2155 articles - 08.09.10
1: Osteoporos Int. 2010 Sep 2; [Epub ahead of print]
Marie PJ, Felsenberg D, Brandi ML.
Laboratory of Osteoblast Biology and Pathology, INSERM, U606, Paris, 75475, France, pierre.marie@inserm.fr.
Oestrogen deficiency increases the rate of bone remodelling which, in association with a negative remodelling balance (resorption exceeding formation), results in impaired bone architecture, mass and strength. Current anti-osteoporotic drugs act on bone remodelling by inhibiting bone resorption or by promoting its formation. An alternative therapeutic approach is based on the concept of inducing opposite effects on bone resorption and formation. One therapeutic agent, strontium ranelate, was shown to induce opposite effects on bone resorption and formation in pre-clinical studies and to reduce fracture risk in postmenopausal osteoporotic patients. How strontium ranelate acts to improve bone strength in humans remains a matter of debate, however. This review of the most recent pre-clinical and clinical studies is a critical analysis of strontium ranelate's action on bone resorption and formation and how it increases bone mass, microarchitecture and strength in postmenopausal osteoporotic women.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20812008&dopt=ExternalLink
Translate in Italian, in French, in German, in Spanish, in Portuguese
PMID: 20812008 [PubMed - as supplied by publisher]2: J Neurosurg Spine. 2010 Sep;13(3):324-8.
Bilsky MH, Laufer I, Fourney DR, Groff M, Schmidt MH, Varga PP, Vrionis FD, Yamada Y, Gerszten PC, Kuklo TR.
Departments of Neurosurgery and.
Objective The evolution of imaging techniques, along with highly effective radiation options has changed the way metastatic epidural tumors are treated. While high-grade epidural spinal cord compression (ESCC) frequently serves as an indication for surgical decompression, no consensus exists in the literature about the precise definition of this term. The advancement of the treatment paradigms in patients with metastatic tumors for the spine requires a clear grading scheme of ESCC. The degree of ESCC often serves as a major determinant in the decision to operate or irradiate. The purpose of this study was to determine the reliability and validity of a 6-point, MR imaging-based grading system for ESCC. Methods To determine the reliability of the grading scale, a survey was distributed to 7 spine surgeons who participate in the Spine Oncology Study Group. The MR images of 25 cervical or thoracic spinal tumors were distributed consisting of 1 sagittal image and 3 axial images at the identical level including T1-weighted, T2-weighted, and Gd-enhanced T1-weighted images. The survey was administered 3 times at 2-week intervals. The inter- and intrarater reliability was assessed. Results The inter- and intrarater reliability ranged from good to excellent when surgeons were asked to rate the degree of spinal cord compression using T2-weighted axial images. The T2-weighted images were superior indicators of ESCC compared with T1-weighted images with and without Gd. Conclusions The ESCC scale provides a valid and reliable instrument that may be used to describe the degree of ESCC based on T2-weighted MR images. This scale accounts for recent advances in the treatment of spinal metastases and may be used to provide an ESCC classification scheme for multicenter clinical trial and outcome studies.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20809724&dopt=ExternalLink
Translate in Italian, in French, in German, in Spanish, in Portuguese
PMID: 20809724 [PubMed - in process]3: J Neurosurg Spine. 2010 Sep;13(3):308-18.
Burkus JK, Haid RW, Traynelis VC, Mummaneni PV.
Spine Service, Wilderness Spine Services, The Hughston Clinic, Columbus, Georgia;
Object The purpose of this study was to determine long-term clinical outcomes in patients undergoing anterior cervical surgery in which a cervical disc prosthesis was used to treat single-level degenerative cervical disc disease. Methods In this prospective, nonblinded study, 541 patients at 32 investigational sites were randomly assigned to 1 of 2 treatment groups. The results of the investigational group, in which patients received the Prestige disc prosthesis, were compared with those of the control group, in which patients underwent an instrumented interbody fusion. Data were collected preoperatively, intraoperatively, and at 1.5, 3, 6, 12, 24, 36, and 60 months postoperatively. To date, 271 patients have completed 5 years of clinical follow-up (144 investigational and 127 control patients). Results Significant improvements in Neck Disability Index (NDI) scores, Physical Component Summary scores of the 36-Item Short-Form Health Survey, and neck and arm pain scores were achieved by 1.5 months in both groups and sustained at 5 years. The mean NDI improvements from preoperative scores were 35.4, 36.3, and 38.4 at 24, 36, and 60 months, respectively, in the investigational group. The corresponding mean NDI improvements were 33.9, 31.3, and 34.1 in the control group. The intergroup differences at both 36 and 60 months were significant (p = 0.008 and 0.022, respectively). The overall rates of maintenance or improvement in neurological status in the investigational group were 91.6%, 92.8%, and 95.0%, respectively, at 24, 36, and 60 months compared with 83.6%, 83.2%, and 88.9% in the control group (p = 0.006, 0.004, and 0.051, respectively). The implant effectively maintained angular motion, averaging more than 7.3 degrees at 36 months and 6.5 degrees at 60 months after surgery. No implant migration was observed up to 60 months. There were statistically significant differences between the investigational and control groups with regard to the rate of revision and supplemental fixation surgical procedures performed subsequent to the index procedure. Additional surgical procedures for adjacent-segment disease were observed in both treatment groups. Rates for surgery at adjacent levels trended lower in the investigational group (8 patients [11 surgeries]) compared with those in the control group (13 patients [16 surgeries]), but the differences were not statistically significant (p = 0.376). Some of the second surgeries involved both index and adjacent levels. Conclusions The Prestige disc maintains improved clinical outcomes and segmental motion after implantation at 5-year follow-up.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20809722&dopt=ExternalLink
Translate in Italian, in French, in German, in Spanish, in Portuguese
PMID: 20809722 [PubMed - in process]4: Osteoporos Int. 2010 Aug 27; [Epub ahead of print]
Jin H, Evangelou E, Ioannidis JP, Ralston SH.
Rheumatic Disease Unit, Molecular Medicine Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh, Edinburgh, EH4 2XU, UK.
A meta-analysis of studies was conducted involving 24,511 participants with 7,864 fractures in which polymorphisms in the 5' flank of COL1A1 (rs1107946, rs2412298, and rs1800012) were related to osteoporosis phenotypes. Polymorphisms of all three sites were associated with BMD, and rs1800012 was associated with fracture but effect sizes were modest. INTRODUCTION AND HYPOTHESIS: Polymorphisms in the 5' flank of COL1A1 gene have been implicated as genetic markers for susceptibility to osteoporosis, but previous studies have yielded conflicting results. METHODS: We conducted a meta-analysis of 32 studies including 24,511 participants and 7,864 fractures in which alleles at the -1997G/T (rs1107946), -1663in/delT (rs2412298), and Sp1 binding site polymorphisms (rs1800012) of COL1A1 had been related to bone mineral density (BMD) or fracture. RESULTS: For the Sp1 polymorphism, BMD values in TT homozygotes were 0.13 units [95% CI, 0.03 to 0.24] lower at the spine (p = 0.01) and 0.16 units [0.10 to 0.23] lower at the hip ([Formula: see text]) than GG homozygotes. Clinical fractures were 1.31-fold [1.04-1.65] increased in TT homozygotes (p = 0.02) and vertebral fractures were 1.34-fold [1.01-1.77] increased (p = 0.04). We also observed associations between spine BMD and allelic variants at the -1997G/T (p = 0.05) and the -1663indelT (p = 0.009) sites. We found no association between alleles at the -1997G/T or -1663indelT sites and fracture but power was limited. CONCLUSIONS: The COL1A1 Sp1 polymorphism is associated with a modest reduction in BMD and an increased risk of fracture, although we cannot fully exclude the possibility that the results may have been influenced by publication bias. Further studies are required to fully evaluate the contribution of the -1997G/T and -1663in/delT sites to these phenotypes and to determine if they interact with the Sp1 polymorphism to regulate susceptibility to osteoporosis.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20798928&dopt=ExternalLink
Translate in Italian, in French, in German, in Spanish, in Portuguese
PMID: 20798928 [PubMed - as supplied by publisher]5: J Orthop Res. 2010 Aug 25; [Epub ahead of print]
Jager M, Herten M, Fochtmann U, Fischer J, Hernigou P, Zilkens C, Hendrich C, Krauspe R.
Research Laboratory for Regenerative Medicine and Biomaterials, Department of Orthopaedics, Heinrich-Heine University Medical School, Moorenstr. 5, D-40225 Duesseldorf, Germany.
Although autologous bone grafting represents an effective tool to induce osteogenic regeneration in local bone defects or pseudarthroses, it is associated with significant donor site morbidity and limited by the amount available for grafting. We investigate the potency of bone marrow aspiration concentrate (BMAC) to augment bone grafting and support bone healing. The functional and radiographic outcome of 39 patients with volumetric bone deficiencies treated with BMAC are presented and evaluated in a prospective clinical trial. A collagen sponge (Col) served as scaffold in 12 patients and a bovine hydroxyapatite (HA) was applied in the other 27 individuals. The minimal follow-up was 6 months. Clinical and radiographic findings were completed by in vitro data. All patients showed new bone formation in radiographs during follow-up. However, two patients underwent revision surgery due to a lack in bone healing. In contrast to the Col group, the postoperative bone formation appeared earlier in the HA group (HA group: 6.8 weeks vs. Col group 13.6 weeks). Complete bone healing was achieved in the HA group after 17.3 weeks compared to 22.4 weeks in the Col group. The average concentration factor of BMAC was 5.2 (SD 1.3). Flow cytometry confirmed the mesenchymal nature of the cells. Cells from BMAC created earlier and larger colonies of forming units fibroblasts (CFU-F) compared to cells from bone marrow aspirate. BMAC combined with HA can reduce the time needed for healing of bone defects when compared to BMAC in combination with collagen sponge. J. Orthop. Res. (c) 2010 Orthopaedic Research Society.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20740672&dopt=ExternalLink
Translate in Italian, in French, in German, in Spanish, in Portuguese
PMID: 20740672 [PubMed - as supplied by publisher]6: Spine (Phila Pa 1976). 2010 Aug 25; [Epub ahead of print]
Endean A, Palmer KT, Coggon D.
From the MRC Epidemiology Resource Centre, University of Southampton, Southampton, United Kingdom.
STUDY DESIGN.: Systematic review and meta-analysis. OBJECTIVE.: To assess how confidently low back pain (LBP) can be attributed to abnormalities on magnetic resonance imaging (MRI), and thereby explore the potential value of MRI abnormalities in refining case definition for mechanical LBP in epidemiological research. SUMMARY OF BACKGROUND DATA.: Most epidemiological studies of mechanical LBP have defined cases only by reported symptoms, but it is possible that the potency of causes differs depending on whether there is demonstrable underlying spinal pathology. METHODS.: We reviewed the published data on MRI abnormalities, looking for data on the repeatability of their assessment, their prevalence in people free from LBP, and their association with LBP. Where data were sufficient, we calculated a summary estimate of prevalence in people without LBP and a meta-estimate of the odds ratio for the association with LBP. A formula was then applied to estimate the corresponding prevalence rate ratio, assuming 3 possible prevalence rates for LBP in the general population. RESULTS.: Data were most extensive for disc protrusion, nerve root displacement or compression, disc degeneration, and high intensity zone, all of which could be assessed repeatedly. All were associated with LBP, meta-estimates of odds ratios ranging from 2.3 (nerve root displacement or compression) to 3.6 (disc protrusion). However, even for disc protrusion, estimates of the corresponding prevalence rate ratios were mostly less than 2. CONCLUSION.: MRI findings of disc protrusion, nerve root displacement or compression, disc degeneration, and high intensity zone are all associated with LBP, but individually, none of these abnormalities provides a strong indication that LBP is attributable to underlying pathology. This limits their value in refining epidemiological case definitions for LBP.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20739918&dopt=ExternalLink
Translate in Italian, in French, in German, in Spanish, in Portuguese
PMID: 20739918 [PubMed - as supplied by publisher]7: Spine (Phila Pa 1976). 2010 Aug 25; [Epub ahead of print]
Fu KM, Smith JS, Polly DW Jr, Perra JH, Sansur CA, Berven SH, Broadstone PA, Choma TJ, Goytan MJ, Noordeen HH, Knapp DR Jr, Hart RA, Donaldson WF 3rd, Boachie-Adjei O, Shaffrey CI.
From the *Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA; daggerDepartments of Orthopedic Surgery and Neurosurgery, University of Minnesota, Minneapolis, MN; double daggerTwin Cities Spine Center, Minneapolis, MN; section signDepartment of Neurosurgery, University of Maryland Medical Center, Baltimore, MD; paragraph signDepartment of Orthopedic Surgery, University of California-San Francisco, San Francisco, CA; parallelSpine Surgery Associates, Chattanooga, TN; **Department of Orthopedic Surgery, University of Missouri; Columbia, MO; daggerdaggerHealth Sciences Centre, Winnipeg, Canada; double daggerdouble daggerThe Royal National Orthopedic Hospital, London, United Kingdom; section sign section signThe Great Ormond Street Children's Hospital, London, United Kingdom; paragraph sign paragraph signArnold Palmer Children's Hospital, Orlando, FL; parallel parallelDepartment of Orthopedic Surgery, Oregon Health and Science University, Portland, OR; ***Department of Orthopedic Surgery, University of Pittsburgh Physicians, Pittsburgh, PA; and daggerdaggerdaggerDepartment of Orthopedic Surgery, Hospital for Special Surgery, New York, NY.
STUDY DESIGN.: Retrospective analysis of prospectively collected database. OBJECTIVE.: To analyze the rate of complications, including neurologic deficits, associated with operative treatment of pediatric isthmic and dysplastic spondylolisthesis. SUMMARY OF BACKGROUND DATA.: Pediatric isthmic and dysplastic spondylolisthesis are relatively uncommon disorders. Several prior studies have suggested a high rate of complication associated with operative intervention. However, most of these studies were performed with sufficiently small sample sizes such that the presence of one complication could significantly affect the overall rate. The Scoliosis Research Society (SRS) prospectively collects morbidity and mortality (M&M) data from its members. This multicentered, multisurgeon database permits analysis of the surgical treatment of this relatively rare condition on an aggregate scale and provides surgeons with useful information for preoperative counseling. METHODS.: Patients who underwent surgical treatment for isthmic or dysplastic spondylolisthesis from 2004 to 2007 were identified from the SRS M&M database. Inclusion criteria for analysis included age </=21 and a primary diagnosis of isthmic or dysplastic spondylolisthesis. RESULTS.: Of 25,432 pediatric cases reported, there were a total of 605 (2.4%) cases of pediatric dysplastic (n = 62, 10%) and isthmic (n = 543, 90%) spondylolisthesis, with a mean age of 15 years (range, 4-21). Approximately 50% presented with neural element compression, and less than 1% of cases were revisions. Surgical procedures included fusions in 92%, osteotomies in 39%, and reductions in 38%. The overall complication rate was 10.4%. The most common complications included postoperative neurologic deficit (n = 31, 5%), dural tear (n = 8, 1.3%), and wound infection (n = 12, 2%). Perioperative deep venous thrombosis and pulmonary embolus were reported in 2 (0.3%) and 1 (0.2%) patients, respectively. There were no deaths in this series. CONCLUSION.: Pediatric isthmic and dysplastic spondylolisthesis are relatively uncommon disorders, representing only 2.4% of pediatric spine procedures in the present study. Even among experienced spine surgeons, surgical treatment of these spinal conditions is associated with a relatively high morbidity.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20739916&dopt=ExternalLink
Translate in Italian, in French, in German, in Spanish, in Portuguese
PMID: 20739916 [PubMed - as supplied by publisher]8: Spine (Phila Pa 1976). 2010 Aug 13; [Epub ahead of print]
Hsu WK.
From the Departments of *Orthopaedic Surgery and daggerNeurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
STUDY DESIGN.: Retrospective cohort study. OBJECTIVE.: To determine the performance-based outcomes in elite athletes of the National Football League (NFL) after a cervical disc herniation. SUMMARY OF BACKGROUND DATA.: Because outcomes after the treatment of cervical disc herniations (CDH) in elite athletes are currently unknown, the treatment decisions for this injury in professional football players are often controversial. METHODS.: NFL players diagnosed with a CDH were identified through previously published protocols using team injury reports and newspaper archives. The "Performance Score" for each player was calculated on the basis of pertinent statistical data, before and after diagnosis of CDH. Data analysis was performed for players with at least a 2-year follow-up. RESULTS.: A total of 99 NFL athletes met the inclusion criteria. In the operative group, on average, 38 of 53 (72%) players successfully returned to play for 29 games over a 2.8-year period, which was significantly greater than that of the nonoperative group, in which only 21 of 46 (46%) players successfully returned to the field to play after treatment for 15 games over a 1.5-year period (P < 0.04). Performance scores and the percentage of games started were not statistically significantly different for either cohort, before and after treatment. Notably, defensive backs had a significantly poorer outcome after treatment for CDH than any other position, playing in only 10 games over a 1.2-year period compared with all others (P < 0.0008). Age at diagnosis demonstrated a negative effect on career longevity after treatment. CONCLUSION.: The data in this study suggest that players have higher return-to-play rates and longer careers after operative treatment than players treated with nonoperative means. Although confounding variables such as concomitant cervical stenosis could have affected these data, these performance-based outcomes after surgical treatment for CDH are better than previously thought. Defensive backs have a poorer prognosis after CDH compared with players of all other positions.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20714275&dopt=ExternalLink
Translate in Italian, in French, in German, in Spanish, in Portuguese
PMID: 20714275 [PubMed - as supplied by publisher]9: Spine (Phila Pa 1976). 2010 Aug 5; [Epub ahead of print]
Videbaek TS, Bunger CE, Henriksen M, Egund N, Christensen FB.
From the Departments of *Orthopedics and daggerDepartment of Radiology, Aarhus University Hospital, Aarhus, Denmark.
STUDY DESIGN.: Randomized clinical trial. OBJECTIVE.: To analyze the long-term clinical impact of anterior column support on sagittal balance after lumbar spinal fusion. SUMMARY OF BACKGROUND DATA.: Several investigators have stressed the importance of maintaining sagittal balance in relation to spinal fusion to avoid lumbar "flat back," accelerated adjacent segment degeneration, pain, and inferior functional outcome. Only limited evidence exists on how sagittal alignment affects clinical outcome. Anterior lumbar interbody fusion combined with posterolateral fusion has been proved superior to posterolateral fusion alone regarding outcome and cost-effectiveness. No randomized controlled trial has been published analyzing the effect of anterior support on radiographic measurements of sagittal balance. METHODS.: Between 1996 and 1999, 148 patients with severe chronic low back pain were randomly selected for posterolateral lumbar fusion plus anterior support (PLF + ALIF) or posterolateral lumbar fusion. A total of 92 patients participated. Sagittal balance parameters were examined on full lateral radiographs of the spine: pelvic incidence (PI), pelvic tilt (PT), sacral slope, thoracic kyphosis, lumbar lordosis, and positioning of C7 plumb line. The type of lumbar lordosis was evaluated and outcome assessed by Oswestry Disability Index (ODI). RESULTS.: Follow-up rate was 74%. Sagittal balance parameters were similar between randomization groups. None of the parameters differed significantly between patients with an ODI from 0 to 40 and patients with ODI over 40. Balanced patients had a significantly superior outcome as measured by ODI (P < 0.05) compared with unbalanced patients. CONCLUSION.: No difference in the investigated sagittal balance parameters was seen between patients treated with PLF + ALIF or posterolateral fusion alone. Lumbar lordosis and type of lordosis correlated with outcome but could not explain the superior outcome in the group with anterior support. Whether sagittal balance and anterior support during fusion provide a protective effect on adjacent motion segments remains unclear.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20693941&dopt=ExternalLink
Translate in Italian, in French, in German, in Spanish, in Portuguese
PMID: 20693941 [PubMed - as supplied by publisher]10: Osteoporos Int. 2010 Aug 4; [Epub ahead of print]
Wicherts IS, Boeke AJ, van der Meer IM, van Schoor NM, Knol DL, Lips P.
EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
Vitamin D deficiency is very common in non-western immigrants. In this randomized clinical trial, vitamin D 800 IU/day or 100,000 IU/3 months were compared with advised sunlight exposure. Vitamin D supplementation was more effective than advised sunlight exposure in improving vitamin D status and lowering parathyroid hormone levels. INTRODUCTION: Vitamin D deficiency (25-hydroxyvitamin D [25(OH)D] < 25 nmol/l) is common among non-western immigrants. It can be treated with vitamin D supplementation or sunlight exposure. METHODS: To determine whether the effect of vitamin D(3) supplementation (daily 800 IU or 100,000 IU/3 months) or sunlight exposure advice is similar with regard to serum 25(OH)D and parathyroid hormone (PTH) concentrations. Randomized clinical trial in 11 general practices in The Netherlands. Non-western immigrants, aged 18-65 years (n = 232) and serum 25(OH)D < 25 nmol/l were randomly assigned to supplementation (daily 800 IU or 100,000 IU/3 months) or advice for sunlight exposure for 6 months (March-September). Blood samples were collected at baseline, during treatment (3 months, 6 months), and at follow-up (12 months). Statistical analysis was performed with multilevel regression modelling. RESULTS: The intention-to-treat analysis included 211 persons. Baseline serum 25(OH)D was 22.5 +/- 11.1 nmol/l. After 6 months, mean serum 25(OH)D increased to 53 nmol/l with 800 IU/day, to 50.5 nmol/l with 100,000 IU/3 months, and to 29.1 nmol/l with advised sunlight exposure (supplementation vs sunshine p < 0.001). Serum PTH decreased significantly in all groups after 3 months, more in the supplementation groups than in the advised sunlight group (p < 0.05). There was no significant effect on physical performance and functional limitations. CONCLUSION: Vitamin D supplementation is more effective than advised sunlight exposure for treating vitamin D deficiency in non-western immigrants.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20683712&dopt=ExternalLink
Translate in Italian, in French, in German, in Spanish, in Portuguese
PMID: 20683712 [PubMed - as supplied by publisher]11: Osteoporos Int. 2010 Aug 4; [Epub ahead of print]
Baird J, Kurshid MA, Kim M, Harvey N, Dennison E, Cooper C.
MRC Epidemiology Resource Centre, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK, jb@mrc.soton.ac.uk.
This systematic review and meta-analysis assessed the strength and magnitude of the association between birthweight and adult bone mass. Higher birthweight was associated with higher bone mineral content of the spine and hip in adult men and women at ages between 18 and 80 years across a range of settings. INTRODUCTION: The aim of this review was to assess the strength and magnitude of the association between early size and adult bone mass. METHODS: Systematic review and meta-analysis of studies that assessed the association between birthweight or weight at 1 year, and bone mineral content (BMC) or bone mineral density (BMD) in adulthood. RESULTS: Fourteen studies met inclusion criteria. Nine assessed the relationship between birthweight and lumbar spine BMC, most showing that higher birthweight was associated with greater adult BMC. Meta-analysis demonstrated that a 1 kg increase in birthweight was associated with a 1.49 g increase in lumbar spine BMC (95% CI 0.77-2.21). Birthweight was not associated with lumbar spine BMD in 11 studies. In six studies, considering the relationship between birthweight and hip BMC, most found that higher birthweight was associated with greater BMC. Meta-analysis demonstrated that a 1 kg increase in birthweight was associated with a 1.41 g increase in hip BMC (95% CI 0.91-1.91). Seven studies considered the relationship between birthweight and hip BMD and, in most, birthweight was not a significant predictor of hip BMD. Three studies assessing the relationship between weight at 1 year and adult bone mass all reported that higher weight at one was associated with greater BMC of the lumbar spine and hip. CONCLUSIONS: Higher birthweight is associated with greater BMC of the lumbar spine and hip in adulthood. The consistency of these associations, across a range of settings, provides compelling evidence for the intrauterine programming of skeletal development and tracking of skeletal size from infancy to adulthood.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20683711&dopt=ExternalLink
Translate in Italian, in French, in German, in Spanish, in Portuguese
PMID: 20683711 [PubMed - as supplied by publisher]12: Spine (Phila Pa 1976). 2010 Jul 30; [Epub ahead of print]
Smith JS, Shaffrey CI, Glassman SD, Berven SH, Schwab FJ, Hamill CL, Horton WC, Ondra SL, Sansur CA, Bridwell KH; the Spinal Deformity Study Group.
From the Departments of *Neurosurgery and daggerOrthopedic Surgery, University of Virginia, Charlottesville, VA; double daggerNorton Leatherman Spine Center, Louisville, KY; section signSpinal Disorders Service, University of California, San Francisco, CA; paragraph signNYU Hospital for Joint Diseases, New York City; parallelState University of New York, Buffalo, NY; **Emory Orthopedics and Spine Center, Atlanta, GA; daggerdaggerDepartment of Neurosurgery, Northwestern University, Chicago, IL; double daggerdouble daggerDepartment of Neurosurgery, University of Maryland Medical Center, Baltimore, MD; and section sign section signSpinal Deformity Service, WA University, St Louis, MO.
STUDY DESIGN.: Retrospective review of a prospective, multicenter database. OBJECTIVE.: The purpose of this study was to assess whether elderly patients undergoing scoliosis surgery had an incidence of complications and improvement in outcome measures comparable with younger patients. SUMMARY OF BACKGROUND DATA.: Complications increase with age for adults undergoing scoliosis surgery, but whether this impacts the outcomes of older patients is largely unknown. METHODS.: This is a retrospective review of a prospective, multicenter spinal deformity database. Patients complete the Oswestry Disability Index (ODI), SF-12, Scoliosis Research Society-22 (SRS-22), and numerical rating scale (NRS; 0-10) for back and leg pain. Inclusion criteria included age 25 to 85 years, scoliosis (Cobb >/=30 degrees ), plan for scoliosis surgery, and 2-year follow-up. RESULTS.: Two hundred six of 453 patients (45%) completed 2-year follow-up, which is distributed among age groups as follows: 25 to 44 (n = 47), 45 to 64 (n = 121), and 65 to 85 (n = 38) years. The percentages of patients with 2-year follow-up by age group were as follows: 25 to 44 (45%), 45 to 64 (48%), and 65 to 85 (40%) years. These groups had perioperative complication rates of 17%, 42%, and 71%, respectively (P < 0.001). At baseline, elderly patients (65-85 years) had greater disability (ODI, P = 0.001), worse health status (SF-12 physical component score (PCS), P < 0.001), and more severe back and leg pain (NRS, P = 0.04 and P = 0.01, respectively) than younger patients. Mean SRS-22 did not differ significantly at baseline. Within each age group, at 2-year follow-up there were significant improvements in ODI (P </= 0.004), SRS-22 (P </= 0.001), back pain (P < 0.001), and leg pain (P </= 0.04). SF-12 PCS did not improve significantly for patients aged 25 to 44 years but did among those aged 45 to 64 (P < 0.001) and 65 to 85 years (P = 0.001). Improvement in ODI and leg pain NRS were significantly greater among elderly patients (P = 0.003, P = 0.02, respectively), and there were trends for greater improvements in SF-12 PCS (P = 0.07), SRS-22 (P = 0.048), and back pain NRS (P = 0.06) among elderly patients, when compared with younger patients. CONCLUSION.: Collectively, these data demonstrate the potential benefits of surgical treatment for adult scoliosis and suggest that the elderly, despite facing the greatest risk of complications, may stand to gain a disproportionately greater improvement in disability and pain with surgery.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20683385&dopt=ExternalLink
Translate in Italian, in French, in German, in Spanish, in Portuguese
PMID: 20683385 [PubMed - as supplied by publisher]13: J Neurosurg Spine. 2010 Aug;13(2):276-82.
Ohmori K.
Department of Orthopedic and Spinal Surgery, Nagoya, Daini Red Cross Hospital, Nagoya, Japan. caz-fb27@hotmail.co.jp
OBJECT: To evaluate the grade of lumbosacral stability, shape analysis was conducted on plain radiographs of the lumbar spine. METHODS: One hundred twenty-six patients were classified into 2 groups: those with a single-segment disc space narrowing at L5-S1 or at L4-5. Stability was evaluated using the discriminant function (z score) derived from the analysis of radiographic parameters-that is, relative thickness of transverse process of L-5 and the sacral table angle. RESULTS: In patients with a space narrowing at L5-S1, the author observed a significantly slender L-5 transverse process and acute obliquity of the sacral endplate; accordingly, the z score was negative. In patients with a broad transverse process and a positive z score, the segment associated with disc height loss was L4-5. Thus, a close correlation was found between the site of the disc height loss and the bony characteristics of L-5 and S-1. Furthermore, it could be expected with a high degree reliability that when young adult patients had a z score less than -2 or -3, their L-5 vertebra would develop degenerative spondylolisthesis after middle age and the L5-S1 segment could be saved from age-related alterations as long as the z score was greater than 2.5. The constitutional characteristics of the lumbosacral junction may exert a major influence on the site of disc degeneration. CONCLUSIONS: Stability at the lumbosacral junction was thought to be quantitatively represented by the z score, with z being designated the lumbosacral stability score.
Publication Types: Clinical Trial Validation Studies
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20672966&dopt=ExternalLink
Translate in Italian, in French, in German, in Spanish, in Portuguese
PMID: 20672966 [PubMed - indexed for MEDLINE]14: J Neurosurg Spine. 2010 Aug;13(2):211-5.
Ploumis A, Albert TJ, Brown Z, Mehbod AA, Transfeldt EE.
Orthopaedic Department, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA. aploumis@cc.uoi.gr
OBJECT: The objective of this study was to examine the efficacy and safety of Healos graft carrier with bone marrow aspirate and local autograft compared with the results of allograft in patients with lumbar degenerative scoliosis undergoing posterolateral fusion. METHODS: Twenty-eight patients with degenerative scoliosis underwent posterolateral instrumented fusion and decompression. Patients were grouped according to the graft used. Group A consisted of 12 cases in which the authors used a Healos graft carrier, bone marrow aspirate, and local autograft, and Group B consisted of 16 cases in which the authors used cancellous allograft and local autograft. Patients were followed for a minimum of 2 years postoperatively in terms of pain (visual analog scale), function (Oswestry Disability Index), curve magnitude (Cobb angle), and fusion status (plain and dynamic radiographs). The 2 groups did not differ statistically significantly (p > 0.05) in age, sex, smoking habits, magnitude of preoperative visual analog scale score, Oswestry Disability Index score, Cobb angle, or number of levels requiring decompression and fusion. RESULTS: The groups had similar (p > 0.05) results in terms of pain, function, curve progression, and fusion rates at the 2-year follow-up examination. Radiographic fusion was achieved in all but 2 cases, 1 in each group, in which the patients were asymptomatic. Patients in the allograft group (Group B) showed evidence of fusion earlier than in the Healos group (p < 0.05). No toxicity from Healos graft was recorded. CONCLUSIONS: The combination of Healos hydroxyapatite sponge and bone marrow aspirate plus local allograft had significantly slower fusion rates but equal clinical outcomes compared with cancellous allograft plus local autograft when used for posterolateral fusion in patients with degenerative lumbar scoliosis.
Publication Types: Clinical Trial Comparative Study
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20672956&dopt=ExternalLink
Translate in Italian, in French, in German, in Spanish, in Portuguese
PMID: 20672956 [PubMed - indexed for MEDLINE]15: J Neurosurg Spine. 2010 Aug;13(2):200-10.
Yamamoto N, Kobashi H, Shiba M, Itoh T.
Department of Orthopaedic Surgery, Tokyo Women's Medical University, Yachiyo Medical Center, Chiba, Japan. naoyama@tymc.twmu.ac.jp
OBJECT: Motor evoked potentials are widely used for intraoperative spinal cord monitoring. However, there are problems with anesthetic constraints and high trial-by-trial variability of compound muscle action potential amplitude in muscle motor evoked potential monitoring. It is difficult to determine when to warn the surgeon of an occurrence of spinal cord risk. A method of estimation for motor function in the spinal cord has not been established. To monitor spinal cord function with reliable evoked potentials, including the upper cervical spinal cord and the ventral spinal cord, the authors developed a nasopharyngeal tube electrode that can be placed in front of the upper and ventral cervical spinal cord. The purpose of this study was to investigate the origins and pathways of descending or ascending spinal cord evoked potentials (SCEPs) elicited with this electrode, and the usefulness and limitations of this method. METHODS: A nasopharyngeal tube electrode was inserted into the nostril. A catheter electrode was placed in the epidural or subarachnoid space at the thoracic spine. Ventral SCEP was recorded from the thoracic spinal cord after transpharyngeal stimulation, and dorsal SCEP was recorded with the nasopharyngeal electrode after thoracic spinal cord stimulation. There was no restriction of anesthetic technique in recording. When the amplitude of either of the SCEPs declined to 80% of the baseline, a warning was provided to the surgeon during the observed operative procedure. At the end of surgery, less than 50% or more than 30% of the baseline amplitude was considered a significant change in both SCEPs. The sensitivity and specificity for both SCEPs to detect neurological deterioration were calculated. RESULTS: The electrode provided noninvasive access to the ventral cervicomedullary junction. The SCEPs showed stable responses. A response change was only observed in situations involving a risky procedure for the spinal cord. Ventral SCEPs showed high sensitivity (73.1%) for identifying patients with new neurological deficits or an exacerbation of preexisting neurological deficits after surgery, but dorsal SCEPs showed lower sensitivity (46.1%) in the total number of cases. Both SCEPs showed high specificities. The sensitivities of ventral SCEP, dorsal SCEP, and either SCEP were 100.0%, 50.0%, and 100.0% for the upper cervical spinal cord, 33.3%, 0%, and 55.6% for the lower cervical spinal cord, and 77.8%, 64.7%, and 88.2% for the thoracic spinal cord. CONCLUSIONS: Combined recording of both SCEPs estimated the ventral and dorsal white matter function in the spinal cord. Measuring the SCEPs with the nasopharyngeal electrode can be another useful approach for upper cervical and thoracic spinal cord monitoring. Ventral SCEP was more reliable for monitoring postoperative spinal cord function than dorsal SCEP. Ventral SCEP does not estimate the gray matter and spinal root functions in the lower cervical spinal cord.
Publication Types: Clinical Trial Research Support, Non-U.S. Gov't Validation Studies
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20672955&dopt=ExternalLink
Translate in Italian, in French, in German, in Spanish, in Portuguese
PMID: 20672955 [PubMed - indexed for MEDLINE]16: J Neurosurg Spine. 2010 Aug;13(2):158-64.
Kang BU, Lee SH, Ahn Y, Choi WC, Choi YG.
Department of Neurosurgery, Wooridul Spine Hospital, Daegu, Korea. grussin@dreamwiz.com
OBJECT: C-reactive protein (CRP) is a well-known sensitive laboratory parameter that shows an increase within 6 hours after the onset of bacterial infection. In relation to surgery, a normal CRP response is a rapid increase followed by a gradual reduction, eventually returning to the normal range. The goal of this study was to determine the diagnostic significance of CRP as a detector for early onset surgical site infection in spinal surgery and to discuss effective medical treatment through clinical interpretation and application of the measured CRP values. METHODS: A prospective study was performed in 348 consecutive cases involving patients who underwent spinal surgery under general anesthesia between February and September 2008. Blood samples were obtained preoperatively and on postoperative Days 1, 3, and 5 in patients undergoing single-level decompression surgery. An additional blood specimen was obtained at postoperative Day 7 in patients requiring more extensive surgeries. Recorded laboratory results were compared with the patients' clinical course to determine the diagnostic significance of CRP. All of the patients received intravenous prophylactic antibiotic therapy. Once an abnormal response of CRP, indicated by a tendency toward continuous elevation, was noted on Day 5 or Day 7, the prophylactic antibiotics were replaced with another regimen and administration was resumed along with careful observation for signs of surgical site infection. RESULTS: Monitoring of CRP revealed a characteristic increase and decrease pattern in 332 of 348 patients (95.4%) showing a normal clinical course with regard to early infectious complications. The mean measured CRP (reference range < 4 mg/L) averaged 14.9 +/- 20.3 mg/L on Day 1, 15.4 +/- 25.1 mg/L on Day 3, and 7.9 +/- 13.3 mg/L on Day 5. In contrast, there were 16 cases (4.6%) of abnormal CRP responses resulting in the resumption of intravenous antibiotic treatment, which included a second rise (in 12 cases) and a steady rise (in 4) in the CRP value. Five (1.4%) of 16 patients experienced infectious complications related to spinal surgery. Three patients (0.9%) received long-term antibiotic therapy for 4-6 weeks; however, all patients recovered with medical treatment alone and did not experience gross wound disruption or subsequent discitis. As a predictor for early wound infection, the sensitivity, specificity, positive predictive value, and negative predictive value for abnormal CRP responses were calculated as 100%, 96.8%, 31.3%, and 100%, respectively. CONCLUSIONS: The above results demonstrate that CRP screening is a simple and reliable test for the detection of early infectious complications after spinal surgery. Close observation and appropriate medical management should be performed in a timely fashion when abnormal CRP responses are observed at 5 or 7 days after surgery.
Publication Types: Clinical Trial
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20672950&dopt=ExternalLink
Translate in Italian, in French, in German, in Spanish, in Portuguese
PMID: 20672950 [PubMed - indexed for MEDLINE]17: J Neurosurg Spine. 2010 Aug;13(2):144-57.
Nasser R, Yadla S, Maltenfort MG, Harrop JS, Anderson DG, Vaccaro AR, Sharan AD, Ratliff JK.
Temple University School of Medicine, Philadelphia, Pennsylvania, USA.
OBJECT: The overall incidence of complications or adverse events in spinal surgery is unknown. Both prospective and retrospective analyses have been performed, but the results have not been critically assessed. Procedures for different regions of the spine (cervical and thoracolumbar) and the incidence of complications for each have been reported but not compared. Authors of previous reports have concentrated on complications in terms of their incidence relevant to healthcare providers: medical versus surgical etiology and the relevance of perioperative complications to perioperative events. Few authors have assessed complication incidence from the patient's perspective. In this report the authors summarize the spine surgery complications literature and address the effect of study design on reported complication incidence. METHODS: A systematic evidence-based review was completed to identify within the published literature complication rates in spinal surgery. The MEDLINE database was queried using the key words "spine surgery" and "complications." This initial search revealed more than 700 articles, which were further limited through an exclusion process. Each abstract was reviewed and papers were obtained. The authors gathered 105 relevant articles detailing 80 thoracolumbar and 25 cervical studies. Among the 105 articles were 84 retrospective studies and 21 prospective studies. The authors evaluated the study designs and compared cervical, thoracolumbar, prospective, and retrospective studies as well as the durations of follow-up for each study. RESULTS: In the 105 articles reviewed, there were 79,471 patients with 13,067 reported complications for an overall complication incidence of 16.4% per patient. Complications were more common in thoracolumbar (17.8%) than cervical procedures (8.9%; p < 0.0001, OR 2.23). Prospective studies yielded a higher incidence of complications (19.9%) than retrospective studies (16.1%; p < 0.0001, OR 1.3). The complication incidence for prospective thoracolumbar studies (20.4%) was greater than that for retrospective series (17.5%; p < 0.0001). This difference between prospective and retrospective reviews was not found in the cervical studies. The year of study publication did not correlate with the complication incidence, although the duration of follow-up did correlate with the complication incidence (p = 0.001). CONCLUSIONS: Retrospective reviews significantly underestimate the overall incidence of complications in spine surgery. This analysis is the first to critically assess differing complication incidences reported in prospective and retrospective cervical and thoracolumbar spine surgery studies.
Publication Types: Review
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20672949&dopt=ExternalLink
Translate in Italian, in French, in German, in Spanish, in Portuguese
PMID: 20672949 [PubMed - indexed for MEDLINE]18: Phys Ther. 2010 Jul 29; [Epub ahead of print]
Ferreira ML, Smeets RJ, Kamper SJ, Ferreira PH, Machado LA.
Faculty of Health Sciences, University of Sydney, 75 East St, PO Box 170, Lidcombe, New South Wales 1825, Australia.
Background Exercise programs may vary in terms of duration, frequency, and dosage; whether they are supervised; and whether they include a home-based program. Uncritical pooling of heterogeneous exercise trials may result in misleading conclusions regarding the effects of exercise on chronic low back pain (CLBP). PURPOSE: /b> The purpose of this study was to establish the effect of exercise on pain and disability in patients with CLBP, with a major aim of explaining between-trial heterogeneity. Data Sources Six databases were searched up to August 2008 using a computerized search strategy. Study Selection Eligible studies needed to be randomized clinical trials evaluating the effects of exercise for nonspecific CLBP. OUTCOMES: of interest were pain and disability measured on a continuous scale. Data Extraction Baseline demographic data, exercise features, and outcome data were extracted from all included trials. Data Synthesis Univariate meta-regressions were conducted to assess the associations between exercise effect sizes and 8 study-level variables: baseline severity of symptoms, number of exercise hours and sessions, supervision, individual tailoring, cognitive-behavioral component, intention-to-treat analysis, and concealment of allocation. Limitations Only study-level characteristics were included in the meta-regression analyses. Therefore, the implications of the findings should not be used to differentiate the likelihood of the effect of exercise based on patient characteristics. CONCLUSIONS:/b> The results show that, in general, when all types of exercise are analyzed, small but significant reductions in pain and disability are observed compared with minimal care or no treatment. Despite many possible sources of heterogeneity in exercise trials, only dosage was found to be significantly associated with effect sizes.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20671101&dopt=ExternalLink
Translate in Italian, in French, in German, in Spanish, in Portuguese
PMID: 20671101 [PubMed - as supplied by publisher]19: Phys Ther. 2010 Jul 29; [Epub ahead of print]
Palmieri-Smith RM, Thomas AC, Karvonen-Gutierrez C, Sowers M.
School of Kinesiology, University of Michigan, 4745G CCRB, 401 Washtenaw Ave, Ann Arbor, MI 48109 (USA), and Bone & Joint Injury Prevention & Rehabilitation Center, University of Michigan.
Background Neuromuscular electrical stimulation (NMES) has demonstrated efficacy in improving quadriceps muscle strength (force-generating capacity) and activation following knee replacement and ligamentous reconstruction. Yet, data are lacking to establish the efficacy of NMES in people with evidence of early radiographic osteoarthritis. Objective The purpose of this study was to determine whether NMES is capable of improving quadriceps muscle strength and activation in women with mild and moderate knee osteoarthritis. Design This study was a randomized controlled trial. METHODS:/b> Thirty women with radiographic evidence of mild or moderate knee osteoarthritis were randomly assigned to receive either no treatment (standard of care) or NMES treatments 3 times per week for 4 weeks. The effects of NMES on quadriceps muscle strength and activation were evaluated upon study enrollment, as well as at 5 and 16 weeks after study enrollment, which represent 1 and 12 weeks after cessation of NMES among the treated participants. The Western Ontario and McMaster Universities Osteoarthritis Index and a 40-foot (12.19-m) walk test were used at each testing session. RESULTS: /b> Improvements in quadriceps muscle strength or activation were not realized for the women in the intervention group. Quadriceps muscle strength and activation were similar across testing sessions for both groups. Limitations Women were enrolled based on radiographic evidence of osteoarthritis, not symptomatic osteoarthritis, which could have contributed to our null finding. A type II statistical error may have been committed despite an a priori power calculation. The assessor and the patients were not blinded to group assignment, which may have introduced bias into the study. CONCLUSIONS:/b> Four weeks of NMES delivered to women with mild and moderate osteoarthritis and mild strength deficits was insufficient to induce gains in quadriceps muscle strength or activation. Future research is needed to examine the dose-response relationship for NMES in people with early radiographic evidence of osteoarthritis.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20671100&dopt=ExternalLink
Translate in Italian, in French, in German, in Spanish, in Portuguese
PMID: 20671100 [PubMed - as supplied by publisher]20: Phys Ther. 2010 Jul 29; [Epub ahead of print]
Borello-France D, Burgio KL, Goode PS, Markland AD, Kenton K, Balasubramanyam A, Stoddard AM; for the Urinary Incontinence Treatment Network.
Department of Physical Therapy, Duquesne University, 111 Health Sciences Bldg, Pittsburgh, PA 15282 (USA).
Background Behavioral intervention outcomes for urinary incontinence (UI) depend on active patient participation. Objective The purpose of this study was to describe adherence to behavioral interventions (pelvic-floor muscle [PFM] exercises, UI prevention strategies, and delayed voiding), patient-perceived exercise barriers, and predictors of exercise adherence in women with urge-predominant UI. Design This was a prospectively planned secondary data analysis from a 2-stage, multicenter, randomized clinical trial. Patients and Intervention Three hundred seven women with urge-predominant UI were randomly assigned to receive either 10 weeks of drug therapy only or 10 weeks of drug therapy combined with a behavioral intervention for UI. One hundred fifty-four participants who received the combined intervention were included in this analysis. Measurements Pelvic-floor muscle exercise adherence and exercise barriers were assessed during the intervention phase and 1 year afterward. Adherence to UI prevention strategies and delayed voiding were assessed during the intervention only. RESULTS: /b> During intervention, 81% of women exercised at least 5 to 6 days per week, and 87% performed at least 30 PFM contractions per day. Ninety-two percent of the women used the urge suppression strategy successfully. At the 12-month follow-up, only 32% of the women exercised at least 5 to 6 days per week, and 56% performed 15 or more PFM contractions on the days they exercised. The most persistent PFM exercise barriers were difficulty remembering to exercise and finding time to exercise. Similarly, difficulty finding time to exercise persisted as a predictor of PFM exercise adherence over time. Limitations Co-administration of medication for UI may have influenced adherence. CONCLUSIONS:/b> Most women adhered to exercise during supervised intervention; however, adherence declined over the long term. Interventions to help women remember to exercise and to integrate PFM exercises and UI prevention strategies into daily life may be useful to promote long-term adherence.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20671098&dopt=ExternalLink
Translate in Italian, in French, in German, in Spanish, in Portuguese
PMID: 20671098 [PubMed - as supplied by publisher]