic and economic factors.
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Affiliation(s)
- James M. Rizkalla
- Baylor University Medical Center, Department of Orthopedic Surgery, 3500 Gaston Avenue, Dallas, TX, 75246, USA
| | - William Hotchkiss
- W.B. Carrell Memorial Clinic, Spine Surgery, 9301 N. Central Expressway, Suite 500, Dallas, TX, 75231, USA
| | - Andrew Clavenna
- W.B. Carrell Memorial Clinic, Spine Surgery, 9301 N. Central Expressway, Suite 500, Dallas, TX, 75231, USA
| | - Andrew Dossett
- W.B. Carrell Memorial Clinic, Spine Surgery, 9301 N. Central Expressway, Suite 500, Dallas, TX, 75231, USA
| | - Ishaq Y. Syed
- Baylor University Medical Center, Department of Orthopedic Surgery, 3500 Gaston Avenue, Dallas, TX, 75246, USA
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Abstract
PURPOSE OF REVIEW This comprehensive review of current concepts in the management of vertebral compression fractures is a manuscript of vertebral augmentation literature of risk factors, clinical presentation, and management. The objective of this review is to compare outcomes between multiple augmentation techniques and ongoing discussions of effectiveness of vertebral augmentation procedures. RECENT FINDINGS Vertebral compression fractures (VCFs) are a prevalent disease affecting approximately 1.5 million US adults annually. VCFs can cause severe physical limitations, including back pain, functional disability, and progressive kyphosis of the thoracic spine that ultimately results in decreased appetite, poor nutrition, impaired pulmonary function, and spinal cord compression with motor and sensory deficits. The deconditioning that affects patients with vertebral compression fractures leads to mortality at a far higher rate than age-matched controls. The management of vertebral compression fractures has been extensively discussed with opponents arguing in favor or restricting conservative management and against augmentation, while proponents argue in favor of augmentation. The literature is well established in reference to the effects on mortality when patients undergo treatment with vertebral augmentation; in over a million patients with vertebral compression fractures treated with vertebral augmentation as compared with patients treated with non-surgical management, the patients receiving augmentation performed well with a decrease in morbidity and mortality. Summary of the literature review shows that understanding the risk factors, appropriate clinical evaluation, and management strategies are crucial. Analysis of the evidence shows, based on level I and II studies, balloon kyphoplasty had significantly better and vertebroplasty tended to have better pain reduction compared with non-surgical management. In addition, balloon kyphoplasty tended to have better height restoration than vertebroplasty.
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Abstract
BACKGROUND Back pain is ranked as the fourth highest medical expense per year. The number of affected patients is constantly increasing because of increasing chronification due to insufficient recognition of the cause. METHODS The diagnosis of back pain is based on three important pillars. On the one hand, a detailed anamnesis and correct clinical examination by the responsible physician is extremely important, followed by an experienced radiologist who is responsible for determining the imaged-based ethiology of the symptoms. RESULTS/CONCLUSION Anamnesis and clinical examination play an important role in identifying patients with a real underlying pathology for the symptomatology in order to provide them with direct imaging for further evaluation. Corresponding pathology in most cases of acute back pain is generally not found but here psychosocial factors ("yellow flags") are in the foreground. Attention should always be paid to the presence of "red flags" and the possibility of extraspinal causes.
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Affiliation(s)
- A Haußmann
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Str. 100 Geb. 90.4, 66421, Homburg/Saar, Deutschland.
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Huang S, Zhu X, Xiao D, Zhuang J, Liang G, Liang C, Zheng X, Ke Y, Chang Y. Therapeutic effect of percutaneous kyphoplasty combined with anti-osteoporosis drug on postmenopausal women with osteoporotic vertebral compression fracture and analysis of postoperative bone cement leakage risk factors: a retrospective cohort study. J Orthop Surg Res 2019; 14:452. [PMID: 31852483 PMCID: PMC6921385 DOI: 10.1186/s13018-019-1499-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 11/27/2019] [Indexed: 12/29/2022] Open
Abstract
Background The purpose of this study is to explore the therapeutic effect of percutaneous kyphoplasty (PKP) combined with anti-osteoporosis drug, zoledronic acid, on postmenopausal women with osteoporotic vertebral compression fracture (OVCF) and to perform an analysis of postoperative bone cement leakage risk factors. Methods A total of 112 OVCF patients, according to therapeutic regimens, were divided into control group (n = 52, treated with PKP) and observation group (n = 60, treated with PKP and zoledronic acid injection). Results Postoperative tumor necrosis factor-α and interleukin-6 levels were significantly decreased in the two groups, compared with those before treatment (both P < 0.05); bone mineral density (BMD), serum bone gla protein (BGP), and vertebral height ratio of injured vertebrae were significantly increased, and procollagen type I N-terminal propeptide (PINP), Cobb angle, visual analogue scale/score (VAS), and Oswestry disability index (ODI) were significantly decreased compared with those before treatment (all P < 0.05). There were significantly higher changes in difference value of BMD, PINP, BGP, vertebral height ratio of injured vertebrae, Cobb angle, VAS, and ODI levels and significantly better therapeutic effect in the observation group than those in the control group (all P < 0.05). Multivariate logistic regression analysis showed that the use of zoledronic acid, vertebral height ratio of injured vertebrae, and ODI were independent factors affecting the therapeutic effect, and that the dosage of bone cement, and peripheral vertebrae wall damage were independent risk factors causing postoperative bone cement leakage. There were no significant differences in postoperative bone cement leakage rate between the two groups. Conclusions Peripheral vertebrae wall damage and the dosage of bone cement are independent risk factors causing bone cement leakage in OVCF patients treated with PKP. PKP combined with zoledronic acid has an improvement effect on the condition of postmenopausal women with OVCF and reduces the inflammation and pain in patients, which is beneficial to clinical treatment.
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Affiliation(s)
- Shuaihao Huang
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong Province, China
| | - Xiaowen Zhu
- Department of Gynaecology and Obstetrics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong Province, China
| | - Dan Xiao
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong Province, China
| | - Jianxiong Zhuang
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong Province, China
| | - Guoyan Liang
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong Province, China
| | - Changxiang Liang
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong Province, China
| | - Xiaoqing Zheng
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong Province, China
| | - Yuhong Ke
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong Province, China
| | - Yunbing Chang
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong Province, China.
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Ouyang X, Ding Y, Yu L, Xin F, Yang X, Sha P, Tong S, Cheng Q, Xu YQ. Effects of hip replacement combined with alendronate sodium on postoperative healing of osteoporotic femoral neck fracture and levels of CTX-1 and BALP in patients. Exp Ther Med 2019; 18:4583-4590. [PMID: 31798698 PMCID: PMC6880394 DOI: 10.3892/etm.2019.8158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 09/02/2019] [Indexed: 12/21/2022] Open
Abstract
This study aimed to explore the improvement of hip replacement combined with alendronate sodium on the condition of patients with osteoporotic femoral neck fracture and factors affecting the efficacy of patients. In total, 140 patients with femoral neck fracture from July 2015 to October 2017 in the Affiliated Xuzhou Hospital of Jiangsu University were collected. Of these, 61 patients were treated with hip replacement as the control group and 79 patients were treated with alendronate sodium as the observation group on the basis of the control group. ELISA was used to detect levels of carboxy-terminal opeptide of type I collagen (CTX–I) and bone alkaline phosphatase (BALP) in serum of patients before and after treatment. Harris score was used to compare the clinical efficacy of patients after treatment. Changes in the expression of CTX–I and BALP before and after treatment were compared between the two groups, and the correlation between CTX–I and BALP levels and Harris score was analyzed. According to the clinical efficacy of patients, the two groups were divided into the significant effect group and poor effect group. Risk factors affecting the efficacy of patients were analyzed, and the ROC of subjects with risk factors was drawn. After treatment, the expression of BALP in serum increased significantly compared with that before treatment, and the expression of CTX–I decreased significantly. After treatment, the expression of BALP in serum in the observation group was significantly higher than that in the control group (P<0.05). Multivariate analysis revealed that age, time of operation, CTX–I after treatment and BALP after treatment were independent risk factors affecting the efficacy of patients. In conclusion, hip replacement combined with alendronate sodium can effectively improve the clinical efficacy of patients, and age, time of operation, CTX–I after treatment and BALP after treatment are found to be independent risk factors affecting the postoperative efficacy of patients.
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Affiliation(s)
- Xiao Ouyang
- Department of Orthopedic Surgery, Affiliated Xuzhou Hospital of Jiangsu University, Xuzhou Third Hospital, Xuzhou, Jiangsu 221005, P.R. China
| | - Yunzhi Ding
- Department of Orthopedic Surgery, Affiliated Xuzhou Hospital of Jiangsu University, Xuzhou Third Hospital, Xuzhou, Jiangsu 221005, P.R. China
| | - Li Yu
- Department of Orthopedic Surgery, Affiliated Xuzhou Hospital of Jiangsu University, Xuzhou Third Hospital, Xuzhou, Jiangsu 221005, P.R. China
| | - Feng Xin
- Department of Orthopedic Surgery, Affiliated Xuzhou Hospital of Jiangsu University, Xuzhou Third Hospital, Xuzhou, Jiangsu 221005, P.R. China
| | - Xiaowei Yang
- Department of Orthopedic Surgery, Affiliated Xuzhou Hospital of Jiangsu University, Xuzhou Third Hospital, Xuzhou, Jiangsu 221005, P.R. China
| | - Peng Sha
- Department of Orthopedic Surgery, Affiliated Xuzhou Hospital of Jiangsu University, Xuzhou Third Hospital, Xuzhou, Jiangsu 221005, P.R. China
| | - Songming Tong
- Department of Orthopedic Surgery, Affiliated Xuzhou Hospital of Jiangsu University, Xuzhou Third Hospital, Xuzhou, Jiangsu 221005, P.R. China
| | - Qi Cheng
- Department of Orthopedic Surgery, Affiliated Xuzhou Hospital of Jiangsu University, Xuzhou Third Hospital, Xuzhou, Jiangsu 221005, P.R. China
| | - Yi Qi Xu
- Department of Orthopedic Surgery, Affiliated Xuzhou Hospital of Jiangsu University, Xuzhou Third Hospital, Xuzhou, Jiangsu 221005, P.R. China
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Yang SC, Chiu YC, Liu PH, Hsieh TJ, Kao YH, Tu YK. Effect of benign prostatic hyperplasia on the development of spine, hip, and wrist fractures. Osteoporos Int 2019; 30:1043-1049. [PMID: 30706096 DOI: 10.1007/s00198-019-04863-5] [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: 05/02/2018] [Accepted: 01/20/2019] [Indexed: 10/27/2022]
Abstract
UNLABELLED Benign prostatic hyperplasia is one of the most common diseases in the elderly male population. The urinary tract symptoms may increase the risk of falls and fractures. The results indicated that patients with benign prostatic hyperplasia could increase the risk of vertebral compression fractures in both the thoracic and lumbar spine and also hip fractures, but did not increase the risk of wrist fracture. INTRODUCTION The relationship between benign prostatic hyperplasia and the development of fall-related fractures, especially vertebral compression fractures, has been seldom mentioned in the literature. This study aimed to evaluate the risk of developing vertebral compression fracture, hip fracture, and wrist fracture in patients with benign prostatic hyperplasia. METHODS This study obtained claims data retrospectively from the National Health Insurance Research Database of Taiwan and identified 48,114 patients who were diagnosed as having benign prostatic hyperplasia. Subjects of the control cohort were individually matched at a ratio of 4:1 with those in the benign prostatic hyperplasia cohort according to age and the index day. Comorbidities were classified as those existing before the index day and included a previous fracture history, osteoporosis, myocardial infarction, congestive heart failure, diabetes mellitus, hypertension, cerebrovascular accident, etc. The end of the follow-up period of the analyses was the day when the patient developed new vertebral compression fractures, hip fractures, or wrist fractures, terminated enrollment from the National Health Insurance, or died or until the end of 2012. The study used the Cox proportion hazard model to determine the hazard ratio for developing new hip fractures. RESULTS Patients with benign prostatic hyperplasia were significantly more likely than those in the control cohort to develop new vertebral compression fractures in the thoracic spine (0.43% vs. 0.40%, adjusted hazard ratio 3.03, confidence interval 2.12-4.31) and lumbar spine (1.26% vs. 1.23%, adjusted hazard ratio 4.12, confidence interval 3.39-5.01), and hip fracture (1.47% vs. 2.09%, adjusted hazard ratio 1.22, confidence interval 1.10-1.36), but does not increase the risk of wrist fracture (0.61% vs. 0.67%, adjusted hazard ratio 1.07, confidence interval 0.85-1.34). CONCLUSIONS Patients with benign prostatic hyperplasia exhibited an increased risk of developing vertebral compression fractures in both the thoracic and lumbar spine and also hip fractures, but did not increase the risk of wrist fracture. However, more research is needed to confirm this trend in the clinical setting.
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Affiliation(s)
- S C Yang
- Department of Orthopedic Surgery, E-Da Hospital / I-Shou University, No.1, E-Da Road, Kaohsiung City, Taiwan, 82445, People's Republic of China.
| | - Y C Chiu
- Department of Orthopedic Surgery, E-Da Hospital, No.1, E-Da Road, Kaohsiung City, Taiwan, 82445, People's Republic of China.
| | - P H Liu
- Department of Biomedical Engineering, I-Shou University, No.8, E-Da Road, Kaohsiung City, Taiwan, 82445, People's Republic of China
| | - T J Hsieh
- Department of Orthopedic Surgery, E-Da Hospital, No.1, E-Da Road, Kaohsiung City, Taiwan, 82445, People's Republic of China
| | - Y H Kao
- Department of Orthopedic Surgery, E-Da Hospital, No.1, E-Da Road, Kaohsiung City, Taiwan, 82445, People's Republic of China
| | - Y K Tu
- Department of Orthopedic Surgery, E-Da Hospital / I-Shou University, No.1, E-Da Road, Kaohsiung City, Taiwan, 82445, People's Republic of China
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Kao FC, Huang YJ, Chiu PY, Hsieh MK, Tsai TT. Factors Predicting the Surgical Risk of Osteoporotic Vertebral Compression Fractures. J Clin Med 2019; 8:E501. [PMID: 31013728 PMCID: PMC6517994 DOI: 10.3390/jcm8040501] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/02/2019] [Accepted: 04/10/2019] [Indexed: 12/30/2022] Open
Abstract
The aim of our study was to investigate the association between global spinal alignment, spinopelvic parameters, and outcomes of osteoporotic vertebral compression fractures (OVCF). Patients with vertebral compression fractures seen at our hospital between October 2017 and November of 2018 with a bone mineral density (BMD) T-score < -2.5 were recruited for the study. Surgical intervention was performed after eight weeks of conservative treatment depending on clinical symptoms and the willingness of patients. Spinopelvic and sagittal alignment parameters were compared between patients who had surgery and those that did not. Seventy-nine patients were included in the study. Twenty-five patients (31.6%, mean age: 73.28 ± 9.78 years) received surgery, and 54 (68.3%, mean age: 73 ± 8.58 years) conservative treatment only. Pelvic tilt, pelvic incidence, and local kyphotic angle were statistically different between the groups (all p < 0.05). A sagittal vertical axis ≥ 50 mm, distance between the C7 plumb line and the center of the fractured vertebra (DSVA) ≥ 60 mm, pelvic incidence outside of the range of 44 to 62°), and pelvic tilt ≥ 27° were associted with the need for surgical intervention. Measurement of spinopelvic parameters can predict the need for surgery in patients with OVCF.
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Affiliation(s)
- Fu-Cheng Kao
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan 333, Taiwan.
| | - Yu-Jui Huang
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan 333, Taiwan.
| | - Ping-Yeh Chiu
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan 333, Taiwan.
| | - Ming-Kai Hsieh
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan 333, Taiwan.
| | - Tsung-Ting Tsai
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan 333, Taiwan.
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Vertebral Fractures among Patients Referred for Bone Densitometry Screening in Dubai Primary Health Care Facilities. Int J Rheumatol 2019; 2019:7974534. [PMID: 30956664 PMCID: PMC6431384 DOI: 10.1155/2019/7974534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/24/2019] [Accepted: 02/14/2019] [Indexed: 01/21/2023] Open
Abstract
Vertebral fractures are one of the most common fractures associated with low bone mineral density. However two-thirds to three-fourths of patients with vertebral fractures are not clinically recognized. The objective of this study was to determine the prevalence of vertebral fractures in patients referred for bone densitometry and the most common site of fracture. The study was carried out in the osteoporosis clinic in Dubai primary health care center. A total of 120 patients were examined using the dual energy X-ray absorptiometry. Of all the patients, 48.3% were osteoporotic and 40.9% were osteopenic. The overall prevalence of vertebral fracture was 14.2%. The result showed that the prevalence of vertebral fracture was higher in female compared to male (15.7% and 9.7%, respectively). It was found that patients aged 80 and above had the highest prevalence of vertebral fracture (54.5%). Undiagnosed vertebral fractures were common. Therefore, it is crucial to prevent vertebral fracture through early diagnosis and appropriate treatment of osteoporosis.
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Yin H, He X, Yi H, Luo Z, Chen J. Analysis of the Causes on Poor Clinical Efficacy of Kyphoplasty Performed in Unilateral Transpedicular Puncture for the Treatment of Senile Osteoporotic Vertebral Compression Fractures. Sci Rep 2019; 9:1498. [PMID: 30728397 PMCID: PMC6365570 DOI: 10.1038/s41598-018-37727-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/13/2018] [Indexed: 12/15/2022] Open
Abstract
This study intends to analyze the causes on poor clinical efficacy of kyphoplasty performed in unilateral transpedicular puncture for the treatment of senile osteoporotic vertebral compression fractures. A retrospective study was conducted on a consecutive series of 70 patients who had underwent kyphoplasty performed in unilateral transpedicular puncture for the treatment of senile osteoporotic vertebral compression fractures between March 2016 to March 2017. These patients were compared for clinical data to investigate the causes on poor clinical efficacy of kyphoplasty performed in unilateral transpedicular puncture for the treatment of senile osteoporotic vertebral compression fractures. Comparison result of the indices between these patients showed that the differences in body weight, fracture type and bone cement dispersion were statistically significant. Logistic multivariate regression analysis showed body weight (OR = 0.892, p = 0.042), fracture type 2 (OR = 0.089, p = 0.020) and bone cement dispersion (OR = 4.773, p = 0.025) are risk factors for poor clinical efficacy. The results of corresponding analysis on VAS (Visual Analogue Scale), vertebral height and Cobb angle in patients with poor clinical efficacy showed that there is a correlation between them. We believe that patients' weight, dispersion degree of bone cement and fracture type of injured vertebra are the risk factors of kyphoplasty with poor clinical efficacy.
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Affiliation(s)
- Hao Yin
- Department of Orthopaedic Surgery, Hunan Provincial People's Hospital, Changsha, People's Republic of China
| | - Xuejun He
- Department of Orthopaedic Surgery, Hunan Provincial People's Hospital, Changsha, People's Republic of China.
| | - Huijun Yi
- Department of Orthopaedic Surgery, Hunan Provincial People's Hospital, Changsha, People's Republic of China
| | - Zhiguo Luo
- Department of Orthopaedic Surgery, Hunan Provincial People's Hospital, Changsha, People's Republic of China
| | - Jianmin Chen
- Department of Orthopaedic Surgery, Hunan Provincial People's Hospital, Changsha, People's Republic of China
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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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Al-Sari UA, Tobias JH, Clark EM. Impact of mild and moderate/severe vertebral fractures on physical activity: a prospective study of older women in the UK. Osteoporos Int 2019; 30:155-166. [PMID: 30194466 DOI: 10.1007/s00198-018-4692-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 08/28/2018] [Indexed: 02/08/2023]
Abstract
UNLABELLED Little is known about the long-term impact of vertebral fractures on physical activity. There is also uncertainty over the clinical significance of mild vertebral fracture. We showed that women with moderate/severe but not mild vertebral fracture do less walking duration and housework than those without fracture after 5.4 years of follow-up. INTRODUCTION Little is known about the long-term impact of vertebral fractures on physical activities. There is also uncertainty over the clinical significance of mild fracture. Therefore, the aim of this study was to evaluate the prospective association between vertebral fracture and future physical activity. METHODS This is a 5-year prospective study of a mixed community and secondary care cohort of women aged > 50 from the UK. Vertebral fractures were identified at baseline on radiographs or DXA-based Vertebral Fracture Assessment by a Quantitative Morphometric approach and defined as moderate/severe (≥ 25% height decrease) or mild (20-24.9% height decrease). Physical activity data were collected 5.4 years later by self-completion questionnaires. Multivariable logistic regression was used to determine the association between presence of fracture and various physical activities while adjusting for potential confounders. RESULTS Two hundred eighty-six women without, 58 with mild, and 69 with moderate/severe fracture were recruited. Those with mild and moderate/severe fracture were older than women without fracture and had more concomitant diseases at baseline. At 5.4 years follow-up, women with moderate/severe fracture self-reported shorter walking duration compared to those without fracture, even after adjusting for potential confounders (OR 2.96, 95%CI 1.11-7.88, P = 0.030). No independent association was seen between the presence of mild fractures and reduced physical activity at follow-up. CONCLUSION This is the first study of older women from the UK that explored the prospective association between vertebral fracture and physical activity duration. Moderate/severe fractures were associated with reduced walking duration. Mild fractures had no impact on future physical ability.
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Affiliation(s)
- U A Al-Sari
- Academic Rheumatology, Musculoskeletal Research Unit, Bristol Medical School, Southmead Hospital, University of Bristol, Westbury-on-Trym, Bristol, BS10 5NB, UK.
- Department of Medicine, College of Medicine, Wasit University, Kut, Iraq.
| | - J H Tobias
- Academic Rheumatology, Musculoskeletal Research Unit, Bristol Medical School, Southmead Hospital, University of Bristol, Westbury-on-Trym, Bristol, BS10 5NB, UK
| | - E M Clark
- Academic Rheumatology, Musculoskeletal Research Unit, Bristol Medical School, Southmead Hospital, University of Bristol, Westbury-on-Trym, Bristol, BS10 5NB, UK
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Xu L, Liu B, Li P, Li J, Wang J, Han J, Yang N. Correlations of Serum Hormones and Bone Mineral Density with Fracture and Balance Ability of Postmenopausal Patients and Effects of Calcitriol. Med Sci Monit 2018; 24:7309-7315. [PMID: 30315646 PMCID: PMC6196597 DOI: 10.12659/msm.910792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background The aim of this study was to analyze the correlations of serum hormones and bone mineral density (BMD) with fracture and balance ability of postmenopausal patients and effects of calcitriol on them. Material/Methods The clinical data of 164 postmenopausal female patients with osteoporosis (OP) treated in our hospital were retrospectively analyzed. Results The incidence rates of OVCF, balance index score (BIS), front-back ratio (FBR), and right-left ratio (RLR) in the normal BMD group, reduced BMD group, and OP group showed increasing trends, and there were statistically significant differences in comparisons among groups (p<0.05). The levels of serum estradiol (E2) and progesterone (P) in the OVCF group were lower than those in the non-OVCF group, and there were statistically significant differences in comparisons between the 2 groups (p<0.05). However, there was no statistically significant difference in the comparison of serum luteinizing hormone (LH) level between the 2 groups (p>0.05). BIS, FBR, and RLR were negatively correlated with E2 and testosterone (T) (p<0.05). With the prolongation of calcitriol treatment time, BIS, FBR, and RLR gradually decreased, but T value gradually increased. At 6 months and 12 months after intervention, BIS, FBR, and RLR had significant differences compared to those before the experiment (p<0.05). (5) Total hip BMD, height, age, and body mass index (BMI) were the independent factors affecting SDI. Conclusions Hip BMD, age, height, and BMI are significantly correlated with OVCF. Calcitriol treatment can increase lumbar BMD and improve balance ability, and these effects become more obvious with prolongation of intervention time.
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Affiliation(s)
- Lili Xu
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Bing Liu
- Department of Vascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Peng Li
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Juanjuan Li
- Department of Endocrinology, Qilu Hospital of Shandong University, Qingdao, Shandong, China (mainland)
| | - Jun Wang
- Department of Endocrinology, The 401 Hospital of PLA, Qingdao, Shandong, China (mainland)
| | - Jialin Han
- Department of Endocrinology, Weifang Hospital of Traditional Chinese Medicine, Weifang, Shandong, China (mainland)
| | - Nailong Yang
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
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Phuan-Udom R, Lektrakul N, Katchamart W. The association between 10-year fracture risk by FRAX and osteoporotic fractures with disease activity in patients with rheumatoid arthritis. Clin Rheumatol 2018; 37:2603-2610. [PMID: 30039267 DOI: 10.1007/s10067-018-4218-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/08/2018] [Accepted: 07/13/2018] [Indexed: 11/29/2022]
Abstract
As rheumatoid arthritis (RA) is an independent risk factor for osteoporotic fractures, the severity of disease activity may correlate with fracture risk. Our objectives were to determine the prevalence of major osteoporotic and hip fractures in patients with RA and to identify the factors related to their 10-year probabilities. This study enrolled 232 patients with RA, aged 40-90 years, who participated in the Siriraj RA Cohort in 2016 and 2017. Demographic data, disease activity scores 28 (DAS28), and health assessment questionnaires (HAQ) were collected. All participants were evaluated for asymptomatic vertebral fractures by thoracolumbar spine radiography. The osteoporotic fracture risks were determined using the fracture risk assessment tool (FRAX). Most subjects were postmenopausal women in their sixth decade; the median disease duration was 12.95 years. Forty-six percent of patients had osteoporotic fractures, and most (87%) were vertebral fractures. Eighty-one patients had asymptomatic vertebral compression fractures. Of those, 57%, 25%, and 18% had low, moderate, and high 10-year probabilities of major osteoporotic fractures, respectively, while 51%, 34%, and 15% had low, moderate, and high 10-year probabilities of hip fractures, respectively. Factors significantly associated with the 10-year probabilities of major osteoporotic and hip fractures were disease duration (p 0.017, 0.009), menopause duration (p < 0.001 both), cumulative disease activity (DAS28; p 0.004, 0.029), and cumulative functional disability (HAQ; p < 0.001 both). Moderate to high 10-year probabilities of major osteoporotic and hip fractures are common in RA. Cumulative disease severity is a high risk for osteoporotic fractures.
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Affiliation(s)
- Ratanapha Phuan-Udom
- Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Asadang Building 8th Floor, Bangkoknoi, Bangkok, 10700, Thailand.,Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Nittaya Lektrakul
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wanruchada Katchamart
- Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Asadang Building 8th Floor, Bangkoknoi, Bangkok, 10700, Thailand.
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