Lumbar Column Research Articles

Effect of Strength Training and the Practice of Alpine Skiing on Bone Mass Density, Growth, Body Composition, and the Strength and Power of the Legs of Adolescent Skiers

This work examines the influence of practicing strength training and Alpine skiing over 2 years on bone mineral density (BMD), growth, body composition, and the strength and power of the legs of adolescent skiers. The study subjects were 20 adolescent skiers (10 girls and 10 boys) and 19 sedentary adolescents (9 girls and 10 boys), all 13-16 years of age. The BMDs of the lumbar column (L2-L4) and hip (neck of the femur, trochanter, and Ward's triangle) were determined by dual x-ray photon absorptiometry at the beginning and end of the experimental period. The increase in height and the percentage fat and muscular masses of the subjects were also recorded, as was their ability to jump (countermovement jump [CMJ]), their leg strength and power (squat test), and their leg anaerobic power (continuous jump test [CMJ15″]). No significant differences were seen in the increase in height, body weight, or percentage fat mass between the skiers and sedentary subjects, although the boy skiers showed a significant increase in percentage muscular mass (p < 0.05) compared to the sedentary boys. The improvement in the values of the different CMJ variables was significantly greater among the boy skiers than among the sedentary boys (p < 0.001-0.01). The same was true for the girls (p < 0.001), except for CMJ15″. The skiers experienced a significantly greater increase in L2-L4 BMD than the sedentary subjects (boys p < 0.05; girls p < 0.01). These results suggest that Alpine skiing combined with rational strength training involves no special risk for the physical development of young people, has a positive effect on the power and the percentage of muscle mass in the legs, and helps to have a higher bone density in the lumbar spine (L2-L4).

A New PMHS Model for Lumbar Spine Injuries During Vertical Acceleration

Ejection from military aircraft exerts substantial loads on the lumbar spine. Fractures remain common, although the overall survivability of the event has considerably increased over recent decades. The present study was performed to develop and validate a biomechanically accurate experimental model for the high vertical acceleration loading to the lumbar spine that occurs during the catapult phase of aircraft ejection. The model consisted of a vertical drop tower with two horizontal platforms attached to a monorail using low friction linear bearings. A total of four human cadaveric spine specimens (T12-L5) were tested. Each lumbar column was attached to the lower platform through a load cell. Weights were added to the upper platform to match the thorax, head-neck, and upper extremity mass of a 50th percentile male. Both platforms were raised to the drop height and released in unison. Deceleration characteristics of the lower platform were modulated by foam at the bottom of the drop tower. The upper platform applied compressive inertial loads to the top of the specimen during deceleration. All specimens demonstrated complex bending during ejection simulations, with the pattern dependent upon the anterior-posterior location of load application. The model demonstrated adequate inter-specimen kinematic repeatability on a spinal level-by-level basis under different subfailure loading scenarios. One specimen was then exposed to additional tests of increasing acceleration to induce identifiable injury and validate the model as an injury-producing system. Multiple noncontiguous vertebral fractures were obtained at an acceleration of 21 g with 488 g/s rate of onset. This clinically relevant trauma consisted of burst fracture at L1 and wedge fracture at L4. Compression of the vertebral body approached 60% during the failure test, with -6,106 N axial force and 168 Nm flexion moment. Future applications of this model include developing a better understanding of the vertebral injury mechanism during pilot ejection and developing tolerance limits for injuries sustained under a variety of different vertical acceleration scenarios.

Bone Health, Daily Physical Activity, and Exercise Tolerance in Patients With Cystic Fibrosis

Daily physical activity (PA) may be an excellent tool for the maintenance of bone health in patients with cystic fibrosis (CF). The aim of this study was to analyze the possible association between physical capacity and activity and bone mineral density (BMD) in young adults with CF. A secondary goal was to evaluate vertebral fractures in this population. A cross-sectional study was conducted in 50 patients with CF who were clinically stable and aged > 16 years but not lung transplant recipients. PA was quantified with a portable motion monitor (BodyMedia Fit Armband). Cardiopulmonary exercise and 6-min walk tests were used to assess exercise capacity. BMD was obtained from dual-energy x-ray absorptiometry of the lumbar column, hip, and whole body. To analyze vertebral fractures and deformity, we performed the Genant and Cobb methods. Daily PA time at low (3-4.8 metabolic equivalent tasks [METs]) and moderate (4.8-7.2 METs) intensity, respectively, was correlated with Z score (BMD) of the lumbar column (r = 0.36, P < .01 and r = 0.59, P < .001), the neck of femur (r = 0.51, P < .001 and r = 0.72, P < .001), and the total hip (r = 0.54, P < .001 and r = 0.74, P < .001). PA, BMI, age, and sex were predictors of BMD. Vertebral fractures correlated with kyphosis (r = 0.42, P = .02), but not with BMD. Patients who were mildly and severely affected differed in vertebral fracture rate and kyphosis prevalence (P = .002 and P = .013, respectively). The most active patients with better exercise capacity had higher BMD. Those with more affected pulmonary function had a greater prevalence of vertebral fractures and dorsal kyphosis.

Impact of the mouth breathing occurred during childhood in the adult age: Biophotogrammetric postural analysis

Objective This study aims to evaluate the impact of the mouth breathing occurred during childhood on the body posture in the adult age. Methods 24 adults, of both genders, aged from 18 to 30 years old with report of clinical manifestations of mouth breathing during the childhood composed the study group (SG). The control group (CG) was composed by 20 adults in the same age, without any respiratory problem since the childhood up to the present time. All the volunteers underwent a physiotherapeutic evaluation consisted of anamnesis and postural biophotogrammetry ( SAPo v 0.68 ®). The comparison between the data of the SG and CG was accomplished by Student's t-test. Results The biophotogrammetric analysis demonstrated that the SG showed more forward head posture confirmed by the angles A9 ( p = 0.0000) and CL ( p = 0.0414) and also by the cervical distance ( p = 0.0079). Additionally, this group presented a larger angular measure of the lumbar lordosis ( p = 0.0141) compared to the CG. Conclusion The results indicate that adults with mouth-breathing childhood have postural alterations, mainly in the head and lumbar column, which keeps for the whole life.

Prevalência de sintomas osteomusculares em professores de escolas públicas e privadas do ensino fundamental

OBJETIVOS: Diante da preocupação com a saúde e as condições de trabalho dos professores, este artigo objetivou verificar a prevalência de sintomas osteomusculares em professores do ensino fundamental de escolas públicas e privadas. MÉTODOS: A amostra foi composta por 320 professores de seis escolas. Para a pesquisa, fez-se uso de um questionário sociodemográfico, de um check-list para avaliação ergonômica, e do questionário nórdico para avaliar os sintomas osteomusculares. Para análise dos dados utilizou-se o programa SPSS® 10.0. RESULTADOS: Dos participantes, 89,7% referiram algum sintoma nos últimos 12 meses. As áreas mais acometidas por estes sintomas foram: coluna dorsal 54,1% (173), pescoço 50,9% (163) coluna lombar 49,1% (157). Os sintomas impossibilitaram 36,6% dos professores de exercer suas atividades normais. Observou-se também que a condição ergonômica do local de trabalho é considerada ruim pelos professores. CONCLUSÃO: Concluímos que a prevalência de sintomas osteomusculares nos professores é alta e as condições ergonômicas são consideradas inapropriadas, podendo interferir diretamente em sua saúde.

Análise computacional para auxílio ao diagnóstico de osteoartrite de coluna lombar baseado em redes neurais artificiais

OBJETIVOS: Conhecer as vantagens da utilizacao das redes neurais artificiais no reconhecimento de padroes em radiografias de coluna lombar na incidencia perfil para auxiliar no diagnostico da osteoartrite primaria. METODO: Estudo transversal, descritivo, analitico, de abordagem quantitativa e com enfase diagnostica. O conjunto de treinamento foi composto por imagens coletadas no periodo de janeiro a julho de 2009 de pacientes submetidos a radiografias digitais de coluna lombar na incidencia em perfil provenientes de um servico de radiologia localizado no municipio de Criciuma (SC). Das 260 imagens coletadas, foram excluidas: as radiografias distorcidas, as patologias que alteram a arquitetura da coluna lombar e os padroes de dificil caracterizacao, resultando em um total de 206 imagens. O banco de imagens (n = 206) foi subdividido, resultando em 68 radiografias para a etapa de treinamento, 68 para testes e 70 para validacao. Foi utilizada uma rede neural hibrida baseada em mapas auto-organizaveis de Kohonen e redes Multilayer Perceptron. RESULTADOS: Apos 90 ciclos, foi realizada a validacao com o melhor teste, alcancando acuracia de 62,85%, sensibilidade de 65,71% e especificidade de 60%. CONCLUSAO: Apesar da demonstracao de uma eficacia mediana, por se tratar de estudo de carater inovador, seus valores mostram um futuro promissor da tecnica utilizada, com sugestao para trabalhos futuros com abrangencia na metodologia de processamento das imagens e ciclos com uma quantidade maior de radiografias.

Chance fracture missed by convencional CT: Presentation of a clinical course

Bending-disruption fractures of the vertebral body are called Chance fracture. In some cases these fractures may not be noticeable with a CT scan. A 9 years-old boy suffered a frontal collision while traveling in the back seat of a car. The child was secured by the safetybelt, without a child car seat or elevator adapted to his height. He had abdominal skin lesions in the physical exploration compatible with a belt mark. Conventional thoraco- abdominal CT scan did not show any vertebral fracture. As the clinical suspicion persisted, lateral plain radiography of the lumbar column was performed showing a Chance fracture in L2, confirmed by MRI. Chance fracture is typically seen in children under 12 years less than 135 cm height and with injuries associated with the belt after a traffic accident. This type of fractures may go unnoticed in a conventional CT scan so clinical suspicion must lead us to further work-up. The MRI is the gold standard for the diagnosis. This case remarks the importance of the use of homologated elevated seat devices in older children.

Neridronate (NE) for the Treatment of Osteoporosis In Patients with β-Thalassemia: Results from an Italian Multicenter Randomized, Open Label, Phase II Trial

AbstractAbstract 4282A high percentage (90%) of patients with β- Thalassemia Major suffers from osteopenia or osteoporosis. The aim of this study was to evaluate the effect of NE on Thalassemia-induced osteoporosis. NE is an aminobisphosfonate which has been proved to inhibit osteoclast-mediated bone resorption. It has been already used in the treatment of several bone disorders such as Paget's disease and Osteogenesis Imperfecta. This trial is registered with ClinicalTrials.gov. NTC01140321. Male and female patients (> 18 years) with transfusion dependent β- Thalassemia who had a BMD Z score <-2 at the level of the femoral neck or of the lumbar column and received regular transfusions in order to maintain pre-transfusional Hb values >9 g/dl were eligible. Exclusion criteria were: Thalassemia Intermedia if not regularly transfused; pregnancy and breast feeding; impaired renal function (creatinine > 1.5 mg/dl); neoplastic disease; mean levels of alanine aminotransferase (ALT) > 300 U/l and variations of aspartate aminotransferase (AST) or AST of 300% within the year before randomization (at least 4 assessments over 12 months); systemic cardiovascular, renal, hepatic disease which would prevent the patient from undergoing the study treatment; hypoparathyroidism; Thalassemia Intermedia occasionally transfused; known hypersensibility to bisphosphonates. If di-bisphosphonates iv within the past 2 years or of bisphosphonates per os had been administered, a wash out period (1 year if >8 weeks <48 weeks; 6 months if > 2 weeks and <8 weeks) was necessary before entering the trial. The trial was approved by the Coordinating Centre Ethics Committee (EC) at E.O. Ospedali Galliera in Genoa, Italy and the local EC at each participating Centre. All participants gave written informed consent before entering the study. 118 patients (51 males and 67 females) were randomized in two groups: group A (n=54) treated with NE 100 mg iv every 90 days plus 500 mg of calcium/400 UI of vitamin D daily; group B (n=64) treated with 500 mg of calcium/400 UI of vitamin D daily. The 2 groups were homogeneous at baseline with respect to age and gender. Efficacy and safety of NE were monitored via monthly Blood Cells Count, creatinine, BUN, AST, ALT, Ca, P, proteins electrophoresis, total protein readings. Bone Mineral Density (BMD) of the lumbar spine, total hip and femoral neck was performed at baseline and at month 6 and 12. Serum levels of bone alkaline phosphatase (bALP) and C-telopeptide of collagen type-I (CTX) and pain scores (questions 7 and 8 of SF-36 Questionnaire) were assessed at baseline and 3, 6 and 12 months after the start of the treatment. The mean increase of the lumbar spine BMD after 12 months was 3.3 % in group A and 0.2 % in group B, with an highly significant difference (p=0.003). After 6 months, the mean changes in lumbar spine BMD were 3.2 % and 0.1 % in group A and B respectively (p<0.001). The comparison between group A and group B showed a significant mean percent increase of the BMD in total hip and in the femoral neck (p<0.01 and p<0.05, respectively). Changes in bALP and CTX became significant as early as 3 months after the first administration in group A (p=0.015 and p<0.001, respectively), while in group B there was a borderline significance only for CTX (p = 0.048) after 3 months. Concerning question 7 of the SF-36 (physical pain in the last 4 weeks), the reduction was statistically significant after 6 months in group A (p=0.008). This result was confirmed after 12 months (p=0.001). Question 8 (pain that has hindered the usual work in the last 4 weeks) showed earlier significant reduction from the third month. One patient of group A dropped out after 6 months because of multiple fractures as a result of a traffic accident. Finally, hematologic and haematochemical and biochemical analyses did not show any clinically relevant variations. Statistically significant changes, although within the normal range, were reported for PTH, calcemia and calciuria in group A, and PTH and BUN in group B. This is the largest randomized trial designed to treat Thalassemia induced osteoporosis. NE, at the dose of 100 mg, iv, every 3 months was shown to be safe and effective both in reducing bone resorption and increasing BMD. Moreover it was shown to be effective in reducing back pain and it has a clinically manageable safety profile at a very affordable price and, being administered once every three months does not interfere with the life of patients already burdened with many treatments. Disclosures:No relevant conflicts of interest to declare.

Biomechanical Evaluation of a Posterolateral Lumbar Disc Arthroplasty Device

This in vitro analysis defines biomechanical properties of the Triumph Lumbar Disc (TLD) for posterolateral lumbar disc arthroplasty. To quantify segmental kinematics afforded by the TLD, determine whether intervertebral positional changes of the device affect spinal kinematics, and compare kinematics following TLD reconstruction with historical CHARITE data. As an alternative to arthrodesis, total disc arthroplasty serves to restore the biomechanical properties of the spine. However, there are kinematic and clinical concerns regarding posterior lumbar column destabilization and reconstruction using motion-preserving technology. Seven human lumbosacral spines were biomechanically evaluated under the following conditions: (1) Intact; (2) Unilateral facetectomy; (3) Facetectomy and discectomy; (4) TLD-posterior; (5) TLD-central; (6) TLD-anterior. Centers of intervertebral rotation (COR) and intradiscal pressures were compared at the operative/adjacent levels. In axial rotation, L4-L5 range of motion (ROM) increased to 110%+/-15.3% following unilateral facetectomy and 134.3%+/-26.9% following facet/discectomy. Implanting the TLD in 3 positions-posterior, central, and anterior-demonstrated no significant differences in ROM (P>0.05). Trends were similar in flexion/extension and lateral bending. The neutral zone increased under the facet/discectomy condition and TLD reconstructions compared to the intact condition (P<0.05). CORs were dispersed at the operative level following destabilization. TLD in posterior and central positions restored loci to near the intact condition, whereas the anterior position produced more diffuse CORs. Adjacent level intradiscal pressures decreased in flexion-extension following destabilization and reconstruction. Axial rotation ROM following TLD reconstruction (central position) was 131.5% of intact, compared to historical controls for the CHARITE device (162.0%). This indicates that lumbar disc arthroplasty performed using a posterolateral approach may offer biomechanical advantages over the anterior approach. Moreover, this approach may minimize surgical complications and allow simultaneous decompression of the neural elements. Intervertebral positional changes of the TLD were not shown to affect spinal kinematics.

GnRH analogue treatment and decrease of bone mass density (BMD) in a patient with Osteogenesis Imperfecta (OI) and Central Precocious Puberty (CPP)

perfecta (OI), with the aim of improving height velocity, bone mineral density (BMD) and projected bone areas.Study design: We observed a randomized population of patients: 30 pre-pubertal children (14 boys and 16 girls) suffering from OI (type I, IV and III), already receiving treatment with Neridronate. After an observational period of 12 months during ongoing Neridronate treatment, the patients were randomized into two groups: Group A, 15 children (7 boys and 8 girls) were treated for 12 months with GH and Neridronate; Group B, 15 (7 boys and 8 girls) continued Neridronate alone. We evaluated auxological parameters, number of fractures, bone age (BA), bone metabolic parameters and bone mass measurements with DXA (lumbar column and radius), in the year before and throughout the GH treatment. Results: Growth velocity was significantly higher during GH treatment in Group A vs Group B and vs pre-treatment period (p<0.05), with no difference in Bone Age advancement. The number of fractures did not increase during GH treatment. IGF-I levels were in the low-normal range before therapy and increased significantly after 12 months in Group A vs Group B and vs pre-treatment (p<0.05). Bone mineral density (BMD) at the lumbar column (L2L3L4), distal radius and ultra distal radius (Δ % BMD), and the projected area of lumbar column increased significantly in Group A vs Group B (p<0.05). With a complete molecular characterization in both type I collagen genes (COL1A1 and COL1A2 ), we differentiate between qualitative and quantitative collagen synthesis defects. Patients with quantitative defects had a higher, although not significant, response to GH treatment in terms of growth velocity and BMD. Conclusions: In patients with Osteogenesis Imperfecta the combined GH Bisphosphonate treatment may give better results than Bisphosphonate treatment alone in terms of growth velocity, higher BMD at the lumbar column and wrist, lumbar column projected area, especially in patients with quantitative collagen synthesis defects.

The vertebral formula of the last common ancestor of African apes and humans

The modal number of lumbar vertebrae in modern humans is five. It varies between three and four in extant African apes (mean=3.5). Because both chimpanzees (Pan troglodytes) and gorillas (Gorilla gorilla) possess the same distributions of thoracic, lumbar, and sacral vertebrae, it has been assumed from parsimony that the last common ancestor (LCA) of African apes and humans possessed a similarly short lower back. This "short-backed LCA" scenario has recently been viewed favorably in an analysis of the intra- and interspecific variation in axial formulas observed among African apes and humans (Pilbeam, 2004. J Exp Zool 302B:241-267). However, the number of bonobo (Pan paniscus) specimens in that study was small (N=17). Here we reconsider vertebral type and number in the LCA in light of an expanded P. paniscus sample as well as evidence provided by the human fossil record. The precaudal (pre-coccygeal) axial column of bonobos differs from those of chimpanzees and gorillas in displaying one additional vertebra as well as significantly different combinations of sacral, lumbar, and thoracic vertebrae. These findings, along with the six-segmented lumbar column of early Australopithecus and early Homo, suggest that the LCA possessed a long axial column and long lumbar spine and that reduction in the lumbar column occurred independently in humans and in each ape clade, and continued after separation of the two species of Pan as well. Such an explanation is strongly congruent with additional details of lumbar column reduction and lower back stabilization in African apes.

Study of posterolateral lumbar arthrodesis by means of a finite element model

Posterolateral lumbar arthrodesis consists in the fixation of the lumbar vertebrae pedicles by means of bars and screws. It is indicated in all those cases in which instability exists previous to the surgery, or in those other cases in which the instability has been caused by the need of bone resections that put the articulations structures in danger. The pedicle fixation of the lumbar arthrodesis is a great advance in the lumbar surgery. It contributes to achieve a stable and biologic fusion. The aim of the present research is the analysis of the contact problem that exists between the screw and the bone as one of the key points to control in order to achieve a good future stability of the arthrodesed spine. In order to achieve such aim, a Finite Elements Model (FEM) of the spine was performed. Such a model was obtained using a computer vision technique that creates 3D bodies using computed tomographies of the sacrum and vertebrae L4 and L5. Not only the bone bodies have been modeled, but also the intervertebral discs that act as the joints of the bones. In order to obtain a complete simulation of the lumbar region the titanium screws and bars have been modeled too. The study of the influence of the contact between bone and screw in the biomechanical behavior of the lumbar column has been studied applying several load conditions simulating different kinds of typical movements of the column. Finally, the stresses on the different elements of the lumbar structure and the relative movements between bone and screw as well as the conclusions of this research are also expounded.

Prevalence of radiological findings among cases of severe secondary hyperparathyroidism.

Patients with end stage renal disease (ESRD) and secondary hyperparathyroidism (HPT2) are prone to develop heterotopic calcifications and severe bone disease. Determination of the sites most commonly affected would decrease costs and patients' exposure to X-ray radiation. The aim here was to determine which skeletal sites produce most radiographic findings, in order to evaluate hemodialysis patients with HPT2, and to describe the most prevalent radiographic findings. This study was cross-sectional, conducted in one center, the Hospital Universitário Clementino Fraga Filho (HUCFF), in Rio de Janeiro, Brazil. Whole-body radiographs were obtained from 73 chronic hemodialysis patients with indications for parathyroidectomy due to severe HPT2. The regions studied were the skull, hands, wrists, clavicles, thoracic and lumbar column, long bones and pelvis. All the radiographs were analyzed by the same two radiologists, with great experience in bone disease interpretation. The most common abnormality was subperiosteal bone resorption, mostly at the phalanges and distal clavicles (94% of patients, each). 'Rugger jersey spine' sign was found in 27%. Pathological fractures and deformities were seen in 27% and 33%, respectively. Calcifications were presented in 80%, mostly at the forearm fistula (42%), abdominal aorta and lower limb arteries (35% each). Brown tumors were present in 37% of the patients, mostly on the face and lower limbs (9% each). The greatest prevalence of bone findings were found on radiographs of the hands, wrists, lateral view of the thoracic and lumbar columns and femurs. The most prevalent findings were bone resorption and ectopic calcifications.

Atividade física regular preserva a função pulmonar em pacientes com espondilite anquilosante sem doença pulmonar prévia

Ankylosing spondylitis is an inflammatory condition which causes restriction in the lung function due to column joint alterations leading to postural dysfunction and thoracic ciphosis. OBJECTIVE: The objective of this study was to evaluate the lung function in patients with ankylosing spondylitis and to associate this parameter with physical activity. METHODS:104 patients were selected and only 15 fulfilled inclusion and exclusion criteria. They were divided in two groups: group I composed by sedentary patients, and group II with patients that has a regular physical activity. Demographic features, parameters of cervical, dorsal and lumbar column mobility were collected. Measurements of minute volume, respiratory rate, maximum inspiratory and expiratory pressures and quality of life (HAQ-S) were also evaluated. RESULTS: Both groups were similar regarding mean age (49.6 ± 1.6 vs. 43.3 ± 13.2 years, p = 0.19), weight (70.9 ± 9.7 vs. 74.1 ± 12.1 kg, p = 0.30) and height (164.6 ± 3.5 vs. 167.6 ± 6.9 cm, p = 0.16). However, the mean disease duration was significantly higher in the group I compared to the active group (20.1 ± 6.9 vs. 9.6 ± 3.4 years, p = 0.004). Interestingly, a significantly higher minute volume was observed in the active group than inactive one (4.83 ± 1.07 vs. 6.1 ± 1.25 L/min, p = 0.035). On the other hand, no differences were found regarding respiratory rate (14.57 ± 1.76 vs. 16.25 ± 3.53 ipm, p = 0.15), tidal volume (0.402 ± 0.07 vs. 0.342 ± 0.10 L, p = 0.13), as well as maximum inspiratory pressure (84.29 ± 24.99 vs. 93.13 ± 16.76 cmH2O), p = 0.24) and maximum expiratory pressure (102.2 ± 29.26 vs. 105 ± 17.32 cmH2O, p = 0.42). ), CONCLUSION: This study seems to show that respiratory volumes are maintained stable in patients with ankylosing spondylitis that are under regular physical activity.

Phytate (myo-Inositol Hexaphosphate) and Risk Factors for Osteoporosis

Several risk factors seem to play a role in the development of osteoporosis. Phytate is a naturally occurring compound that is ingested in significant amounts by those with diets rich in whole grains. The aim of this study was to evaluate phytate consumption as a risk factor in osteoporosis. In a first group of 1,473 volunteer subjects, bone mineral density was determined by means of dual radiological absorptiometry in the calcaneus. In a second group of 433 subjects (used for validation of results obtained for the first group), bone mineral density was determined in the lumbar column and the neck of the femur. Subjects were individually interviewed about selected osteoporosis risk factors. Dietary information related to phytate consumption was acquired by questionnaires conducted on two different occasions, the second between 2 and 3 months after performing the first one. One-way analysis of variance or Student's t test was used to determine statistical differences between groups. Bone mineral density increased with increasing phytate consumption. Multivariate linear regression analysis indicated that body weight and low phytate consumption were the risk factors with greatest influence on bone mineral density. Phytate consumption had a protective effect against osteoporosis, suggesting that low phytate consumption should be considered an osteoporosis risk factor.

Teriparatide (recombinant human parathyroid hormone 1-34) in postmenopausal women with osteoporosis: systematic review.

Osteoporosis is defined as a disease characterized by low bone mass and deterioration of the bone tissue microarchitecture. Teriparatide stimulates the formation and action of osteoblasts, which are responsible for bone formation, thus promoting bone tissue increase. The aim was to assess the effectiveness and safety of teriparatide for treating postmenopausal osteoporosis. A systematic review was conducted using the Cochrane Collaboration methodology. 1) Teriparatide 20 microg or 40 microg versus placebo: there was a benefit from teriparatide, considering the following outcomes: reduction in the number of new vertebral and non-vertebral fractures, and increased whole-body, lumbar and femoral bone mineral density. 2) Teriparatide 40 microg versus alendronate 10 mg/day for 14 months: there was no statistical difference regarding the incidence of new vertebral or non-vertebral fractures, although in the group that received teriparatide there was greater bone mineral density increase in the whole body, lumbar column and femur. 3) Estrogen plus teriparatide 25 microg versus estrogen: there was a benefit, considering the following outcomes: reduction in the number of new vertebral fractures, and increased whole-body, lumbar and femoral bone mineral density after three years. When teriparatide is intermittently administered in low doses, it reduces the incidence of vertebral fractures (67%) and non-vertebral fractures (38%) and increases bone mineral density in the lumbar column and femur. There is a need for studies with longer observation in order to allow conclusions regarding the safety and duration of the therapeutic effects.

Comparative study of Moroto vertebral specimens

The hypodigm of Morotopithecus bishopi includes several vertebral specimens from Moroto II in addition to a scapular fragment, and femoral and craniodental specimens. The Moroto vertebral specimens include UMP 67.28, which is a well-preserved lumbar vertebra. Based on the derived morphological traits in UMP 67.28, together with evidence from other postcranial elements, it has been claimed that certain aspects of the modern hominoid body plan appeared in the hominoid lineage by as early as 20 Ma. Other vertebral specimens from the site are not well-preserved and have not been described in detail. This article provides the first detailed description of these specimen with an emphasis on a lumbar vertebral body UMP 68.06. Results confirm the existing interpretations that M. bishopi had a more dorsostable lumbar column compared to other African Miocene hominoids, such as Proconsul nyanzae/heseloni or Nacholapithecus kerioi. The vertebral body is craniocaudally short and the median ventral keel is absent through the lumbar column. However, M. bishopi might have had a similar number segments as inferred for P. nyanzae (6–7) if UMP 68.06 and UMP 67.28 are associated. Likewise, the ventral wedging of UMP 68.06 may suggest that M. bishopi had more lumbar vertebrae than extant great apes. The origin of the transverse process relative to the vertebral body is variable by level among the Moroto specimens. Thus, if these specimens derive from a single taxon, this may suggest considerable variability in this feature that would advise caution when using this feature to draw taxonomic or functional conclusions.

The extent of laminectomy affects pain-related behavior in a rat model of neuropathic pain

One of the unresolved questions in neuropathic pain research is whether we can prevent or reverse mechanical hyperalgesia by rhizotomy or ganglionectomy. However, one of the obstacles in answering that question is lack of a standardized surgical procedure used in experimental ganglionectomy. We tested the hypothesis that laminectomy performed during ganglionectomy induces lumbar column deformity. We further examined whether spinal deformity is a source of pain-related behavior. Five conditions were studied. Fifth and sixth lumbar (L5 and L6) ganglionectomy were performed in rats using either minimal or extensive laminectomy technique. Two other groups had minimal and extensive laminectomy without ganglionectomies. A final control group had no surgery. Sensory responsiveness of the plantar aspect of the hind paw was repeatedly tested, and a plain radiograph in anteroposterior projection was made to assess the extent of deformity by measurement of deformity angles. Hyperalgesia resulted in groups with extensive laminectomy regardless of performance or absence of ganglionectomy, while in groups with minimal laminectomy there was no increase in pain-related behavior. Lateral deformity of the spine was observed in rats with or without ganglionectomy, confirming that laminectomy can produce deformity. The extent of deformity was more pronounced in rats exposed to the extensive laminectomy. Our results indicate that laminectomy can produce spine deformity and that there is a direct relationship between the extent of laminectomy and the development of mechanical hypersensitivity. The data presented suggest that there is a need for standardization of laminectomy procedure in rat experimental pain models.

Ventral intercorporal spondylodesis in lumbar instabilities

Ventral spondylodesis is said to be a useful method for the treatment of lumbar illness in combination with instability and pain. Between 1969 and 1983 62 patients of the Orthopedic University Hospital Berlin were operated for a ventral fusion of the lumbar column, excluded the Dwyer spondylodesis indicated in lumbar scoliosis. 50 of them could be re-examined. The result was good and fair in seventy per cent; the consolidation rate 62 per cent in no relation to the clinical result. Best satisfaction was got by those patient who suffered from spondylolisthesis without any compressions of sciatic nerve. Any previous operation of the nerve root with persistent symptoms lowers the aim of spondylodesis as a salvage procedure. With the experience of the surgeon the method itself is without a higher rate of complication than any other way of spondylodesis.

Abnormal Dentition in an 8 Years Old Female Child

Patient with shortening distal phalanx 1st finger both hands, from the birth and familiar precedents of similar abnormality. At the age of 8 she presented dental alterations with hipertrofia gingival and dental incorporations, and backaches and pain in femoral region. Radiology: increase of bony widespread density, hypoplasia lower jaw, and acrosteolisis distal phalanxes. The jaw biopsy (dental piece and alveolar surrounding bone): bony fragments are constituted for coarse and irregular trabeculas with importantly bony resorption and newly formed. Bone densitometry: T+5.2 in column lumbar and neck femoral. Gamma scan bone: diffuse captation of the axial skeleton. Diagnosis: picnodisostosis.