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Noriega DC. Reply to letter to the Editor regarding "Does the interfacing angle between pedicle screws and support rods affect clinical outcomes after posterior thoracolumbar fusion? A retrospective clinical study". Spine J 2024; 24:915-916. [PMID: 38670785 DOI: 10.1016/j.spinee.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 04/28/2024]
Affiliation(s)
- David C Noriega
- Department of Orthopaedics, University Hospital of Valladolid, Calle Ramon y Cajal, Valladolid, Spain.
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Noriega DC, Eastlack RK, Hernández GL, Kafchitsas K, Ryang YM, Spitz SM, Lite IS. Does the interfacing angle between pedicle screws and support rods affect clinical outcomes after posterior thoracolumbar fusion? A retrospective clinical study. Spine J 2024; 24:125-131. [PMID: 37726089 DOI: 10.1016/j.spinee.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 09/05/2023] [Accepted: 09/11/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND CONTEXT Proper alignment and tightening of the pedicle screw/rod assembly after instrumented posterior fusion of the lower spine is known to be crucial in order to achieve satisfactory clinical results. Such interfacing angle mismatches indicate stress overloading of the implant system. PURPOSE The objective of this study is to investigate the incidence of postoperative screw/rod interfacing angle mismatch and to analyze the impact of mismatches on clinical outcome in terms of (1) revision surgery, (2) adjacent segment degeneration (ASD), and (3) pain. STUDY DESIGN This is a monocentric retrospective observational study. PATIENT SAMPLE Patients underwent fusion surgery with pedicle screw/rod systems for predominantly degenerative pathologies. OUTCOME MEASURES Pedicle screw/rod interfacing angle mismatch (mismatch is the angular deviation from 90° formed by the rod axis and the pedicle screw head axis as an indicator for missing form-fit) revision rate, ASD at the immediately adjacent cranial segment and VAS pain. METHODS Revision refers to subsequent procedures in which all or part of the original implant configuration is changed or removed. Radiographic parameters are evaluated using a/p and lateral radiographs at final follow-up. The interfacing angle mismatch between pedicle screw and rod is measured as the angle between two parallel lines on either side of each pedicle screw head and a line laterally along the associated rod. Multiple comparisons are counteracted by Bonferroni correction, adjusted significance level is at *p<.01. RESULTS Pedicle screw and rod interfacing angle mismatch was found in 171/406 (42.1%) of patients undergoing fusion surgery, affecting 613/3016 (20.3%) screws. The overall revision incidence was 11.8% (48/406), and a new ASD occurred in 12.1% of all patients (49/406) with an average follow-up of 5 years. Mean VAS pain score at final follow-up was 2.0. Comparison of the two groups with and without mismatches revealed statistically significantly higher (1) numbers of revision procedures performed (26.9% vs 0.9%), (2) numbers of new ASD developed (27.5% vs 3.8%), and (3) higher VAS pain scores (2.8/10 vs 1.4/10) for cases with mismatch. When comparing patients who underwent intraoperative correction and/or reduction with those who did not, statistically significant more screw mismatches (63.4% vs 39.7%) and revision surgeries (29.3% vs 9.9%) were noted in patients who had these forceful maneuvers. CONCLUSIONS Pedicle screw/rod interfacing angle mismatch is a frequent occurrence after fusion surgery. Mismatches indicate that the construct was assembled under mechanical stress. All preventable mechanical stresses, for example, unintentional uncontrolled forces on the instrumentation, should be avoided as much as possible, as they can negatively influence the clinical outcome.
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Affiliation(s)
- David C Noriega
- Department of Orthopaedics, University Hospital of Valladolid, Calle Ramon y Cajal, Valladolid, Spain.
| | - Robert K Eastlack
- Department of Orthopaedics, Scripps Clinic, N Torrey Pines Rd, La Jolla, CA, USA
| | | | | | - Yu-Mi Ryang
- Department of Neurosurgery and Center for Spine Therapy, Helios Clinic Berlin-Buch, Schwanebecker Chaussee, Berlin, Germany
| | - Steven M Spitz
- Department of Neurosurgery, Northside Hospital, Northside Cherokee Blvd, Canton, GA, USA
| | - Israel Sánchez Lite
- Department of Radiology, University Hospital of Valladolid, Calle Ramon y Cajal, Valladolid, Spain
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Aguado HJ, Mingo-Robinet J, García-Virto V, SanJose-Pardo I, Pais S, Álvarez-Ramos BA, Simón-Pérez C, Noriega DC. AO/OTA type C3 distal humeral fractures in patients aged 75 years and older: Is ORIF with double precontoured anatomical locking plates a reliable treatment? Injury 2023; 54 Suppl 7:111043. [PMID: 38225158 DOI: 10.1016/j.injury.2023.111043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 08/19/2023] [Accepted: 09/09/2023] [Indexed: 01/17/2024]
Abstract
INTRODUCTION The incidence of osteoporotic distal humeral fractures (DHF) is on the rise. Their operative management is demanding. Fixation with non-locking reconstruction plates was associate with a high number of complications. Elbow arthroplasty (total or hemi) has been proposed as an alternative treatment, in spite of lifetime activity restrictions, and risk of complications, unknown implant survival and problematic revision surgery. Precontoured anatomical locking plates have increased the strength of the fixation in complex fractures. HYPOTHESIS double plating ORIF with precontoured anatomical locking plates is a safe and reliable treatment option for the management of AO/OTA type C3 DHF in patients aged 75 and older. PATIENTS AND METHODS A retrospective case series study of patients aged 75 years old and older with an AO/OTA type C3 DHF treated with ORIF with double precontoured anatomical locking plates between 2007 and 2021. Pathologic fractures were excluded. Patients' demographic, surgical, clinical, and radiological data were reviewed. RESULTS A total of 27 women and 3 men, mean age of 80.1 years (range 75-93 years), were included. Mean Charlson index was 5 (range 3-8). Out of 30 patients, 19 had already died. Mean survival time after the surgical treatment was 72.3 months. Mean Mayo elbow performance score was 88.9 (range 60-100); 23 patients scored excellent or good. All fractures healed with no cases of delay union or non-union, hardware failure or loss of reduction. No patient needed a revision surgery to arthroplasty. The total number of complications was 12 (40%), mainly ulnar neuropathy (5) and cerclage removal (4). CONCLUSION ORIF with double pre-contoured locking plates may be a safe and reliable treatment for type C3 DHF in patients aged 75 years and older, with a good functional outcome. Complications are expected but not related to loss of reduction, fixation failure or revision to elbow arthroplasty.
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Affiliation(s)
- Héctor J Aguado
- Orthopaedic and Traumatology Department, Hospital Clínico Universitario, Valladolid, Spain.
| | - Juan Mingo-Robinet
- Orthopaedics and Traumatology Department, Complejo Asistencial Universitario, Palencia, Spain
| | - Virginia García-Virto
- Orthopaedic and Traumatology Department, Hospital Clínico Universitario, Valladolid, Spain
| | - Iñigo SanJose-Pardo
- Orthopaedics and Traumatology Department, Complejo Asistencial Universitario, Palencia, Spain
| | - Sergio Pais
- Orthopaedic and Traumatology Department, Hospital Clínico Universitario, Valladolid, Spain
| | - Begoña A Álvarez-Ramos
- Orthopaedic and Traumatology Department, Hospital Clínico Universitario, Valladolid, Spain
| | - Clarisa Simón-Pérez
- Orthopaedic and Traumatology Department, Hospital Clínico Universitario, Valladolid, Spain
| | - David C Noriega
- Orthopaedic and Traumatology Department, Hospital Clínico Universitario, Valladolid, Spain
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Córdova A, Caballero-García A, Drobnic F, Roche E, Noriega DC. Influence of Stress and Emotions in the Learning Process: The Example of COVID-19 on University Students: A Narrative Review. Healthcare (Basel) 2023; 11:1787. [PMID: 37372905 DOI: 10.3390/healthcare11121787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/06/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
Emotional instability and stress are the main disturbances that condition the learning process, affecting both teachers and students. The main objective of this review is to analyze the influence of stress and emotions (as part of stress) on the learning environment. Stress is a physiological mechanism that the organism develops to adapt and survive external and internal challenges. In this context, stress tends to be seen as a negative condition in the learning process when it is chronic. Extreme stress situations, such as the COVID-19 pandemic, can generate anxiety and frustration in students. However, other studies indicate that controlled stress can positively enhance the learning process. On the other hand, the quality and intensity of emotions resulting from stress can influence as well the learning process. Positive emotions are healthy and can promote optimal learning. Emotions lead to sentimental, cognitive, behavioral, and physiological changes, which will have a strong influence on intellectual performance. The activation of coping strategies constitutes a key mechanism for dealing positively with problems and challenges, generating positive emotions essential for the self-regulation of learning. In conclusion, correct management of emotions in stressful situations could promote effective learning through enhanced attention and capacity to solve problems.
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Affiliation(s)
- Alfredo Córdova
- Department de Bioquímica, Biología Molecular y Fisiología, Facultad de Ciencias de la Salud, GIR: "Ejercicio Físico y Envejecimiento", Universidad de Valladolid, Campus Universitario "Los Pajaritos", 42004 Soria, Spain
| | - Alberto Caballero-García
- Department de Anatomía y Radiología, Facultad de Ciencias de la Salud, GIR: "Ejercicio Físico y Envejecimiento", Universidad de Valladolid, Campus Universitario "Los Pajaritos", 42004 Soria, Spain
| | - Franchek Drobnic
- Medical Services Wolverhampton Wanderers FC, Wolverhampton WV3 9BF, UK
| | - Enrique Roche
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Department of Applied Biology-Nutrition, Institute of Bioengineering, University Miguel Hernández, 03202 Elche, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain
| | - David C Noriega
- Department Cirugía, Oftalmología, Otorrinolaringología y Fisioterapia, Facultad de Medicina, 47003 Valladolid, Spain
- Departamento de Columna Vertebral, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
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Hassanzadeh H, Baber J, Begier E, Noriega DC, Konishi H, Yato Y, Wang MY, Le Huec JC, Patel V, Varga P, Liljenqvist U, Conly J, Sabharwal C, Munjal I, Cooper D, Radley D, Jaques A, Patton M, Gruber WC, Jansen KU, Anderson AS, Gurtman A. Efficacy of a 4-Antigen Staphylococcus aureus Vaccine in Spinal Surgery: The STRIVE Randomized Clinical Trial. Clin Infect Dis 2023:7147455. [PMID: 37125490 PMCID: PMC10371312 DOI: 10.1093/cid/ciad218] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/27/2023] [Accepted: 04/10/2023] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND Staphylococcus aureus is a global pathogen frequently responsible for healthcare-associated infections, including surgical site infections (SSIs). Current infection prevention and control approaches may be limited, with S aureus antibiotic resistance remaining problematic. Thus, a vaccine to prevent or reduce S aureus infection is critically needed. This study evaluated efficacy and safety of an investigational 4-antigen S aureus vaccine (SA4Ag) in adults undergoing elective open posterior spinal fusion procedures with multilevel instrumentation. METHODS In this multicenter, site-level, randomized, double-blind trial, subjects 18-85 years old received a single dose of SA4Ag or placebo 10-60 days before surgery. SA4Ag efficacy in preventing postoperative S aureus bloodstream infection and/or deep incisional or organ/space SSI was the primary endpoint. Safety evaluations included local reactions, systemic events, and adverse events (AEs). Immunogenicity and colonization were assessed. RESULTS Study enrollment was halted when a prespecified interim efficacy analysis met predefined futility criteria. SA4Ag showed no efficacy (0.0%) in preventing postoperative S aureus infection (14 cases in each group through postoperative Day 90), despite inducing robust functional immune responses to each antigen compared with placebo. Colonization rates across groups were similar through postoperative Day 180. Local reactions and systemic events were mostly mild or moderate in severity, with AEs reported at similar frequencies across groups. CONCLUSIONS In patients undergoing elective spinal fusion surgical procedures, SA4Ag was safe, well tolerated, but despite eliciting substantial antibody responses that blocked key S aureus virulence mechanisms, was not efficacious in preventing S aureus infection. ClinicalTrials.gov: NCT02388165.
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Affiliation(s)
| | - James Baber
- Pfizer Vaccine Clinical Research, L15, 151 Clarence St, Sydney, NSW 2000, Australia
| | - Elizabeth Begier
- Pfizer Vaccine Research, 401 North Middletown Rd, Pearl River, NY 10965, USA
| | - David C Noriega
- Hospital Universitario de Valladolid, Valladolid, 47005, Spain
| | - Hiroaki Konishi
- Nagasaki Rosai Hospital, 2-12-5, Setogoe, Sasebo, Nagasaki, 857-0134, Japan
| | - Yoshiyuki Yato
- National Hospital Organization Murayama Medical Center, 2-37-1, Gakuen, Musashimurayama, Tokyo, 208-0011, Japan
| | | | - Jean Charles Le Huec
- Polyclinique Bordeaux Nord Aquitaine, Bordeaux University, Bordeaux, 33076, France
| | - Vikas Patel
- 12631 E. 17th Ave, Mail Stop B202, Academic Office 1, Room 4615, Denver, CO 80045, USA
| | - Peter Varga
- National Center for Spinal Disorders, Buda Health Center, Kiralyhago u. 1-3., Budapest, 1126, Hungary
| | - Ulf Liljenqvist
- St. Franziskus-Hospital Munster Orthopaedie II, Hohenzollernring 72, 48155 Muenster, Germany
| | - John Conly
- Foothills Medical Centre, Alberta Health Services and University of Calgary, 1403 29th St NW, Calgary, AB T2N 2T9, Canada
| | - Charu Sabharwal
- Pfizer Vaccine Research, 401 North Middletown Rd, Pearl River, NY 10965, USA
| | - Iona Munjal
- Pfizer Vaccine Research, 401 North Middletown Rd, Pearl River, NY 10965, USA
| | - David Cooper
- Pfizer Vaccine Research, 401 North Middletown Rd, Pearl River, NY 10965, USA
| | - David Radley
- Pfizer Vaccine Research, 401 North Middletown Rd, Pearl River, NY 10965, USA
| | - Anna Jaques
- Pfizer Vaccine Clinical Research, L15, 151 Clarence St, Sydney, NSW 2000, Australia
| | - Michael Patton
- Pfizer Vaccine Clinical Research, Hurley SL6 6RJ, United Kingdom
| | - William C Gruber
- Pfizer Vaccine Research, 401 North Middletown Rd, Pearl River, NY 10965, USA
| | - Kathrin U Jansen
- Pfizer Vaccine Research, 401 North Middletown Rd, Pearl River, NY 10965, USA
| | | | - Alejandra Gurtman
- Pfizer Vaccine Research, 401 North Middletown Rd, Pearl River, NY 10965, USA
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Noriega DC, Cristo Á, León A, García-Medrano B, Caballero-García A, Córdova-Martinez A. Plantar Fasciitis in Soccer Players-A Systemic Review. Int J Environ Res Public Health 2022; 19:14426. [PMID: 36361304 PMCID: PMC9653655 DOI: 10.3390/ijerph192114426] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
Soccer is one of the most popular sports in the world. Players often suffer a variety of injuries, the most common being injuries to muscles and tendons. It is striking that with soccer, being the most practiced sport, and considering that most injuries occur in the lower extremities, plantar fasciitis (PF) is not one of the most frequent injuries (at least in terms of clinical data collected). The purpose of this review was to provide a comprehensive update of the topic "plantar fasciitis" focusing on soccer players. The review was conducted in accordance with the PRISMA (Preferred Reportiog ltems for Systmiatic reviews and Meta-Analyses) statement. PubMed, Cochrane Library and Scopus were researched. PICO (Patient, Population or Problem; Intervention; Comparison; and Outcome) components were identified. The keywords used were "plantar fasciitis", "plantar fasciitis and sport", "plantar fasciitis risk factors", "plantar fasciitis soccer" and "plantar fasciitis football players". With respect to the objective proposed for the research, we found eight specific articles focused on soccer. Of these, five were general reviews discussing the different methods of treatment of this pathology, and we have only found three studies that focused on PF in soccer, with two of them referring to a clinical case whereby the report and discussion only dealt with the specific treatment followed by the soccer player. After reviewing the manuscripts included in this work, we were surprised that there is no data in which the Silfverskiöld test was performed, as this test explores the passive mobility of the ankle and the degree of dorsiflexion in the supine position. We concluded that soccer players suffer pain in the sole of the foot compatible with plantar fasciitis; however, as indicated by Suzue et al., it is often not diagnosed because the athlete does not consider performing the clinical examinations necessary for its diagnosis. The shortage of reported publications in soccer may mask other PF-associated injuries.
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Affiliation(s)
- David C. Noriega
- Department of Orthopedic Surgery, Clinic University Hospital of Valladolid, 47005 Valladolid, Spain
- Department of Surgery, Ophthalmology, Otorhinolaryngology and Physiotherapy, Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain
| | - Ángel Cristo
- Department of Orthopedic Surgery, Clinic University Hospital of Valladolid, 47005 Valladolid, Spain
| | - Alejandro León
- Department of Orthopedic Surgery, Clinic University Hospital of Valladolid, 47005 Valladolid, Spain
| | - Belén García-Medrano
- Department of Orthopedic Surgery, Clinic University Hospital of Valladolid, 47005 Valladolid, Spain
| | - Alberto Caballero-García
- Department of Anatomy and Radiology, Faculty of Health Sciences, GIR Physical Exercise and Aging University of Valladolid, University Campus Los Pajaritos, 42004 Soria, Spain
| | - Alfredo Córdova-Martinez
- Biochemistry, Molecular Biology and Physiology, Faculty of Health Sciences, GIR Physical Exercise and Aging, Campus Duques de Soria, University of Valladolid, 42004 Soria, Spain
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Córdova-Martínez A, Caballero-García A, Bello HJ, Pons-Biescas A, Noriega DC, Roche E. l-Arginine and Beetroot Extract Supplementation in the Prevention of Sarcopenia. Pharmaceuticals (Basel) 2022; 15:ph15030290. [PMID: 35337088 PMCID: PMC8954952 DOI: 10.3390/ph15030290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/19/2022] [Accepted: 02/24/2022] [Indexed: 12/13/2022] Open
Abstract
Aging is associated with a significant decline in neuromuscular function, leading to a reduction in muscle mass and strength. The aim of the present report was to evaluate the effect of supplementation with nitric oxide precursors (l-arginine and beetroot extract) in muscular function during a training period of 6 weeks in elderly men and women. The study (double-blind, placebo-controlled) involved 66 subjects randomly divided into three groups: placebo, arginine-supplemented and beetroot extract-supplemented. At the end of this period, no changes in anthropometric parameters were observed. Regarding other circulating parameters, urea levels were significantly (p < 0.05) lower in women of the beetroot-supplemented group (31.6 ± 5.9 mg/dL) compared to placebo (41.3 ± 8.5 mg/dL) after 6 weeks of training. In addition, the circulating creatine kinase activity, as an index of muscle functionality, was significantly (p < 0.05) higher in women of the arginine- (214.1 ± 162.2 mIU/L) compared to the beetroot-supplemented group (84.4 ± 36.8 mIU/L) at the end of intervention. No significant effects were noticed with l-arginine or beetroot extract supplementation regarding strength, endurance and SPPB index. Only beetroot extract supplementation improved physical fitness significantly (p < 0.05) in the sprint exercise in men after 6 weeks (2.33 ± 0.59 s) compared to the baseline (2.72 ± 0.41 s). In conclusion, beetroot seems to be more efficient during short-term training while supplementing, preserving muscle functionality in women (decreased levels of circulating creatine kinase) and with modest effects in men.
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Affiliation(s)
- Alfredo Córdova-Martínez
- Biochemistry, Molecular Biology and Physiology, Faculty of Health Sciences, GIR Physical Exercise and Aging, University of Valladolid, Campus Duques de Soria, 42004 Soria, Spain
- Correspondence: (A.C.-M.); (E.R.)
| | - Alberto Caballero-García
- Department of Anatomy and Radiology, Faculty of Health Sciences, GIR Physical Exercise and Aging, University of Valladolid, Campus Los Pajaritos, 42004 Soria, Spain;
| | - Hugo J. Bello
- Department of Mathematics, School of Forestry, Agronomy and Bioenergy Engineering, GIR Physical Exercise and Aging, University of Valladolid, Campus Los Pajaritos, 42004 Soria, Spain;
| | - Antoni Pons-Biescas
- Research Group on Community Nutrition and Oxidative Stress, University of Balearic Islands, 07122 Palma de Mallorca, Balearic Islands, Spain;
| | - David C. Noriega
- Department of Surgery, Ophthalmology, Otorhinolaryngology and Physiotherapy, Faculty of Medicine, Hospital Clínico Universitario de Valladolid, 03010 Valladolid, Spain;
| | - Enrique Roche
- Department of Mathematics, School of Forestry, Agronomy and Bioenergy Engineering, GIR Physical Exercise and Aging, University of Valladolid, Campus Los Pajaritos, 42004 Soria, Spain;
- Department of Applied Biology-Nutrition, Institute of Bioengineering, University Miguel Hernández, 03202 Elche, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL Foundation), 03010 Alicante, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Correspondence: (A.C.-M.); (E.R.)
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Caballero-García A, Noriega DC, Bello HJ, Roche E, Córdova-Martínez A. The Immunomodulatory Function of Vitamin D, with Particular Reference to SARS-CoV-2. Medicina (Kaunas) 2021; 57:1321. [PMID: 34946266 PMCID: PMC8706376 DOI: 10.3390/medicina57121321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/20/2021] [Accepted: 11/30/2021] [Indexed: 12/15/2022]
Abstract
Vaccines are the only way to reduce the morbidity associated to SARS-CoV-2 infection. The appearance of new mutations urges us to increase the effectiveness of vaccines as a complementary alternative. In this context, the use of adjuvant strategies has improved the effectiveness of different vaccines against virus infections such as dengue, influenza, and common cold. Recent reports on patients infected by COVID-19 reveal that low levels of circulating vitamin D correlate with a severe respiratory insufficiency. The immunomodulatory activity of this micronutrient attenuates the synthesis of pro-inflammatory cytokines and at the same time, increases antibody production. Therefore, the present review proposes the use of vitamin D as adjuvant micronutrient to increase the efficacy of vaccines against SARS-CoV-2 infection.
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Affiliation(s)
- Alberto Caballero-García
- Department of Anatomy and Radiology, Health Sciences Faculty, GIR of Physical Exercise and Aging, Campus Universitario “Los Pajaritos”, 42004 Soria, Spain;
| | - David C. Noriega
- Spine Department, Valladolid University Hospital, University of Valladolid, 47005 Valladolid, Spain;
| | - Hugo J. Bello
- Department of Mathematics, School of Forestry Industry and Agronomic Engineering and Bioenergy, GIR of Physical Exercise and Aging, Campus Universitario “Los Pajaritos”, 42004 Soria, Spain;
| | - Enrique Roche
- Department of Applied Biology-Nutrition, Institute of Bioengineering, University Miguel Hernández, 03202 Elche, Spain;
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Alfredo Córdova-Martínez
- Department of Biochemistry, Molecular Biology and Physiology, Faculty of Health Sciences, GIR of Physical Exercise and Aging, Campus Universitario “Los Pajaritos”, Valladolid University, 42004 Soria, Spain
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Córdova-Martínez A, Caballero-García A, Roche E, Noriega DC. β-Glucans Could Be Adjuvants for SARS-CoV-2 Virus Vaccines (COVID-19). Int J Environ Res Public Health 2021; 18:ijerph182312636. [PMID: 34886361 PMCID: PMC8656611 DOI: 10.3390/ijerph182312636] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/26/2021] [Accepted: 11/27/2021] [Indexed: 12/23/2022]
Abstract
Waiting for an effective treatment against the SARS-CoV-2 virus (the cause of COVID-19), the current alternatives include prevention and the use of vaccines. At the moment, vaccination is the most effective strategy in the fight against pandemic. Vaccines can be administered with different natural biological products (adjuvants) with immunomodulating properties. Adjuvants can be taken orally, complementing vaccine action. Adjuvant compounds could play a key role in alleviating the symptoms of the disease, as well as in enhancing vaccine action. Adjuvants also contribute to an effective immune response and can enhance the protective effect of vaccines in immunocompromised individuals such as the elderly. Adjuvants must not produce adverse effects, toxicity, or any other symptoms that could alter immune system function. Vaccine adjuvants are substances of wide varying chemical structure that are used to boost the immune response against a simultaneously administered antigen. Glucans could work as adjuvants due to their immunomodulatory biological activity. In this respect, β-(1,3)-(1,6) glucans are considered the most effective and safe according to the list issued by the European Commission. Only glucans with a β-(1,3) bond linked to a β-(1,6) are considered modulators of certain biological responses. The aim of this review is to present the possible effects of β-glucans as adjuvants in the efficacy of vaccines against SARS-CoV-2 virus.
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Affiliation(s)
- Alfredo Córdova-Martínez
- Department of Biochemistry, Molecular Biology and Physiology, Faculty of Health Sciences, GIR: “Physical Exercise and Ageing”, University Campus “Los Pajaritos”, Valladolid University, 42004 Soria, Spain
- Correspondence:
| | - Alberto Caballero-García
- Department of Anatomy and Radiology, Faculty of Health Sciences, GIR: “Physical Exercise and Ageing”, University Campus “Los Pajaritos”, Valladolid University, 42004 Soria, Spain;
| | - Enrique Roche
- Department of Applied Biology-Nutrition, Institute of Bioengineering, Miguel Hernández University, 03202 Elche, Spain;
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010 Alicante, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - David C. Noriega
- Spine Unit, Department of Surgery, Ophthalmology, Otorhinolaryngology and Physiotherapy, Faculty of Medicine, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain;
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Noriega DC, Crespo-Sanjuan J, Olan WJ, Hernandez-Ramajo R, Bell DP, Sanz JJC, Hernandez GDJL, Sanchez-Lite I, Ardura F. Treatment of Thoracolumbar Type A3 Fractures Using a Percutaneous Intravertebral Expandable Titanium Implant: Long-term Follow-up Results of a Pilot Single Center Study. Pain Physician 2021; 24:E631-E638. [PMID: 34323451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND There are controversies about the optimal management of AO subtype A3 burst fractures. The most common surgical treatment consists of posterior fixation with pedicle screw and rod augmentation. Nevertheless, a loss of correction in height restoration and kyphotic reduction has been observed. OBJECTIVES The aim of this study was to assess long-term outcomes of a minimally invasive technique using a percutaneous intravertebral expandable titanium implant (PIETI). STUDY DESIGN This prospective, single center, pilot study was carried out on a consecutive case series of 44 patients with acute (< 2 weeks) traumatic thoracolumbar fractures AO type A3. The average follow-up was 5.6 years. SETTING A single center in Castilla y Leon, SpainMETHODS: Clinical outcomes (pain intensity on visual analog scale [VAS], Oswestry Disability Index [ODI], analgesic consumption) and radiographic outcomes (anterior/mid/posterior vertebral body height, vertebral area, local kyphosis angle, traumatic regional angulation) were analyzed before surgery, at one month after surgery, and at the end of the follow-up period. RESULTS At one-month postsurgery, significant improvements in VAS score and ODI score were observed. PIETI achieved significant vertebral body height restoration with median height increases of 2.9 mm/4.3 mm/2.3 mm for anterior/middle/posterior parts, respectively. Significant correction of the local kyphotic angle and improvement of the traumatic regional angulation were accomplished. All these improvements were maintained throughout the follow-up period. The only complication reported was a case of cement leakage. LIMITATIONS In our opinion, the main limitation of the study is the small number of patients. However, the sample is superior to that shown in other papers. CONCLUSIONS This study showed that using a PIETI in the treatment of fractures type A3 is a safe and effective method that allows marked clinical improvement, as well as anatomical vertebral body restoration. Unlike with other treatments, results were maintained over time, allowing a better long-term clinical and functional improvement. The rate of cement leakage was lower than other reports.
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Affiliation(s)
- David C Noriega
- Unidad de Columna, Servicio Cirugía Ortopédica, Hospital Clínico Universitario de Valladolid, Spain
| | - Jesus Crespo-Sanjuan
- Unidad de Columna, Servicio Cirugía Ortopédica, Hospital Clínico Universitario de Valladolid, Spain; Hospital Clinico Universitario de Valladolid, Calle Ramón y Cajal, Spain
| | - Wayne J Olan
- Minimally Invasive and Endovascular Neurosurgery, The George Washington University Medical Center, Washington D.C
| | - Ruben Hernandez-Ramajo
- Unidad de Columna, Servicio Cirugía Ortopédica, Hospital Clínico Universitario de Valladolid, Spain
| | - Douglas P Bell
- Interventional Radiology. Summit Medical Center. Oklahoma City. USA
| | - J Javier Castrodeza Sanz
- Jefe de Servicio de Medicina Preventiva y Salud Pública, Hospital Clínico Universitario de Valladolid, Spain
| | | | - Israel Sanchez-Lite
- Servicio de Radiodiagnóstico, Hospital Clínico Universitario de Valladolid, Spain
| | - Francisco Ardura
- Unidad de Columna, Servicio Cirugía Ortopédica, Hospital Clínico Universitario de Valladolid, Spain
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Loenen ACY, Noriega DC, Ruiz Wills C, Noailly J, Nunley PD, Kirchner R, Ito K, van Rietbergen B. Misaligned spinal rods can induce high internal forces consistent with those observed to cause screw pullout and disc degeneration. Spine J 2021; 21:528-537. [PMID: 33007470 DOI: 10.1016/j.spinee.2020.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/31/2020] [Accepted: 09/24/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Manual contouring of spinal rods is often required intraoperatively for proper alignment of the rods within the pedicle screw heads. Residual misalignments are frequently reduced by using dedicated reduction devices. The forces exerted by these devices, however, are uncontrolled and may lead to excessive reaction forces. As a consequence, screw pullout might be provoked and surrounding tissue may experience unfavorable biomechanical loads. The corresponding loads and induced tissue deformations are however not well identified. Additionally, whether the forced reduction alters the biomechanical behavior of the lumbar spine during physiological movements postoperatively, remains unexplored. PURPOSE To predict whether the reduction of misaligned posterior instrumentation might result in clinical complications directly after reduction and during a subsequent physiological flexion movement. STUDY DESIGN Finite element analysis. METHODS A patient-specific, total lumbar (L1-S1) spine finite element model was available from previous research. The model consists of poro-elastic intervertebral discs with Pfirrmann grade-dependent material parameters, with linear elastic bone tissue with stiffness values related to the local bone density, and with the seven major ligaments per spinal motion segment described as nonlinear materials. Titanium instrumentation was implemented in this model to simulate a L4, L5, and S1 posterolateral fusion. Next, coronal and sagittal misalignments of 6 mm each were introduced between the rod and the screw head at L4. These misalignments were computationally reduced and a physiological flexion movement of 15° was prescribed. Non-instrumented and well-aligned instrumented models were used as control groups. RESULTS Pulling forces up to 1.0 kN were required to correct the induced misalignments of 6 mm. These forces affected the posture of the total lumbar spine, as motion segments were predicted to rotate up to 3 degrees and rotations propagated proximally to and even affect the L1-2 level. The facet contact pressures in the corrected misaligned models were asymmetrical suggesting non-physiological joint loading in the misaligned models. In addition, the discs and vertebrae experienced abnormally high forces as a result of the correction procedure. These effects were more pronounced after a 15° flexion movement following forced reduction. CONCLUSIONS The results of this study indicate that the correction of misaligned posterior instrumentation can result in high forces at the screws consistent with those reported to cause screw pullout, and may cause high-tissue strains in adjacent and downstream spinal segments. CLINICAL SIGNIFICANCE Proper alignment of spinal posterior instrumentation may reduce clinical complications secondary to unfavorable biomechanics.
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Affiliation(s)
- Arjan C Y Loenen
- Department of Orthopaedic Surgery, Laboratory for Experimental Orthopaedics, CAPHRI, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Biomedical Engineering, Orthopaedic Biomechanics, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - David C Noriega
- Spine-Unit, University Hospital of Valladolid, Valladolid, Spain
| | - Carlos Ruiz Wills
- Department of Information and Communication Technologies, Barcelona Centre for New Medical Technologies (BCN MedTech), Universitat Pompeu Fabra, Barcelona, Spain
| | - Jérôme Noailly
- Department of Information and Communication Technologies, Barcelona Centre for New Medical Technologies (BCN MedTech), Universitat Pompeu Fabra, Barcelona, Spain
| | | | - Rainer Kirchner
- Department of Orthopaedic Surgery and Trauma Surgery, Clinics Husum and Niebüll, Husum, Germany
| | - Keita Ito
- Department of Biomedical Engineering, Orthopaedic Biomechanics, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Bert van Rietbergen
- Department of Orthopaedic Surgery, Laboratory for Experimental Orthopaedics, CAPHRI, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Biomedical Engineering, Orthopaedic Biomechanics, Eindhoven University of Technology, Eindhoven, the Netherlands.
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Noriega DC, Rodrίguez-Monsalve F, Ramajo R, Sánchez-Lite I, Toribio B, Ardura F. Long-term safety and clinical performance of kyphoplasty and SpineJack® procedures in the treatment of osteoporotic vertebral compression fractures: a pilot, monocentric, investigator-initiated study. Osteoporos Int 2019; 30:637-645. [PMID: 30488273 DOI: 10.1007/s00198-018-4773-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 11/11/2018] [Indexed: 11/25/2022]
Abstract
UNLABELLED This pilot monocenter study in 30 patients with painful osteoporotic vertebral compression fractures compared two vertebral augmentation procedures. Over a 3-year post-surgery follow-up, pain/disability/quality of life remained significantly improved with both balloon kyphoplasty and SpineJack® techniques, but the latter allowed better vertebral body height restoration/kyphosis correction. INTRODUCTION Patient follow-up rarely exceed 2 years in trials comparing vertebral augmentation procedures for the treatment of painful osteoporotic vertebral compression fractures (VCFs). This pilot, investigator-initiated, prospective study aimed to compare long-term results of SpineJack® (SJ) and balloon kyphoplasty (BKP). Preliminary results showed that SJ resulted in a better restoration of vertebral heights and angles, maintained over 12 months. METHODS Thirty patients were randomized to SJ (n = 15) or BKP (n = 15). Clinical endpoints were analgesic consumption, back pain intensity (visual analog scale (VAS)), the Oswestry Disability Index (ODI), and quality of life (EQ-VAS score). They were recorded preoperatively, at 5 days (except EQ-VAS), 1, 3, 6, 12, and 36 months post-surgery. Spine X-rays were taken 48 h prior to the procedure and 5 days, 6, 12, and 36 months after. RESULTS Clinical improvements were observed with both procedures over the 3-year period without significant inter-group differences, but the final mean EQ-5Dindex score was significantly in favor of the SJ group (0.93 ± 0.11 vs 0.81 ± 0.09; p = 0.007). Vertebral height restoration/kyphotic correction was still evident at 36 months with a greater mean correction of anterior (10 ± 13% vs 2 ± 8% for BKP, p = 0.007) and central height (10 ± 11% vs 3 ± 7% for BKP, p = 0.034) and a larger correction of the vertebral body angle (- 5.0° ± 5.1° vs 0.4° ± 3.4°; p = 0.003) for SJ group. CONCLUSIONS In this study, both techniques displayed very good long-term clinical efficiency and safety in patients with osteoporotic VCFs. Over the 3-year follow-up, vertebral body height restoration/kyphosis correction was better with the SpineJack® procedure.
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Affiliation(s)
- D C Noriega
- Hospital Clinico Universitario de Valladolid, Calle Ramon y Cajal, 47008, Valladolid, Spain.
| | - F Rodrίguez-Monsalve
- Hospital Clinico Universitario de Valladolid, Calle Ramon y Cajal, 47008, Valladolid, Spain
| | - R Ramajo
- Hospital Clinico Universitario de Valladolid, Calle Ramon y Cajal, 47008, Valladolid, Spain
| | - I Sánchez-Lite
- Hospital Clinico Universitario de Valladolid, Calle Ramon y Cajal, 47008, Valladolid, Spain
| | - B Toribio
- Hospital Clinico Universitario de Valladolid, Calle Ramon y Cajal, 47008, Valladolid, Spain
| | - F Ardura
- Hospital Clinico Universitario de Valladolid, Calle Ramon y Cajal, 47008, Valladolid, Spain
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Noriega DC, Rodrίguez-Monsalve F, Ramajo R, Sánchez-Lite I, Toribio B, Ardura F. Correction to: Long-term safety and clinical performance of kyphoplasty and SpineJack® procedures in the treatment of osteoporotic vertebral compression fractures: a pilot, monocentric, investigator-initiated study. Osteoporos Int 2019; 30:647. [PMID: 30659338 DOI: 10.1007/s00198-018-04825-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The author list was incomplete. The complete list of authors is the following: D. Noriega, F. Rodrίguez-Monsalve, R. Ramajo, I.Sánchez-Lite, B. Toribio, F. Ardura. The corresponding author regrets sincerely this error. The original article got update.
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Affiliation(s)
- D C Noriega
- Hospital Clinico Universitario de Valladolid, Calle Ramon y Cajal, 47008, Valladolid, Spain.
| | - F Rodrίguez-Monsalve
- Hospital Clinico Universitario de Valladolid, Calle Ramon y Cajal, 47008, Valladolid, Spain
| | - R Ramajo
- Hospital Clinico Universitario de Valladolid, Calle Ramon y Cajal, 47008, Valladolid, Spain
| | - I Sánchez-Lite
- Hospital Clinico Universitario de Valladolid, Calle Ramon y Cajal, 47008, Valladolid, Spain
| | - B Toribio
- Hospital Clinico Universitario de Valladolid, Calle Ramon y Cajal, 47008, Valladolid, Spain
| | - F Ardura
- Hospital Clinico Universitario de Valladolid, Calle Ramon y Cajal, 47008, Valladolid, Spain
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14
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Noriega DC, Hernández-Ramajo R, Rodríguez-Monsalve Milano F, Sanchez-Lite I, Toribio B, Ardura F, Torres R, Corredera R, Kruger A. Risk-benefit analysis of navigation techniques for vertebral transpedicular instrumentation: a prospective study. Spine J 2017; 17:70-75. [PMID: 27503262 DOI: 10.1016/j.spinee.2016.08.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 06/30/2016] [Accepted: 08/02/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Pedicle screws in spinal surgery have allowed greater biomechanical stability and higher fusion rates. However, malposition is very common and may cause neurologic, vascular, and visceral injuries and compromise mechanical stability. PURPOSE The purpose of this study was to compare the malposition rate between intraoperative computed tomography (CT) scan assisted-navigation and free-hand fluoroscopy-guided techniques for placement of pedicle screw instrumentation. STUDY DESIGN/SETTING This is a prospective, randomized, observational study. PATIENT SAMPLE A total of 114 patients were included: 58 in the assisted surgery group and 56 in the free-hand fluoroscopy-guided surgery group. OUTCOME MEASURES Analysis of screw position was assessed using the Heary classification. Breach severity was defined according to the Gertzbein classification. Radiation doses were evaluated using thermoluminescent dosimeters, and estimates of effective and organ doses were made based on scan technical parameters. METHODS Consecutive patients with degenerative disease, who underwent surgical procedures using the free-hand, or intraoperative navigation technique for placement of transpedicular instrumentation, were included in the study. RESULTS Forty-four out of 625 implanted screws were malpositioned: 11 (3.6%) in the navigated surgery group and 33 (10.3%) in the free-hand group (p<.001). Screw position according to the Heary scale was Grade II (4 navigated surgery, 6 fluoroscopy guided), Grade III (3 navigated surgery, 11 fluoroscopy guided), Grade IV (4 navigated surgery, 16 fluoroscopy guided), and Grade V (1 fluoroscopy guided). There was only one symptomatic case in the conventional surgery group. Breach severity was seven Grade A and four Grade B in the navigated surgery group, and eight Grade A, 24 Grade B, and one Grade C in free-hand fluoroscopy-guided surgery group. Radiation received per patient was 5.8 mSv (4.8-7.3). The median dose received in the free-hand fluoroscopy group was 1 mGy (0.8-1.1). There was no detectable radiation level in the navigation-assisted surgery group, whereas the effective dose was 10 µGy in the free-hand fluoroscopy-guided surgery group. CONCLUSIONS Malposition rate, both symptomatic and asymptomatic, in spinal surgery is reduced when using CT-guided placement of transpedicular instrumentation compared with placement under fluoroscopic guidance, with radiation values within the safety limits for health. Larger studies are needed to determine risk-benefit in these patients.
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Affiliation(s)
- David C Noriega
- Unidad de Columna, Servicio Cirugía Ortopédica, Hospital Clínico Universitario de Valladolid, Calle Ramón y Cajal, 47008 Valladolid, Spain.
| | - Rubén Hernández-Ramajo
- Unidad de Columna, Servicio Cirugía Ortopédica, Hospital Clínico Universitario de Valladolid, Calle Ramón y Cajal, 47008 Valladolid, Spain
| | - Fiona Rodríguez-Monsalve Milano
- Unidad de Columna, Servicio Cirugía Ortopédica, Hospital Clínico Universitario de Valladolid, Calle Ramón y Cajal, 47008 Valladolid, Spain
| | - Israel Sanchez-Lite
- Servicio de Radiología, Hospital Clínico Universitario de Valladolid, Calle Ramón y Cajal, 47008 Valladolid, Spain
| | - Borja Toribio
- Servicio de Radiología, Hospital Clínico Universitario de Valladolid, Calle Ramón y Cajal, 47008 Valladolid, Spain
| | - Francisco Ardura
- Unidad de Columna, Servicio Cirugía Ortopédica, Hospital Clínico Universitario de Valladolid, Calle Ramón y Cajal, 47008 Valladolid, Spain
| | - Ricardo Torres
- Servicio de Radiofísica y Protección Radiológica, Hospital Clínico Universitario de Valladolid, Calle Ramón y Cajal, 47008 Valladolid, Spain
| | - Raul Corredera
- Unidad de Columna, Servicio Cirugía Ortopédica, Hospital Clínico Universitario de Valladolid, Calle Ramón y Cajal, 47008 Valladolid, Spain
| | - Antonio Kruger
- Center for Orthopaedics and Trauma Surgery University Hospital Giessen and Marburg GmbH, Marburg, Germany
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Baeesa SS, Krueger A, Aragón FA, Noriega DC. The efficacy of a percutaneous expandable titanium device in anatomical reduction of vertebral compression fractures of the thoracolumbar spine. Saudi Med J 2016; 36:52-60. [PMID: 25630005 PMCID: PMC4362189 DOI: 10.15537/smj.2015.1.9463] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES To evaluate the feasibility of a minimally invasive technique using a titanium expandable device to achieve anatomical restoration of vertebral compression fractures (VCF) of the thoracolumbar spine. METHODS This prospective study included 27 patients diagnosed with VCF (Magerl classification A.1.2, A.1.3, and A.3.1) of the thoracolumbar spine treated with percutaneous cement augmentation using the SpineJack® device. The study was conducted in Valladolid University Hospital, Valladolid, Spain from January to December 2012, with a minimum one-year follow up. Preoperative evaluation included visual analogue scale (VAS) for pain, and radiological assessment of the VCF using 3-dimensional computed tomography (3D-CT) scans for measurements of vertebral heights and angles. The patients were followed at 3, 6, and 12 months with clinical VAS and radiological assessments. RESULTS The procedure was performed in 27 patients with a mean age of 55.9 ± 17.3 years, 55.6% females. All patients underwent surgery within 6 weeks from time of injury. No procedure related complications occurred. Pain measured by VAS score decreased from 7.0 preoperatively to 3.2 within 24 hours, and remained 2.2 at 3 months, 2.1 at 6 months, and 1.5 at 12-months follow-up (p<0.05). Mean height restorations for the anterior was 3.56 mm, central was 2.49, and posterior vertebral was 1.28 mm, and maintained at 12-months follow-up (p=0.001). CONCLUSION This new percutaneous technique for VCF has shown good clinical results in pain control and the possibility to reduce both vertebral kyphosis angles and fractured endplates seen in 3D-CT scans assessment method. Further studies are needed to confirm those results on larger cohorts with long-term follow up.
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Affiliation(s)
- Saleh S Baeesa
- Division of Neurosurgery, Faculty of Medicine, King Abdulaziz University, PO Box 80215, Jeddah 21589, Kingdom of Saudi Arabia. Fax. +966 (12) 6408469. E-mail.
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Noriega DC, Ramajo RH, Lite IS, Toribio B, Corredera R, Ardura F, Krüger A. Safety and clinical performance of kyphoplasty and SpineJack(®) procedures in the treatment of osteoporotic vertebral compression fractures: a pilot, monocentric, investigator-initiated study. Osteoporos Int 2016; 27:2047-55. [PMID: 26856586 DOI: 10.1007/s00198-016-3494-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 01/14/2016] [Indexed: 12/27/2022]
Abstract
UNLABELLED Clinical performance and safety of two percutaneous vertebral cement augmentation (VA) procedures (SpineJack® and Kyphx Xpander® balloon) were compared in patients with osteoporotic compression fractures. Both techniques were safe, efficient, and led to a rapid and marked improvement in clinical signs; nevertheless, SpineJack showed better restoration of vertebral heights and angles, maintained over time. INTRODUCTION In patients with osteoporotic vertebral compression fractures (VCFs), both SpineJack® (SJ) and balloon kyphoplasty (BKP) led to a rapid and marked improvement in clinical signs. This pilot, monocentric, investigator-initiated, prospective study aimed to compare two percutaneous vertebral augmentation procedures in the painful osteoporotic VCF treatment. METHODS Thirty patients were randomized to receive SJ (n = 15) or BKP (n = 15). Analgesic consumption, back pain intensity (visual analog scale (VAS)), and Oswestry Disability Index (ODI) scores were recorded preoperatively, at 5 days and 1, 3, 6, and 12 months post-surgery. Quality of life (EQ-VAS score) was evaluated at 1, 3, 6, and 12 months. Spine X-rays were taken 48 h prior to procedure and 5 days and 6 and 12 months after. RESULTS SpineJack® led to a significantly shorter intervention period (23 vs 32 min; p < 0.001), a strong, rapid, and long-lasting decline in pain (94 vs 82 % at 12 months) and in functional disability (94 vs 90 % at 12 months), a greater and sustainable mean correction of anterior (12 ± 13 vs 0 ± 7 % for BKP, p = 0.003) and central height (12 ± 10 vs 2 ± 6 % for BKP, p = 0.001) at 12 months, and a larger restoration of the vertebral body angle still evident 12 months after implantation (-4.4° ± 5.8° vs 0.2° ± 3.0° for BKP; p = 0.012). CONCLUSIONS This pilot study showed that both techniques were safe and efficient for the osteoporotic VCF treatment. Radiological results indicate that the SpineJack® procedure has a higher potential for vertebral body height restoration and maintenance over time.
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Affiliation(s)
- D C Noriega
- Unidad de Columna, Servicio Cirugía Ortopédica, Hospital Clínico Universitario de Valladolid, Calle Ramón y Cajal, 47008, Valladolid, Spain.
| | - R H Ramajo
- Unidad de Columna, Servicio Cirugía Ortopédica, Hospital Clínico Universitario de Valladolid, Calle Ramón y Cajal, 47008, Valladolid, Spain
| | - I S Lite
- Servicio de Radiología, Hospital Clínico Universitario de Valladolid, Calle Ramón y Cajal, 47008, Valladolid, Spain
| | - B Toribio
- Servicio de Radiología, Hospital Clínico Universitario de Valladolid, Calle Ramón y Cajal, 47008, Valladolid, Spain
| | - R Corredera
- Unidad de Columna, Servicio Cirugía Ortopédica, Hospital Clínico Universitario de Valladolid, Calle Ramón y Cajal, 47008, Valladolid, Spain
| | - F Ardura
- Unidad de Columna, Servicio Cirugía Ortopédica, Hospital Clínico Universitario de Valladolid, Calle Ramón y Cajal, 47008, Valladolid, Spain
| | - A Krüger
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Baldingerstraße, 35043, Marburg, Germany
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Krüger A, Oberkircher L, Figiel J, Floßdorf F, Bolzinger F, Noriega DC, Ruchholtz S. Height restoration of osteoporotic vertebral compression fractures using different intravertebral reduction devices: a cadaveric study. Spine J 2015; 15:1092-8. [PMID: 24200410 DOI: 10.1016/j.spinee.2013.06.094] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 06/12/2013] [Accepted: 06/24/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND The treatment of osteoporotic vertebral compression fractures using transpedicular cement augmentation has grown significantly during the past two decades. Balloon kyphoplasty was developed to restore vertebral height and improve sagittal alignment. Several studies have shown these theoretical improvements cannot be transferred universally to the clinical setting. PURPOSE The aim of the current study is to evaluate two different procedures used for percutaneous augmentation of vertebral compression fractures with respect to height restoration: balloon kyphoplasty and SpineJack. MATERIALS AND METHODS Twenty-four vertebral bodies of two intact, fresh human cadaveric spines (T6-L5; donor age, 70 years and 60 years; T-score -6.8 points and -6.3 points) were scanned using computed tomography (CT) and dissected into single vertebral bodies. Vertebral wedge compression fractures were created by a material testing machine (Universal testing machine, Instron 5566, Darmstadt, Germany). The axial load was increased continuously until the height of the anterior edge of the vertebral body was reduced by 40% of the initial measured values. After 15 minutes, the load was decreased manually to 100 N. After postfracture CT, the clamped vertebral bodies were placed in a custom-made loading frame with a preload of 100 N. Twelve vertebral bodies were treated using SpineJack (SJ; Vexim, Balma, France), the 12 remaining vertebral bodies were treated with balloon kyphoplasty (BKP; Kyphon, Medtronic, Sunnyvale, CA, USA). The load was maintained during the procedure until the cement set completely. Posttreatment CT was performed. Anterior, central, and posterior height as well as the Beck index were measured prefracture and postfracture as well as after treatment. RESULTS For anterior height restoration (BKP, 0.14±1.48 mm; SJ, 3.34±1.19 mm), central height restoration (BKP, 0.91±1.04 mm; SJ, 3.24±1.22 mm), and posterior restoration (BKP, 0.37±0.57 mm; SJ, 1.26±1.05), as well as the Beck index (BKP, 0.00±0.06 mm; SJ, 0.10±0.06), the values for the SpineJack group were significantly higher (p<.05) CONCLUSION: The protocols for creating wedge fractures and using the instrumentation under a constant preload of 100 N led to reproducible results and effects. The study showed that height restoration was significantly better in the SpineJack group compared with the balloon kyphoplasty group. The clinical implications include a better restoration of the sagittal balance of the spine and a reduction of the kyphotic deformity, which may relate to clinical outcome and the biological healing process.
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Affiliation(s)
- Antonio Krüger
- Department of Trauma and Reconstructive Surgery Philipps University of Marburg, University Hospital Giessen and Marburg, Baldingerstrasse, 35043 Marburg, Germany.
| | - Ludwig Oberkircher
- Department of Trauma and Reconstructive Surgery Philipps University of Marburg, University Hospital Giessen and Marburg, Baldingerstrasse, 35043 Marburg, Germany
| | - Jens Figiel
- Department of Diagnostic Radiology, Philipps University of Marburg, University Hospital Giessen and Marburg, Baldingerstrasse, 35043 Marburg, Germany
| | - Felix Floßdorf
- Department of Trauma and Reconstructive Surgery Philipps University of Marburg, University Hospital Giessen and Marburg, Baldingerstrasse, 35043 Marburg, Germany
| | - Florent Bolzinger
- Biomechanics Laboratory, IMFT UMR 5502 Purpan University Hospital, Place Dr. Baylac, 31059 Toulouse, France
| | - David C Noriega
- Spine-Unit, University Hospital, Avenida de Ramon y Cajal 7, 47005 Valladolid, Spain
| | - Steffen Ruchholtz
- Department of Trauma and Reconstructive Surgery Philipps University of Marburg, University Hospital Giessen and Marburg, Baldingerstrasse, 35043 Marburg, Germany
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