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Qiu R, Cai K, Zhang K, Ying Y, Hu H, Jiang G, Luo K. The current status and development trend of hydrogel application in spinal surgery. J Mater Chem B 2024; 12:1730-1747. [PMID: 38294330 DOI: 10.1039/d3tb02613b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Spinal diseases often result in compromised mobility and diminished quality of life due to the intricate anatomy surrounding the nervous system. Medication and surgical interventions remain the primary treatment methods for spinal conditions. However, currently available medications have limited efficacy in treating spinal surgical diseases and cannot achieve a complete cure. Furthermore, surgical intervention frequently results in inevitable alterations and impairments to the initial anatomical integrity of the spinal structure, accompanied by the consequential loss of certain physiological functionalities. Changes in spine surgery treatment concepts and modalities in the last decade have led to a deepening of minimally invasive treatment, with treatment strategies focusing more on repairing and reconstructing the patient's spine and preserving physiological functions. Therefore, developing novel and more efficient treatment strategies to reduce spinal lesions and iatrogenic injuries is essential. In recent years, significant advancements in biomedical research have led to the discovery that hydrogels possess excellent biocompatibility, biodegradability, and adjustable mechanical properties. The application of hydrogel-based biotechnology in spinal surgery has demonstrated remarkable therapeutic potential. This review presents the therapeutic strategies for spinal diseases based on hydrogel tissue engineering technology.
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Affiliation(s)
- Rongzhang Qiu
- Health Science Center, Ningbo University, Ningbo, Zhejiang, 315000, China
| | - Kaiwen Cai
- Department of Orthopaedics, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315000, China.
| | - Kai Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315000, China.
| | - Yijian Ying
- Health Science Center, Ningbo University, Ningbo, Zhejiang, 315000, China
| | - Hangtian Hu
- Health Science Center, Ningbo University, Ningbo, Zhejiang, 315000, China
| | - Guoqiang Jiang
- Department of Orthopaedics, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315000, China.
| | - Kefeng Luo
- Department of Orthopaedics, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315000, China.
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Lafford HW, Stewart EE, Koslowsky IL, Rabin HR, Kloiber R. The routine clinical use of fluorodeoxyglucose PET/CT to confirm treatment response in pyogenic spine infection. Skeletal Radiol 2024; 53:161-170. [PMID: 37393203 DOI: 10.1007/s00256-023-04393-6] [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: 05/29/2023] [Revised: 06/19/2023] [Accepted: 06/19/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVE Response of pyogenic spine infection to antibiotic therapy is usually based on nonspecific symptoms and inflammation markers. Abnormalities on MRI persist too long to influence therapy. Is FDG-PET/CT a timely and robust predictor of successful therapy? MATERIALS AND METHODS Retrospective study. Sequential FDG-PET/CTs done to assess treatment response over a 4-year period. Recurrence of infection after stopping treatment was the endpoint. RESULTS One hundred seven patients enrolled. First treatment response scan showed no signs of infection in 69 patients (low risk). Twenty-four additional patients underwent additional treatment after an initial positive scan with low-risk pattern on follow-up imaging. After stopping antibiotics, none had clinical recurrence of infection. One had positive cultures at surgery for negative predictive value of 0.99. Thirty-eight patients had evidence of residual infection. Abnormalities in 28 were comparable to what is seen with untreated infection (high-risk). Twenty-seven received additional treatment until resolution. Antibiotics were stopped in 1 who suffered recurrence. Ten had low-grade/localized abnormalities consistent with infection (intermediate-risk). Signs of infection resolved in 3 after additional treatment. Of the remaining 7 patients who had minor residual abnormalities when antibiotics were stopped, 1 had recurrent infection for a positive predictive value of 0.14. CONCLUSION Risk stratification proposed: A low-risk scan with only inflammation at a destroyed joint indicates negligible risk of recurrence. Unexplained activity in bone, soft tissue or spinal canal indicates high risk with further antibiotics recommended. Most patients with subtle or localized findings (intermediate risk) did not experience recurrence. Stopping therapy could be considered under careful observation.
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Affiliation(s)
- Hans W Lafford
- Department of Radiology, University of Calgary, Foothills Medical Centre, 1403 29 Street NW, Calgary, Alberta, T2N 2T9, Canada.
- Diagnostic Radiology Residency Program, University of Calgary, Foothills Medical Centre, 1403 29 Street NW, Calgary, Alberta, T2N 2T9, Canada.
| | - Errol E Stewart
- Department of Radiology, University of Calgary, Foothills Medical Centre, 1403 29 Street NW, Calgary, Alberta, T2N 2T9, Canada
| | - Ingrid L Koslowsky
- Department of Radiology, University of Calgary, Foothills Medical Centre, 1403 29 Street NW, Calgary, Alberta, T2N 2T9, Canada
| | - Harvey R Rabin
- Department of Medicine, University of Calgary, Foothills Medical Centre, 1403 29 Street NW, Calgary, Alberta, T2N 2T9, Canada
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Canada
| | - Reinhard Kloiber
- Department of Radiology, University of Calgary, Foothills Medical Centre, 1403 29 Street NW, Calgary, Alberta, T2N 2T9, Canada.
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Kim SH, Park SJ, Yoon KB, Jun EK, Cho J, Kim HJ. Influence of Handgrip Strength and Psoas Muscle Index on Analgesic Efficacy of Epidural Steroid Injection in Patients With Degenerative Lumbar Spinal Disease. Pain Physician 2022; 25:E1105-E1113. [PMID: 36288597] [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: 06/16/2023]
Abstract
BACKGROUND Handgrip strength (HGS) and psoas muscle index (PMI) are widely used protocols for screening or diagnosing sarcopenia by measuring muscle strength and mass. Epidural steroid injection (ESI) is a common intervention for the treatment of spinal pain; however, the influence of pre-procedural sarcopenic status on therapeutic effects after ESI has not been investigated. OBJECTIVES In the present study, whether pre-procedural HGS or PMI predicts analgesic efficacy of ESI in elderly patients with degenerative lumbar spinal disease was investigated. STUDY DESIGN This was a retrospective observational study. SETTING The study included patients from the outpatient department for interventional pain management at a university hospital. METHODS Following institutional review board (IRB) approval, patients >= 65 years of age who underwent fluoroscopy-guided lumbar ESI from 2016 to 2017 in our clinic were enrolled in the present study. Good analgesia was defined as >= 50% reduction in pain score at 4 weeks after injection. Patient characteristics, pain-related factors, clinical factors, HGS, and PMI measurements were collected and analyzed using multivariate analysis to identify the predictors of good analgesia after lumbar ESI. In addition, a receiver operating characteristic curve (ROC) analysis was performed, and area under the curve (AUC) values with 95% confidence interval (CI) were calculated for the HGS. RESULTS A total of 259 patients satisfied the study protocol requirements. HGS was significantly higher in the good analgesia group (23.12 ± 7.54 vs 16.55 ± 6.66 kg, P < 0.001). However, the PMI did not differ between the 2 groups (5.25 ± 1.55 vs 5.08 ± 1.69 cm2/m2, P = 0.406). Multivariate analysis revealed higher HGS (odds ratio, OR = 1.142, 95% CI = 1.094-1.193, P < 0.001) and low-grade foraminal stenosis (OR = 0.403, 95% CI = 0.199-0.814, P = 0.011) were significantly associated with good analgesia after injection. The AUC values with 95% CI for HGS were 0.819 (0.718-0.920) in men and 0.800 (0.732-0.869) in women. In addition, HGS cutoff values for predicting good analgesic outcomes were 26.5 kg in men and 16.5 kg in women. LIMITATIONS This study was conducted in a single center, and sample size was relatively small. The lack of physical performance evaluation did not fully meet the current criteria for sarcopenia. In addition, post-procedural clinical data associated with disability or quality of life could not be collected. CONCLUSION In the present study, pre-procedural HGS was an independent predictor of analgesic efficacy after ESI in elderly patients with degenerative lumbar spinal disease. However, the PMI was not associated with pain relief after injection.
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Affiliation(s)
- Shin Hyung Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Jun Park
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung Bong Yoon
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun-Kyung Jun
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jaehee Cho
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hee Jung Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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Lee SH, Kim J, Kim TH. Treatment Guideline for Patients with Native Culture-negative Pyogenic Vertebral Osteomyelitis. Clin Orthop Relat Res 2022; 480:124-136. [PMID: 34128841 PMCID: PMC8673978 DOI: 10.1097/corr.0000000000001866] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/28/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND With the development of evidence-based guidelines for the diagnosis and antibiotic treatment of patients with pyogenic vertebral osteomyelitis, various nonsurgical and surgical treatment strategies have achieved favorable results. However, sufficient administration of appropriate antibiotics is a prerequisite for treatment success, which cannot be guaranteed in patients with culture-negative pyogenic vertebral osteomyelitis. Unfortunately, previous studies on culture-negative pyogenic vertebral osteomyelitis were limited by small patient groups, short follow-up periods, varied treatment protocols, and inconsistently defined clinical endpoints. QUESTIONS/PURPOSES Among patients treated according to our center's treatment protocol for culture-negative pyogenic vertebral osteomyelitis, which included patients treated without surgery, with surgery but without spinal instrumentation, as well as patients treated with instrumented surgery, (1) what proportion of patients in each treatment group experienced recurrence (or persistence) of infection, complications of treatment, and death; and (2) what factors were independently associated with recurrent or persistent infection after treatment under this algorithm? METHODS This was a retrospective evaluation of a treatment protocol in use at one center from 2008 to 2020. During that time, we treated 183 patients for culture-negative pyogenic vertebral osteomyelitis. The diagnosis was based on clinical, laboratory, and radiological features excluding disease that presents similar features to pyogenic vertebral osteomyelitis. For those patients, our protocol included three possible approaches: nonsurgical treatment, including the use of empirical antibiotics (nonoperative group, n = 82); spinal decompression without instrumentation (noninstrumented group, n = 41); and spinal decompression with instrumentation (instrumented group, n = 60). The indications for each treatment during the period remained relatively consistent. Nonsurgical treatment including empirical antibiotics was applied to all patients according to the specified antibiotic protocol. Spinal decompression without instrumentation was employed when a patient presented substantial or aggravating neurologic deficits or intractable pain from an abscess. Instrumentation was added in patients with mechanical instability before or after spinal decompression. Minimum follow-up to be included in this study was 1 year, and 91% (252 of 277) of patients were accounted for at that time, with no differential loss to follow-up among the study groups (12, five, and four patients missing from the three groups, respectively, at 1 year). Chart review was performed to ascertain the proportion of patients in each group who experienced recurrence, complications, and death. Factors associated with recurrence were assessed across the entire cohort using a multivariable logistic model. We analyzed 1-year recurrence and mortality rates using the Kaplan-Meier method, and their 95% confidence intervals were calculated using the method by Hosmer and Lemeshow. RESULTS At 1 year, the recurrence-free survival rate was 87% (95% confidence interval 78% to 93%) in the nonoperative group, 87% (95% CI 72% to 94%) in the noninstrumented group, and 91% (95% CI 80% to 96%) in the instrumented group. The proportion of patients who experienced a major medical complication in each group was 12% (10 of 82), 10% (4 of 41), and 8% (5 of 60), respectively. At 1 year, the survival rate with patient death as the endpoint was 95% (95% CI 88% to 98%) in the nonoperative group, 95% (95% CI 82% to 99%) in the noninstrumented group, and 97% (95% CI 87% to 99%) in the instrumented group. After controlling for potentially confounding variables including age, medical comorbidities, and anatomical involvement of infection, the following factors were independently associated with increased odds of infection recurrence or persistence: higher Charlson Comorbidity Index (CCI) score (odds ratio 1.6 per point on the CCI [95% CI 1.2 to 2.1]; p = 0.004) and the presence of a psoas abscess (OR 4.7 [95% CI 1.6 to 13.9]; p = 0.005). CONCLUSION Among patients with negative initial nonoperative culture results, spinal decompression and abscess drainage can be used in those with substantial or aggravating neurological deficits or intractable pain caused by an abscess, while additional early spinal instrumentation can be applied upon consideration of their medical comorbidities and the presence of a psoas abscess when mechanical instability is present before or after the spinal decompression. Reasonable clinical results can be expected, regardless of the results from subsequent operative cultures. However, our study results should be replicated by other centers, and further studies that consider individual differences such as bone mineral density and include patients with previous spinal instrumentation or recurrent infection should be performed to establish a more comprehensive treatment protocol. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Seung Hun Lee
- Spine Center, Department of Orthopedics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Jihye Kim
- Division of Infection, Department of Pediatrics, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Tae-Hwan Kim
- Spine Center, Department of Orthopedics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
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Koh PX, Neo SX, Chiew HJ, Singh DR, Saini M, Chen Z. Syphilitic Spinal Disease: An Old Nemesis Revisited. A Case Series and Review of Literature. Sex Transm Dis 2021; 48:e126-e131. [PMID: 33512899 DOI: 10.1097/olq.0000000000001391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Syphilitic spinal disease is a rare condition caused by the spirochete Treponema pallidum, either from direct spirochete involvement of the cord or as a consequence of indirect spirochete involvement of the meninges, blood vessels, or the vertebral column. After the introduction of penicillin therapy in the 1940s, it has become an increasingly rare condition. We report 3 challenging cases of syphilitic spinal disease presenting as myelopathy-1 with an extra-axial gumma of tertiary syphilis causing cord compression and 2 with tabes dorsalis complicated by tabetic spinal neuroarthropathy-each presenting a diagnostic dilemma to their treating physicians. We also review the literature for updates on modern investigative modalities and discuss pitfalls physicians need to avoid to arrive at the diagnosis.
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Affiliation(s)
- Pei Xuan Koh
- From the Department of Neurology, National Neuroscience Institute, Singapore
| | - Shermyn Xiumin Neo
- From the Department of Neurology, National Neuroscience Institute, Singapore
| | - Hui Jin Chiew
- From the Department of Neurology, National Neuroscience Institute, Singapore
| | | | - Monica Saini
- From the Department of Neurology, National Neuroscience Institute, Singapore
| | - Zhiyong Chen
- From the Department of Neurology, National Neuroscience Institute, Singapore
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Del Sindaco G, Berlanga P, Brugières L, Thebault E, Mantovani G, Wicart P, Linglart A. Mineral and Bone Consequences of High Dose Denosumab Therapy to Treat an Aneurysmal Bone Cyst, a Child Case Report. Front Endocrinol (Lausanne) 2021; 12:698963. [PMID: 34335473 PMCID: PMC8322664 DOI: 10.3389/fendo.2021.698963] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/25/2021] [Indexed: 11/25/2022] Open
Abstract
Aneurysmal bone cysts (ABCs) are rare benign pseudotumoral bone lesions with potential aggressive behavior due to the extensive destruction of surrounding bone. Traditionally, these tumors were treated with open surgery, but there is more and more a shift to less invasive procedures. In particular, treatment for spinal ABCs is generally unsatisfactory due to the risk of morbidity, neurological impairment and recurrence, and there is a need for innovative therapies. Denosumab has been reported as a useful treatment in giant cell tumors of bone (GCTB), so its efficacy has been tested also in other fibro-osseus lesions affecting children and adolescents, such as spinal aneurysmal bone cysts. The pediatric literature is limited to case reports and small series, all of which highlight the efficacy of this treatment on lesions growth and associated bone pain. Some of these reports have already reported well known side effects associated with denosumab, such as hypocalcemia at the beginning of the treatment, and rebound hypercalcemia at the discontinuation. The latter seems to be more frequent in children and adolescents than in adults, probably due to the higher baseline bone turnover in children. In addition, the use of denosumab in young patients could affect both bone modeling and remodeling, even if the consequences on the growing skeleton have not been reported in detail. Here we describe the case of a spinal ABC diagnosed in an 8-year old young boy which was not accessible to surgery but responded favorably to denosumab. Our aim is to describe the rapid changes in mineral and bone homeostasis in this patient, that required advice from the experts of the European Reference Network (ERN) for rare bone and endocrine diseases.
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Affiliation(s)
- Giulia Del Sindaco
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, ERN BOND, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- AP-HP, Service d’endocrinologie et diabète de l’enfant, ERN BOND, ERN for rare endocrine disorders, et Plateforme d’expertise des maladies rares, Hôpital Bicêtre Paris Saclay, Le Kremlin-Bicêtre, France
| | - Pablo Berlanga
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Center, Paris-Saclay University, Villejuif, France
| | - Laurence Brugières
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Center, Paris-Saclay University, Villejuif, France
| | - Eric Thebault
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Center, Paris-Saclay University, Villejuif, France
| | - Giovanna Mantovani
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, ERN BOND, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Philippe Wicart
- AP-HP, Centre de Référence des maladies rares du métabolisme du Calcium et du Phosphate, filière OSCAR, Paris, France
- AP-HP, Department of Pediatric Orthopedic Surgery, Necker - Enfants Malades University Hospital, Paris, France. Paris Descartes University, Paris, France
| | - Agnès Linglart
- AP-HP, Service d’endocrinologie et diabète de l’enfant, ERN BOND, ERN for rare endocrine disorders, et Plateforme d’expertise des maladies rares, Hôpital Bicêtre Paris Saclay, Le Kremlin-Bicêtre, France
- AP-HP, Centre de Référence des maladies rares du métabolisme du Calcium et du Phosphate, filière OSCAR, Paris, France
- Université de Paris Saclay, INSERM, U1185, Le Kremlin-Bicêtre, France
- *Correspondence: Agnès Linglart,
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Cheng SH, Kuo YJ, Chen C, Kang YN. Effects of teriparatide and bisphosphonate on spinal fusion procedure: A systematic review and network meta-analysis. PLoS One 2020; 15:e0237566. [PMID: 32870946 PMCID: PMC7462270 DOI: 10.1371/journal.pone.0237566] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Received: 04/14/2020] [Accepted: 07/14/2020] [Indexed: 01/11/2023] Open
Abstract
Background Giving patients anti-osteoporotic agents peri-operatively is a well-accepted strategy to increase fusion rate and prevent complications. The purpose of this study was to investigate effectiveness of teriparatide and bisphosphonate on fusion surgery of thoracic and lumbar spine. Methods We searched EMBASE and PubMed for randomized clinical trials (RCTs) and prospective comparative studies using teriparatide or bisphosphonate in peri-operative spinal fusion surgery. Our synthesized data of fusion rate, Oswestry disability index (ODI), and adverse event in contrast-based network meta-analysis. Pooled results were presented in risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI). Results Our search hit eight RCTs and three prospective studies with 676 patients receiving spinal surgery. Pooled result showed that teriparatide+Denosumab leads to significantly higher fusion rate than placebo (RR, 2.84; 95% CI: 1.22 to 6.60) and bisphosphonate (RR, 2.59; 95% CI: 1.13 to 5.96). We did not observe significant finding among placebo, teriparatide, and bisphosphonate in the two network models. Conclusion This is the first network meta-analysis providing an overview of the use of teriparatide and bisphosphonate for spinal fusion surgery. Teriparatide treatments are worth to be consider for spinal fusion surgery.
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Affiliation(s)
- Shih-Hao Cheng
- Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, Taipei, Republic of China (Taiwan)
- Department of Orthopedics, Cheng Hsin General Hospital, Taipei, Republic of China (Taiwan)
| | - Yi-Jie Kuo
- Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, Taipei, Republic of China (Taiwan)
- Department of Orthopedic Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Republic of China (Taiwan)
| | - Chiehfeng Chen
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Republic of China (Taiwan)
- Cochrane Taiwan, Taipei Medical University, Taipei, Republic of China (Taiwan)
- Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Republic of China (Taiwan)
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Republic of China (Taiwan)
| | - Yi-No Kang
- Cochrane Taiwan, Taipei Medical University, Taipei, Republic of China (Taiwan)
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Republic of China (Taiwan)
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Republic of China (Taiwan)
- Institute of Health Policy & Management, College of Public Health, National Taiwan University, Taipei, Republic of China (Taiwan)
- * E-mail:
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Hills JM, Carlile CR, Archer KR, Wick JB, Butler M, Daryoush J, Khan I, Call R, Devin CJ, Pennings JS. Duration and Dosage of Opioids After Spine Surgery: Implications on Outcomes at 1 Year. Spine (Phila Pa 1976) 2020; 45:1081-1088. [PMID: 32675616 DOI: 10.1097/brs.0000000000003446] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Longitudinal Cohort Study OBJECTIVE.: The aim of this study was to determine whether duration of postoperative opioids is associated with long-term outcomes, and if initial postoperative opioid dosage is associated with opioid cessation after spine surgery. SUMMARY OF BACKGROUND DATA Preoperative opioid use is associated with poor outcomes, but little evidence exists regarding the implications of opioid dosage and duration after spine surgery. METHODS Data from our state's prescription drug database was linked to our prospective clinical spine registry to analyze opioid dispensing and outcomes in elective surgical spine patients between 2010 and 2017. Patients were stratified based on preoperative chronic opioid use and multivariable regression was used to assess associations between duration of postoperative opioids and outcomes at one year, including satisfaction, chronic opioid use, and meaningful improvements in pain, disability, and quality of life. In a secondary aim, a Cox proportional hazards model was used to determine whether initial postoperative opioid dosage was associated with time to opioid cessation. RESULTS Of 2172 patients included, 35% had preoperative chronic opioid use. In patients without preoperative chronic opioid use, a postoperative opioid duration of 31 to 60 days was associated with chronic opioid use at 1 year (adjusted odds ratio [aOR]: 4.1 [1.7-9.8]) and no meaningful improvement in extremity pain (aOR: 1.8 [1.3-2.6]) or axial pain (aOR: 1.6 [1.1-2.2]); cessation between 61 and 90 days was associated with no meaningful improvement in disability (aOR: 2 [1.3-3]) and dissatisfaction (aOR:1.8 [1-3.1]). In patients with preoperative chronic opioid use, postoperative opioids for ≥90 days was associated with dissatisfaction. Cox regression analyses showed lower initial postoperative opioid dosages were associated with faster opioid cessation in both groups. CONCLUSION Our results suggest that a shorter duration of postoperative opioids may result in improved 1-year patient-reported outcomes, and that lower postoperative opioid dosages may lead to faster opioid cessation. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Jeffrey M Hills
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Catherine R Carlile
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Kristin R Archer
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN
| | - Joseph B Wick
- Department of Orthopedic Surgery, UC Davis, Sacramento, CA
| | | | | | - Inamullah Khan
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Richard Call
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Clinton J Devin
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
- Steamboat Orthopedic and Spine Institute, Steamboat Springs, CO
| | - Jacquelyn S Pennings
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN
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Sim SE, Hong HJ, Roh K, Seo J, Moon HS. Relationship Between Epidural Steroid Dose and Suppression of Hypothalamus-Pituitary-Adrenal Axis. Pain Physician 2020; 23:S283-S294. [PMID: 32942788] [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: 06/11/2023]
Abstract
BACKGROUND The suppression of hypothalamic-pituitary-adrenal (HPA) axis is a common complication associated with epidural steroid injections (ESIs). However, the effect of different doses is unknown. OBJECTIVES The primary objective was to compare the differences in the duration of HPA suppression following treatment with different doses of ESI; triamcinolone acetate (TA) 40 mg and TA 20 mg. The secondary objectives were to compare the extent of salivary cortisol (SC) reduction, the incidence of adrenal insufficiency (AI), and the differences in a numeric rating scale (NRS) depending on the varying levels of TA dose used for ESI. STUDY DESIGN A double-blind, parallel-group, randomized controlled trial. SETTING Pain clinics in a university hospital. METHODS The patients were treated with TA epidurally and divided into 2 groups (T20 and T40) depending on the dose of TA (20 mg and 40 mg). The SC concentration was measured before and after ESI to calculate the duration of HPA axis suppression, the extent of SC concentration reduction, and the SC recovery rate. Additionally, NRS and adrenocorticotropic hormone stimulation tests were used. RESULTS Thirty patients were analyzed. The T40 group showed longer HPA suppression (19.7 ± 3.1 days) compared with that of the T20 group (8.0 ± 2.4 days). The recovery rate of the T40 group was lower than that of the T20 group (P < 0.015). However, there was no difference in the extent of reduction in SC concentration after ESI, the occurrence of AI, and pain reduction. LIMITATIONS There were selection bias and no placebo control. CONCLUSIONS Although the difference in pain relief according to the ESI dose is not significant, the HPA suppression is prolonged with a higher dose than a lower dose, and the recovery is slower. Therefore, the time interval between consecutive ESIs should be adjusted depending on the steroid dose to ameliorate the adverse effects of steroids.
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Affiliation(s)
- Sung-Eun Sim
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyo Ju Hong
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyungmoon Roh
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jaeho Seo
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ho Sik Moon
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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De Silva SW, De Silva SDN, De Silva CE. A patient with extensive cerebral calcification due to pseudohypoparathyroidism: a case report. BMC Endocr Disord 2019; 19:142. [PMID: 31856822 PMCID: PMC6923949 DOI: 10.1186/s12902-019-0475-z] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 12/11/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Pseudohypoparathyroidism(PHP) is a heterogeneous group of disorders due to impaired activation of c AMP dependant pathways following binding of parathyroid hormone (PTH) to its receptor. In PHP end organ resistance to PTH results in hypocalcaemia, hyperphosphataemia and high PTH levels. CASE PRESENTATION A 59 year old male presented with a history of progressive impairment of speech and unsteadiness of gait for 1 week and acute onset altered behavior for 1 day and one episode of generalized seizure. His muscle power was grade four according to MRC (medical research council) scale in all limbs and Chovstek's and Trousseau's signs were positive. Urgent non contrast computed tomography scan of the brain revealed extensive bilateral cerebral and cerebellar calcifications. A markedly low ionized calcium level of 0.5 mmol/l, an elevated phosphate level of 9.5 mg/dl (reference range: 2.7-4.5 mg/dl) and an elevated intact PTH of 76.3 pg/l were noted. His renal functions were normal. His hypocalcemia was accentuated by the presence of hypomagnesaemia. His 25 hydroxy vitamin D level was only marginally low which could not account for severe hypocalcaemia. A diagnosis of pseudohypoparathyroidism without phenotypic defects, was made due to hypocalcaemia and increased parathyroid hormone levels with cerebral calcifications. The patient was treated initially with parenteral calcium which was later converted to oral calcium supplements. His coexisting Vitamin D deficiency was corrected with 1αcholecalciferol escalating doses. His hypomagnesaemia was corrected with magnesium sulphate parenteral infusions initially and later with oral preparations. With treatment there was a significant clinical and biochemical response. CONCLUSION Pseudohypoparathyroidism can present for the first time in elderly resulting in extensive cerebral calcifications. Identification and early correction of the deficit will result in both symptomatic and biochemical response.
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Affiliation(s)
- S. W. De Silva
- Sri Jayawardenapura General Hospital, Thalapathpitiya, Nugegoda, Sri Lanka
| | - S. D. N. De Silva
- Sri Jayawardenapura General Hospital, Thalapathpitiya, Nugegoda, Sri Lanka
| | - C. E. De Silva
- Sri Jayawardenapura General Hospital, Thalapathpitiya, Nugegoda, Sri Lanka
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Chiang HY, Chung CW, Kuo CC, Lo YC, Chang WS, Chi CY. First-4-week erythrocyte sedimentation rate variability predicts erythrocyte sedimentation rate trajectories and clinical course among patients with pyogenic vertebral osteomyelitis. PLoS One 2019; 14:e0225969. [PMID: 31800625 PMCID: PMC6892503 DOI: 10.1371/journal.pone.0225969] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 11/15/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The trajectory pattern of erythrocyte sedimentation rate (ESR) in patients with pyogenic vertebral osteomyelitis (PVO) and its clinical significance is unclear. We further evaluated whether the first-4-week ESR variability can predict the trajectory pattern, treatment duration and recurrence of PVO. METHODS The longitudinal ESR patterns of adults with PVO within the first 6 months were characterized through group-based trajectory modeling (GBTM). The ESR variability within the first 4 weeks was defined using the absolute difference (AD), coefficient of variation, percent change, and slope change. The first-4-week ESR variabilities were analyzed using ordinal logistic regression to predict the 6-month ESR trajectory and using logistic regression to predict treatment duration and recurrence likelihood. The discrimination and calibration of the prediction models were evaluated. RESULTS Three ESR trajectory patterns were identified though GBTM among patients with PVO: Group 1, initial moderate high ESR with fast response; Group 2, initial high ESR with fast response; Group 3, initial high ESR with slow response. Group 3 patients (initial high ESR with slow response) were older, received longer antibiotic treatment, and had more comorbidities and higher recurrence rates than patients in the other two groups. The initial ESR value and ESR - AD could predict the 6-month ESR trajectory. By incorporating the first-4-week ESR variabilities and the clinical features of patients, our models exhibited moderate discrimination performance to predict prolonged treatment (≥12 weeks; C statistic, 0.75; 95% confidence interval [CI], 0.70 to 0.81) and recurrence (C statistic, 0.69; 95% CI, 0.61 to 0.78). CONCLUSIONS The initial ESR value and first-4-week ESR variability are useful markers to predict the treatment duration and recurrence of PVO. Future studies should validate our findings in other populations.
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Affiliation(s)
- Hsiu-Yin Chiang
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Wei Chung
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Chin-Chi Kuo
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Yen-Chun Lo
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Wei-Shuo Chang
- Division of Infectious Diseases, Department of Internal Medicine, Asia University Hospital, Taichung, Taiwan
| | - Chih-Yu Chi
- Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- * E-mail:
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12
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Matsunaga K, Takemaru M, Yamashiro K, Yoshihara-Hirata C, Inohara K, Shimoe Y, Tanaka A, Kuriyama M, Takashiba S. Acute Prevertebral Abscesses Caused by Bacterial-infected Traumatic Tooth Fractures. Acta Med Okayama 2019; 73:449-456. [PMID: 31649372 DOI: 10.18926/amo/57376] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
We report a case of acute prevertebral abscess caused by traumatic tooth fractures in a 77-year-old Japanese man. After being transferred to our hospital the patient was initially diagnosed with a neck hematoma; however, blood culture showed Streptococcus parasanguinis, an oral bacterium, and an MRI examination suggested prevertebral abscesses. Tooth fractures, severe periodontitis, and peri-implantitis with Streptococcus parasanguinis were observed. Antibiotics were administered and fractured teeth were extracted. The patient's condition then gradually improved. We concluded that bacteremia caused by traumatic tooth fractures induced the acute prevertebral abscesses.
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Affiliation(s)
- Kazuyuki Matsunaga
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Hiroshima 720-0825, Japan
| | - Makoto Takemaru
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Hiroshima 720-0825, Japan
| | - Keisuke Yamashiro
- Department of Pathophysiology-Periodontal Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Chiaki Yoshihara-Hirata
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Hiroshima 720-0825, Japan
| | - Ken Inohara
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Hiroshima 720-0825, Japan
| | - Yutaka Shimoe
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Hiroshima 720-0825, Japan
| | - Akio Tanaka
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Hiroshima 720-0825, Japan
| | - Masaru Kuriyama
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Hiroshima 720-0825, Japan
| | - Shogo Takashiba
- Department of Pathophysiology-Periodontal Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
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Abstract
OBJECTIVE We have noted an increased number of cases of vertebral osteomyelitis secondary to Candida species over the past few years at our facility. Our aim was to identify and review these cases to elucidate risk factors, treatment regimens and outcomes. METHODS We performed a retrospective chart review using our electronic medical record and microbiology laboratory database to identify cases of vertebral osteomyelitis due to Candida at a single teaching hospital from 2006-2018. RESULTS We found 15 cases of Candida vertebral osteomyelitis. The majority of cases were due to Candida albicans and affected either the lumbar or the thoracic spine. Injection drug use and previous spine surgery were the two most common risk factors identified. Treatment was largely with intravenous antifungal induction followed by prolonged therapy with oral fluconazole. There was no short-term mortality though we lacked long-term follow-up on most patients. CONCLUSIONS The number of vertebral infections due to Candida may be increasing. This may be partially driven by both a rise in intravenous drug use as well as the growing rate of spine surgery. Management following currently available guidelines seems favorable, though further studies are necessary to determine the optimal treatment regimen.
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Affiliation(s)
- Nathan McLeod
- Department of Medicine, Section of Infectious Diseases, West Virginia University School of Medicine, Morgantown, West Virginia, USA.
| | - Melanie Fisher
- Department of Medicine, Section of Infectious Diseases, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - P Rocco Lasala
- Department of Pathology and Laboratory Medicine, West Virginia University School of Medicine, Morgantown, West Virginia, USA
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14
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Metfessel BA, Mentel MD, Phanel A, Dimartino MA, Allen M, Ho S. Opioid Use is Associated with Higher Severity-Adjusted Episode Costs in Patients with Conservatively Managed Degenerative Joint Disease of the Back and Neck. Pharmacoeconomics 2019; 37:419-433. [PMID: 30519854 DOI: 10.1007/s40273-018-0753-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Opioid use and misuse are urgent health issues. Previous studies suggest that opioid use increases healthcare resource use but severity adjustment is lacking. OBJECTIVE The objective of this study was to evaluate the severity-adjusted cost difference between opioid users and non-users among patients with conservatively managed degenerative joint disease of the spine within a large commercial health plan population in the United States. METHODS A retrospective observational study was performed using a national commercial database covering 531,819 patients aged 18-64 years with non-surgically managed cervical or lumbar degenerative spine disease during 2015-6. Patients were grouped based on whether there was evidence for an opioid prescription. Costs for the opioids themselves were excluded. Severity adjustment, on an ascending integer scale from 1 to 4, was performed based on member demographics, clinical comorbidities, disease progression indicators, and complications. RESULTS Median episode costs for patients given opioids were approximately twice that for patients not given opioids after severity adjustment. For patients with episodes in both years and stable severity, patients with new prescriptions for opioids in 2016 doubled their median 2015 costs, and patients who had opioids discontinued in 2016 had a 60% cost reduction. Episode costs showed a nearly linear increase based on the length of time taking opioids, as well as with a higher average daily dose. Cost increases with opioids were broad across service categories even when comparing within the same severity-adjusted episodes of care. CONCLUSIONS The data suggest a clinically and statistically significant increase in episode costs associated with opioid use for degenerative joint disease of the spine, both within and between patients, and higher costs with a longer duration of opioid use as well as with higher daily dosages. Given the health consequences surrounding the overuse of opioids, concerted efforts to move towards a non-opioid pain control strategy are needed.
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Affiliation(s)
- Brent A Metfessel
- Clinical Data Services and Analytics, UnitedHealthcare, 9700 Health Care Lane, Minnetonka, MN, 55343, USA.
| | - Michelle D Mentel
- Clinical Data Services and Analytics, UnitedHealthcare, 381 Winter Bluff Drive, Fenton, MO, USA
| | - Amy Phanel
- Aetna, 135 W. 1st St., Santa Ana, CA, USA
| | - Mary Ann Dimartino
- Clinical Data Services and Analytics, UnitedHealthcare, 378 Broad Rock Road, Wakefield, RI, USA
| | | | - Samuel Ho
- Clinical Data Services and Analytics, UnitedHealthcare, 9700 Health Care Lane, Minnetonka, MN, 55343, USA
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15
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Formenti AM, Doga M, Frara S, Ritelli M, Colombi M, Banfi G, Giustina A. Skeletal fragility: an emerging complication of Ehlers-Danlos syndrome. Endocrine 2019; 63:225-230. [PMID: 30554346 DOI: 10.1007/s12020-018-1822-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 08/01/2018] [Accepted: 11/21/2018] [Indexed: 12/31/2022]
Abstract
Ehlers-Danlos syndrome (EDS) is an emerging cause of skeletal fragility. Mechanism of bone damage are probably multifactorial in line with the different skeletal phenotypes that can be found in clinical practice. A structured approach to clinical management of bone metabolic complication in EDS is proposed.
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Affiliation(s)
| | - Mauro Doga
- Vita-Salute San Raffaele University, Milano, Italy
| | | | - Marco Ritelli
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Marina Colombi
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Giuseppe Banfi
- IRCCS, Istituto Ortopedico Galeazzi, Milano, Italy
- Vita-Salute San Raffaele University, Milano, Italy
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16
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Lu VM, Ho YT, Nambiar M, Mobbs RJ, Phan K. The Perioperative Efficacy and Safety of Antifibrinolytics in Adult Spinal Fusion Surgery: A Systematic Review and Meta-analysis. Spine (Phila Pa 1976) 2018; 43:E949-E958. [PMID: 30063223 DOI: 10.1097/brs.0000000000002580] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE Compare outcomes of adult patients undergoing spinal fusion surgery who receive and do not receive perioperative antifibrinolytics to reduce operative blood loss. SUMMARY OF BACKGROUND DATA The clinical potential for antifibrinolytics such as tranexamic acid and epsilon aminocaproic acid to significantly reduce blood loss during adult spinal fusion surgery remains underexplored. Outcomes for assessment included operative blood loss, and other surgical, clinical, and haematological outcomes. METHODS We followed the recommended Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews. Electronic database searches identified 2041 for screening. Data were extracted and analyzed using meta-analysis of proportions. RESULTS A total of 11 randomized controlled trials with a total of 937 adult spinal fusion surgery patients were included for analysis. There were 472 (50%) patients who were treated with antifibrinolytics, with 345 of 472 (73%) and 127 of 472 (27%) receiving tranexamic acid and epsilon aminocaproic acid respectively. The use of antifibrinolytics was associated with significantly lower intraoperative (MD -127.08 mL; P = 0.002) and total blood loss (MD -229.76 mL; P < 0.00001), as well as incidence of blood transfusion (OR 0.58; P = 0.04). There was no significant difference with antifibrinolytic use in terms of many surgical parameters, including surgery duration (P = 0.50), overall complications (P = 0.21), and length of stay (P = 0.88). Finally, postoperative haemoglobin was significantly greater (MD 0.30 g/dL; P = 0.02) following antifibrinolytic use, with other haematological parameters mostly unaffected. CONCLUSION Based on the highest level comparative evidence available, the possibility for blood loss reduction in adult spinal fusion surgery with the use of perioperative antifibrinolytics is not unreasonable, as it appears both efficacious and safe. In addition to further, larger investigations to validate the associations found in this study, practical aspects such as cost-benefit analysis, and long-term follow-up will further enhance our understanding. LEVEL OF EVIDENCE 1.
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Affiliation(s)
- Victor M Lu
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Yam-Ting Ho
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Mithun Nambiar
- Department of Orthopedic Surgery, Royal Melbourne Hospital, Melbourne, Australia
| | - Ralph J Mobbs
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Clinical School, Randwick, Sydney, Australia
| | - Kevin Phan
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Clinical School, Randwick, Sydney, Australia
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17
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De Luca P, de Girolamo L, Perucca Orfei C, Viganò M, Cecchinato R, Brayda-Bruno M, Colombini A. Vitamin D's Effect on the Proliferation and Inflammation of Human Intervertebral Disc Cells in Relation to the Functional Vitamin D Receptor Gene FokI Polymorphism. Int J Mol Sci 2018; 19:E2002. [PMID: 29987250 PMCID: PMC6073257 DOI: 10.3390/ijms19072002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 06/29/2018] [Accepted: 07/06/2018] [Indexed: 02/04/2023] Open
Abstract
Vitamin D is known to have immunomodulatory effects, is involved in osteo-cartilaginous metabolism, and may have a role in human intervertebral disc pathophysiology. Although a link between vitamin D receptor (VDR) gene variants and disc degeneration-related pathologies has been observed, its functional contribution to pathologic processes has not been assessed yet. The aim of this study was to investigate the response of disc cells to vitamin D in terms of the regulation of proliferation, metabolism, and inflammatory processes, with a particular focus on the FokI VDR genotype. However, although it was found that vitamin D had a pro-apoptotic effect regardless of genotype, an up-regulation of IL-1Ra and downregulation of IL-6 was found to be evident only in Ff cells. Regarding the metabolic effects, in Ff cells, vitamin D promoted an upregulation of the aggrecan in inflammatory conditions but did not have an effect on the expression of collagen-related markers. Moreover, cells bearing the Ff genotype were the most responsive to vitamin D in the upregulation of catabolic markers. In addition, in contrast to the FF genotype, vitamin D downregulated the vitamin D-dependent signaling pathway in inflamed Ff cells, counteracting the inflammation-mediated catabolic effects. In conclusion, Ff cells were found to be more responsive to the anti-inflammatory and catabolic effects of vitamin D, which is likely to be related to matrix remodeling.
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Affiliation(s)
- Paola De Luca
- Orthopaedic Biotechnology Lab, IRCCS Galeazzi Orthopaedic Institute, Via R. Galeazzi 4, 20161 Milan, Italy.
| | - Laura de Girolamo
- Orthopaedic Biotechnology Lab, IRCCS Galeazzi Orthopaedic Institute, Via R. Galeazzi 4, 20161 Milan, Italy.
| | - Carlotta Perucca Orfei
- Orthopaedic Biotechnology Lab, IRCCS Galeazzi Orthopaedic Institute, Via R. Galeazzi 4, 20161 Milan, Italy.
| | - Marco Viganò
- Orthopaedic Biotechnology Lab, IRCCS Galeazzi Orthopaedic Institute, Via R. Galeazzi 4, 20161 Milan, Italy.
| | - Riccardo Cecchinato
- GSpine4, IRCCS Galeazzi Orthopaedic Institute, Via R. Galeazzi 4, 20161 Milan, Italy.
| | - Marco Brayda-Bruno
- Scoliosis Unit, Department of Orthopedics and Traumatology-Spine Surgery III, IRCCS Galeazzi Orthopaedic Institute, Via R. Galeazzi 4, 20161 Milan, Italy.
| | - Alessandra Colombini
- Orthopaedic Biotechnology Lab, IRCCS Galeazzi Orthopaedic Institute, Via R. Galeazzi 4, 20161 Milan, Italy.
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18
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Yu GJ, Koslowsky IL, Riccio SA, Chu AKM, Rabin HR, Kloiber R. Diagnostic challenges in pyogenic spinal infection: an expanded role for FDG-PET/CT. Eur J Clin Microbiol Infect Dis 2018; 37:501-509. [PMID: 29411191 DOI: 10.1007/s10096-018-3197-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 01/18/2018] [Indexed: 12/13/2022]
Abstract
In a preliminary investigation of FDG-PET/CT for assessment of therapy response of pyogenic spine infection, it was concluded that activity confined to the margins of a destroyed or degenerated joint with bone-on-bone contact represents nonseptic inflammation, regardless of the intensity of uptake. Only activity in bone, soft tissue, or within the epidural space represents active infection. The purpose of this investigation was to assess the performance of these pattern-based interpretation criteria in a series of problem cases of proven or suspected spine infection. Eighty-two FDG-PET/CTs were done for initial diagnosis because other imaging failed to provide a definitive diagnosis and 147 FDG-PET/CTs were done to assess treatment responses. Pattern-based interpretations were compared with the clinical diagnosis based on bacterial cultures and outcomes after cessation or withholding of antibiotic therapy. Pattern-based interpretation criteria achieved a sensitivity and specificity of 98 and 100%, respectively, for initial diagnosis and a specificity of 100% for assessment of treatment response. The same data was analyzed using intensity of activity as the primary factor. Sensitivity and specificity using the intensity-based criteria were 93 and 68%, respectively, for initial diagnosis, and the specificity of a negative interpretation for therapy response was 55%. Differences from pattern-based criteria are highly significant. Pattern-based criteria perform well in problem cases with equivocal MR and for treatment response because they correctly eliminate activity from nonspecific inflammation associated with destroyed joints with bone-on-bone contact. Response occurs within a timeframe that is useful for managing antibiotic therapy.
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Affiliation(s)
- Gannon J Yu
- Department of Medicine, Foothills Medical Centre, University of Calgary, Calgary, Canada
| | - Ingrid L Koslowsky
- Department of Radiology, Foothills Medical Centre, University of Calgary, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada
| | - Silvia A Riccio
- Department of Radiology, Foothills Medical Centre, University of Calgary, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada
| | - Angel K M Chu
- Department of Medicine, Foothills Medical Centre, University of Calgary, Calgary, Canada
| | - Harvey R Rabin
- Department of Medicine, Foothills Medical Centre, University of Calgary, Calgary, Canada.
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Canada.
| | - Reinhard Kloiber
- Department of Radiology, Foothills Medical Centre, University of Calgary, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada.
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Lemaignen A, Ghout I, Dinh A, Gras G, Fantin B, Zarrouk V, Carlier R, Loret JE, Denes E, Greder A, Lescure FX, Boutoille D, Tattevin P, Issartel B, Cottier JP, Bernard L. Characteristics of and risk factors for severe neurological deficit in patients with pyogenic vertebral osteomyelitis: A case-control study. Medicine (Baltimore) 2017; 96:e6387. [PMID: 28538361 PMCID: PMC5457841 DOI: 10.1097/md.0000000000006387] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Severe neurological deficit (SND) is a rare but major complication of pyogenic vertebral osteomyelitis (PVO). We aimed to determine the risk factors and the variables associated with clinical improvement for SND during PVO.This case-control study included patients without PVO-associated SND enrolled in a prospective randomized antibiotic duration study, and patients with PVO-associated SND managed in 8 French referral centers. Risk factors for SND were determined by logistic regression.Ninety-seven patients with PVO-associated SND cases, and 297 controls were included. Risk factors for SND were epidural abscess [adjusted odds ratio, aOR 8.9 (3.8-21)], cervical [aOR 8.2 (2.8-24)], and/or thoracic involvement [aOR 14.8 (5.6-39)], Staphylococcus aureus PVO [aOR 2.5 (1.1-5.3)], and C-reactive protein (CRP) >150 mg/L [aOR 4.1 (1.9-9)]. Among the 81 patients with PVO-associated SND who were evaluated at 3 months, 62% had a favorable outcome, defined as a modified Rankin score ≤ 3. No factor was found significantly associated with good outcome, whereas high Charlson index [adjusted Hazard Ratio (aHR) 0.3 (0.1-0.9)], low American Spinal Injury Association (ASIA) impairment scale at diagnosis [aHR 0.4 (0.2-0.9)], and thoracic spinal cord compression [aHR 0.2 (0.08-0.5)] were associated with poor outcome. Duration of antibiotic treatment was not associated with functional outcome.SND is more common in cervical, thoracic, and S. aureus PVO, in the presence of epidural abscess, and when CRP >150 mg/L. Although neurological deterioration occurs in 30% of patients in early follow-up, the functional outcome is quite favorable in most cases after 3 months. The precise impact of optimal surgery and/or corticosteroids therapy must be specified by further studies.
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Affiliation(s)
- Adrien Lemaignen
- Department of Infectious Diseases, University Hospital of Tours, Francois Rabelais University, Tours
| | - Idir Ghout
- Clinical Research Unit, University Hospital A. Paré, APHP, Boulogne
| | - Aurélien Dinh
- Infectious Diseases Unit, University Hospital R. Poincaré, APHP, Versailles Saint Quentin University, Garches
| | - Guillaume Gras
- Department of Infectious Diseases, University Hospital of Tours, Francois Rabelais University, Tours
| | - Bruno Fantin
- Department of Internal Medicine, University Hospital Beaujon, APHP, Clichy
| | - Virginie Zarrouk
- Department of Internal Medicine, University Hospital Beaujon, APHP, Clichy
| | - Robert Carlier
- Radiology Department, Neuro-musculoskeletal Pole, University Hospital R Poincaré, APHP, Versailles University, Paris-Saclay UMR 1179, Garches
| | | | - Eric Denes
- Department of Infectious Diseases, University Hospital of Limoges, Limoges
| | - Alix Greder
- Department of Infectious Diseases, Mignot Hospital, Versailles
| | | | - David Boutoille
- Department of Infectious Diseases, Hotel-Dieu University Hospital, Nantes
| | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes
| | | | - Jean-Philippe Cottier
- Department of Neuroradiology, University Hospital of Tours, Francois Rabelais University, Tours, France
| | - Louis Bernard
- Department of Infectious Diseases, University Hospital of Tours, Francois Rabelais University, Tours
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Charokopos A, Muhammad T, Surbhi S, Brateanu A. Weakness and pain in arms and legs · dark urine · history of vertebral osteomyelitis · Dx? J Fam Pract 2017; 66:170-173. [PMID: 28249055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Rhabdomyolysis is a serious complication of statin treatment. Both higher statin doses and pharmacokinetic factors can raise statin levels, leading to this serious usclerelated syndrome. Co-administration of statins with drugs that are strong inhibitors of cytochrome P450 (CYP) 3A4 (the main cytochrome P450 isoform that metabolizes most statins) can increase statin levels several fold. The trigger for our patient's statin-induced rhabdomyolysis was fluconazole, a known moderate inhibitor of CYP3A4, which is comparatively weaker than certain potent azoles like itraconazole or ketoconazole.
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Affiliation(s)
| | - Tariq Muhammad
- Department of Internal Medicine, Cleveland Clinic, Ohio, USA
| | - Sidana Surbhi
- Department of Internal Medicine, Cleveland Clinic, Ohio, USA
| | - Andrei Brateanu
- Department of Internal Medicine, Cleveland Clinic, Ohio, USA
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Moreau N, Dieb W, Descroix V, Svensson P, Ernberg M, Boucher Y. Topical Review: Potential Use of Botulinum Toxin in the Management of Painful Posttraumatic Trigeminal Neuropathy. J Oral Facial Pain Headache 2017; 31:7-18. [PMID: 28118416 DOI: 10.11607/ofph.1753] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Painful posttraumatic trigeminal neuropathy (PPTTN) is a chronic condition that is difficult to endure and has a poorly understood pathophysiology. Treatment options are limited and often unsatisfactory due to insufficient efficacy and significant adverse effects. Botulinum toxin type A (BTX-A), initially used in the management of pathologically sustained or twisting muscular contractions, has recently been advocated for treatment of neuropathic pain. Its action is not limited to the blockage of acetylcholine release at the neuromuscular junction, but also includes inhibition of exocytosis of other neurotransmitters by interfering with the SNARE complexes of synaptic membranes. When injected into the painful location, the toxin can be taken up by peripheral terminals of nociceptive afferent nerve fibers, and this action suppresses peripheral and central release of algogenic neurotransmitters such as glutamate or substance P, thus promoting analgesia. Several randomized controlled trials in humans have provided emerging evidence for the therapeutic use of BTX-A in neuropathic pain states, including trigeminal neuralgia. This evidence, in addition to its good safety profile and long-lasting effect, suggests that BTX-A could be a potential novel treatment for PPTTN.
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Stjepanovic MI, Pesut DP, Lesic AR, Stevic RS. Pulmonary and Vertebral Mycobacterium avium Disease in a HIV-negative 71-year-old Man - A Case Report. Infez Med 2016; 24:345-348. [PMID: 28011973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Nontuberculous mycobacteria (NTM) caused pulmonary disease is on increase worldwide, especially in countries with decreasing time trend of tuberculosis incidence. NTM skeletal affection is rare. Mycobacterium avium related disease, with still unclear clinical and radiologic features, is in current focus of both clinicians and researchers. An exhausted severely ill 71-year-old man was admitted on emergency due to cough, dyspnea and lumbar back pain to be diagnosed with terminal phase M. avium disease. Three sputum smears were positive for acid fast bacilli and M. avium was identified with hybridization reaction by means of GenoType ® MTBC (Hain). Apart from pulmonary disease, compressive fractures of the 12th thoracic and 1-4th lumbar vertebrae were detected. We found age, chronic alcoholism, previous professional exposure, tobacco smoking, chronic obstructive pulmonary disease and previous tuberculosis as risk factors for NTM disease in the HIV-negative patient. Despite combined antibiotic treatment, disease had lethal outcome. This case report might contribute to clinicians' awareness and improved knowledge on this sort of pathology, and lead to earlier diagnosis with possibly better disease outcome.
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Affiliation(s)
| | - Dragica P Pesut
- Clinical Center of Serbia, Teaching Hospital of Pulmonology, Belgrade, Serbia; University of Belgrade, School of Medicine, Belgrade, Serbia
| | - Aleksandar R Lesic
- University of Belgrade, School of Medicine, Belgrade, Serbia; Clinical Center of Serbia, Teaching Hospital of Orthopedic Surgery and Traumatology, Belgrade, Serbia
| | - Ruza S Stevic
- University of Belgrade, School of Medicine, Belgrade, Serbia;Center of Radiologic Diagnostics and Magnetic Resonance, Clinical Center of Serbia, Belgrade, Serbia
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Abstract
Mycobacterium riyadhense is a newly described slowly growing, non-tuberculous mycobacterium species. We describe 2 new cases of Mycobacterium riyadhense infections presenting with extra-pulmonary involvement, and reviewed all previously reported cases in the literature. We also describe the spectrum of the disease and explore treatment options based on the experience with the current and previously reported cases.
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Affiliation(s)
- Mustafa M Saad
- Division of Infectious Diseases, Prince Sultan Military Medical City, PO Box 9789 A-55, Riyadh 11159, Kingdom of Saudi Arabia. Tel. +966 (11) 4777714 Ext 88231. E-mail.
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Issa K, Pourtaheri S, Vijapura A, Stewart T, Sinha K, Hwang K, Emami A. Delay in Diagnosis of Vertebral Osteomyelitis Affects the Utility of Cultures. Surg Technol Int 2016; 29:379-383. [PMID: 27608747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Obtaining blood or tissue cultures prior to administration of antibiotics has been the standard of care in the treatment of osteomyelitis of the spine. A delay in diagnosis of vertebral osteomyelitis is the primary culprit for the inaccuracy of blood cultures and biopsies. The purpose of this study was to evaluate the outcomes of spinal osteomyelitis in patients where the infecting organism was identified through cultures in contrast to cases where the cultures continued to be negative. MATERIALS AND METHODS We retrospectively reviewed the database of spinal osteomyelitis cases presented at a high-volume institution from 2001-2011. This resulted in 91 patients (51 men and 40 women) who had a mean age of 59 years with a mean follow-up of four years. Delay in diagnosis was defined as greater than 2.5 months from first ER visit for non-specific back pain to diagnosis of osteomyelitis without antibiotic treatment in the interim. Nineteen patients had a delay in diagnosis (DD) and 72 were diagnosed early (ED). Outcomes evaluated include clearance of infection, clinical outcomes measured by Oswestry disability index scores (ODIs), and the efficacy of blood cultures and biopsies. RESULTS The ED group had a higher odds ratio of osteomyelitis clearance compared to the delay in diagnosis group and this trended toward significance [p=0.08]. The mean improvements in ODIs were significantly greater in the ED group compared to the DD group. Positive blood cultures were more positive when drawn within one month compared to after one month [p=.001]. Percutaneous biopsy cultures were more positive when drawn within 2.5 months compared to after 2.5 months [p=.025]. Open biopsy cultures were more positive when drawn within 4.5 months compared to after that [p<0.001]. DISCUSSION We found that delayed diagnosis may negatively affect the treatment outcome as evidenced by the greater improvements in ODI scores among those diagnosed early. Although we were unable to show a difference in clearance between early and delayed diagnosis, it is quite possible that larger cohorts may have shown this given the trend toward significance. CONCLUSION Hence, an early diagnosis has improved vertebral osteomyelitis clearance and clinical outcomes, and blood cultures and biopsies may have a low yield if delayed.
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Affiliation(s)
- Kimona Issa
- Seton Hall University, St Joseph's Regional Medical Center, Paterson, NJ
| | - Sina Pourtaheri
- Department of Orthopaedics, University of California, Los Angeles, Los Angeles, California
| | - Anita Vijapura
- Department of Medicine, Temple University Hospital, Philadelphia, Pennsylvania
| | - Tyler Stewart
- Department of Orthopaedics, Wayne State University, Detroit, Michigan
| | - Kumar Sinha
- Seton Hall University, St Joseph's Regional Medical Center, Paterson, NJ
| | - Ki Hwang
- Seton Hall University, St Joseph's Regional Medical Center, Paterson, NJ
| | - Arash Emami
- Seton Hall University, St Joseph's Regional Medical Center, Paterson, NJ
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Buzelé R, Lemaignen A, Gras G, Bernard L. [Vertebral osteomyelitis: to suspect ahead any inflammatory spinal pain]. Rev Prat 2016; 66:893-898. [PMID: 30512545] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Vertebral osteomyelitis: to suspect ahead any inflammatory spinal pain. Infectious vertebral osteomyelitis is a rare and severe condition with potential septic, neurologic or mechanical complications and a lethality of about 10%. Clinical diagnosis is difficult and delay in management is frequent. Diagnosis confirmation relies on MRI and microbiological documentation by blood cultures and/or image-guided percutaneous vertebral biopsy. Adapted antibiotic therapy during 6 weeks is the mainstay of treatment, with fast oral relay. Associated treatments include a short rest, initial immobilization, analgesia and sometimes surgery. Outcome is usually favorable. Adverse evolution is mainly associated with age and comorbidities, and to a less extent to presence of neurological impairment, Staphylococcus aureus and diagnosis delay.
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Affiliation(s)
- Rodolphe Buzelé
- Service de médecine interne et maladies infectieuses, CHRU de Tours. Université François Rabelais - Faculté de médecine de Tours-Centre de référence de prise en charge des infections ostéo-articulaires du Grand-Ouest (CRIOGO)
| | - Adrien Lemaignen
- Service de médecine interne et maladies infectieuses, CHRU de Tours. Université François Rabelais - Faculté de médecine de Tours-Centre de référence de prise en charge des infections ostéo-articulaires du Grand-Ouest (CRIOGO)
| | - Guillaume Gras
- Service de médecine interne et maladies infectieuses, CHRU de Tours. Université François Rabelais - Faculté de médecine de Tours-Centre de référence de prise en charge des infections ostéo-articulaires du Grand-Ouest (CRIOGO)
| | - Louis Bernard
- Service de médecine interne et maladies infectieuses, CHRU de Tours. Université François Rabelais - Faculté de médecine de Tours-Centre de référence de prise en charge des infections ostéo-articulaires du Grand-Ouest (CRIOGO)
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Abstract
Pain related to various musculoskeletal conditions is a common patient complaint, and one that is often difficult to remedy. In addition to oral analgesics and physical therapy, local injections (most commonly of corticosteroids) are a common intervention and have been for decades. However, in most cases, the literature is full of poor-quality studies, making the true utility of these injections questionable. This article reviews some of the literature studying these injections with the goal of providing clinicians the information to make evidence-based, high-value choices.
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Affiliation(s)
- Robert K Cato
- Penn Presbyterian Medical Center, 51 North 29th Street, Medical Arts Building, Suite 102, Philadelphia, PA 19104, USA.
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Choi JH, Hong JY, Suh SW, Yang JH, Park SY, Park JH, Hong SJ. What Is the Role of Epidural Steroid Injections in Lumbar Spinal Disease with Moderate Disability? Pain Physician 2016; 19:293-298. [PMID: 27228516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
UNLABELLED Epidural steroid injections have been gaining popularity as an alternative to surgical treatment of radicular pain with associated spinal derangement. To determine the effectiveness and indications of lumbar epidural steroid injections in patients with or without surgery, we performed a prospective observational study. We gathered data from 262 degenerative short-segment spinal disease patients (affected at one or 2 levels) with greater than 12 weeks of medication-resistant radicular pain without neurological deficits but with moderate disability (visual analog scale < 6.5; Oswestry Disability Index < 35). All patients received initial fluoroscopically guided transforaminal epidural steroid injections of the affected vertebral level(s) corresponding to their symptoms. Those with inadequate responses or who wanted subsequently surgery underwent decompression surgery. Clinical and demographic characteristics were assessed to compare the differences between the groups. RESULTS Of the 262 patients who received epidural steroid injections, 204 did not have operations for up to one year. However, 58 patients experienced inadequate relief of pain or wanted operations and therefore underwent surgery. At baseline, the 2 groups had similar mean disability indices and pain scores, as well as gender ratios, ages, and durations of symptoms (P > 0.05). In the patients who underwent surgery, the mean disability and pain scores were not significantly decreased after injection compared to those in the injection-alone group, although the scores for the injection plus surgery patients decreased significantly after surgery (P < 0.05). In contrast, patients who underwent epidural steroid injection alone experienced a significant decrease in disability and pain after injection, and that persisted up to one year of follow-up (P < 0.05). Epidural steroid injection can decrease the pain and disability in the majority of a moderate disability group for up to one year, although a significant number of patients underwent surgery regardless of injection. We recommend epidural steroid injection as a first-line treatment in patients with moderate disability that can be converted to surgery without significant delay. KEY WORDS Epidural steroid injection, spinal surgery, lumbar spinal disease, lumbar radiculopathy, lumbar radicular pain.
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Affiliation(s)
- Jae Ho Choi
- Korea University graduate school of medicine, Seoul, South Korea
| | - Jae-Young Hong
- Department of Orthopedics, Korea University Ansan Hospital, Ansan, South Korea
| | - Seung-Woo Suh
- Department of Orthopedics, Korea University Guro Hospital, Seoul, South Korea
| | - Jae-Hyuk Yang
- Department of Orthopedics, Korea University Guro Hospital, Seoul, South Korea
| | - Si-Young Park
- Department of Orthopedics, Korea University Anam Hospital, Seoul, South Korea
| | - Jung-Ho Park
- Department of Orthopedics, Korea University Ansan Hospital, Ansan, South Korea
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Pampati S, Manchikanti L. What Is the Prevalence of Symptomatic Obstructive Sleep Apnea Syndrome in Chronic Spinal Pain Patients? An Assessment of the Correlation of OSAS with Chronic Opioid Therapy, Obesity, and Smoking. Pain Physician 2016; 19:E569-E579. [PMID: 27228523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND In modern medicine, obstructive sleep apnea syndrome (OSAS) is a commonly described sleep disorder with airway obstruction, disrupted sleep, and excessive daytime sleepiness. Since its description in 1976 by Guilleminault et al, numerous epidemiologic studies and systematic reviews, with multiple comorbidities related to cardiovascular sequelae, altered cognitive function, and multiple other potential complications have been described. Multiple risk factors have been identified included obesity, smoking, alcohol consumption, and other factors. Chronic pain and chronic opioid therapy also have been described to contribute to a large proportion of patients with OSAS. Chronic pain, obesity, smoking, and chronic opioid therapy are often found together, yet there is a paucity of literature describing OSAS in chronic pain patients. OBJECTIVES To assess the prevalence of symptomatic OSAS in chronic spinal pain patients receiving chronic opioid therapy and determine the association of OSAS with multiple risk factors and comorbidities. STUDY DESIGN A retrospective assessment of patients who attend a single interventional pain management practice from January 1, 2010to December 31, 2014. SETTING A private interventional pain management practice in the United States. METHODS The data were collected from 4,036 consecutive patients presenting for assessment to a pain management center from January 1, 2010 to December 31, 2014. All assessments were comprehensive and performed by 2 physicians. The comprehensive assessment included a complete history, a physical examination, and a review of records. RESULTS The prevalence of OSAS in patients with chronic spinal pain was 13.8%. The results showed a higher prevalence in males compared to females (15.1% versus 12.8%), a higher prevalence in those aged 45 or older compared to those 25-45 years and those 18-25 years (16.3% versus 10.7% or 2.5%), higher prevalence in Hispanics and Asians compared to African Americans and whites (23.7% versus 16.2% versus 13.4%), higher prevalence in patients with combined back and neck pain compared to patients with thoracic pain only or back pain only (16.3% versus 8.2% to 11%). Prevalence also varied by body mass index (BMI): 32.4% in morbidly obese patients, 20.3% in severely obese patients, 15.7% in obese patients, 9.2% in those who were overweight, and only 5.7% in those with normal weight. A significant correlation with OSAS was also observed in patients smoking more than 40 pack years and multiple respiratory symptoms except for chronic bronchitis and multiple cardiovascular ailments. LIMITATIONS The retrospective nature of the assessment. CONCLUSION This retrospective assessment of over 4,000 patients suffering from chronic pain and receiving chronic opioid therapy indicated a prevalence of sleep apnea syndrome as 13.8%. Multiple risk factors including obesity, chronic obstructive pulmonary disease (COPD), chronic sinus and nasal discharge, and multiple comorbidities including cardiovascular and related ailments have been identified. KEY WORDS Obstructive sleep apnea syndrome, chronic pain, chronic spinal pain, chronic opioid therapy, obesity, smoking, cardiovascular risk factors, pulmonary risk factors.
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Affiliation(s)
- Sanjana Pampati
- University of Michigan School of Public Health, Ann Arbor, MI
| | - Laxmaiah Manchikanti
- Pain Management Center of Paducah, Paducah, KY, and University of Louisville, Louisville, KY
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Mustapić M, Višković K, Borić I, Marjan D, Zadravec D, Begovac J. VERTEBRAL OSTEOMYELITIS IN ADULT PATIENTS--CHARACTERISTICS AND OUTCOME. Acta Clin Croat 2016; 55:9-15. [PMID: 27333712 DOI: 10.20471/acc.2016.55.01.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The aim of the study was to assess disease characteristics and outcome in patients with vertebral osteomyelitis (VO). A two medical centre retrospective cohort study was performed by chart review after discharge of 110 patients with confirmed VO treated during a 5-year period. Patients were divided in two groups: patients with uncomplicated VO and patients with complicated VO. All patients underwent clinical and biological examinations and magnetic resonance imaging (MRI) according to the same protocol. Patients with complicated VO were significantly older (p = 0.038). They were longer treated with antibiotics parenterally (p = 0.047) and more often surgically (p < 0.001). In these patients, high Charlson comorbidity index (CCI) score was more often observed (p = 0.024), as well as liver cirrhosis (p = 0.013) and degenerative spine disease (p = 0.007) as comorbidities. Patients with advanced MRI changes of VO had a modified CCI score of 2 or more (p = 0.006). They more often experienced neurological deficit (p = 0.021). Staphylococcus aureus was the most frequently isolated bacterium from blood and tissue samples. Advanced MRI changes and complicated VO were more often observed in patients with high CCI score due to impaired immune system caused by chronic comorbid disease(s) or modulation of immunity with medications. High CCI scores were more frequently associated with positive blood cultures due to bacteremia because of impaired immunity. Patients with complicated VO were longer treated with antibiotics parenterally and more often surgically treated for phlegmon and abscess formation. Liver cirrhosis and degenerative spine disease, which were more often found in patients with complicated VO, obviously impacted the course of the disease.
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Vital JM, Boudissa M, Campana M. [Surgery for chronic low back pain: good option? Better than conservative treatment?]. Bull Acad Natl Med 2015; 199:1367-1382. [PMID: 29874425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The goal of this article is to assess, using the literature and our own experience, whether surgery is a reasonable option in the management of non-specific or degenerative chronic low back pain. The usual starting points for low back pain are without doubt the intervertebral disc and the facet joints, but the actual etiology is often difficult to determine. Moreover, psychogenic factors may amplify clinical symptoms. In our experience, thorough clinical, psychological, and socioprofessional assessment along with relevant imaging studies, parti- cularly MRI to look for inflammatory disc disease and EOS system to evaluate sagittal balance, leads to surgical indication in only 5 % of the patients with chronic low back pain. In these cases, surgery is aimed at short-circuiting ideally one, but sometimes two, interver- tebral segment by a conventional rigid fixation (arthrodesis), or by more recent non-rigid fixation techniques (disc replacement or interspinous dynamic stabilization). Their preven- tive effect on accelerated degeneration of adjacent segment appears to be moderate at best. The problem is to compare the results of surgical and conservative treatment: The analysis of publications concerning comparative randomized studies and personal studies shows that surgery is useful in only a small proportion of well selected patients with chronic low back pain, compared with physical and cognitive-behavioral management techniques.
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Bernard L, Dinh A, Ghout I, Simo D, Zeller V, Issartel B, Le Moing V, Belmatoug N, Lesprit P, Bru JP, Therby A, Bouhour D, Dénes E, Debard A, Chirouze C, Fèvre K, Dupon M, Aegerter P, Mulleman D. Antibiotic treatment for 6 weeks versus 12 weeks in patients with pyogenic vertebral osteomyelitis: an open-label, non-inferiority, randomised, controlled trial. Lancet 2015; 385:875-82. [PMID: 25468170 DOI: 10.1016/s0140-6736(14)61233-2] [Citation(s) in RCA: 271] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Duration of treatment for patients with vertebral osteomyelitis is mainly based on expert recommendation rather than evidence. We aimed to establish whether 6 weeks of antibiotic treatment is non-inferior to 12 weeks in patients with pyogenic vertebral osteomyelitis. METHODS In this open-label, non-inferiority, randomised controlled trial, we enrolled patients aged 18 years or older with microbiologically confirmed pyogenic vertebral osteomyelitis and typical radiological features from 71 medical care centres across France. Patients were randomly assigned to either 6 weeks or 12 weeks of antibiotic treatment (physician's choice in accordance with French guidelines) by a computer-generated randomisation list of permuted blocks, stratified by centre. The primary endpoint was the proportion of patients who were classified as cured at 1 year by a masked independent validation committee, analysed by intention to treat. Non-inferiority would be declared if the proportion of cured patients assigned to 6 weeks of treatment was not less than the proportion of cured patients assigned to 12 weeks of treatment, within statistical variability, by an absolute margin of 10%. This trial is registered with EudraCT, number 2006-000951-18, and Clinical Trials.gov, number NCT00764114. FINDINGS Between Nov 15, 2006, and March 15, 2011, 359 patients were randomly assigned, of whom six in the 6-week group and two in the 12-week group were excluded after randomisation. 176 patients assigned to the 6-week treatment regimen and 175 to the 12-week treatment regimen were analysed by intention to treat. 160 (90·9%) of 176 patients in the 6-week group and 159 (90·9%) of 175 of those in the 12-week group met the criteria for clinical cure. The difference between the groups (0·05%, 95% CI -6·2 to 6·3) showed the non-inferiority of the 6-week regimen when compared with the 12-week regimen. 50 patients in the 6-week group and 51 in the 12-week group had adverse events, the most common being death (14 [8%] in the 6-week group vs 12 [7%] in the 12-week group), antibiotic intolerance (12 [7%] vs 9 [5%]), cardiorespiratory failure (7 [4%] vs 12 [7%]), and neurological complications (7 [4%] vs 3 [2%]). INTERPRETATION 6 weeks of antibiotic treatment is not inferior to 12 weeks of antibiotic treatment with respect to the proportion of patients with pyogenic vertebral osteomyelitis cured at 1 year, which suggests that the standard antibiotic treatment duration for patients with this disease could be reduced to 6 weeks. FUNDING French Ministry of Health.
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Affiliation(s)
- Louis Bernard
- Division of Infectious Diseases, University Hospital Bretonneau, Tours, France; Division of Infectious Diseases, Bretonneau University Hospital, Tours, France.
| | - Aurélien Dinh
- Division of Infectious Diseases, University Hospital Raymond Poincaré, Garches, France
| | - Idir Ghout
- Clinical Research Unit, University Hospital Ambroise Paré, Boulogne, France
| | - David Simo
- Clinical Research Unit, University Hospital Ambroise Paré, Boulogne, France
| | - Valerie Zeller
- Referral Centre for Bone and Joint Infections, Hospital Diaconesses Croix Saint-Simon, Paris, France
| | | | - Vincent Le Moing
- Maladies Infectieuses et Tropicales, University Hospital, Montpellier, France
| | - Nadia Belmatoug
- Division of Internal Medicine, University Hospital, Beaujon-Clichy, France
| | - Philippe Lesprit
- Mobile Infectious Diseases Unit, University Hospital, Créteil, France
| | - Jean-Pierre Bru
- Division of Infectious Diseases, Regional Hospital, Annecy, France
| | - Audrey Therby
- Division of Infectious Diseases, General Hospital of Versailles, Le Chesnay, France
| | - Damien Bouhour
- Division of Infectious Diseases, General Hospital, Bourg en Bresse, France
| | - Eric Dénes
- Division of Infectious Diseases, Limoges University Hospital, Limoges, France
| | - Alexa Debard
- Division of Infectious Diseases, University Hospital, Toulouse, France
| | | | - Karine Fèvre
- Division of Infectious Diseases, Bretonneau University Hospital, Tours, France
| | - Michel Dupon
- Division of Infectious Diseases, Bordeaux University Hospital, Bordeaux, France
| | - Philippe Aegerter
- Clinical Research Unit, AP-HP, Ambroise Paré University Hospital, Boulogne, France
| | - Denis Mulleman
- Division of Rheumatology, University Hospitals of Tours, Tours, France
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Affiliation(s)
- Jaime Lora-Tamayo
- Unit of Infectious Diseases, Hospital Universitario 12 de Octubre, Avenida de Córdoba, 28041 Madrid, Spain.
| | - Oscar Murillo
- Department of Infectious Diseases, Hospital Universitario de Bellvitge, Barcelona, Spain
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Riccio SA, Chu AKM, Rabin HR, Kloiber R. Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Interpretation Criteria for Assessment of Antibiotic Treatment Response in Pyogenic Spine Infection. Can Assoc Radiol J 2015; 66:145-52. [PMID: 25592988 DOI: 10.1016/j.carj.2014.08.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 08/18/2014] [Accepted: 08/20/2014] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The objective of the study was to determine if fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) can assess the response of patients with pyogenic spine infection to antibiotic treatment in a clinically useful time frame. METHODS Twenty-eight patients with suspected pyogenic spine infection had baseline (18)F-FDG PET/CT. Patients with proven or probable infection were divided into good and poor responders to antibiotic therapy based on clinical criteria. These patients had a follow-up (18)F-FDG PET/CT 6-8 weeks later. RESULTS Six of 28 patients were deemed negative for infection based on (18)F-FDG PET/CT. Two patients were excluded because of discrepancies in interpretation. Of the 20 patients deemed positive for infection, 13 had a pathogen isolated and all showed (18)F-FDG uptake in bone and/or soft tissue at baseline. Patients with a poor clinical response to treatment had persistent (18)F-FDG uptake in bone and/or soft tissue on follow-up. Patients with good clinical response had uptake confined to the margins of the destroyed disc. None of these patients had recurrent infection, even if antibiotics had already been discontinued at the time of the follow-up scan. CONCLUSIONS (18)F-FDG uptake confined to the margins of a destroyed disc after antibiotic therapy of pyogenic spine infection must not be considered indicative of persistent infection and likely represents mechanically induced inflammation. (18)F-FDG uptake in bone or soft tissue does indicate active infection. Quantification of activity could not reliably differentiate patients with active infection from those without active infection and those who had had a successful response to therapy. The pattern of activity is critical to accurate interpretation.
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Affiliation(s)
- Silvia A Riccio
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada.
| | - Angel K M Chu
- Department of Medicine, Microbiology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - Harvey R Rabin
- Department of Medicine, Microbiology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - Reinhard Kloiber
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
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Morozova TE, Rykova SM, Chukina MA. [NSAID GASTROPATHY IN PATIENTS WITH COMORBID DISEASES]. Eksp Klin Gastroenterol 2015:64-70. [PMID: 26817107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The widespread use in clinical practice of non-steroidal anti-inflammatory drugs (NSAIDs), largely due to the general trend towards an aging population and, as a consequence, increase the number of individuals with comorbid conditions and diseases, including the most common are diseases of the cardiovascular system, diseases of the joints and spine, requiring of therapy with, combining the anti-inflammatory and analgesic properties. However, NSAIDs not only have favorable effects, but have quite a wide range of adverse effects, an important place among which is NSAID-induced gastropathy. The article deals with the rational choice of NSAIDs in patients depending on the degree of cardiovascular risk and gastrointenstinalnogo, as well as the possibility of preventing NSAID-associated gastropathy. Particular attention is paid to the choice of individual NSAIDs with regard to their pharmacological properties.
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Yanamadala V, Walcott BP, Fecci PE, Rozman P, Kumar JI, Nahed BV, Swearingen B. Reversal of warfarin associated coagulopathy with 4-factor prothrombin complex concentrate in traumatic brain injury and intracranial hemorrhage. J Clin Neurosci 2014; 21:1881-4. [PMID: 24953825 DOI: 10.1016/j.jocn.2014.05.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Accepted: 05/04/2014] [Indexed: 11/18/2022]
Abstract
Warfarin-associated intracranial hemorrhage is associated with a high mortality rate. Ongoing coagulopathy increases the likelihood of hematoma expansion and can result in catastrophic hemorrhage if surgery is performed without reversal. The current standard of care for emergency reversal of warfarin is with fresh frozen plasma (FFP). In April 2013, the USA Food and Drug Administration approved a new reversal agent, 4-factor prothrombin complex concentrate (PCC), which has the potential to more rapidly correct coagulopathy. We sought to determine the feasibility and outcomes of using PCC for neurosurgical patients. A prospective, observational study of all patients undergoing coagulopathy reversal for intracranial hemorrhage from April 2013 to December 2013 at a single, tertiary care center was undertaken. Thirty three patients underwent emergent reversal of coagulopathy using either FFP or PCC at the discretion of the treating physician. Intracranial hemorrhage included subdural hematoma, intraparenchymal hematoma, and subarachnoid hemorrhage. FFP was used in 28 patients and PCC was used in five patients. International normalized ratio at presentation was similar between groups (FFP 2.9, PCC 3.1, p=0.89). The time to reversal was significantly shorter in the PCC group (FFP 256 minutes, PCC 65 minutes, p<0.05). When operations were performed, the time delay to perform operations was also significantly shorter in the PCC group (FFP 307 minutes, PCC 159 minutes, p<0.05). In this preliminary experience, PCC appears to provide a rapid reversal of coagulopathy. Normalization of coagulation parameters may prevent further intracranial hematoma expansion and facilitate rapid surgical evacuation, thereby improving neurological outcomes.
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Affiliation(s)
- Vijay Yanamadala
- Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, White Building Room 502, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA
| | - Brian P Walcott
- Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, White Building Room 502, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA.
| | - Peter E Fecci
- Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, White Building Room 502, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA
| | - Peter Rozman
- Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, White Building Room 502, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA
| | - Jay I Kumar
- Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, White Building Room 502, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA
| | - Brian V Nahed
- Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, White Building Room 502, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA
| | - Brooke Swearingen
- Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, White Building Room 502, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA
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Abstract
Lumbar spinal cysts often present with backache and may be accompanied by lower extremity weakness as well as radiation pain if root compression occurs. The treatment regimens include anti-inflammatory drugs, physical therapy, procedures guided by fluoroscopy or computed tomography, and surgery. We report the case of a patient with a symptomatic lumbar spinal cyst at the L4-L5 facet joint. The symptoms immediately remitted after ultrasound-guided steroid-lidocaine injection into the L4-L5 facet joint. Magnetic resonance imaging follow up 4 months after injection showed complete resolution of the cyst.
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Affiliation(s)
- Tung-Liang Lin
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan, ROC; Department of Statistics, Feng Chia University, Taichung, Taiwan, ROC
| | - Chin-Teng Chung
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Howard Haw-Chang Lan
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Huey-Min Sheen
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
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Liu K, Wu WW, Guo JD, Ren DF, Li L, Wang HD, Tang J. [Preliminary curative effect of interspinous blocking injection guiding by X-ray for the diagnosis and treatment of lumbar Baastrup's disease]. Zhongguo Gu Shang 2014; 27:220-223. [PMID: 24974425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate the preliminary curative effect of interspinous injections for the diagnosis and treatment of back pain caused by lumbar kissing spine (Baastrup's disease) under fluoroscopically guiding. METHODS From November 2011 to March 2013,17 patients with back pain caused by Baastrup's disease were treated with fluoroscopically-guided interspinous injections, including 7 males and 10 females with an average age of 49.6 years old ranging from 40 to 71 years old; the duration of the disease ranged from 2 to 5 years with a mean of 3.7 years. The visual analogue scale (VAS) and the lumbar segments range of motion (ROM) was analyzed at pre-operation, 2 days, 3 months and final followed-up after operation, the effects were evaluated with modified Macnab standard. RESULTS All patients were follow-up from 6 to 10 months with an average of 7.6 months. The pre-operative VAS was 6.41 +/- 0.94, the postoperative VAS at different time points improved significantly comparing with pre-operation,and the differences were statistically significant (P < 0.01). There was no significant difference in VAS at different time points after operation (P > 0.05). The ROM of operated segment and adjacent segment was (4.88 +/- 0.86) degrees and (6.82 +/- 0.73) degrees respectively at pre-operation. The postoperative operated segment ROM at different time points improved significantly comparing with pre-operation, and the differences were statistically significant (P < 0.05). Compared with pre-operation, there was no significant difference in adjacent segment ROM at different time points after operation (P > 0.05). According to modified Macnab, the result was excellent in 6 cases, good in 7 cases, fair in 3 cases and poor in 1 case. CONCLUSION Fluoroscopically-guided interspinous injections is an effective method for the diagnosis and treatment of Baastrup's disease. The method has advantages of simple operation, minimal invasion and safety, satisfactory short-term and medium-term therapeutic effect; it can also effectively lessen the pain of lumbar and back.
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Hadziahmetovic NV, Aganovic D, Kadic A, Biscevic M. Short Term Results After Local Application of Steroids and Anesthetics in Patients with Painful Spine Conditions. Med Arch 2014; 68:121-3. [PMID: 24937937 PMCID: PMC4272496 DOI: 10.5455/medarh.2014.68.121-123] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 12/02/2022] Open
Abstract
Introduction: Spinal pain is the most common of all chronic pain disorders. Imaging studies can be used to determine whether a pathological process is associated with the patient’s symptoms. Objective: To determine the short-term efficiency of local instillation of steroids in patients with painful spine conditions. Materials and methods: A prospective study included 35 patients with diagnosis of lumbar or cervical radiculopathy, or cervical and lumbar syndrome at the Department for the Physical Medicine and Rehabilitation, Department for the Orthopedics and Traumatology, and Department for the Neurosurgery, Clinical Canter University of Sarajevo (KCUS). A clinical examination, visual pain scale (VAS) and Oswestry Disability Index (ODI) were performed prior to the needle procedure and seven days after it. Descriptive and comparative statistics were used for comparison of pre and post-interventional results. This procedure was done for the first time in our region. Results: The males and females were equally represented in this study (17:18). The patients were 29 to 80 years old. The highest number of patients have been between 40-60 years, older then that have been 44,2% of patients, and younger only 8,5%. Patients have complained about the radicular pain along the legs or arms or back or neck pain. Most of them had disc herniation–57,14%, 8,57% had bulging disc, 8,57% had spinal canal stenosis, 5,71% had fasetarthrosis, rest of them had combination of those conditions. There was a statistically significant difference between the value of ODI score before procedure and 7 days later (26±10:16±12; p<0,001). The difference was also statistically significant in VAS values (7±1:1±1; p <0,001). Discussion: Our study suggests that needle instillation of steroid and lidocaine is effective in short-term pain occurs in different painful spine conditions (Sy cervicale, lumbare and radiculopathy). It is valuable alternative to the classic methods of physical and drug therapy. It can also postpone surgical treatment, and it is very useful in situations of diffuse degenerative changes when is very important to define exact source of pain, like for instance in hip-spine syndrome.
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Affiliation(s)
- Narcisa Vavra Hadziahmetovic
- Department for Physical medicine and rehabilitation, Clinical Center University of Sarajevo
- Corresponding author: Prof. Narcisa Vavra-Hadziahmetovic, MD, PhD. Department for Physical medicine and rehabilitation, Clinical Center University of Sarajevo, Bosnia & Herzegovina, E-mail:
| | - Damir Aganovic
- Department for Urology, Clinical Center University of Sarajevo
| | - Aldijana Kadic
- Department for Physical medicine and rehabilitation, Clinical Center University of Sarajevo
| | - Mirza Biscevic
- Department for Orthopedic and Traumatology, Clinical Center University of Sarajevo
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Marcucci G, Masi L, Carossino AM, Franchi A, Capanna R, Sinigaglia L, Brandi ML. Cystic bone angiomatosis: a case report treated with aminobisphosphonates and review of the literature. Calcif Tissue Int 2013; 93:462-71. [PMID: 23836156 DOI: 10.1007/s00223-013-9761-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 05/29/2013] [Indexed: 01/09/2023]
Abstract
Cystic angiomatosis (CA) is a rare disease characterized by multifocal hemangiomatous and/or lymphangiomatous lesions of the skeleton with possible visceral organ involvement. The exact pathogenetic mechanism of the disease is still unknown. We describe a patient affected by CA of bone treated with surgical procedures and subsequently with intravenous aminobisphosphonates for 7 years. During the follow-up progression of lesions, the painful symptoms, markers of bone turnover, computed tomographic examination, and bone mineral density were evaluated. Aminobisphosphonate therapy showed an immediate effectiveness in reducing bone pain, with a significant decrease in circulating bone alkaline phosphatase and stable radiological findings during clinical follow-up. In addition, at baseline, high levels of bone biomarkers and cytokines (osteoprotegerin, osteopontin, and interleukin-6) capable of controlling bone metabolism and angiomatosis were identified. Aminobisphosphonate treatment produced a decrease of all these increased markers. Local cell therapy with bone marrow osteoblast precursors did not produce any measurable clinical improvement. Aminobisphosphonate therapy represents an elective treatment for bone angiomatosis syndromes, but further studies are necessary to understand the molecular basis of these disorders and of their pharmacological treatment.
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Affiliation(s)
- Gemma Marcucci
- Bone and Mineral Metabolic Unit, Department of Internal Medicine, University of Florence Medical School, Largo Palagi 1, 50139, Florence, Italy
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Neumayr A, Tamarozzi F, Goblirsch S, Blum J, Brunetti E. Spinal cystic echinococcosis--a systematic analysis and review of the literature: part 2. Treatment, follow-up and outcome. PLoS Negl Trop Dis 2013; 7:e2458. [PMID: 24069501 PMCID: PMC3777903 DOI: 10.1371/journal.pntd.0002458] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [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] [Received: 06/06/2013] [Accepted: 08/13/2013] [Indexed: 12/13/2022] Open
Abstract
Bone involvement in human cystic echinococcosis (CE) is rare, but affects the spine in approximately 50% of cases. Despite significant advances in diagnostic imaging techniques, surgical treatment and introduction of pharmacological therapy, spinal echinococcosis remains associated with a high degree of morbidity, disability and mortality. We systematically reviewed the published literature of the last five decades to update and summarize the currently existing data on treatment, follow-up and outcome of spinal CE.
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Affiliation(s)
- Andreas Neumayr
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Francesca Tamarozzi
- Division of Infectious and Tropical Diseases, University of Pavia, IRCCS S. Matteo Hospital Foundation, WHO Collaborating Centre for Clinical Management of Cystic Echinococcosis, Pavia, Italy
| | - Sam Goblirsch
- Department of Medicine and Pediatrics, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Johannes Blum
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Enrico Brunetti
- Division of Infectious and Tropical Diseases, University of Pavia, IRCCS S. Matteo Hospital Foundation, WHO Collaborating Centre for Clinical Management of Cystic Echinococcosis, Pavia, Italy
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Matthey A, Cedraschi C, Piguet V, Besson M, Chabert J, Daali Y, Courvoisier D, Montagne A, Dayer P, Desmeules JA. Dual reuptake inhibitor milnacipran and spinal pain pathways in fibromyalgia patients: a randomized, double-blind, placebo-controlled trial. Pain Physician 2013; 16:E553-E562. [PMID: 24077206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Investigations based on quantitative sensory testing have consistently shown evidence of allodynia in fibromyalgia syndrome (FMS) patients involving both the spinal and supraspinal pain regulatory systems. Functional imaging studies have demonstrated enhanced neural activities in pain-related brain areas as well as impairment of pain inhibition in the descending nociceptive regulatory system. A higher state of excitability of spinal nociceptive neurons as evidenced by lowered nociceptive flexion reflex R-III (NFR) threshold was reported for FMS patients. The NFR procedure has been shown to be a valuable tool to evaluate pharmacologically active therapeutic agents at the spinal level. OBJECTIVE Serotonin-noradrenaline reuptake inhibitors have been shown to reduce pain in FMS patients possibly through descending monoaminergic pain pathways modulation. This randomized double-blind placebo-controlled trial assessed the pharmacodynamic activity of the dual-reuptake inhibitor milnacipran (MLN) at the spinal level by means of the objective spinal NFR. STUDY DESIGN Randomized, double-blind, placebo-controlled trial. SETTING A single academic medical center, outpatient setting. METHODS Seven-week exposure (100, 150, 200mg/day) in women fibromyalgia patients. Evaluation consisted of extensive quantitative sensory testing including determination of the NFR threshold, self-reported standard questionnaires investigating pain, visual analog scales, fibromyalgia impact, health-related quality of life, depression and anxiety questionnaires, as well as the Patient's Global Impression of Change (PGIC). Analysis of covariance adjusted for baseline value was used for all endpoints. RESULTS Seventy-seven (39 placebo, 38 milnacipran all doses) out of 80 randomized patients were available for analysis. The absence of influence of MLN (any dose) on the NFR surprisingly contrasted with the dose-dependent analgesic effect observed in MLN-treated patients with an adjusted change difference of -18.4mm (-30.9; -5.8) in pain reduction between placebo and the maximum dosage (200 mg) MLN groups (P = 0.02). Unchanged depression and anxiety scores confirmed the predominant selectivity of the analgesic effect of MLN on nociceptive pain pathway. Self-reported questionnaires consistently reflected the positive effects of MLN on quality of life and psychological well-being. Odds ratio 5.1 for PGIC responders (i.e. much/very much improved) was significantly in favor of MLN (P = 0.04). CONCLUSION Milnacipran has a predominantly supraspinal analgesic effect as evidenced by the significant clinical benefits and the absence of changes in the nociceptive spinal reflex threshold. Higher dose was associated with higher pain reduction. Reported analgesia was independent of patients' emotional status.
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Affiliation(s)
- Alain Matthey
- Division of Clinical Pharmacology & Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals, Switzerland;Division of General Medical Rehabilitation, Geneva University Hospitals, Switzerland; University of Geneva, Switzerland; Division of Cl
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Lange T, Schulte TL. Answer to the Letter to the Editor of H. Namazi concerning "Denosumab: a potential new and innovative treatment option for aneurysmal bone cysts" by Lange T, Stehling C, Fröhlich B, Klingenhöfer M, Kunkel P, Schneppenheim R, Escherich G, Gosheger G, Hardes J, Jürgens H, Schulte TL (2013), Eur Spine J;22(6):1417-1422. Eur Spine J 2013; 22:2343. [PMID: 23975436 DOI: 10.1007/s00586-013-2956-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Revised: 08/03/2013] [Accepted: 08/03/2013] [Indexed: 11/25/2022]
Affiliation(s)
- T Lange
- Department of Orthopedics and Tumor Orthopedics, Münster University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany,
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43
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Lange T, Stehling C, Fröhlich B, Klingenhöfer M, Kunkel P, Schneppenheim R, Escherich G, Gosheger G, Hardes J, Jürgens H, Schulte TL. Denosumab: a potential new and innovative treatment option for aneurysmal bone cysts. Eur Spine J 2013; 22:1417-22. [PMID: 23455951 PMCID: PMC3676549 DOI: 10.1007/s00586-013-2715-7] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 01/20/2013] [Accepted: 02/05/2013] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Aneurysmal bone cysts (ABCs) are expansive and destructive lesions positive for osteoclast markers, resembling benign giant cell tumors (GCTs). Treatment options include surgical resection, curettage and cavity filling, embolization, injection of fibrosing agents, or radiotherapy. Particularly in children and adolescents with spinal ABCs, these options may be unsatisfactory, and innovative forms of treatment are needed. Denosumab is a human monoclonal antibody that inhibits osteoclast function by blocking the cytokine receptor activator of the nuclear factor-kappa B ligand. Satisfactory results with denosumab in treating GCTs and immunohistochemical similarities suggest that it may also have positive effects on ABCs. METHODS AND RESULTS This report is the first description of the therapeutic use of denosumab in two patients with spinal ABCs. Two boys (aged 8 and 11) had recurrent ABCs at C5 after surgery with intralesional tumor resection. Treatment options were discussed by the interdisciplinary tumor board. Arterial embolization was attempted, but failed due to an absence of appropriate afferent arteries. After the families had received extensive information and provided written consent, denosumab therapy was initiated as an individualized treatment, despite the absence as yet of scientific evidence. After the start of denosumab therapy, both patients recovered from pain and neurologic symptoms significantly and are now in a healthy condition with no severe side effects. Magnetic resonance imaging check-ups after 2 or 4 months of denosumab treatment, respectively, showed tumor regression in both patients. DISCUSSION Longer follow-up and clinical studies are warranted to establish the value of denosumab in the treatment of ABCs.
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Affiliation(s)
- Tobias Lange
- Department of Orthopedics and Tumor Orthopedics, Münster University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.
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Angelo KM, Nnedu ON. Rare manifestations of coccidioidomycosis. J La State Med Soc 2013; 165:137-139. [PMID: 24015425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Involvement of the central nervous system and extrapulmonary sites by Coccidioides immitis is reported primarily in patients with cell-mediated immune deficiency. We present a case of a patient with no prior history of immunosuppression who presented to a public hospital in New Orleans with disseminated Coccidioides infection.
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45
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De Smet E, Vanhoenacker FM. The "kissing spine" revisited. JBR-BTR 2013; 96:38. [PMID: 23610881] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- E De Smet
- Department of Radiology, AZ Sint-Maarten, Duffel-Mechelen, Belgium
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46
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Mattei TA. Imaging is not everything: thoracic intradural arachnoid cyst with severe spinal cord compression in an asymptomatic patient. Spine J 2012; 12:1077. [PMID: 23063424 DOI: 10.1016/j.spinee.2012.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 08/17/2012] [Accepted: 09/12/2012] [Indexed: 02/03/2023]
Affiliation(s)
- Tobias A Mattei
- Department of Neurosurgery, University of Illinois College of Medicine at Peoria, 828 NE Glen Oak Ave. #302, Peoria, IL 61603, USA
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47
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Federman DG, Kravetz JD, Luciano RL, Brown JE. Gout: what a pain in the neck. Conn Med 2012; 76:143-146. [PMID: 22666972] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Daniel G Federman
- Department of Medicine, Yale University School of Medicine, New Haven, USA
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Uno K, Kasahara K, Komatsu Y, Konishi M, Yoshihmoto E, Maeda K, Mikasa K. Rupture of renal mycotic aneurysm that developed during the treatment of streptococcal infective endocarditis and vertebral osteomyelitis. Intern Med 2012; 51:1255-8. [PMID: 22687800 DOI: 10.2169/internalmedicine.51.6418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 50-year-old woman received two weeks of cefozopran and two weeks of imipenem for streptococcal endocarditis and vertebral osteomyelitis. Subsequently she received four weeks of oral levofloxacin and eight weeks of oral clarithromycin due to persistent elevation of C-reactive protein. Finally, she was admitted to our hospital due to massive hematuria. Abdominal CT showed rupture of an aneurysm in the right kidney and emergent coil embolization was performed. Multiple sets of blood culture grew Streptococcus oralis, and transthoracic echocardiography revealed vegetation at the aortic valve. Retrospective review of the abdominal images revealed the emergence of the aneurysm during the treatment.
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Affiliation(s)
- Kenji Uno
- Center for Infectious Diseases, Nara Medical University, Japan
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49
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Ribakovs A, Uzoigwe CE, Bhansali H. Sequential Arcanobacterium haemolyticum and Escherichia coli spinal infections after local excision of a rectal polyp. Am Surg 2011; 77:791-793. [PMID: 21679653] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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50
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Scarlata F, Giordano S, Saporito L, Marasa L, Li Pani G, Odierna A, Scaglione V, Di Carlo P, Romano A. Cystic hydatidosis: a rare case of spine localization. Infez Med 2011; 19:39-41. [PMID: 21471745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Cystic hydatidosis is a zoonosis endemic both to Sicily and other Mediterranean areas. Generally, Echinococcus granulosus tapeworms develop in the liver, lung and less frequently in the peritoneum, spleen or kidney. We present a rare case of spinal hydatid disease. The patient was a 38-year-old housewife with a vertebral echinococcosis revealed by acute paraplegia of the legs. Medical treatment with albendazole and surgical intervention improved the clinical symptoms. This case is emblematic both for the unusual localization and for the need of a multidisciplinary approach for diagnosing and monitoring suspected hydatid lesions. Patients with suspected abdominal or lung echinococcosis should also be investigated for other localizations such as the brain, spine and heart. Furthermore, in endemic areas hydatidosis must be suspected in the presence of lesions occupying space in these districts.
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Affiliation(s)
- Francesco Scarlata
- Dipartimento di Scienze per la Promozione della Salute, Sezione di Malattie Infettive, Universita di Palermo, Italy
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