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1.
Zhonghua Wai Ke Za Zhi ; 58(3): 161-164, 2020 Mar 01.
Artigo em Chinês | MEDLINE | ID: mdl-32187918

RESUMO

Vertebral compression fractures(VCFs) are severe and common complications of osteoporosis. Most VCFs were caused by osteopenia or osteoporosis. Nevertheless, spinal metastases probably result in pathological fractures that easily confused with osteoporotic vertebral compression fractures(OVCFs). Using biopsy during vertebral augmentation(VA) is considered as the golden standard protocol to rule out pathological VCFs. Up to data, conventionally using biopsy during VA is suggested by more and more researchers to confirm the etiology of VCFs and to avoid missed diagnosis and misdiagnosis of spinal metastases with pathological vertebral fractures as the first manifestation. For patients with spinal metastases, histological evaluation of vertebral biopsy specimens is convenient for further treatment.


Assuntos
Fraturas por Compressão/cirurgia , Osteoporose/complicações , Fraturas da Coluna Vertebral/cirurgia , Biópsia , Fraturas por Compressão/etiologia , Humanos , Fraturas da Coluna Vertebral/etiologia , Coluna Vertebral/patologia , Resultado do Tratamento
2.
Medicine (Baltimore) ; 99(4): e18789, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977870

RESUMO

Clinical features of extremity fractures (EFs) in patients presenting with traumatic spinal fractures (TSFs) and spinal cord injury (SCI) have not been investigated. To investigate the clinical features and risk factors for EFs in patients presenting with TSFs and SCI.Data from 1392 patients presenting with TSFs and SCI in our hospitals between 2001 and 2010 were retrospectively reviewed, among which 165 patients (129 males and 36 females, 37.5 ±â€Š10.6 years old) presented with EFs. The clinical features of EFs have been investigated.The frequencies of upper limb fractures were significantly higher in the motor vehicle collisions (MVCs) group than in the high-fall group (P = .012) and the struck-by-object group (P = .002). The frequencies of lower limb fractures were significantly higher in the struck-by-object group (P = .019) and the high-fall group (P = .011) than the MVCs group. Univariate logistic regression analysis show that being in the 19 to 39 age group (P = .001), having a lumbar spinal fracture (P < .001) and experiencing a high fall (P < .001) were risk factors for EFs. Multivariate logistic regression analysis showed that we should focus on the factors that having a lumbar spinal fracture and experiencing a high fall.High fall and MVCs were the most common aetiologies for EFs. Having a lumbar spinal fracture and experiencing a high fall were significant risk factors for EFs. We should make early diagnoses and initiate timely treatment according to different patterns of extremity fractures in patients with TSFs and SCI.


Assuntos
Fraturas Ósseas/epidemiologia , Extremidade Inferior/lesões , Fraturas da Coluna Vertebral/epidemiologia , Extremidade Superior/lesões , Acidentes/estatística & dados numéricos , Adulto , Fatores Etários , Feminino , Fraturas Ósseas/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fraturas da Coluna Vertebral/etiologia
3.
Zhonghua Wai Ke Za Zhi ; 57(12): 951-955, 2019 Dec 01.
Artigo em Chinês | MEDLINE | ID: mdl-31826602

RESUMO

The majority of cervical spine injuries in children occur in the upper cervical spine, of which odontoid fracture is the most common. Odontoid fracture in children is a very insidious injury. Due to the unclear language and incompatible physical examination, the disease is often missed diagnosis. Because the child axis is still in the developmental segment, including 4 synchondrosis and 6 ossification centers, there are obvious anatomical and biological differences between the child odontoid fracture and the adult. Therefore, the choice of treatment is different from that of adults. This article will introduce the development of odontoid in children, and summarize the injury characteristics, clinical classification and treatment of odontoid fracture in children.


Assuntos
Processo Odontoide/lesões , Fraturas da Coluna Vertebral/diagnóstico , Fraturas da Coluna Vertebral/terapia , Adulto , Pesquisa Biomédica , Criança , Humanos , Lesões do Pescoço/complicações , Fraturas da Coluna Vertebral/classificação , Fraturas da Coluna Vertebral/etiologia
4.
Maturitas ; 130: 13-20, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31706431

RESUMO

OBJECTIVES: To investigate the association between hand-grip strength and site-specific risks of major osteoporotic fracture. STUDY DESIGN: Prospective cohort study. MAIN OUTCOME: Associations between low hand-grip strength and increased risk of fracture at the distal forearm, vertebrae, and hip. MEASURES: We enrolled 1342 postmenopausal women aged 50 years or more into baseline and follow-up surveys of the Japanese Population-based Osteoporosis Cohort Study in 1996, 1999, 2002, or 2006. Fracture events were ascertained by follow-up surveys until 2011 or 2012. The Cox proportional hazards model was used to estimate hazard ratios (HRs) of hand-grip strength on fracture event. RESULTS: During a median follow-up of 15.2 years, 162 women sustained at least one osteoporotic fracture and 135 of these women sustained at least one major osteoporotic fracture, the larger group including 65, 38, 35, and 8 women with fractures of the distal forearm, vertebrae, hip, and proximal humerus, respectively. In the crude models, the associations between low hand-grip strength and increased risk of fracture at the distal forearm, vertebrae, and hip were significant; the HRs (95% confidence interval) of the lowest tertile of hand-grip strength were 2.02 (1.10-3.71), 11.35 (4.07-31.63), and 4.72 (1.79-12.47), respectively. Age adjustment attenuated the significance of hip fracture risk, and adjusting for bone mineral density attenuated the significance of distal forearm fracture risk. After additional adjustment for body mass index, history of diabetes mellitus, and calcium intake, the HR for vertebral fracture risk was 4.55 (1.56-13.27). When limiting the follow-up period to 5 and 10 years, low hand-grip strength was associated with an increased risk of distal forearm fracture independently of the aforementioned covariates; the HRs were 4.22 (1.12-15.95) and 2.52 (1.03-6.17), respectively. CONCLUSIONS: Low hand-grip strength is specifically associated with the risk of distal forearm fractures within 10 years and clinical vertebral fractures within 15 years or more in Japanese postmenopausal women.


Assuntos
Força da Mão , Fraturas do Quadril/epidemiologia , Fraturas por Osteoporose/epidemiologia , Fraturas do Rádio/epidemiologia , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Ulna/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Densidade Óssea , Feminino , Seguimentos , Fraturas do Quadril/etiologia , Humanos , Japão/epidemiologia , Pessoa de Meia-Idade , Osteoporose/complicações , Pós-Menopausa , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fraturas do Rádio/etiologia , Fatores de Risco , Fraturas da Coluna Vertebral/etiologia , Fatores de Tempo , Fraturas da Ulna/etiologia
6.
Medicine (Baltimore) ; 98(44): e17776, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689843

RESUMO

RATIONALE: To our knowledge, this is the first report of traumatic combined vertical atlanto-occipital dislocation (AOD) and atlanto-axial dislocation (AAD) with 2-part fracture of the atlas. PATIENT CONCERNS: The first case was of a 31-year-old woman admitted to the emergency room comatose after a traffic accident. The second case was of a 21-year-old woman admitted to the emergency room comatose after a fall. DIAGNOSES: Traumatic combined vertical AOD and AAD with 2-part fractures of the atlas was diagnosed using plain radiography, 2-dimensional computed tomography, and/or magnetic resonance imaging of the cervical spine. INTERVENTION: The first patient received immediate intubation and cardiopulmonary resuscitation in the emergency room. The second patient also received immediate intubation in the emergency room. After her vitals stabilized, she underwent occipitocervical fusion with instrumentation. OUTCOMES: The first patient died 2 days after the accident. The second patient remained quadriplegic in a ventilatory-dependent state at 1 year after surgery. She continues to receive comprehensive rehabilitation. LESSONS: Immediate respiratory support and surgical stabilization are important for saving lives in this kind of extremely unstable and fatal complex upper cervical spine injury.


Assuntos
Articulação Atlantoaxial/lesões , Articulação Atlantoccipital/lesões , Atlas Cervical/lesões , Luxações Articulares/cirurgia , Fraturas Cranianas/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Acidentes por Quedas , Acidentes de Trânsito , Adulto , Articulação Atlantoaxial/cirurgia , Articulação Atlantoccipital/cirurgia , Atlas Cervical/cirurgia , Feminino , Humanos , Luxações Articulares/etiologia , Fraturas Cranianas/etiologia , Fraturas da Coluna Vertebral/etiologia , Fusão Vertebral/métodos , Adulto Jovem
7.
Pan Afr Med J ; 34: 26, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31762894

RESUMO

Introduction: Road traffic accidents (RTAs) are the most frequent cause of traumatic spinal injuries (TSIs), which account for up to 33.6% of all spinal fractures. The Kingdom of Saudi Arabia (KSA) is one of the countries which has high rates of SCIs and bears the economic burden of that situation. Methods: 120 patients were included in this study, using a stringent set of inclusion and exclusion criteria. The patients were followed-up from the point of triage to admission and discharge. We analysed the clinical notes of the patients to determine the severity of their traumatic spinal injuries, the neurosurgical management carried out, and other prognosticating factors such as blood transfusion and the Glasgow Coma Scale (GCS). The data collected was analysed anonymously, and the confidentiality of all participants was respected. Results: Most of the patients were young adults and adolescents under the age of 40 (n = 96). There was a male preponderance of 84.1%. With respect to spinal injury stratification, 55 patients had cervical spine fractures, 10 patients had cervical lacerations, 85 patients had thoracolumbar spinal fractures, and 10 patients had thoracolumbar spinal lacerations. 35 patients had other fractures documented. All 120 patients were followed up to assess the management of their traumatic spinal injuries. 66.6% (n= 80) of all patients were managed conservatively, whereas the remaining 33.3% (n=40) were managed surgically. Conclusion: Trauma is an important cause of spinal injuries (TSIs), and untreated TSIs may lead to poor clinical outcome, especially if the cervical region is involved.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Fraturas da Coluna Vertebral/epidemiologia , Traumatismos da Coluna Vertebral/epidemiologia , Adolescente , Adulto , Criança , Pré-Escolar , Estudos Transversais , Feminino , Seguimentos , Escala de Coma de Glasgow , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Arábia Saudita/epidemiologia , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/terapia , Traumatismos da Coluna Vertebral/etiologia , Traumatismos da Coluna Vertebral/terapia , Adulto Jovem
8.
Medicine (Baltimore) ; 98(43): e17666, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651894

RESUMO

RATIONALE: Traumatic AOD is rare but highly associated with upper cervical spine injuries. We found no references in the literature of traumatic posterior atlantooccipital dislocation (AOD) combined with type II dens fracture (Anderson-D'Alonzo classification) and C1 anterior arch fracture. PATIENT CONCERNS: The first case was a 93-year-old male patient who was admitted to the Emergency Department complaining of incomplete quadriplegia after a fall from a height. The second was a 53-year-old male patient who visited the emergency department complaining of posterior neck pain following a high-speed motor vehicle collision. DIAGNOSIS: Reconstructed computed tomography (CT) scans clearly demonstrated posterior AOD combined with type II dens fracture and C1 anterior arch fracture. In addition, magnetic resonance imaging (MRI) also revealed type II transverse atlantal ligament injury (Dickman's classification) in the first patient. INTERVENTIONS: The patients chose not to undergo surgery; instead, they were immobilized with a rigid cervical brace. OUTCOMES: The patients were lost to follow-up. LESSONS: A thorough clinical evaluation and radiologic investigation (CT and MRI) on concomitant upper cervical injuries should be evaluated in traumatic AOD patients.


Assuntos
Articulação Atlantoaxial/lesões , Braquetes , Vértebras Cervicais/lesões , Luxações Articulares/terapia , Fraturas da Coluna Vertebral/terapia , Acidentes por Quedas , Acidentes de Trânsito , Idoso de 80 Anos ou mais , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/etiologia , Masculino , Pessoa de Meia-Idade , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/etiologia , Tomografia Computadorizada por Raios X
9.
Orthopade ; 48(10): 879-896, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31511916

RESUMO

Atraumatic fractures of the spine are a common orthopedic disease condition that can be asymptomatic or associated with complaints of varying intensity and quality. The risk factors for such fracture forms are often metabolic and genetic diseases, which have a direct or indirect effect on bone metabolism and therefore secondarily affect the stability of the spinal vertebrae. Furthermore, benign and malignant tumors as well as infectious diseases can also be causative for atraumatic spinal fractures; however, those factors that are attributable to lifestyle habits should also not be underestimated. The treatment of affected patients is complex and nearly always interdisciplinary. In addition to purely symptom-oriented treatment concepts, orthoses in particular and when indicated surgical treatment procedures can be implemented. This article summarizes the important clinical, diagnostic and therapeutic aspects of atraumatic spinal fractures.


Assuntos
Aparelhos Ortopédicos , Fraturas da Coluna Vertebral/diagnóstico , Coluna Vertebral , Discite/complicações , Humanos , Vértebras Lombares , Fatores de Risco , Fraturas da Coluna Vertebral/etiologia
10.
BMC Musculoskelet Disord ; 20(1): 399, 2019 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-31472671

RESUMO

BACKGROUND: Bone loss with aging and menopause increases the risk of fragile vertebral fracture, osteoporotic vertebral compression fracture (OVCF). The fracture causes severe pain, impedes respiratory function, lower the quality of life, and increases the risk of new fractures and deaths. Various medications have been prescribed to prevent a secondary fracture, but few study summarized their effects. Therefore, we investigated their effects on preventing subsequent OVCF via meta-analyses of randomized controlled trials. METHODS: Electronic databases, including MEDLINE, EMBASE, CENTRAL, and Web of Science were searched for published randomized controlled trials from June 2015 to June 2019. The trials that recruited participants with at least one OVCF were included. We assessed the risk of bias of every study, estimated relative risk ratio of secondary OVCF, non-vertebral fracture, gastrointestinal complaints and discontinuation due to adverse events. Finally, we evaluated the quality of evidence. RESULTS: Forty-one articles were included. Moderate to high quality evidence proved the effectiveness of zoledronate (Relative Risk, RR: 0.34; 95% CI, 0.17-0.69, p = 0.003), alendronate (RR: 0.54; 95% CI: 0.43-0.68; p < 0.0001), risedronate (RR: 0.61; 95% CI: 0.51-0.73; p < 0.0001), etidronate (RR, 0.50; 95% CI, 0.29-0.87, p < 0.01), ibandronate (RR: 0.52; 95% CI: 0.38-0.71; p < 0.0001), parathyroid hormone (RR: 0.31; 95% CI: 0.23-0.41; p < 0.0001), denosumab (RR, 0.41; 95% CI, 0.29-0.57; p < 0.0001) and selective estrogen receptor modulators (Raloxifene, RR: 0.58; 95% CI: 0.44-0.76; p < 0.0001; Bazedoxifene, RR: 0.66; 95% CI: 0.53-0.82; p = 0.0002) in preventing secondary fractures. Moderate quality evidence proved romosozumab had better effect than alendronate (Romosozumab vs. alendronate, RR: 0.64; 95% CI: 0.49-0.84; p = 0.001) and high quality evidence proved that teriparatide had better effect than risedronate (risedronate vs. teriparatide, RR: 1.98; 95% CI: 1.44-2.70; p < 0.0001). CONCLUSION: Zoledronate, alendronate, risedronate, etidronate, ibandronate, parathyroid hormone, denosumab and selective estrogen receptor modulators had significant secondary prevention effects on OVCF. Moderate quality evidence proved romosozumab had better effect than alendronate. High quality evidence proved PTH had better effect than risedronate, but with higher risk of adverse events.


Assuntos
Conservadores da Densidade Óssea/administração & dosagem , Fraturas por Compressão/prevenção & controle , Osteoporose/complicações , Fraturas por Osteoporose/prevenção & controle , Fraturas da Coluna Vertebral/prevenção & controle , Conservadores da Densidade Óssea/efeitos adversos , Fraturas por Compressão/epidemiologia , Fraturas por Compressão/etiologia , Gastroenteropatias/induzido quimicamente , Gastroenteropatias/epidemiologia , Humanos , Oligopeptídeos , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/etiologia , Prevalência , Ensaios Clínicos Controlados Aleatórios como Assunto , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/etiologia , Suspensão de Tratamento/estatística & dados numéricos
11.
BMJ Case Rep ; 12(8)2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31471360

RESUMO

Running is one of the most popular sports worldwide. Studies suggest that 11%-85% of recreational runners have at least one running-related injury (RRI) each year, resulting in a reduction or interruption in training. A high risk for running-related injuries (RRIs) represents an important inconvenience counterbalancing the beneficial effects of running. RRIs primarily affect the joints of the lower limb and lumbar spine. Noteworthy, in some cases, the clinical presentation of signs and symptoms is confusing and may hide serious conditions; thus, clinicians have to pay special attention when potential factors arise, such as the presence of red flags. As reported in this case report, patients can present with low back pain (LBP) as a primary problem, mimicking a red flag such as a fracture of the spine. The aim of this case report was to describe a case of a recreational runner presenting with LBP as the sole symptom of an underlying thoracolumbar fracture.


Assuntos
Dor Lombar/diagnóstico , Vértebras Lombares/lesões , Corrida/lesões , Fraturas da Coluna Vertebral/diagnóstico , Vértebras Torácicas/lesões , Adulto , Diagnóstico Diferencial , Humanos , Dor Lombar/etiologia , Masculino , Programas de Rastreamento/métodos , Modalidades de Fisioterapia , Fraturas da Coluna Vertebral/etiologia
12.
Eur J Endocrinol ; 181(5): 509-517, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31484162

RESUMO

Introduction: The role of vitamin D on bone microarchitecture and fragility is not clear. Objective: To investigate whether vitamin D deficiency (25(OH)D <20 ng/mL) increases cortical bone loss and the severity of fractures. Design: Cross-sectional study of 287 elderly women with at least one prevalent low-impact fracture. Methods: Biochemistry, X-rays to identify vertebral fractures (VFs) and to confirm non-vertebral fractures (NonVFs), and high-resolution peripheral quantitative computed tomography (HR-pQCT) to evaluate bone microstructure. Results: Serum 25(OH)D levels were associated with body mass index (BMI: r = -0.161, P = 0.006), PTH (r = -0.165; P = 0.005), CTX (r = -0.119; P = 0.043) and vBMD at cortical bone (Dcomp: r = 0.132; P = 0.033) and entire bone (D100: r = 0.162 P = 0.009) at the distal radius, but not at the tibia. Age and PTH levels were potential confounding variables, but in the multiple linear regressions only BMI (95% CI: 0.11-4.16; P < 0.01), 25(OH)D (95% CI: -0.007 to 1.70; P = 0.05) and CTX (95% CI: -149.04 to 21.80; P < 0.01) predicted Dcomp, while BMI (95% CI: 1.13-4.18; P < 0.01) and 25(OH)D (95% CI: 0.24-1.52; P < 0.01) predicted D100. NonVFs predominated in patients with 25(OH)D <20 ng/mL (P = 0.013). Logistic regression analysis showed a decrease in the likelihood of presenting grade 2-3 VFs/NonVFs for every increase in 25(OH)D (OR = 0.962, 95% CI: 0.940-0.984; P = 0.001), BMI (OR = 0.932, 95% CI: 0.885-0.981; P = 0.007) and D100 at radius (OR = 0.994, 95% CI: 0.990-0.998; P = 0.005). Conclusion: In elderly patients with prevalent fractures, vitamin D deficiency was associated with cortical bone loss and severity of fractures.


Assuntos
Fraturas Ósseas/epidemiologia , Fraturas Ósseas/etiologia , Osteoporose/epidemiologia , Osteoporose/etiologia , Deficiência de Vitamina D/complicações , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/etiologia , Hormônio Paratireóideo/sangue , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/etiologia
13.
Iowa Orthop J ; 39(1): 77-80, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31413678

RESUMO

Background: Vertebral fracture after posterior arthrodesis and instrumentation for idiopathic scoliosis is a rare occurrence with limited reported cases in the literature. Case Presentation: A 16-year-old female patient surgically treated for adolescent idiopathic scoliosis with T2-L1 posterior spinal fusion was in a low-energy fall resulting in fracture of L1 and new kyphosis and scoliosis of the thoracolumbar spine at the distal aspect of the fusion. The fracture was initially managed conservatively, however pain persisted and thus she was indicated for extension of the fusion and correction of the post-traumatic kyphosis. Conclusions: Fractures after posterior spinal fusion for idiopathic scoliosis are rare and evidence for the appropriate management remains limited in the literature.Level of Evidence: V.


Assuntos
Acidentes por Quedas , Cifose/cirurgia , Escoliose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , Adolescente , Feminino , Seguimentos , Humanos , Cifose/etiologia , Vértebras Lombares/lesões , Vértebras Lombares/cirurgia , Radiografia Torácica/métodos , Reoperação/métodos , Medição de Risco , Escoliose/diagnóstico , Escoliose/etiologia , Fraturas da Coluna Vertebral/etiologia , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia , Resultado do Tratamento
14.
Cardiovasc Intervent Radiol ; 42(12): 1726-1737, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31444627

RESUMO

INTRODUCTION: To evaluate the long-term consolidation of vertebral metastases (VM) after preventive vertebroplasty (PV) and to report risk factors of pathological fracture despite PV. MATERIALS AND METHODS: Files of 100 consecutives cancer patients referred for PV of VM were retrospectively analyzed. We enumerated 215 VM at the time of the PV procedure (T0): 138 VM were considered at risk of pathological fracture and had PV (treated-VM), and 77 VM were not cemented. We compared the VM characteristics using the spine instability neoplastic score (SINS) at T0 and the rate of pathologic fracture between treated-VM and untreated-VM using Kaplan-Meier method. We analyzed risk factors of pathological fracture despite PV using treated-VM characteristics and quality of cement injection criteria. RESULTS: Despite a lower SINS value at T0 (p < 0.001), the rate of pathological fracture was significantly higher among untreated-VM compared to the treated-VM, (log-rank, p < 0.001). Major risk factors of fracture among treated-VM were: SINS value ≥ 8 (p < 0.012), mechanical pain (p = 0.001), osteolytic lesion (p = 0.033), metastatic vertebral body involvement > 50% with no collapse (p < 0.001) and unilateral posterior involvement by the vertebral metastasis (p = 0.024), Saliou score < 9 (p = 0.008), vertebral metastasis filling with cement < 50% (p = 0.007) and the absence of cement's contact with vertebral endplates (p = 0.014). CONCLUSION: PV is long-term effective for consolidation of VM and must be discussed at the early diagnosed. Quality of cement injection matters, suggesting that techniques that improve the quantity and the quality of cement diffusion into the VM must be developed.


Assuntos
Fraturas Espontâneas/etiologia , Fraturas Espontâneas/prevenção & controle , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/prevenção & controle , Neoplasias da Coluna Vertebral/complicações , Vertebroplastia/métodos , Cimentos para Ossos/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Traumatismos da Coluna Vertebral/prevenção & controle , Neoplasias da Coluna Vertebral/secundário , Coluna Vertebral/cirurgia , Resultado do Tratamento
15.
BMJ Case Rep ; 12(8)2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31451470

RESUMO

A 42-year-old man reported to our service with a 1-week history of vague cervical neck pain on a background history of a gelastic seizure disorder. Radiological imaging confirmed a type II hangman's fracture through the C2 pedicle. A CT angiogram of carotid and vertebral arteries was normal, and the patient was managed with an occipitocervical fusion. The patient had no neurological insult and was discharged on day 5 with a Miami-J collar for 6 weeks. Although there are case report evidence of lumbar and thoracic vertebral fractures secondary to seizures, this is the first report of a spine injury resulting from a gelastic seizure.


Assuntos
Vértebras Cervicais , Epilepsias Parciais/complicações , Cervicalgia/diagnóstico , Fraturas da Coluna Vertebral , Fusão Vertebral/métodos , Adulto , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/lesões , Epilepsias Parciais/diagnóstico , Humanos , Masculino , Cervicalgia/etiologia , Exame Neurológico/métodos , Fraturas da Coluna Vertebral/diagnóstico , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
16.
Obstet Gynecol Clin North Am ; 46(3): 541-552, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31378294

RESUMO

Osteoporosis is a common condition among postmenopausal women. Women 65 years and older should receive bone mineral testing; younger women should undergo risk assessment using a formal risk assessment tool to determine if they should receive bone density testing. Many pharmacologic agents are available to treat women with osteoporosis on bone density testing. Women with previous hip or vertebral fractures should also receive osteoporosis pharmacotherapy.


Assuntos
Densidade Óssea/fisiologia , Osteoporose/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Conservadores da Densidade Óssea/uso terapêutico , Feminino , Fraturas do Quadril/etiologia , Fraturas do Quadril/prevenção & controle , Humanos , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Osteoporose/complicações , Osteoporose/tratamento farmacológico , Medição de Risco , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/prevenção & controle
17.
Pain Res Manag ; 2019: 9292617, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31281560

RESUMO

Introduction: Osteoporotic vertebral fracture treatment options include vertebroplasty, in which development of new fractures is among the possible complications which may develop during the postoperative period. We aim to evaluate whether or not postoperative mobilization time has effect on occurrence of new fractures. Materials and Methods: A total of 126 patients, consisting of 30 (39.7%) males and 96 (60.3%) females, who underwent sedation-assisted vertebroplasty under local anesthesia between January 2014 and June 2017 were retrospectively evaluated. Preoperative and postoperative visual analogue scores (VASs) and mobilization time (hours) were assessed. Day of new fracture occurrence during follow-up was assessed. Results: The mean follow-up period was 9 months (7-13 months). The most common fracture segment was the L1 vertebra (15.9%). The preoperative VAS was 8.29 ± 0.95, and the postoperative VAS was 2.33 ± 0.91. The change in VAS was statistically significant (p=0.01, p < 0.05). Of all the patients, 21 (16.66%) had developed new fractures. No statistical difference was observed between mobilization time (hours) and formation of new fractures (p=0.48, p > 0.05). Conclusion: We came to the conclusion that mobilization time (hours) was not a risk factor in the development of new fractures. In addition, there is no relationship between mobilization time and localization of new fractures.


Assuntos
Deambulação Precoce/efeitos adversos , Fraturas por Osteoporose/etiologia , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia , Idoso , Feminino , Fraturas por Compressão/etiologia , Fraturas por Compressão/cirurgia , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Recidiva , Estudos Retrospectivos , Fatores de Tempo
18.
Artigo em Inglês | MEDLINE | ID: mdl-31323765

RESUMO

A quasi-experimental pilot study was performed to determine the feasibility and safety of an Adapted Physical Activity (APA) protocol and its effect on health-related quality of life (HRQOL), fear of falling, pain, and physical performance in women with osteoporosis-related vertebral fractures. Forty-four post-menopausal women (mean age: 67.6 ± 4.6) with osteoporotic vertebral fractures were assigned to an exercise group (APA group = 26) who attended a six-month exercise protocol that included postural and muscular reinforcement exercises, and a control group (CG = 18) who was asked to maintain their current lifestyle. At baseline and six months after baseline, HRQOL was measured as primary outcome by the Assessment of Health Related Quality of Life in Osteoporosis (ECOS-16) questionnaire. Secondary outcomes were fear of falling (Fall Efficacy Scale International, FES-I), lumbar back pain (Visual Analogue Scale-VAS), functional exercise capacity (Six Minutes Walking Test-6MWT, Borg scale), balance and gait (Tinetti Scale), and flexibility of the column (Chair Sit-and-Reach). The effects of the intervention were analyzed by comparison within groups and between groups. Effect sizes (ES) were calculated using Cohen's d. All the outcomes significantly improved in the APA group, while they remained unchanged in the CG. After adjustment for unbalanced variables, the comparison between groups showed significant effects of the intervention for ECOS-16-score, functional exercise capacity, balance, and gait. The exercise program had big effect sizes on HRQOL (ES = 1.204), fear of falling (ES = 1.007), balance (ES = 0.871), and functional exercise capacity (ES = 1.390). Good adherence (75.8%) and no injuries were observed. Due to its feasibility, safety, and effectiveness, the proposed exercise protocol can be adopted in APA programs addressed to patients with osteoporosis-related vertebral fractures.


Assuntos
Terapia por Exercício/métodos , Exercício/fisiologia , Osteoporose/complicações , Fraturas da Coluna Vertebral/prevenção & controle , Acidentes por Quedas/prevenção & controle , Idoso , Tolerância ao Exercício , Medo , Estudos de Viabilidade , Feminino , Fraturas Ósseas , Marcha , Humanos , Dor Lombar/prevenção & controle , Pessoa de Meia-Idade , Projetos Piloto , Equilíbrio Postural , Qualidade de Vida , Prevenção Secundária , Fraturas da Coluna Vertebral/etiologia , Inquéritos e Questionários
19.
Spine (Phila Pa 1976) ; 44(23): 1661-1667, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31348180

RESUMO

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: Compare a novel two-step algorithm for indicating a computed tomography angiography (CTA) in the setting of a cervical spine fracture with established gold standard criteria. SUMMARY OF BACKGROUND DATA: As CTA permits the rapid detection of blunt cerebrovascular injuries (BCVI), screening criteria for its use have broadened. However, more recent work warns of the potential for the overdiagnosis of BCVI, which must be considered with the adoption of broad criteria. METHODS: A novel two-step metric for indicating CTA screening was compared with the American College of Surgeons guidelines and the expanded Denver Criteria using patients who presented with cervical spine fractures to a tertiary-level 1 trauma center from January 1, 2012 to January 1, 2016. The ability for each metric to identify BCVI and posterior circulation strokes that occurred during this period was assessed. RESULTS: A total of 721 patients with cervical fractures were included, of whom 417 underwent CTAs (57.8%). Sixty-eight BCVIs and seven strokes were diagnosed in this cohort. All algorithms detected an equivalent number of BCVIs (52 with the novel metric, 54 with the ACS and Denver Criteria, P = 0.84) and strokes (7/7, 100% with the novel metric, 6/7, 85.7% with the ACS and Denver Criteria, P = 1.0). However, 63% fewer scans would have been needed with the proposed screening algorithm compared with the ACS or Denver Criteria (261/721, 36.2% of all patients with our criteria vs. 413/721, 57.3% with the ACS standard and 417/721, 57.8%) with the Denver Criteria, P < 0.0002 for each). CONCLUSION: A two-step criterion based on mechanism of injury and patient factors is a potentially useful guide for identifying patients at risk of BCVI and stroke after cervical spine fractures. Further prospective analyses are required prior to widespread clinical adoption. LEVEL OF EVIDENCE: 4.


Assuntos
Traumatismo Cerebrovascular/diagnóstico por imagem , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/lesões , Angiografia por Tomografia Computadorizada/métodos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Traumatismo Cerebrovascular/complicações , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fraturas da Coluna Vertebral/etiologia
20.
BMC Surg ; 19(1): 99, 2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31349822

RESUMO

BACKGROUND: Ankylosing spondylitis (AS) is a chronic inflammatory disease that primarily affects spine and paraspinal soft tissue. Ankylosing spondylitis is one of the causes of osteoporosis and patients with ankylosing spondylitis tend to have spinal fractures due to limited mobility and osteoporosis. In recent years, due to the increase in the number of patients with AS, patients with AS and thoracolumbar spine fractures have gradually increased. In the past 1 year, we have treated 3 cases of AS with thoracolumbar spine fractures via simple posterior internal fixation and this paper aims to report its clinic effect. CASE PRESENTATION: All the three patients selected had a history of ankylosing spondylitis for nearly 30 years, and one of them developed a thoracolumbar spine fracture after falling when he walked, and the other two developed a thoracolumbar spine fracture without any reason. They were hospitalized for "low back pain" and were diagnosed as fractures after careful physical examination and imaging examinations such as X-ray, CT, and MRI. After the preoperative preparation was completed, all the three patients underwent surgery with simple posterior internal fixation-reduction of the fracture and pedicle screw fixation via posterior approach. All the implants-pedicle screws and connecting rods-are made of titanium alloy. For postoperative management, we asked all the patients to stay in bed for 3 weeks after the operation, and then slowly move down with the help of crutches. Fracture healing and neurological function recovery were observed postoperatively. All the three patients recovered satisfactorily after surgery, and the follow-up confirmed that the fracture healed successfully after 3 months. CONCLUSIONS: The 3 patients included 2 men and 1 women. All the 3 patients recovered well after surgery, and the follow-up confirmed that the fracture healed successfully after 3 months. One man developed urination dysfunction after operation and recovered to normal 3 months after rehabilitation exercise.


Assuntos
Fixação Interna de Fraturas/métodos , Vértebras Lombares/lesões , Fraturas da Coluna Vertebral/cirurgia , Espondilite Anquilosante/complicações , Vértebras Torácicas/lesões , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Fraturas da Coluna Vertebral/etiologia , Vértebras Torácicas/cirurgia
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