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https://www.readbyqxmd.com/read/29679728/magnetic-resonance-imaging-of-the-lumbar-spine-determining-clinical-impact-and-potential-harm-from-overuse
#1
Nathan M Wnuk, Tarik K Alkasab, Daniel I Rosenthal
BACKGROUND: Lumbar spine MRI is frequently said to be "overused" in the evaluation of low-back pain, yet data concerning the extent of overuse and on potential harmful effects are lacking. PURPOSE: To determine the proportion of examinations with a detectable impact on patient care (actionable outcomes). STUDY DESIGN: Retrospective cohort study PATIENT SAMPLE: 5,365 outpatient lumbar spine MR examinations OUTCOME MEASURES: Actionable outcomes included: 1) findings leading to an intervention making use of anatomical information such as surgery; 2) new diagnoses of cancer, infection, or fracture; or 3) following known lumbar spine pathology...
April 18, 2018: Spine Journal: Official Journal of the North American Spine Society
https://www.readbyqxmd.com/read/29679136/the-pedicle-instrumentation-and-percutaneous-elevation-pi-pe-a-new-cementless-surgical-technique-in-type-a-post-traumatic-vertebral-fractures
#2
Andrea Piazzolla, Giuseppe Solarino, Davide Bizzoca, Claudia Parato, Gaetano Monteleone, Franca Dicuonzo, Biagio Moretti
PURPOSE: To investigate if bone substitutes are strictly necessary to restore the vertebral body height and improve the clinical outcome, in patients with thoracolumbar or lumbar AO type A post-traumatic vertebral fractures, managed with balloon kyphoplasty combined with posterior screw and rod system. METHODS: 105 patients with post-traumatic thoracolumbar spine fracture were recruited. At baseline, the patients underwent a CT and an MRI of the spine. Clinical evaluation was performed, using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI), at baseline, 48 h after surgery, at 3-month follow-up (FU), 6-month FU, 48 h after the instrumentation removal and at 24-month FU...
April 20, 2018: European Spine Journal
https://www.readbyqxmd.com/read/29678526/long-term-outcomes-after-stereotactic-radiosurgery-for-spine-metastases-radiation-dose-response-for-late-toxicity
#3
Diane C Ling, John C Flickinger, Steven A Burton, Dwight E Heron, Annette E Quinn, Ghassan K Bejjani, Johnathan A Engh, Peter C Gerszten, Nduka M Amankulor, John A Vargo
PURPOSE: To document the 5- and 10-year rates of late toxicity and vertebral compression fracture (VCF) in long-term survivors after stereotactic radiosurgery for spine metastases. METHODS AND MATERIALS: A retrospective review was performed on 562 patients treated with SRS for spine metastases between April 2001 and July 2011. Selecting those with at least 5-year survival after SRS, included were 43 patients who collectively underwent 84 treatments at 54 spine sites...
March 6, 2018: International Journal of Radiation Oncology, Biology, Physics
https://www.readbyqxmd.com/read/29678393/positive-correlations-between-free-vitamin-d-and-bone-variables-in-a-group-of-young-lebanese-women
#4
Abir Alwan, Maroun Rizkallah, Ghassan Maalouf, Joseph Matta, Fabienne Frenn, Angélique Barakat, Falah Bachour, Amer Sebaaly, Abdel-Jalil Berro, Nathalie Al Rassy, Mirza Howayek, Hassane Zouhal, Rawad El Hage
Optimizing bone mass in adulthood is of great importance to prevent the occurrence of osteoporosis in later age. Vitamin D is an essential component of bone health. Low-serum vitamin D is associated with low bone mineral density (BMD), which is an important predictor of fracture risk. However, most cells, apart from renal tubular cells, are exposed to free rather than to total 25-hydroxyvitamin D. Whether free vitamin D would be a better marker than total vitamin D is still under debate. The aim of the present study was to explore the relationships between serum total vitamin D, vitamin D-binding protein (BP), free vitamin D, and bone parameters in a group of young Lebanese women...
March 26, 2018: Journal of Clinical Densitometry
https://www.readbyqxmd.com/read/29677654/diagnosis-of-lumbar-spinal-fractures-in-emergency-department-low-dose-versus-standard-dose-ct-using-model-based-iterative-reconstruction
#5
Sun Hwa Lee, Seong Jong Yun, Hyeon Hwan Jo, Jae Gwang Song
PURPOSE: To compared the diagnostic performance of low-dose (LD) lumbar-spine (L-spine) CT with that of standard-dose (SD) L-spine CT. METHODS: Patients who underwent SD (n = 76) or LD (n = 68) L-spine CT using model-based iterative reconstruction were included. Two reviewers independently analyzed 10 anatomical regions on both CT scans. Also, suggested treatment decision between both CT scans was compared. RESULTS: LD L-spine CT showed an excellent diagnostic accuracy (98...
April 14, 2018: Clinical Imaging
https://www.readbyqxmd.com/read/29677554/glass-polyalkenoate-cement-an-alternative-material-for-kyphoplasty-in-osteoporotic-vertebral-compression-fractures-an-ex-vivo-study
#6
Tim Leschinger, Karsten Engel, Gert Peter Brüggemann, Viktoria Dederer, Wolfram Friedrich Neiss, Max Joseph Scheyerer, Lars Peter Müller, Kilian Wegmann
Adjacent vertebral body fracture is described as a risk after vertebroplasty and kyphoplasty. It may be true that this phenomenon is caused precisely because of the frequently used polymethylmethacrylate cement (PMMA), which shows a higher level of stiffness than bone material and may ultimately lead to shifting stress levels within the entire spine. The goal of the present study was to evaluate and compare the pressure distribution in the endplate of human vertebrae after kyphoplasty with PMMA and aluminum-free glass-polyalkenoate cement (gpc)...
March 21, 2018: Journal of the Mechanical Behavior of Biomedical Materials
https://www.readbyqxmd.com/read/29675770/sports-participation-and-fracture-in-older-australian-men
#7
Kara L Holloway-Kew, David J Moloney, Gosia Bucki-Smith, Natalie K Hyde, Sharon L Brennan-Olsen, Elizabeth N Timney, Amelia G Dobbins, Julie A Pasco
Older men who participated in a sporting activity were less likely to sustain any fracture or major osteoporotic fracture over a 6-year follow-up period. PURPOSE: Regular weight-bearing physical activity can reduce fracture risk through an increase in bone strength, as well as reducing falls risk by improving muscle strength and balance. In this study, we aimed to determine whether a specific type of physical activity, sports participation, reduces fracture risk in older Australian men...
April 19, 2018: Archives of Osteoporosis
https://www.readbyqxmd.com/read/29675674/osteoporotic-thoracolumbar-compression-fractures-long-term-retrospective-comparison-between-vertebroplasty-and-conservative-treatment
#8
Konstantinos Martikos, Tiziana Greggi, Cesare Faldini, Francesco Vommaro, Antonio Scarale
PURPOSE: To compare long term clinical and radiographic outcomes in osteoporotic vertebral compression fractures of the thoracolumbar spine treated with conservative treatment and percutaneous vertebroplasty. METHODS: The retrospective study with inclusion criteria focused on osteoporotic fractures of the thoracolumbar junction (T10-L2). Clinical outcomes were evaluated by using the VAS, Oswestry and SF36 questionnaires. Radiographic outcomes were evaluated by comparing the following sagittal parameters: body angle, sagittal index of fractured vertebral body and adjacent vertebral segments kyphosis...
April 19, 2018: European Spine Journal
https://www.readbyqxmd.com/read/29672437/risk-of-fractures-in-inflammatory-bowel-diseases-a-systematic-review-and-meta-analysis
#9
Yuga Komaki, Fukiko Komaki, Dejan Micic, Akio Ido, Atsushi Sakuraba
BACKGROUND: Studies assessing the risk of fractures in inflammatory bowel diseases (IBD) have shown controversial results. GOALS: We performed a systematic review and meta-analysis to assess the risk of fractures in IBD. STUDY: Electronic databases were searched for cohort studies assessing the risk of fractures in IBD. The outcomes were the risk of overall fractures and at specific sites, and the association between the risk of fractures and the proportion of patients with corticosteroid use or osteoporosis...
April 18, 2018: Journal of Clinical Gastroenterology
https://www.readbyqxmd.com/read/29665068/osteoporosis-and-hip-fracture-risk-from-routine-computed-tomography-scans-the-fracture-osteoporosis-and-ct-utilization-study-focus
#10
Annette L Adams, Heidi Fischer, David L Kopperdahl, David C Lee, Dennis M Black, Mary L Bouxsein, Shireen Fatemi, Sundeep Khosla, Eric S Orwoll, Ethel S Siris, Tony M Keaveny
Methods now exist for analyzing previously taken clinical computed tomography (CT) scans to measure a dual-energy X-ray absorptiometry (DXA)-equivalent bone mineral density (BMD) at the hip and a finite element analysis-derived femoral strength. We assessed the efficacy of this "biomechanical CT" (BCT) approach for identifying patients at high risk of incident hip fracture in a large clinical setting. Using a case-cohort design sampled from 111,694 women and men aged 65 or older who had a prior hip CT scan, a DXA within 3 years of the CT, and no prior hip fracture, we compared those with subsequent hip fracture (n = 1959) with randomly selected sex-stratified controls (n = 1979) and analyzed their CT scans blinded to all other data...
April 17, 2018: Journal of Bone and Mineral Research: the Official Journal of the American Society for Bone and Mineral Research
https://www.readbyqxmd.com/read/29664878/c2-translaminar-screw-fixation-in-children
#11
Brian W Yang, Michael P Glotzbecker, Michael Troy, Mark R Proctor, Michael T Hresko, Daniel J Hedequist
BACKGROUND: Axis (C2) screw fixation has been shown to be effective in treating disorders that necessitate cervical stabilization. Although translaminar C2 screws have demonstrated clinical efficacy in adults, this technique has not yet been thoroughly investigated in children. This study describes the indications, technique, and results of translaminar C2 screw fixation in a case series of pediatric cervical spine disorders. METHODS: We searched the orthopaedic database at our institution for patients who had undergone a cervical spinal fusion that encompassed C2 between 2007 and 2017...
April 16, 2018: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/29663146/thoraco-lumbar-fractures-with-blunt-traumatic-aortic-injury-in-adult-patients-correlations-and-management
#12
Giorgio Santoro, Alessandro Ramieri, Vito Chiarella, Massimo Vigliotta, Maurizio Domenicucci
PURPOSE: Traumatic thoraco-lumbar spine fracture spine with a concomitant blunt aortic injury is uncommon but potentially a fatal association. Our aim was to clarify: morphology of spinal fractures related to vascular damages and vice versa, diagnostic procedures and decision-making process for the best treatment options for spine and vessels. METHODS: We enrolled 42 cases culled from the literature and five personal ones, reviewing in detail by AO Spine Classification, Society of Vascular Surgery classification and Abbreviated Injury Scale for neurological evaluation...
April 16, 2018: European Spine Journal
https://www.readbyqxmd.com/read/29661687/impact-of-weight-loss-with-intragastric-balloon-on-bone-density-and-microstructure-in-obese-adults
#13
Eduardo Madeira, Miguel Madeira, Erika Paniago Guedes, Thiago Thomaz Mafort, Rodrigo Oliveira Moreira, Laura Maria Carvalho de Mendonça, Inayá Correa Barbosa Lima, Leonardo Vieira Neto, Paulo Roberto Alves de Pinho, Agnaldo José Lopes, Maria Lucia Fleiuss Farias
The historical concept that obesity protects against bone fractures has been questioned. Weight loss appears to reduce bone mineral density (BMD); however, the results in young adults are inconsistent, and data on the effects of weight loss on bone microstructure are limited. This study aimed to evaluate the impact of weight loss using an intragastric balloon (IGB) on bone density and microstructure. Forty obese patients with metabolic syndrome (mean age 35.1 ± 7.3 yr) used an IGB continuously for 6 mo...
March 21, 2018: Journal of Clinical Densitometry
https://www.readbyqxmd.com/read/29661684/trabecular-bone-score-and-hip-structural-analysis-in-patients-with-atypical-femur-fractures
#14
Sanne K C Buitendijk, Denise M van de Laarschot, Alexandra A A Smits, Fjorda Koromani, Fernando Rivadeneira, Thomas J Beck, M Carola Zillikens
Bisphosphonate use has declined dramatically in recent years, partly because of fear of rare side effects like atypical femur fractures (AFFs). It is therefore desirable to have a diagnostic method to identify those at risk of AFF to prevent this serious complication. We compared trabecular microarchitecture and hip geometry between 30 patients with AFF and 141 controls of similar age and sex, using bisphosphonates. Trabecular bone score (TBS) and hip structural analysis (HSA) were used to assess trabecular microarchitecture and macroscopic hip geometry from dual-energy X-ray absorptiometry images of the lumbar spine and hip, respectively...
March 22, 2018: Journal of Clinical Densitometry
https://www.readbyqxmd.com/read/29659886/bone-parameters-in-anorexia-nervosa-and-athletic-amenorrhea-comparison-of-two-hypothalamic-amenorrhea-states
#15
Nurgun Kandemir, Meghan Slattery, Kathryn E Ackerman, Shreya Tulsiani, Amita Bose, Vibha Singhal, Charumathi Baskaran, Seda Ebrahimi, Mark Goldstein, Kamryn Eddy, Anne Klibanski, Madhusmita Misra
Purpose: We have reported low bone mineral density (BMD), impaired bone structure, and increased fracture risk in anorexia nervosa (AN) and normal-weight, oligo-amenorrheic athletes (OA). However, data directly comparing compartment-specific bone parameters in AN, OA and controls are lacking. Methods: 426 females 14-21.9 years old were included; 231 AN, 94 OA and 101 normal-weight eumenorrheic controls. Dual energy x-ray absorptiometry was used to assess areal BMD (aBMD) of the whole body less head (WBLH), spine, and hip...
April 5, 2018: Journal of Clinical Endocrinology and Metabolism
https://www.readbyqxmd.com/read/29658832/the-associations-between-hypovitaminosis-d-higher-pth-levels-with-bone-mineral-densities-and-risk-of-the-10-year-probability-of-major-osteoporotic-fractures-in-chinese-patients-with-t2dm
#16
Xiao-Feng Wang, Jing-Jia Yu, Xiao-Jing Wang, Yi-Xuan Jing, Li-Hao Sun, Bei Tao, Wei-Qing Wang, Guang Ning, Jian-Min Liu, Hong-Yan Zhao
OBJECTIVE: In the current study, we investigated the vitamin D status, and its relationships with parathyroid hormone (PTH) levels, bone mineral density (BMD), and the 10-year probability of fractures in Chinese patients with type 2 diabetes mellitus (T2DM). METHODS: This was a cross-sectional study of 785 patients. BMDs at the lumbar spine (L2-4), femoral neck (FN), and total hip (TH) were measured by dual-energy X-ray absorptiometry (DXA). Serum levels of 25-hydroxyvitamin D (25(OH)D) and intact PTH were also quantified...
April 2018: Endocrine Practice
https://www.readbyqxmd.com/read/29657469/anatomical-differences-in-the-bony-structure-of-l5-and-l4-a-possible-classification-according-to-the-lateral-tilt-of-the-pedicles
#17
Giorgio Cacciola, Giuseppe Anastasi, Salvatore Bertino, Giuseppina Rizzo, Giuseppina Cutroneo, Fabio Trimarchi, Alessandro Pisani, Pietro Cavaliere, Andrea Barbanera, Daniele Bruschetta
The aim of this study is to underline the necessity of a better knowledge of pedicles anatomy in order to improve surgical treatment of spine disorders such us low back pain, spinal fractures and scholiosis. A classification of pedicles lateral tilt which could help surgeons before the application of screws during transpedicular fixation is reported. Anatomical differences in the orientiation of the pedicles of L5 and L4 have been found. For each patient that met the inclusion criteria underwent: Radiography of the lumbo-sacral region, CT examination, MRI acquisition...
March 2018: Journal of Orthopaedics
https://www.readbyqxmd.com/read/29656630/etiopathogenesis-of-traumatic-spinal-epidural-hematoma
#18
Francesco Ciro Tamburrelli, Maria Concetta Meluzio, Giulia Masci, Andrea Perna, Aaron Burrofato, Luca Proietti
Spinal epidural hematoma (SEH) is a rare cause of nerve root or cord compression; its pathogenesis is not always clearly recognizable. The aim of this paper was to investigate possible etiopathological factors in a consecutive series of patients affected by traumatic SEH treated at our institution. Seven patients with neurologic impairment due to traumatic SEH were retrospectively analyzed after diagnosis and surgical treatment. Thoracic localization was found in 5 cases, and lumbar and cervical localization were found in 1 patient each...
March 2018: Neurospine
https://www.readbyqxmd.com/read/29656532/of-lamp-posts-keys-and-fabled-drunkards-a-perspectival-tale-of-4-guidelines
#19
Trisha Greenhalgh
BACKGROUND: Evidence-based medicine is the application of research findings to inform individual clinical decisions. There is a tension-both philosophical and practical-between the average result from a population study and the circumstances and needs of an individual patient. This personal account of "evidence-based" trauma care illustrates and explores this tension. THE CASE: The author, a keen athlete, describes her experience of a high-impact cycle accident that led to limb fractures (which were diagnosed and treated according to evidence-based guidelines) and also an occult injury to the cervical spine (which was not diagnosed at the time)...
April 15, 2018: Journal of Evaluation in Clinical Practice
https://www.readbyqxmd.com/read/29656174/multiplanar-realignment-for-unstable-hangman-s-fracture-with-posterior-c2-3-fusion-a-prospective-series
#20
Pravin Salunke, Madhivanan Karthigeyan, Sushanta K Sahoo, Prashant K Prasad
OBJECTIVE: There is lack of consensus on the preferred approach for unstable Hangman's fracture. The associated soft tissue injuries apart from apparent bony injury add to the complexity of dislocation and needs to be addressed. Here, we evaluated the clinico-radiological characteristics and outcome of patients managed by posterior C2-3 fusion. PATIENTS & METHODS: Nine patients with unstable Hangman's fracture (type II and IIA) were prospectively studied. The displacement of fractured fragments and C2-3 dislocation was studied in multiple planes...
March 27, 2018: Clinical Neurology and Neurosurgery
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