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1.
Neurosurg Focus ; 51(4): E2, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34598125

RESUMO

OBJECTIVE: Ankylosing spinal disorders (ASDs) such as ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH) are complex diseases regarding diagnostics, treatment, and patient outcome, especially in trauma. Originating from rigid biomechanics and low bone quality in considerably comorbid patients, serious spinal injury requires thorough and immediate imaging and is frequently missed. The aim of this study was to evaluate patient characteristics as well as procedures in patients with ASD in order to identify the major particularities of treatment. METHODS: A total of 60 patients aged 78.5 ± 8.9 years were retrospectively included. Preoperative imaging as well as surgical treatment procedures and postoperative patient outcome were analyzed, including 30-day readmissions. RESULTS: CT imaging of the entire spine was performed within 24 hours after the initial trauma in 73.3% of patients. A delay in diagnostics (> 24 hours) occurred in 41.7% of patients transferred from primary care centers. At admission, 25.0% of patients had fracture-related neurological deficits (American Spinal Injury Association [ASIA] grades A and B in 4 patients, and ASIA grades C and D in 11 patients). A spinal epidural hematoma was found in 21.2% of patients and was symptomatic in 72.7% of those patients. Of the patients with fracture-related neurological deficits, 93.3% were operated on within 48 hours from symptom onset. One patient (1.7%) developed neurological deficits from diagnosis to surgery. Postoperatively, 18.3% of patients had surgical complications, and 76.7% of patients developed further medical issues, with pneumonia (38.3%), pulmonary decompensation (25.0%), and cardiac decompensation (20.0%) being the leading causes. The 30-day mortality rate was high at 10.0%. CONCLUSIONS: Treatment of patients with ASDs is complex. While surgical outcome is usually good, the multimorbid nature of these patients results in a high rate of major medical complications. If an ankylosing disease is suspected, MRI of the entire spine is mandatory. Upon diagnosis, treatment should be performed in centers capable of managing all aspects of the regular complications these patients will develop.


Assuntos
Hiperostose Esquelética Difusa Idiopática , Fraturas da Coluna Vertebral , Espondilite Anquilosante , Humanos , Hiperostose Esquelética Difusa Idiopática/complicações , Hiperostose Esquelética Difusa Idiopática/diagnóstico por imagem , Hiperostose Esquelética Difusa Idiopática/cirurgia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Coluna Vertebral , Espondilite Anquilosante/complicações , Espondilite Anquilosante/diagnóstico por imagem , Espondilite Anquilosante/cirurgia
2.
BMC Musculoskelet Disord ; 22(1): 867, 2021 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-34635092

RESUMO

BACKGROUND: Early versions of spinal muscular atrophy (SMA) scoliosis correction surgery often involved sublaminar devices. Recently, the utilization of pedicle screws has gained much popularity. Pedicle screws are generally believed to provide additional deformity correction, but pedicle size and rotational deformity limit their application in the thoracic spine, resulting in a hybrid construct involving pedicle screws and sublaminar wire. Studies of the efficacy of hybrid instrumentation in SMA scoliosis are often limited by the scarcity of the disease itself. In this study, we aimed to compare the surgical outcomes between hybrid constructs involving pedicle screws and sublaminar wire and sublaminar wire alone in patients with SMA scoliosis. METHODS: We retrospectively reviewed the clinical records and radiographic assessments of patients with SMA scoliosis who underwent corrective surgery between 1993 and 2017. The radiographic assessments included deformity correction and progressive changes in the major curve angle, pelvic tilt (PT) and coronal balance (CB). The correction of deformities was observed postoperatively and at the patient's 2-year follow-up to test the efficacy of each type of construct. RESULTS: Thirty-three patients were included in this study. There were 14 and 19 patients in the wiring and hybrid construct groups, respectively. The hybrid construct group demonstrated a higher major curve angle correction (50.5° ± 11.2° vs. 36.4° ± 8.4°, p < 0.001), a higher apical vertebral rotation correction (10.6° ± 3.9° vs. 4.8° ± 2.6°, p < 0.001), and a reduced progression of the major curve angle at the 2-year follow-up (5.1° ± 2.9° vs. 8.7° ± 4.8°, p < 0.001). A moderate correlation was observed between the magnitude of correction of the apical vertebral rotation angle and the major curve (r = 0.528, p = 0.002). CONCLUSION: This study demonstrated that hybrid instrumentation can provide a greater magnitude of correction in major curve and apical rotation as well as less major curve progression than sublaminar wire instrumentation alone in patients with SMA scoliosis. Level of evidence III.


Assuntos
Atrofia Muscular Espinal , Escoliose , Humanos , Atrofia Muscular Espinal/diagnóstico por imagem , Atrofia Muscular Espinal/cirurgia , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Coluna Vertebral , Resultado do Tratamento
3.
J Nepal Health Res Counc ; 19(2): 411-413, 2021 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-34601540

RESUMO

We report cases of vertebral body enhancement in patients with superior vena cava and brachiocephalic venous obstruction appearing as sclerotic metastases in post-contrast CT.A 58-year-old male presented with right lung mass compressing the superior vena cava.Sclerotic areas seen involving few vertebrae in post-contrast scans.Another patient, 64-year-old female with right lung mass and narrowing of left brachiocephalic vein, sclerosis of lower cervical and upper dorsal vertebrae were seen in contrast studies. In both cases after resolution of pathology following treatment showed no enhancement in post contrast scan which was attributed to the collaterals arising due to obstruction, obviously not seen in metastases. Keywords: Brachiocephalic vein obstruction; computed tomography CT; superior vena cava SVC; vertebral enhancement; venous collaterals.


Assuntos
Neoplasias Pulmonares , Veia Cava Superior , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Nepal , Esclerose , Coluna Vertebral
4.
J Coll Physicians Surg Pak ; 31(10): 1239-1241, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34601851

RESUMO

Langerhans cell histiocytosis (LCH) is a rare haematological disorder characterised by accumulation and abnormal proliferation of bone marrow-derived Langerhans cells and mature eosinophils. The clinical presentation of patients with LCH may be localised or systemic, depending on the site and the degree of involvement. LCH may involve any bone, but the most commonly involved bones are long bones, pelvis, ribs, skull, vertebrae, and facial bones. In head and neck region, frontal and parietal bones are commonly involved followed by the jaws, with a predilection for mandible. In this report, we present a case of LCH involving the craniofacial bones in a 10-year boy, who presented initially with multiple ulcerative lesions on gingiva. Key Words: Craniofacial, Langerhans cell histiocytosis, Gingiva.


Assuntos
Histiocitose de Células de Langerhans , Crânio , Histiocitose de Células de Langerhans/diagnóstico por imagem , Humanos , Masculino , Mandíbula , Costelas , Crânio/diagnóstico por imagem , Coluna Vertebral
5.
Neurosurg Focus ; 51(4): E5, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34598124

RESUMO

OBJECTIVE: Ankylosing spondylitis (AS) is a chronic inflammatory disease affecting the sacroiliac joints and axial spine that is closely linked with human leukocyte antigen-B27. There appears to be an increased frequency of associated epidural hematomas in spine fractures in patients with AS. The objective was to review the incidence within the literature and a single-institution experience of the occurrence of epidural hematoma in the context of patients with AS requiring spine surgery. METHODS: Deep 6 AI software was used to search the entire database of patients at a single level I trauma center (since the advent of the institution's modern electronic health record system) to look at all patients with AS who underwent spinal surgery and who had a diagnosis of epidural hematoma. Additionally, a systemic literature review was performed of all papers evaluating the incidence of epidural hematoma in patients with spine fractures. RESULTS: A single-institution, retrospective review of records from 2009 to 2020 yielded a total of 164 patients with AS who underwent spine surgery. Of those patients, 17 (10.4%) had epidural hematomas on imaging, with the majority requiring surgical decompression. These spine fractures occurred close to the cervicothoracic or thoracolumbar junction. The patients ranged in age from 51 to 88 years, and there were 14 males and 3 females in the cohort. Eight patients were administered an antiplatelet and/or anticoagulant agent, and the rest were not. All patients required surgical stabilization, with 64.7% of patients also requiring decompressive laminectomies for evacuation of the hematoma and spinal cord decompression. Only 1 death was reported in the series. There was a tendency toward neurological improvement after surgical intervention. CONCLUSIONS: AS has been a well-described pathologic process that leads to an increased risk of three-column injury in spine fracture, with an increased incidence of symptomatic epidural hematoma compared with patients without AS. Early recognition of this entity is important to ensure that appropriate surgical management includes addressing compression of the neural elements in addition to surgical stabilization.


Assuntos
Hematoma Epidural Espinal , Fraturas da Coluna Vertebral , Espondilite Anquilosante , Idoso , Idoso de 80 Anos ou mais , Feminino , Hematoma Epidural Espinal/diagnóstico por imagem , Hematoma Epidural Espinal/epidemiologia , Hematoma Epidural Espinal/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Coluna Vertebral , Espondilite Anquilosante/complicações , Espondilite Anquilosante/diagnóstico por imagem , Espondilite Anquilosante/epidemiologia
7.
Rev Assoc Med Bras (1992) ; 67(3): 390-394, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34468603

RESUMO

OBJECTIVE: The aim of this study is to analyze the relations of heart-type fatty acid-binding protein (H-FABP) and brain-type fatty acid-binding protein (B-FABP) with postoperative cognitive dysfunction (POCD) in elderly patients undergoing spinal surgery. METHODS: One hundred and twenty-five patients who underwent spinal surgery were enrolled in this study. According to whether patients had POCD within 5 days after surgery, the participants were divided into POCD group and non-POCD group. Before surgery and 6 h after surgery, the serum H-FABP and B-FABP contents were detected. RESULTS: There were 33 (26.4%) patients in POCD group, and 92 (73.60%) patients in non-POCD group. After surgery, the serum H-FABP and B-FABP contents in POCD group were significantly higher than those before surgery, respectively (p<0.05), and those in non-POCD group were significantly lower than those before surgery, respectively (p<0.05). After surgery, the serum H-FABP and B-FABP contents in POCD group were significantly higher than those in non-POCD group, respectively (p<0.05). CONCLUSION: The serum H-FABP and B-FABP contents are positively related to the occurrence of POCD in elderly patients undergoing spinal surgery.


Assuntos
Disfunção Cognitiva , Complicações Cognitivas Pós-Operatórias , Coluna Vertebral/cirurgia , Idoso , Encéfalo , Disfunção Cognitiva/etiologia , Proteínas de Ligação a Ácido Graxo , Humanos , Complicações Pós-Operatórias/etiologia
8.
Spine (Phila Pa 1976) ; 46(19): 1336-1343, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34517403

RESUMO

STUDY DESIGN: Retrospective. OBJECTIVE: The aim of this study was to investigate the effect of body mass index (BMI) on pain and disability in patients with chronic mechanical low back pain (LBP) treated with multimodal rehabilitation. SUMMARY OF BACKGROUND DATA: Despite being a well-known risk factor for developing LBP, there is minimal data on the effect of BMI on pain and disability in patients with chronic mechanical low back pain (LBP) treated with multimodal rehabilitation. METHODS: Data from patients with chronic mechanical LBP who underwent multimodal rehabilitation treatment at a chain of spine rehabilitation outpatient clinics in one of the three BMI groups-1564 patients in normal body weight (BMI ≥18.5-24.9), 1990 patients in overweight (BMI ≥25-29.9), and 891 patients in obese (BMI ≥ 30) groups-were retrospectively analyzed. Pre- and post-treatment Numerical Pain Rating Scale (NPRS) and Oswestry Disability Index (ODI) scores, and final treatment outcomes were compared between the three groups. Multivariate analysis was used to determine the association between pre-treatment covariates and post-treatment clinical outcomes. RESULTS: Post-treatment, the mean NPRS (P = 0.005) and mean ODI (P < 0.001) scores were significantly higher with a significantly lower percentage of full success outcome (P = 0.009) in the obese group when compared to normal and overweight groups. However, multivariate analysis showed a significant correlation between age, the number of treatment sessions, pre-treatment NPRS and ODI scores, and post-treatment NPRS and ODI scores and treatment failure, and no correlation with patient BMI. CONCLUSION: Patient BMI may not affect pain and disability outcomes in patients undergoing a multimodal rehabilitation treatment for chronic LBP. In contrast to BMI, other covariates such as age, treatment sessions, and pre-treatment NPRS and ODI scores may be associated with increased risk for poor treatment outcome. Obese individuals can expect clinical outcomes similar to normal or overweight individuals with multimodal physical rehabilitation for chronic LBP.Level of Evidence: 3.


Assuntos
Dor Lombar , Índice de Massa Corporal , Avaliação da Deficiência , Humanos , Dor Lombar/diagnóstico , Estudos Retrospectivos , Coluna Vertebral , Resultado do Tratamento
9.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(9): 1161-1166, 2021 Sep 15.
Artigo em Chinês | MEDLINE | ID: mdl-34523282

RESUMO

Objective: To compare the refracture risk between sandwich vertebrae and ordinary adjacent vertebrae, and to explore the risk factors related to refracture. Methods: Retrospective analysis was performed on the data of patients who received percutaneous vertebral augmentation (PVA) and formed sandwich vertebrae between April 2015 and October 2019. Of them, 115 patients were enrolled in the study. There were 27 males and 88 females with an average age of 73.9 years (range, 53-89 years). Univariate analysis was performed to analyzed the patients' general data, vertebral augmentation related indexes, and sandwich vertebrae related indexes. Survival analysis was performed for all untreated vertebrae at T 4-L 5 of the included patients at the vertebra-specific level, and risk curves of refracture probability of untreated vertebrae between sandwich vertebrae and ordinary adjacent vertebrae were compared. Cox's proportional hazards regression model was used to analyze risk factors for refracture. Results: The 115 patients were followed up 12.6-65.9 months (mean, 36.2 months). Thirty-seven refractures involving 51 vertebral bodies occurred in 31 patients. The refracture rate of 27.0% (31/115) in patients with sandwich vertebrae was significantly higher than that of 15.2% (187/1228) in all patients who received PVA during the same period ( χ 2=10.638, P=0.001). Univariate analysis results showed that there was a significant difference in the number of augmented vertebrae between patients with and without refractures ( Z=0.870, P=0.004). However, there was no significant difference in gender, age, body mass index, whether had clear causes of fracture, whether had dual energy X-ray absorptiometry testing, whether the sandwich vertebra generated through the same PVA, puncture method, method of PVA, number of PVA procedures, number of vertebrae with old fracture, whether complicated with spinal deformity, bone cement distribution, and kyphosis angle of sandwich vertebral area ( P>0.05). Among the 1 293 untreated vertebrae, there were 136 sandwich vertebrae and 286 ordinary adjacent vertebrae. The refracture rate of sandwich vertebrae was 11.3% which was higher than that of ordinary adjacent vertebrae (6.3%)( χ 2=4.668, P=0.031). The 1- and 5-year fracture-free probabilities were 0.90 and 0.87 for the sandwich vertebrae, and 0.95 and 0.93 for the ordinary adjacent vertebrae, respectively. There was a significant difference between the two risk curves of refracture ( χ 2=4.823, P=0.028). Cox's proportional hazards regression model analysis results showed that the sandwich vertebrae, thoracolumbar location, the number of the augmented vertebrae, and the unilateral puncture were significant risk factors for refracture ( P<0.05). Conclusion: The sandwich vertebrae has a higher risk of refracture when compared with the ordinary adjacent vertebrae, and its 1- and 5-year fracture-free probabilities are lower than those of the ordinary adjacent vertebrae. However, the 5-year fracture-free probability of sandwich vertebrae is still 0.87, so prophylactic enhancement is not recommended for all sandwich vertebrae. In addition, the sandwich vertebrae, thoracolumbar location, the number of the augmented vertebrae, and the unilateral puncture were important risk factors for refracture.


Assuntos
Fraturas por Compressão , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Vertebroplastia , Idoso , Cimentos Ósseos , Feminino , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco , Coluna Vertebral
10.
Spine (Phila Pa 1976) ; 46(20): E1105-E1112, 2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34559751

RESUMO

STUDY DESIGN: A multicenter retrospective review of consecutive series of patients. OBJECTIVE: Long-term experience with using the magnetically controlled growing rods (MCGR) to treat patients with deformity in the growing spine to the conclusion of treatment with posterior spine fusion. SUMMARY OF BACKGROUND DATA: MCGR treatment for growing spine gained popularity with paucity of long-term follow up data. We hypothesized that final fusion might be more effective in bringing additional correction of the spine deformity after treatment with MCGR than that reported after traditional growing rods (TGR) due to less scarring and auto-fusion. METHODS: Retrospective review of 47 patients with varied etiology, treated between 2011 and 2017 which graduated treatment were followed in five academic medical centers for average of 50 months (range, 10-88). RESULTS: The initial mean coronal deformity of 69.6° (95% CI 65-74) was corrected to 40° (95% CI 36-40) immediately after the MCGR implantation but progressed to 52.8° (95% CI 46-59) prior to the final surgery (P < 0.01). Nevertheless, thoracic spine growth (T1-T12 height) improved from 187.3 mm (95% CI 179-195) following index surgery to 208.9 mm (95% CI 199-218) prior to final fusion (P < 0.01). Significant correction and spinal length were obtained at final fusion, but metallosis was a frequent observation (47%, 22/47). The average growth rate was 0.5 mm/month (95% CI 0.3-0.6). The overall complication rate within our cohort was 66% (31/47) with 45% (21/47) of unplanned returns to the operating theater. 32% (15/47) of the patients had an implant related complication. Unplanned surgery was highly correlated with thoracic kyphosis greater than 40° (OR 5.42 95% CI 1.3-23). CONCLUSION: Treatment of growing spine deformities with MCGR provides adequate control of spine deformity it is comparable to previously published data about TGR. The overall high complications rate over time and specifically implant related complications.Level of Evidence: 4.


Assuntos
Cifose , Escoliose , Fusão Vertebral , Humanos , Cifose/cirurgia , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Fusão Vertebral/efeitos adversos , Coluna Vertebral , Resultado do Tratamento
11.
Spine (Phila Pa 1976) ; 46(20): 1428-1435, 2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34559754

RESUMO

STUDY DESIGN: Single-center, investigator-initiated, prospective cohort study. OBJECTIVE: This study aimed to determine patient-reported reasons for persistent opioid use following elective spine surgery, assess the frequency of withdrawal symptoms, and characterize pain-related care sought after discharge. SUMMARY OF BACKGROUND DATA: Patients are often prescribed opioids at discharge from hospital following surgery. Several studies have shown that a large number of patients fail to discontinue opioid treatment and use opioids even months to years after surgery. Spine surgery has proven to be a high-risk procedure in regard to persistent opioid use. There is, however, limited evidence on why patients continue to take opioids. METHODS: Three hundred patients, scheduled to undergo spine surgery at Aarhus University Hospital, Denmark, were included. Baseline characteristics and discharge data on opioid consumption were collected. Data on opioid consumption, patient-reported reasons for opioid use, withdrawal symptoms, and pain-related care sought were collected at 3- and 6-month follow-up via a REDCap survey. RESULTS: Before surgery, opioid use was reported in 53% of patients. Three months after surgery, opioid use was reported in 60% of preoperative opioid-users and in 9% of preoperative opioid non-users. Patients reported the following reasons for postoperative opioid use: treatment of surgery-related pain (53%), treatment of surgery-related pain combined with other reasons (37%), and reasons not related to spine surgery (10%). Withdrawal symptoms were experienced by 33% of patients during the first 3 months after surgery and were associated with failure to discontinue opioid treatment (P < 0.001). Half of patients (52%) contacted health care after discharge with pain-related topics the first 3 months. CONCLUSION: Patients use opioids after spine surgery for reasons other than surgery-related pain. Withdrawal symptoms are frequent even though patients are given tapering plans at discharge. Further studies should address how to facilitate successful and safe opioid tapering in patients undergoing spine surgery.Level of Evidence: 3.


Assuntos
Analgésicos Opioides , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides/uso terapêutico , Humanos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Estudos Prospectivos , Coluna Vertebral/cirurgia
12.
J Mech Behav Biomed Mater ; 123: 104797, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34492614

RESUMO

Growth-preserving spinal surgery suffer from high complications rate. A recent bipolar instrumentation using two anchoring points (thoracic and pelvic) showed lower rates, but its biomechanical behaviour has not been characterised yet. The aim of this work was to combine in vitro and in vivo data to improve and validate a finite element model (FEM) of the spine, and to apply it to compare bipolar and classical all-screws implants. Spinal segments were tested in vitro to measure range of motion (ROM). Thoracic segments were also tested with bipolar instrumentation to measure ROM and rod strain using a strain gage. A subject-specific FEM of the spine, pelvis and ribcage of an in vivo asymptomatic subject was built. Spinal segments were extracted from it to reproduce the in-vitro mechanical tests. Experimental and simulated ROM and rod strain were compared. Then, the full trunk FEM was used to compare bipolar and all-screws instrumentations. The FEM fell within 1° of the experimental corridors, and both in silico and in vitro instrumentation rods showed 0.01% maximal axial strain. Bipolar and all-screws constructs had similar maximal Von Mises stresses. This work represents a first step towards subject-specific simulation to evaluate spinal constructs for neuromuscular scoliosis in children.


Assuntos
Escoliose , Fusão Vertebral , Fenômenos Biomecânicos , Criança , Simulação por Computador , Análise de Elementos Finitos , Humanos , Vértebras Lombares , Amplitude de Movimento Articular , Coluna Vertebral
13.
Orv Hetil ; 162(39): 1573-1578, 2021 09 26.
Artigo em Húngaro | MEDLINE | ID: mdl-34570720

RESUMO

Összefoglaló. Bevezetés: Nincs egységesen elfogadott álláspont, hogy a serdülokori idiopathiás gerincferdülés sebészi korrekcióját melyik életkorban optimális elvégezni. Világszerte 11 éves kortól akár (kezeletlen esetben) 50-60 éves korig végeznek fúziós mutétet a betegségben, 63-83%-os átlagos koronális síkú korrekciós hatékonysággal. Célkituzés: Célul tuztük ki, hogy felmérjük a gerinckorrekciós mutétek hatékonyságát három dimenzióban, illetve a páciens életkorának függvényében. Módszerek: A vizsgálatba 23, serdülokori idiopathiás gerincferdüléssel diagnosztizált beteget (12 fo 17 évnél fiatalabb, 11 fo 17 évnél idosebb) vontunk be. Minden betegnél csavaros derotációt és spondylodesist végeztünk, és a beavatkozás elott és után EOS 2D/3D felvételeket, majd sterEOS 3D rekonstrukciókat készítettünk. A következo paramétereket számítottuk: Cobb-fok, háti kyphosis, ágyéki lordosis, apicalis csigolyarotáció, maximális csigolyarotáció. A különbözo életkorú csoportok közötti különbséget kétmintás t-próbával, illetve Wilcoxon-féle próbával vizsgáltuk. Eredmények: A gerinckorrekciós mutétek során a koronális síkú eltérést 78,2%-ban (átlagosan 55,1 Cobb-fokról 12,0 Cobb-fokra), az apicalis csigolyarotációt 56,7%-ban (átlagosan 21,0 fokról 9,1 fokra) tudtuk korrigálni. A 17 éves életkor után operált páciensek esetén átlagosan 79,2%-os Cobb-fok-csökkenést értünk el, míg a fiatalabb betegcsoportban 77,0%-ban korrigáltuk a koronális fogörbületet (p = 0,614). Az idosebb betegcsoportban szignifikánsan kevésbé sikerült az apicalis csigolyarotáció korrekciója (átlagosan 38,1%; 21,8 fokról 12,4 fokra), mint a fiatalabb pácienseknél (átlagosan 68,5%; 20,2 fokról 6,2 fokra; p = 0,016). Következtetés: Összességében a nemzetközi publikációknak megfelelo korrekciót értünk el. A koronális síkban közel azonos korrekciós hatékonyság figyelheto meg a különbözo életkorú betegcsoportok között, a csigolyarotáció azonban 17 éves életkor elott hatékonyabban korrigálható. Orv Hetil. 2021; 162(39): 1573-1578. INTRODUCTION: There is no clear recommendation for the optimal age to perform corrective surgery in adolescent idiopathic scoliosis. Fusion surgery is performed from the age of 11 to 50-60 years, with an average coronal plane correction efficiency of 63-83%. OBJECTIVE: We aimed to evaluate the effectiveness of correction surgeries in three dimensions in adolescent idiopathic scoliosis. In addition, our objective was to examine the influence of the patient's age on the correction. METHODS: The study included 23 patients with adolescent idiopathic scoliosis (12 patients younger than 17 years, 11 patients older than 17 years). All patients underwent screw-derotation and spondylodesis and underwent EOS 2D/3D imaging before and after the operation, followed by sterEOS 3D reconstructions. The following parameters were calculated: Cobb degree, thoracic kyphosis, lumbar lordosis, apical vertebral rotation, maximal vertebral rotation. Differences between different age groups were examined by paired-sample t-test and Wilcoxon rank sum test. RESULTS: The mean efficiency of correction surgeries was 78.2% in the coronal plane (from an average of 55.1 Cobb degrees to 12.0 Cobb degrees) and 56.7% in the axial plane (from an average of 21.0 degrees to 9.1 degrees). We achieved an average 79.2% reduction of Cobb angle in patients operated after the age of 17 years, which was 77.0% in the younger group (p = 0.614). Apical vertebral rotation correction was significantly less successful in the elderly group (mean 38.1%; from 21.8 degrees to 12.4 degrees) than in patients operated before the age of 17 years (mean 68.5%; from 20.2 degrees to 6.2 degrees; p = 0.016). CONCLUSION: We achieved scoliosis correction in line with the international publications. Nearly the same correction efficiency was observed between different age groups of patients in the coronal plane. However, vertebral rotation can be derotated more effectively before the age of 17 years. Orv Hetil. 2021; 162(39): 1573-1578.


Assuntos
Cifose , Lordose , Escoliose , Adolescente , Idoso , Humanos , Estudos Retrospectivos , Escoliose/cirurgia , Coluna Vertebral
15.
Comput Biol Med ; 137: 104833, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34534795

RESUMO

Osteoporosis-related vertebral compression fracture can occur under normal physiological activities. Bone metastasis is another source of vertebral fracture. Different loading rates, either high-energy traumas such as falls or low-energy traumas under normal physiological activities, can result in different fracture outcomes. The aim of the current study was to develop a quantitative computed tomography-based finite element analysis (QCT/FEA) technique for single vertebral bodies to predict fracture strength of three-level spine segments. Developed QCT/FEA technique was also used to characterize vertebral elastic moduli at two loading rates of 5 mm/min, representing a physiologic loading condition, and 12000 mm/min, representing a high-energy trauma. To this end, a cohort of human spine segments divided into three groups of intact, defect, and augmented were mechanically tested to fracture; then, experimental stiffness and fracture strength values were measured. Outcomes of this study showed no significant difference between the elastic modulus equations at the two testing speeds. Areal bone mineral density measured by dual x-ray absorptiometry (DXA/BMD) explained only 53% variability (R2 = 0.53) in fracture strength outcomes. However, QCT/FEA could explain 70% of the variability (R2 = 0.70) in experimentally measured fracture strength values. Adding disk degeneration grading, testing speed, and sex to QCT/FEA-estimated fracture strength values further increased the performance of our statistical model by 14% (adjusted R2 of 0.84 between the prediction and experimental fracture forces). In summary, our results indicated that a single-vertebra model, which is computationally less expensive and more time efficient, is capable of estimating fracture outcomes with acceptable performance (range: 70-84%).


Assuntos
Fraturas por Compressão , Fraturas da Coluna Vertebral , Absorciometria de Fóton , Densidade Óssea , Análise de Elementos Finitos , Fraturas por Compressão/diagnóstico por imagem , Humanos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral
16.
Int J Infect Dis ; 111: 354-359, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34487853

RESUMO

OBJECTIVE: To analyze the clinical and laboratory characteristics of vertebral osteomyelitis in community-acquired bacterial meningitis patients. METHODS: All episodes of vertebral osteomyelitis in a cohort study of adult patients with community-acquired bacterial meningitis in the Netherlands were analyzed. Subsequently, a systematic review of published cases was performed. RESULTS: Between March 2006 and August 2018, 10 of 1974 (0.5%) meningitis patients were diagnosed with vertebral osteomyelitis. The median age was 70 years (interquartile range (IQR) 54-74 years); six (60%) were male and four (40%) were female. The median time between diagnosis of bacterial meningitis and vertebral osteomyelitis was 6 days (IQR 1-13 days). The most common presenting symptoms were back or neck pain, occurring in seven patients (70%); one patient presented with neurological deficits due to cauda equina compression. Streptococcus pneumoniae was the causative pathogen in five patients and Staphylococcus aureus in three. The literature review identified 32 additional cases, showing a similar distribution by age, sex, and pathogen. Seven (18%) of 40 patients from the series presented here and those reported in the literature died. CONCLUSIONS: Concomitant vertebral osteomyelitis is rare in community-acquired bacterial meningitis patients. Persisting back pain is a clue to the diagnosis and should prompt magnetic resonance imaging of the spine, because prolonged antibiotic treatment or surgical treatment may be indicated.


Assuntos
Meningites Bacterianas , Osteomielite , Infecções Estafilocócicas , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Meningites Bacterianas/complicações , Meningites Bacterianas/diagnóstico , Pessoa de Meia-Idade , Osteomielite/diagnóstico , Coluna Vertebral
17.
Turk Neurosurg ; 31(5): 795-802, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34374984

RESUMO

AIM: To describe a new pedicle screw insertion technique, a modification of the funnel technique, and to compare this technique with conventional freehand screw insertion regarding their accuracy and complications in the thoracic spine. MATERIAL AND METHODS: Three hundred forty-three patients who underwent a posterior spinal fusion with different etiologies were retrospectively analyzed. In 84 patients, pedicle screws were placed using the freehand technique, and in 259 patients, the modified funnel technique was used. Screw malposition was evaluated in the immediate and final follow-up in anteroposterior and lateral spinal radiographs by two independent observers. The rates of incorrect pedicle screws and complications, surgical duration, and estimated blood loss were compared between the groups. RESULTS: A total of 6141 pedicle screws (1468 in the freehand group, 4673 in the modified funnel group) were evaluated. The rate of incorrect pedicle screws was higher in the freehand group (12.0% vs. 4.6%, p=0.001). The surgical time was shorter in the modified funnel group (190.9 ± 57.0 vs. 174.1 ± 47.6 min; p=0.017). The estimated blood loss was similar between the groups (1391.50 ± 570.01 vs. 1264.13 ± 602.29 mL; p=0.053). There were 82 intraoperative pedicle fractures but no neurologic complications in either group. CONCLUSION: The modified funnel technique provides more accurate pedicle screw insertion in the thoracic spine in the presence of dysplastic pedicles in conjunction with axial rotation compared with the freehand technique. Furthermore, surgical time may be reduced without increasing blood loss.


Assuntos
Parafusos Pediculares , Fusão Vertebral , Humanos , Radiografia , Estudos Retrospectivos , Coluna Vertebral , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia
18.
Int J Mol Sci ; 22(16)2021 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-34445514

RESUMO

Oxaliplatin, a well-known chemotherapeutic agent, can induce severe neuropathic pain, which can seriously decrease the quality of life of patients. JI017 is an herb mixture composed of Aconitum carmichaelii, Angelica gigas, and Zingiber officinale. Its anti-tumor effect has been reported; however, the efficacy of JI017 against oxaliplatin-induced allodynia has never been explored. Single oxaliplatin injection [6 mg/kg, intraperitoneal, (i.p.)] induced both cold and mechanical allodynia, and oral administration of JI017 (500 mg/kg) alleviated cold but not mechanical allodynia in mice. Real-time polymerase chain reaction (PCR) analysis demonstrated that the upregulation of mRNA of spinal transient receptor potential vanilloid 1 (TRPV1) and astrocytes following oxaliplatin injection was downregulated after JI017 treatment. Moreover, TRPV1 expression and the activation of astrocytes were intensely increased in the superficial area of the spinal dorsal horn after oxaliplatin treatment, whereas JI017 suppressed both. The administration of TRPV1 antagonist [capsazepine, intrathecal (i.t.), 10 µg] attenuated the activation of astrocytes in the dorsal horn, demonstrating that the functions of spinal TRPV1 and astrocytes are closely related in oxaliplatin-induced neuropathic pain. Altogether, these results suggest that JI017 may be a potent candidate for the management of oxaliplatin-induced neuropathy as it decreases pain, spinal TRPV1, and astrocyte activation.


Assuntos
Astrócitos/metabolismo , Hiperalgesia/tratamento farmacológico , Oxaliplatina/efeitos adversos , Compostos Fitoquímicos/administração & dosagem , Canais de Cátion TRPV/metabolismo , Aconitum/química , Administração Oral , Angelica/química , Animais , Astrócitos/efeitos dos fármacos , Temperatura Baixa , Modelos Animais de Doenças , Regulação para Baixo , Gengibre/química , Hiperalgesia/induzido quimicamente , Hiperalgesia/genética , Hiperalgesia/metabolismo , Camundongos , Compostos Fitoquímicos/farmacologia , Coluna Vertebral/metabolismo , Canais de Cátion TRPV/genética
19.
Med Image Anal ; 73: 102166, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34340104

RESUMO

Vertebral labelling and segmentation are two fundamental tasks in an automated spine processing pipeline. Reliable and accurate processing of spine images is expected to benefit clinical decision support systems for diagnosis, surgery planning, and population-based analysis of spine and bone health. However, designing automated algorithms for spine processing is challenging predominantly due to considerable variations in anatomy and acquisition protocols and due to a severe shortage of publicly available data. Addressing these limitations, the Large Scale Vertebrae Segmentation Challenge (VerSe) was organised in conjunction with the International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI) in 2019 and 2020, with a call for algorithms tackling the labelling and segmentation of vertebrae. Two datasets containing a total of 374 multi-detector CT scans from 355 patients were prepared and 4505 vertebrae have individually been annotated at voxel level by a human-machine hybrid algorithm (https://osf.io/nqjyw/, https://osf.io/t98fz/). A total of 25 algorithms were benchmarked on these datasets. In this work, we present the results of this evaluation and further investigate the performance variation at the vertebra level, scan level, and different fields of view. We also evaluate the generalisability of the approaches to an implicit domain shift in data by evaluating the top-performing algorithms of one challenge iteration on data from the other iteration. The principal takeaway from VerSe: the performance of an algorithm in labelling and segmenting a spine scan hinges on its ability to correctly identify vertebrae in cases of rare anatomical variations. The VerSe content and code can be accessed at: https://github.com/anjany/verse.


Assuntos
Benchmarking , Tomografia Computadorizada por Raios X , Algoritmos , Humanos , Processamento de Imagem Assistida por Computador , Coluna Vertebral/diagnóstico por imagem
20.
Eur J Med Genet ; 64(10): 104307, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34407464

RESUMO

Metaphyseal anadysplasia is a very rare hereditary skeletal dysplasia with onset occurring normally during the second and third years of life, but unlike many other dysplasias, symptoms appear to resolve by adolescence. Two types exist, the more severe form, type 1, with both autosomal dominant and recessive inheritance due to pathogenic variants in MMP13, whilst type 2, an even rarer form is due to biallelic MMP9 variants. To date, only two metaphyseal anadysplasia type 2 families have been reported. We describe a third family, a young boy, born to consanguineous parents, referred at 19 months old for abnormal gait due to bowed legs. Clinical and radiological examination revealed scoliosis, genu varum and metaphyseal abnormalities. A homozygous MMP9 nonsense variant, NM_004994.2:c.1764G>A; p.(Trp588*) was identified. By the age of 39 months, lower limb alignment and metaphyseal features had already significantly improved and scoliosis had disappeared. This case confirms that biallelic MMP9 variants cause this very rare skeletal dysplasia, metaphyseal anadysplasia type 2 but also shows that the skeletal manifestations can improve within a short period time and at an early age.


Assuntos
Deformidades Congênitas dos Membros/genética , Osteocondrodisplasias/genética , Ossos da Extremidade Inferior/diagnóstico por imagem , Pré-Escolar , Códon sem Sentido , Marcha , Humanos , Deformidades Congênitas dos Membros/diagnóstico por imagem , Deformidades Congênitas dos Membros/patologia , Masculino , Metaloproteinase 9 da Matriz/genética , Osteocondrodisplasias/diagnóstico por imagem , Osteocondrodisplasias/patologia , Fenótipo , Coluna Vertebral/diagnóstico por imagem
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