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2.
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
3.
Tunis Med ; 97(3): 512-515, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31729729

RESUMO

Tuberculosis of the cervical spine is a rare extra-pulmonary localization. We reported the case of a 59-year-old woman with no medical history. She consulted for a 9 weeks history of painful cervical stiffness. Neurological examination was normal. Plain radiography revealed an osteolytic lesion of the C3 body, with infiltration of adjacent soft tissues. MRI showed a compression fracture of the C3 body with a signal anomaly extending to the anterior epidural space and pre-vertebral soft tissues. First, tumoral extension assessment was done and was normal. BK's research into sputum was negative. Histological examination of a CT biopsy revealed typical granulomatous inflammation. The diagnosis of tuberculosis was retained and antituberculous treatment was started with immobilization for 12 months. The patient had a total functional recovery at 18 months follow-up, with complete radiographic bone reconstruction of C3 after 12 months.


Assuntos
Vértebras Cervicais/patologia , Tuberculose da Coluna Vertebral/diagnóstico , Antituberculosos/uso terapêutico , Vértebras Cervicais/microbiologia , Diagnóstico Diferencial , Feminino , Fixação de Fratura , Fraturas por Compressão/diagnóstico , Fraturas por Compressão/etiologia , Fraturas por Compressão/terapia , Humanos , Imobilização , Pessoa de Meia-Idade , Cervicalgia/diagnóstico , Fraturas da Coluna Vertebral/diagnóstico , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/terapia , Tuberculose da Coluna Vertebral/complicações , Tuberculose da Coluna Vertebral/terapia
4.
Neuroimaging Clin N Am ; 29(4): 481-494, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31677725

RESUMO

Percutaneous vertebroplasty (VP) progressed from a virtually unknown procedure to one performed on hundreds of thousands of patients annually. The development of VP provides a historically exciting case study into a rapidly adopted procedure. VP was the synthesis of information gained from spinal biopsy developments, the inception of biomaterials used in medicine, and the unique health care climate in France during the 1980s. It was designed as a revolutionary technique to treat vertebral body fractures with minimal side effects and was rapidly adopted and marketed in the United States. The impact of percutaneous vertebroplasty on spine surgery was profound.


Assuntos
Fraturas da Coluna Vertebral/economia , Fraturas da Coluna Vertebral/terapia , Vertebroplastia/economia , Vertebroplastia/métodos , Cimentos para Ossos/economia , Cimentos para Ossos/uso terapêutico , Humanos , Polimetil Metacrilato/economia , Polimetil Metacrilato/uso terapêutico
5.
Neuroimaging Clin N Am ; 29(4): 495-513, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31677726

RESUMO

Osteoporotic compression fractures of the vertebral body can result in pain and long-term morbidity, including spinal deformity, with increased risk of mortality resulting from associated complications. Conservative management includes opioids and other analgesics, bed rest, and a back brace. For patients with severe and disabling pain, vertebral augmentation (vertebroplasty and kyphoplasty) is often considered, with these procedures endorsed by multiple professional societies, and provides immediate structural support, and stabilizes and reinforces the weakened bone structure. The purpose of this article is to review the vertebral biomechanics, indications and contraindications, and techniques of performing successful vertebral augmentation.


Assuntos
Fraturas por Compressão/terapia , Fixadores Internos , Fraturas da Coluna Vertebral/terapia , Vertebroplastia/métodos , Cimentos para Ossos/uso terapêutico , Humanos , Cifoplastia , Polimetil Metacrilato/uso terapêutico
6.
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
7.
J Vasc Interv Radiol ; 30(11): 1845-1854, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31587952

RESUMO

PURPOSE: To evaluate the safety and efficacy of sacroplasty for the treatment of osteoporotic and malignant sacral fractures by performing a systematic review and meta-analysis of existing literature. MATERIALS AND METHODS: PubMed, Web of Science, and SCOPUS databases were searched from their inception until February 2018 for articles describing sacroplasty. Inclusion criteria were as follows: studies reporting > 5 patients, and pain assessment before and after the procedure recorded with visual analog scale (VAS). Demographic data, procedural details, technical success rates, VAS scores before and after the procedure, and procedural complications were recorded. A random-effects meta-analyses of the VAS pain score before the procedure, at 24-48 hours, at 6 months, and at 12 months were calculated. RESULTS: Nineteen studies (18 case series and 1 cohort study) were identified consisting of 861 total patients (682 women and 167 men; mean age 73.89 ± 9.73 years). Patients underwent sacroplasty for the following indications: sacral insufficiency fractures secondary to osteoporosis (n = 664), malignancy (n = 167), and nonspecified sacral insufficiency fractures (n = 30). Technical and clinical successes were achieved in 98.9% (852/861) and 95.7% (623/651) of patients undergoing sacroplasty, respectively. The pooled major complication rate was 0.3%, with 3 patients requiring surgical decompression for cement leakage. Random-effects meta-analyses demonstrated statistically significant differences in the VAS pain level at preprocedure, 24-48 hours, 6 months, and 12 months, with cumulative pain scores of 8.32 ± 0.01, 3.55 ± 0.01, 1.48 ± 0.01, and 0.923 ± 0.01, respectively. CONCLUSIONS: Sacroplasty appears safe and effective for pain relief in patients with osteoporotic or malignant sacral fractures, with statistically significant sustained improvement in VAS pain scores up to 12 months.


Assuntos
Dor nas Costas/terapia , Cimentos para Ossos/uso terapêutico , Cementoplastia/métodos , Fraturas por Osteoporose/terapia , Sacro/lesões , Fraturas da Coluna Vertebral/terapia , Idoso , Idoso de 80 Anos ou mais , Dor nas Costas/diagnóstico , Dor nas Costas/etiologia , Cimentos para Ossos/efeitos adversos , Cementoplastia/efeitos adversos , Feminino , Consolidação da Fratura , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/etiologia , Fatores de Risco , Sacro/diagnóstico por imagem , Sacro/patologia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/etiologia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/patologia , Resultado do Tratamento
8.
Z Orthop Unfall ; 157(5): 574-596, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31594004

RESUMO

The basis for assessing thoracolumbar vertebral body fractures are two established classification systems. Important, especially in terms of further treatment, is the distinction between osteoporotic and healthy bones. The AO Spine classification offers a comprehensive tool for healthy bones to reliably specify the morphological criterias (alignment, integrity of the intervertebral disc, fragment separation, stenosis of the spinal canal). In addition to the fracture morphology, the OF classification for osteoporotic fractures includes patient-specific characteristics to initiate adequate therapy. In general an adequate pain therapy is required for early rehabilitation. While in the bone healthy population, physiotherapy reduces the risk of muscle deconditioning, in the osteoporotic population it additionally serves to prevent subsequent fractures. Unlike osteoporotic patients, bone healthy patients with vertebral fractures should not undergo a corset/orthosis treatment.


Assuntos
Tratamento Conservador/métodos , Vértebras Lombares/lesões , Fraturas da Coluna Vertebral/terapia , Vértebras Torácicas/lesões , Educação Médica Continuada , Fraturas por Compressão/terapia , Humanos , Fraturas por Osteoporose/classificação , Fraturas por Osteoporose/terapia , Modalidades de Fisioterapia , Fraturas da Coluna Vertebral/classificação , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico , Traumatismos do Sistema Nervoso/classificação , Traumatismos do Sistema Nervoso/diagnóstico , Traumatismos do Sistema Nervoso/etiologia , Traumatismos do Sistema Nervoso/terapia , Resultado do Tratamento
9.
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
10.
World Neurosurg ; 132: 63-66, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31479787

RESUMO

BACKGROUND: Symptomatic calcification of the ligamentum flavum (CLF) is common in the cervical spine but rare in the thoracic spine. Rapidly progressing CLF in the thoracic spine has not been reported in the literature. CASE DESCRIPTION: A 76-year-old Asian male experienced back pain after a fall and was diagnosed with osteoporotic vertebral fractures at T11 and L1. He was treated conservatively because of the lack of neurologic deficits. Nine months after the initial visit, he complained of progressive incomplete paraplegia. Magnetic resonance imaging and computed tomography of the thoracic spine showed CLF at T11-T12 severely compressing the spinal cord. This finding had not been seen on imaging studies at the initial visit. The patient underwent surgical resection of CLF and posterior instrumented spine fusion. Symptoms of muscle weakness recovered postoperatively. CONCLUSIONS: In this case, sequential imaging studies with a 9-month interval showed evidence of rapidly progressing thoracic CLF. The preceding osteoporotic vertebral fracture may have triggered the development of CLF.


Assuntos
Calcinose/cirurgia , Ligamento Amarelo/cirurgia , Vértebras Lombares/cirurgia , Fraturas por Osteoporose/terapia , Fraturas da Coluna Vertebral/terapia , Vértebras Torácicas/cirurgia , Idoso , Calcinose/complicações , Calcinose/diagnóstico por imagem , Tratamento Conservador , Progressão da Doença , Humanos , Ligamento Amarelo/diagnóstico por imagem , Masculino , Aparelhos Ortopédicos , Fraturas por Osteoporose/complicações , Paraplegia/etiologia , Fraturas da Coluna Vertebral/complicações , Fusão Vertebral , Vértebras Torácicas/lesões , Vertebroplastia
11.
Acta Orthop Traumatol Turc ; 53(6): 402-407, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31521456

RESUMO

OBJECTIVE: The aim of this study was to assess the effect of transverse atlantal ligament (TAL) integrity on clinical and radiological outcomes in patients with unilateral sagittal split fracture (USSF) of the C1 lateral mass (LM). METHODS: Twenty-six consecutive patients (16 men and 10 women; mean age: 52 years (range: 32-69)) with C1 LM USSF were included in this study. Sixteen were TAL injury group (nine of type I injuries and seven of type II injuries according to Dickman's classification) and ten were TAL intact group. All cases were conservatively treated with a rigid brace for TAL intact or by halo-vest stabilization for TAL injury for three months. The mean follow-up was 16 months (range, 12-47 months). The results were compared with radiological assessment of fracture healing, LM displacement and Neck visual analog scale. RESULTS: At the last follow-up, for TAL intact group, total LM displacement (LMD), unilateral LMD of fracture side, atlanto-dental interval, basion-dental interval, clivus canal angle, and atlanto-occipital joint axis angle were maintained compared to initial presentation. However, for TAL injury group, all radiological parameters were worsened. The worsening of radiological parameters was more severe in type I injury than type II injury except for total LMD and unilateral LMD. Neck visual analog scale significantly decreased and patient's satisfaction was higher in TAL intact group compared to TAL injury group. CONCLUSION: Conservative treatment for USSF of C1 LM with TAL injury failed to achieve healing of the fracture, which resulted in lateral displacement of C1 LM. This caused coronal and sagittal malalignment of occipitocervical junction, resulting in unsatisfactory clinical outcomes. Our results suggest that early surgical stabilization should be considered in USSF of C1 LM with TAL injury, especially type I injury. However, conservative treatment may be sufficient for a USSF of the C1 LM with TAL intact. LEVEL OF EVIDENCE: Level III, Therapeutic Study.


Assuntos
Articulação Atlantoaxial/lesões , Braquetes , Tratamento Conservador/métodos , Radiografia/métodos , Fraturas da Coluna Vertebral/terapia , Adulto , Idoso , Articulação Atlantoaxial/diagnóstico por imagem , Feminino , Consolidação da Fratura , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas da Coluna Vertebral/diagnóstico , Resultado do Tratamento
12.
Best Pract Res Clin Rheumatol ; 33(2): 227-235, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-31547980

RESUMO

Approximately 20% of men and women aged 50 years or older will present with a vertebral fragility fracture - a prevalence that steadily increases with age. The condition may be associated with severe pain and disability, significant reductions in overall quality of life, mobility, social participation, sleep quality and increased fear for the future. There is, however, no current consensus on what constitutes the best management of symptomatic vertebral fractures. Moreover, evidence supporting common treatment approaches is scarce and often of poor quality. The lack of adequate management of VFF and associated osteoporosis and the burden of this condition to patient and society are estimated to increase substantially in coming years as recurrent, disabling episodes are set to occur. This chapter will address these issues, including a discussion on existing care pathways for vertebral fragility fractures, and an overview of the evidence supporting recommendations of the main international clinical practice guidelines.


Assuntos
Dor nas Costas/terapia , Fraturas por Osteoporose/terapia , Fraturas da Coluna Vertebral/terapia , Idoso , Dor nas Costas/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/psicologia , Manejo da Dor/métodos , Guias de Prática Clínica como Assunto , Qualidade de Vida/psicologia , Fraturas da Coluna Vertebral/psicologia , Vertebroplastia
13.
Artigo em Russo | MEDLINE | ID: mdl-31513171

RESUMO

Osteoporotic vertebral fractures (VF) have a negative impact on quality of life within a year after injury. A recent-onset vertebral body compression fracture in the presence of osteoporosis (OP) is generally accompanied by acute back pain, hypokinesia, and a reduction in daily physical and social activities, further leading to social isolation. Rehabilitation measures are of particular importance to restore quality of life in OP patients, especially in the people who have a history of fractures. Exercise therapy is the mainstay of management in patients with OP and VF; however, pain and limited mobility can be a barrier to exercises. Competent bracing is a method that can assist in reducing pain in VF, stabilizing the spine, and increasing motor activity. The use of an orthosis not only improves quality of life, but also gives an opportunity to take physical exercises. Semi-rigid and elastic corsets are preferable to rigid structures that are less convenient to use and associated with a large number of undesirable phenomena. Wearing a brace continuously (with its obligatory taking off overnight) is rational for 6-8 weeks. Above this period, there is an increased risk of muscle atrophy. It is acceptable to longer use orthoses situationally, if there is a need to be in an upright position, during long walks, trips, or physical exercises.


Assuntos
Braquetes , Terapia por Exercício , Fraturas por Compressão/terapia , Fraturas por Osteoporose/terapia , Fraturas da Coluna Vertebral/terapia , Humanos , Qualidade de Vida , Resultado do Tratamento
15.
World Neurosurg ; 131: e346-e352, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31356973

RESUMO

OBJECTIVE: The present study compared the clinical functional outcomes and new vertebral compression fractures (NVCFs) between percutaneous vertebroplasty (PVP) and conservative treatment (CT) in patients with severe pain due to acute osteoporotic vertebral compression fractures (OVCFs). PVP has been increasingly used for the treatment of pain in patients with OVCFs. However, the effectiveness of the procedure and whether it causes NVCFs has remained controversial. METHODS: A total of 544 eligible patients with OVCFs found on spinal radiographs and intractable back pain for ≤6 weeks were recruited from September 2012 to February 2018 and assigned to PVP (n = 280; 392 levels) or CT (n = 264; 366 levels). The visual analog scale and Oswestry Disability Index scores were determined before the intervention and at the 1-week and 1-, 3-, 6-, 12-, and 24-month follow-up examinations. In addition, monthly telephone follow-up interviews were performed. In the case of a sudden increase in back pain, the patient returned to the hospital for medical and magnetic resonance imaging examinations for NVCF detection. RESULTS: The PVP group had significantly lower visual analog scale and Oswestry Disability Index scores than those for the CT group at 1 week and 1, 3, and 6 months (P < 0.05). However, the differences after 6 months were not statistically significant (P > 0.05). Similar numbers of NVCFs (total and adjacent fractures) were found at 24 months in both groups (P > 0.05). CONCLUSIONS: Compared with CT, PVP provided a rapid decrease in pain and an early return to daily life activities, without an increase in the incidence of NVCFs.


Assuntos
Tratamento Conservador , Fraturas por Compressão/terapia , Fraturas por Osteoporose/terapia , Fraturas da Coluna Vertebral/terapia , Vertebroplastia , Idoso , Dor nas Costas/etiologia , Dor nas Costas/fisiopatologia , Feminino , Fraturas por Compressão/complicações , Fraturas por Compressão/fisiopatologia , Humanos , Vértebras Lombares/lesões , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/complicações , Fraturas por Osteoporose/fisiopatologia , Medição da Dor , Dor Intratável/etiologia , Dor Intratável/fisiopatologia , Recidiva , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/fisiopatologia , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia , Resultado do Tratamento
16.
World Neurosurg ; 131: 27-31, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31356975

RESUMO

BACKGROUND: Ankylosing spondylitis (AS) is a systemic enthesopathy. In its presence, spinal fractures are often unstable. Acknowledging the preinjury level of kyphosis is key in the management of cervical fractures, and placement into a hard collar has been shown to result in life-threatening spinal cord complications. CASE DESCRIPTION: This report presents the unique case of a patient with AS who developed a unilateral C5 palsy after the application of a hard collar for a C5/6 fracture, to our knowledge the first such case presented to date. The patient subsequently went on to an anterior fixation and partially recovered from the C5 palsy/injury. After the case report is an examination of the currently available literature and evidence exploring the factors that may contribute to C5 palsy after the application of a collar for acute fracture in AS. CONCLUSIONS: We described the first case in the literature of a posttraumatic C5 palsy after application of a hard collar in AS. This report and literature review should act to underscore the importance of respecting a preexisting rigid kyphotic deformity in cervical fractures but also to stimulate further thoughts and investigations into what may contribute to a posttraumatic C5 palsy.


Assuntos
Discotomia , Aparelhos Ortopédicos/efeitos adversos , Radiculopatia/etiologia , Fraturas da Coluna Vertebral/terapia , Fusão Vertebral , Vértebras Cervicais , Humanos , Masculino , Pessoa de Meia-Idade , Radiculopatia/cirurgia , Fraturas da Coluna Vertebral/complicações , Espondilite Anquilosante/complicações
17.
Cochrane Database Syst Rev ; 7: CD008618, 2019 07 05.
Artigo em Inglês | MEDLINE | ID: mdl-31273764

RESUMO

BACKGROUND: Vertebral fractures are associated with increased morbidity (e.g. pain, reduced quality of life) and mortality. Therapeutic exercise is a non-pharmacological conservative treatment that is often recommended for patients with vertebral fractures to reduce pain and restore functional movement. This is an update of a Cochrane Review first published in 2013. OBJECTIVES: To assess the effects (benefits and harms) of exercise intervention of four weeks or greater (alone or as part of a physical therapy intervention) versus non-exercise/non-active physical therapy intervention, no intervention or placebo among adults with a history of vertebral fractures on incident fragility fractures of the hip, vertebra or other sites. Our secondary objectives were to evaluate the effects of exercise on the following outcomes: falls, pain, physical performance, health-related quality of life (disease-specific and generic), and adverse events. SEARCH METHODS: We searched the following databases until November 2017: the Cochrane Library (Issue 11 of 12), MEDLINE (from 2005), Embase (from 1988), CINAHL (Cumulative Index to Nursing and Allied Health Literature, from 1982), AMED (from 1985), and PEDro (Physiotherapy Evidence Database, from 1929). Ongoing/recently completed trials were identified by searching the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov. Conference proceedings were searched via ISI and SCOPUS, and targeted searches of proceedings of the American Congress of Rehabilitation Medicine and American Society for Bone and Mineral Research. Search terms or MeSH headings included terms such as vertebral fracture AND exercise OR physical therapy. For this update, the search results were limited from 2011 onward. SELECTION CRITERIA: We included all randomized controlled trials and quasi-randomized trials comparing exercise or active physical therapy interventions with placebo/non-exercise/non-active physical therapy interventions or no intervention implemented in individuals with a history of vertebral fracture. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials and extracted data using a pre-tested data extraction form. Disagreements were resolved by consensus, or third-party adjudication. We used Cochrane's tool for assessing risk of bias to evaluate each study. Studies were grouped according to duration of follow-up (i.e. a) 4-12 weeks; b) 16-24 weeks; c) 52 weeks); a study could be represented in more than one group depending on the number of follow-up assessments. For dichotomous data, we reported risk ratios (RR) and corresponding 95% confidence intervals (95% CI). For continuous data, we reported mean differences (MD) of the change from baseline and 95% CI. Data were pooled for Timed Up and Go test, self-reported physical function measured by the QUALEFFO-41 physical function subscale score (scale of zero to 100; lower scores indicate better self-reported physical function), and disease-specific quality of life measured by the QUALEFFO-41 total score (scale of zero to 100; lower scores indicate better quality of life) at 12 weeks using a fixed-effect model. MAIN RESULTS: Nine trials (n = 749, 68 male participants; two new trials in this review update) were included. Substantial variability across the trials prevented any meaningful pooling of data for most outcomes. Risk of bias across all studies was variable; low risk across most domains in four studies, and unclear/high risk in most domains for five studies. Performance bias and blinding of subjective outcome assessment were almost all high risk of bias.One trial reported no between-group difference in favor of the effect of exercise on incident fragility fractures after 52 weeks (RR 0.54, 95% CI 0.17 to 1.71; very low-quality evidence with control: 184 per 1000 and exercise: 100 per 1000, 95% CI 31 to 315; absolute difference: 8%, 95% CI 2 to 30). One trial reported no between-group difference in favor of the effect of exercise on incident falls after 52 weeks (RR 1.06, 95% CI 0.53 to 2.10; very low-quality evidence with control: 262 per 1000 and exercise: 277 per 1000; 95% CI 139 to 550; absolute difference: 2%, 95% CI -12 to 29). These findings should be interpreted with caution because of the very serious risk of bias in these studies and the small sample sizes resulting in imprecise estimates.We are uncertain that exercise could improve pain, self-reported physical function, and disease-specific quality of life, because certain studies showed no evidence of clinically important differences for these outcomes. Pooled analyses revealed a small between-group difference in favor of exercise for Timed Up and Go (MD -1.13 seconds, 95% CI -1.85 to -0.42; studies = 2), which did not change following a sensitivity analysis (MD -1.09 seconds, 95% CI -1.78 to -0.40; studies = 3; moderate-quality evidence). Exercise improved QUALEFFO-41 physical function score (MD -2.84 points, 95% CI -5.57 to -0.11; studies = 2; very low-quality evidence) and QUALEFFO-41 total score (MD -3.24 points, 95% CI -6.05 to -0.43; studies = 2; very low-quality evidence), yet it is unlikely that we observed any clinically important differences. Three trials reported four adverse events related to the exercise intervention (costal cartilage fracture, rib fracture, knee pain, irritation to tape, very low-quality evidence). AUTHORS' CONCLUSIONS: In conclusion, we do not have sufficient evidence to determine the effects of exercise on incident fractures, falls or adverse events. Our updated review found moderate-quality evidence that exercise probably improves physical performance, specifically Timed Up and Go test, in individuals with vertebral fracture (downgraded due to study limitations). However, a one-second improvement in Timed Up and Go is not a clinically important improvement. Although individual trials did report benefits for some pain and disease-specific quality of life outcomes, the findings do not represent clinically meaningful improvements and should be interpreted with caution given the very low-quality evidence due to inconsistent findings, study limitations and imprecise estimates. The small number of trials and variability across trials limited our ability to pool outcomes or make conclusions. Evidence regarding the effects of exercise after vertebral fracture in men is scarce. A high-quality randomized trial is needed to inform safety and effectiveness of exercise to lower incidence of fracture and falls and to improve patient-centered outcomes (pain, function) for individuals with vertebral fractures (minimal sample size required is approximately 2500 untreated participants or 4400 participants if taking anti-osteoporosis therapy).


Assuntos
Terapia por Exercício , Fraturas por Osteoporose/terapia , Fraturas da Coluna Vertebral/terapia , Exercício Físico/fisiologia , Terapia por Exercício/métodos , Humanos , Equilíbrio Postural , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos de Tempo e Movimento
18.
Neurochirurgie ; 65(6): 417-420, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31301388

RESUMO

BACKGROUND: Decision-making is often difficult in odontoid fracture in children. CASE REPORT: We present the case of a 6-year-old boy who sustained cervical trauma on falling out of a tree. Initial cervical X-ray and CT-scan did not find any traumatic lesion. Three-week check-up revealed an unstable C2 fracture in the synchondrosis at the base of the odontoid bone, with anterior displacement (type IC on the classification of Hosalkar et al.), without neurological symptoms except for cervical pain and limitation of head rotation. MRI confirmed the absence of medullary lesion. The Harms technique was used to fix C1 and C2, using adult instrumentation without bone graft. Bone fusion was obtained at 8 months. Hardware was removed at 10 months. No complications were reported. CONCLUSIONS: Posterior internal fixation for unstable C2 fractures in children can be effective and relatively safe.


Assuntos
Vértebras Cervicais/lesões , Fixação Interna de Fraturas/métodos , Processo Odontoide/lesões , Fraturas da Coluna Vertebral/terapia , Acidentes por Quedas , Vértebras Cervicais/cirurgia , Criança , Humanos , Masculino , Lesões do Pescoço/diagnóstico por imagem , Lesões do Pescoço/terapia , Procedimentos Neurocirúrgicos , Processo Odontoide/diagnóstico por imagem , Dor/etiologia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fusão Vertebral , Tomografia Computadorizada por Raios X
19.
Vet Comp Orthop Traumatol ; 32(6): 492-498, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31242518

RESUMO

OBJECTIVE: The aim of this study was to describe the signalment, clinical presentation, diagnostic findings, medical and surgical treatment and outcome of 22 farm animals diagnosed with a vertebral fracture or luxation. STUDY DESIGN: Medical records of 22 farm animals (7 goats, 6 alpacas, 5 cattle, 3 sheep and 1 deer) were reviewed for signalment, history, presenting clinical signs and neurological examination findings, clinicopathological results, diagnostic imaging, final diagnosis, medical and surgical management, clinical progression and outcome. RESULTS: Animals' age ranged from 1 day to 15 years. Neurological examination findings included decreased motor function (20/22), recumbency (14/22), altered mentation (13/22), cranial nerve deficits (4/22) and lack of nociception (3/22). Lesions were localized to the atlanto-occipital region (2/22), C1 to C5 (7/22), C6 to T2 (4/22), T3 to L3 (3/22), and L4 to S1 (6/22). Diagnoses included vertebral fracture only (4/22), luxation only (5/22) or both vertebral fracture and luxation (13/22). In five cases, no therapy was attempted, while 12 cases were treated medically and five cases were treated surgically. Surgical interventions included manual reduction (n = 1); arthrodesis (n = 2); laminectomy (n = 1); and laminectomy with pin fixation, cerclage wire and polymethylmethacrylate bridging (n = 1). Five of the 22 cases survived to hospital discharge; two of these were treated surgically. CONCLUSION: The cervical region was most commonly affected. Prognosis for these injuries in farm animals is guarded.


Assuntos
Fraturas Ósseas/veterinária , Luxações Articulares/veterinária , Gado/lesões , Fraturas da Coluna Vertebral/veterinária , Animais , Feminino , Fraturas Ósseas/patologia , Fraturas Ósseas/terapia , Luxações Articulares/patologia , Luxações Articulares/terapia , Masculino , Estudos Retrospectivos , Fraturas da Coluna Vertebral/patologia , Fraturas da Coluna Vertebral/terapia , Traumatismos da Coluna Vertebral/patologia , Traumatismos da Coluna Vertebral/terapia , Traumatismos da Coluna Vertebral/veterinária , Resultado do Tratamento
20.
Am J Case Rep ; 20: 794-799, 2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31168047

RESUMO

BACKGROUND Sacral stress fractures are rare complications of pregnancy and the early postpartum. Of these, few present with lumbosacral radiculopathy. We report the first Australian case of a young multiparous woman who sustained an atraumatic, fatigue sacral fracture with associated radiculopathy. We highlight the diagnostic process and chronic management of this case, particularly in relation to a future pregnancy. CASE REPORT A 26-year-old multiparous Caucasian female presented with worsening lumbosacral back pain and radicular symptoms following the rapid and spontaneous vaginal delivery of her second infant. Her pregnancy was unremarkable and she had no personal risk factors for osteoporosis. A magnetic resonance imaging (MRI) scan confirmed the diagnosis of a right S1 vertebral fracture. Bone densitometry and fasting bone metabolic testing excluded pregnancy-associated osteoporosis. She was managed conservatively with intermittent bed rest, regular physiotherapy and multimodal analgesia. During a future pregnancy, she experienced a severe exacerbation of her lumbosacral radiculopathy requiring hospital admission, up-titration of her analgesia and a right S1 epidural injection. She subsequently underwent an elective caesarean section and has since benefitted from regular hydrotherapy. CONCLUSIONS Lumbosacral radiculopathy in the absence of trauma during pregnancy or the early postpartum should prompt consideration of an underlying atraumatic, fatigue sacral fracture. Such fractures may result from the abnormal biomechanical loading of the sacrum during rapid vaginal deliveries and are most effectively diagnosed by MRI. Conservative management strategies involving physiotherapy and multimodal analgesia are recommended. Future pregnancies may exacerbate radicular symptoms. Such patients may subsequently benefit from elective caesarean section deliveries and hydrotherapy.


Assuntos
Fraturas Espontâneas/etiologia , Dor Lombar/fisiopatologia , Radiculopatia/diagnóstico por imagem , Fraturas da Coluna Vertebral/diagnóstico por imagem , Adulto , Austrália , Tratamento Conservador/métodos , Feminino , Fraturas Espontâneas/diagnóstico por imagem , Humanos , Dor Lombar/diagnóstico por imagem , Região Lombossacral , Imagem por Ressonância Magnética/métodos , Medição da Dor , Paridade , Período Pós-Parto , Gravidez , Prognóstico , Radiculopatia/complicações , Sacro/lesões , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/terapia
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