Lumbar Spine In Patients Research Articles

Surgical stabilization for degenerative lesions of the lumbar spine in patients with reduced bone mineral density: a systematic literature review

Objective. To analyze methods contributing to the improvement of clinical and radiological outcomes of surgical stabilization of the lumbar spine in conditions of reduced bone mineral density (BMD).Material and Methods. A search for publications presenting the results of clinical studies of surgical treatment of patients with degenerative lesions of the lumbar spine and reduced BMD was conducted in English and Russian in the MEDLINE and Russian Science Citation Index (RSCI) databases using key words “osteoporosis”, “osteopenia”, “spinal surgery”, “spinal fusion” and related terms in titles and abstracts with a search depth of 20 years. After applying the inclusion and exclusion criteria, 17 clinical studies were selected for analysis.Results. Among the large number of techniques and implant-associated factors affecting the success of surgical intervention for degenerative lesions of the lumbar spine and reduced BMD, high-quality clinical studies have proven the effectiveness of expandable screws, spinal fusion with cortical screw placement and cement augmentation with polymethyl methacrylate.Conclusion. The combination of techniques for cortical pedicle screw placement, cement augmentation and the use of expandable screws makes it possible to achieve results in surgical treatment of patients with degenerative lesions of the lumbar spine with reduced BMD comparable with those in patients with normal BMD. Of particular importance is the preoperative assessment of the regional state of bone tissue, which should be carried out using quantitative CT or MRI studies.

An optimal deep learning model for the scoring of radiographic damage in patients with ankylosing spondylitis.

Detecting vertebral structural damage in patients with ankylosing spondylitis (AS) is crucial for understanding disease progression and in research settings. This study aimed to use deep learning to score the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) using lateral X-ray images of the cervical and lumbar spine in patients with AS in Asian populations. A deep learning model was developed to automate the scoring of mSASSS based on X-ray images. We enrolled patients with AS at a tertiary medical center in Taiwan from August 1, 2001 to December 30, 2020. A localization module was used to locate the vertebral bodies in the images of the cervical and lumbar spine. Images were then extracted from these localized points and fed into a classification module to determine whether common lesions of AS were present. The scores of each localized point were calculated based on the presence of these lesions and summed to obtain the total mSASSS score. The performance of the model was evaluated on both validation set and testing set. This study reviewed X-ray image data from 554 patients diagnosed with AS, which were then annotated by 3 medical experts for structural changes. The accuracy for judging various structural changes in the validation set ranged from 0.886 to 0.985, whereas the accuracy for scoring the single vertebral corner in the test set was 0.865. This study demonstrated a well-trained deep learning model of mSASSS scoring for detecting the vertebral structural damage in patients with AS at an accuracy rate of 86.5%. This artificial intelligence model would provide real-time mSASSS assessment for physicians to help better assist in radiographic status evaluation with minimal human errors. Furthermore, it can assist in a research setting by offering a consistent and objective method of scoring, which could enhance the reproducibility and reliability of clinical studies.

Treatment of patients with posttraumatic deformities of the thoracolumbar spine using Schwab 5 osteotomy through combined and posterior approaches

Objective. To analyze the results of surgical treatment of patients with rigid posttraumatic deformities of the thoracolumbar spine operated on using Schwab 5 osteotomy through combined and posterior approaches.Material and Methods. A retrospective cohort study was conducted. Study group included 60 patients (m/f = 25/35). Median age was 48 (26–58) years, median time since injury was 11 (9–14) months, and minimum follow-up period was 2 years. A two-stage intervention with resection of the vertebral body, correction of the deformity, and placement of an interbody implant through the anterior approach followed by final fixation through the posterior approach (VCRa+p group) was performed in 29 cases. Vertebral body resection through the posterior approach with correction of the deformity, installation of an interbody implant, and rigid transpedicular fixation (VCRp group) was performed in 31 cases. In all patients, the magnitude of correction was assessed, as well as the following parameters: frontal balance, sagittal balance, thoracic kyphosis, lumbar lordosis, pelvic incidence, sacral slope and pelvic tilt. The results of treatment were evaluated in dynamics by the level of pain syndrome (VAS) and quality of life (ODI), as well as based on the analysis of postoperative complications.Results. The groups were comparable in terms of gender, age, magnitude of the kyphotic component of the deformity, level of pain syndrome and degree of initial neurological deficit (p > 0.05). Correction of the deformity kyphotic component was significantly better in patients in the VCRp group compared to those in the VCRa+p group (p = 0.036). Both groups showed a significant decrease in the level of pain syndrome 3 months after surgery. However, further follow-up showed a tendency for back pain to increase on average one year after surgery in the VCRa+p group. A total of 67 complications were revealed in 40 (66.7 %) patients. Herewith, in the early postoperative period there were 55 complications in 31 patients, and in the late period there were 12 complications in 9 patients. Analysis of early complications showed a higher incidence of anemia (p = 0.002) and liquorrhea (p = 0.017) in the VCRp group compared to those in the VCRa+p group. The incidence of long-term complications did not differ significantly between groups (p = 0.866). An increase in back pain in the long-term period was observed in 12 (41.4 %) patients of the VCRa+p group and in 4 (12.9 %) patients of the VCRp group. Analysis of risk factors for this condition showed a tendency for back pain to increase in the long-term period in patients with residual local deformity against the background of low pelvic index values.Conclusion. Correction of the kyphotic component of deformity was significantly better in patients of the VCRp group, which was accompanied by greater surgical trauma and incidence of early postoperative complications. The tendency of patients’ quality of life to deteriorate in the long-term follow-up period seems to be related to the occurrence of pain syndrome in the lumbar spine in patients with residual kyphotic deformity against the background of initially low compensatory capabilities.

Comparison of Clinical Signs Associated with Lumbar Spine in Patients with Simultaneous Knee Osteoarthritis and Lumbar Spine Osteoarthritis before and after Knee Arthroplasty

Background: Knee osteoarthritis (OA) and low back pain (LBP) are common and co-occur in the elderly. The LBP in patients who are candidates for knee arthroplasty affects the outcome and prognosis after surgery. In this study, we investigated the LBP in patients with simultaneous knee and lumbar spine OA after total knee arthroplasty.
 Methods: In this cross-sectional study, 41 candidates for knee arthroplasty suffering from LBP were included. Demographic and visual analogue scale (VAS) questionnaires for LBP and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire for knee pain and function were completed by patients before surgery. Patients were graded according to VAS index. They were followed up for at least six months to two years.
 Results: The mean age of 41 patients was 64.30 ± 6.46 years. The mean of the preoperative VAS index was 5.15 ± 2.75, while postoperative VAS decreased to 4.34 ± 3.53 (P = 0.024). Of the total number of patients in preoperative evaluation, 24.4% were in low grades based on the VAS index, followed by moderate (41.5%) and severe (34.1%) grades. The greatest improvement in the VAS index was related to those in mild and moderate grades before surgery. The mean preoperative WOMAC index was 55.1 ± 23.7, while it was postoperatively reduced to 42.9 ± 30.6 (P < 0.001). Postoperative WOMAC was found to be correlated with postoperative VAS (P = 0.004).
 Conclusion: In patients with mild to moderate LBP and knee OA, their back pain would improve if they had knee arthroplasty. However, in patients with severe LBP and knee OA, the spine should be examined further.

Oblique lateral interbody fusion with internal fixations in the treatment for cross-segment degenerative lumbar spine disease (L2-3 and L4-5) finite element analysis

Multi-segmental lumbar degenerative disease, including intersegmental disc degeneration, is found in clinical practice. Controversy still exists regarding the treatment for cross-segment degeneration. Oblique Lateral Interbody Fusion (OLIF) with several internal fixations was used to treat cross-segment lumbar degenerative disease. A whole lumbar spine model was extracted from CT images of the whole lumbar spine of patients with lumbar degeneration. The L2-3 and L4-5 intervertebral spaces were fused with OLIF using modeling software, the Pedicle screws were performed on L2-3 and L4-5, and different internal fixations were performed on L3-4 in Finite Element (FE) software. Among the six 10 Nm moments of different directions, the L3-4 no surgery (NS) group had the relatively largest Range of Motion (ROM) in the whole lumbar spine, while the L2-5 Long segmental fixation (LSF)group had the smallest ROM and the other groups had similar ROM. The ROM in the L1-2 and L5-S1 was relatively close in the six group models, and the articular cartilage stress and disc stress on the L1-2 and L5-S1 were relatively close. In contrast, the L3-4 ROM differed relatively greatly, with the LSF ROM the smallest and the NS ROM the largest, and the L3-4 Coflex (Coflex) group more active than the L3-4 Bacfuse (Bacfuse) group and the L3-4 translaminar facet screw fixation (TFSF) group. The stress on the articular cartilage and disc at L3-4 was relatively greater in the NS disc and articular cartilage, and greater in the Coflex group than in the Bacfuse and TFSF groups, with the greatest stress on the internal fixation in the TFSF group, followed by the Coflex group, and relatively similar stress in the Bacfuse, LSF, and NS groups. In the TFSF group, the stress on the internal fixation was greater than the yield strength among different directional moments of 10 Nm, which means it is unsuitable to be an internal fixation. The LSF group had the greatest overall ROM, which may lead to postoperative low back discomfort. The NS group has the greatest overall ROM, but its increased stress on the L3-4 disc and articular cartilage may lead to accelerated degeneration of the L3-4 disc and articular cartilage. The Coflex and Bacfuse groups had a reduced L3-4 ROM but a greater stress on disc compared to the LSF group, which may lead to disc degeneration in the long term. However, their stress on the articular cartilage was relatively low. Coflex and Bacfuse can still be considered better surgical options.

Association between Modic changes and intervertebral vacuum phenomenon severity in patients undergoing percutaneous cement discoplasty.

Modic changes and intervertebral vacuum phenomenon (IVP) are considered spinal degenerative changes. The correlation between Modic and IVP has not been analyzed in the literature. To analyze the correlation between IVP severity, Modic changes, and subchondral sclerosis across the lumbar spine in patients with lumbar degeneration. This is a retrospective study analyzing patients who underwent percutaneous cement discoplasty at a single institution between 2015 and 2020. Preoperative magnetic resonance imaging and computed tomography scans were analyzed to make the measurements. Modic type and grade as well as severity of IVP were preoperatively measured. The association between Modic type, grade, subchondral sclerosis, and the presence of IVP was analyzed. In total, 110 patients (mean age = 77.03 ± 7.1 years) were finally included in the study. Per level correlation analysis showed a significant positive association between IVP and Modic type, IVP and Modic grade, and IVP and subchondral sclerosis. Moreover, subchondral sclerosis was significantly associated with Modic type and grade. Our study showed a significant positive correlation among Modic changes, IVP, and subchondral sclerosis throughout the lumbar spine. Our findings support the theory that endplate degeneration parameters are associated with the presence and severity of IVP.

Trabecular Bone Score as a More Sensitive Tool to Evaluate Bone Involvement in MEN1-related Primary Hyperparathyroidism.

The skeletal involvement of multiple endocrine neoplasia type 1-related primary hyperparathyroidism (MHPT) is not exactly the same as that of sporadic primary hyperparathyroidism (SHPT). Trabecular bone score (TBS) as a texture parameter has been reported to reflect trabecular bone damage. This study aimed to compare the clinical characteristics, especially the skeletal involvement, between patients with MHPT and SHPT. The clinical characteristics were retrospectively collected in 120 patients with MHPT and compared with 360 patients with SHPT in the same period. Dual-energy X-ray absorptiometry were conducted in some patients with MHPT, in whom bone mineral density (BMD) and calculated TBS derived from lumbar spine dual-energy X-ray absorptiometry images were compared with those of patients with SHPT. Although the duration of disease in the MHPT group was longer, the age at hospital visit was significantly lower than that in the SHPT group (43.5 [interquartile range, 31.5-52.0] vs 52.0 [interquartile range, 40.5-61.0], P < .001). The proportion of skeletal involvement in the MHPT group was significantly lower. However, in the subgroup of MHPT cases (n = 86) with data of BMD, there was no significant difference in skeletal involvement from SHPT cases matched for gender and age. Although the BMD and TBS in the lumbar spines of patients with MHPT were lower than those of patients with SHPT (BMD: 0.91 ± 0.18 g/cm2 vs 1.01 ± 0.17 g/cm2; TBS: 1.22 ± 0.14 vs 1.29 ± 0.11, P < .001). According to TBS, among 34 patients with MHPT with normal BMD, 15 patients had bone microstructure damage. The cancellous bone microarchitecture was more severely damaged in patients with MHPT according to TBS, which suggested that TBS could be a sensitive supplemental index in addition to BMD to identify bone-involvement risk in patients with MHPT.

Correlation between frontal X-ray parameters of the hip joint and sagittal vertebral-pelvic profile in patients with cerebral palsy

BACKGROUND:Posture disorders and spinal deformity in the sagittal plane (kyphotic deformity of the thoracic region and lumbar hyperlordosis in combination with pelvic inclination) are quite common in patients with cerebral palsy. However, their relationship with the frontal indicators of the hip joint is not reported in the scientific literature.&#x0D; AIM:To reveal the relationship between the radiographic frontal indicators of the hip joint and the indicators of the spinal-pelvic sagittal balance in patients with cerebral palsy.&#x0D; MATERIALS AND METHODS:Atransverse study of the X-ray parameters of the hip joints in the frontal plane and sagittal vertebral-pelvic profile was performed in 46 patients with cerebral palsy aged 515 (mean age, 8.2 3.6) years.&#x0D; RESULTS:Asignificant difference from the norm was found in the following parameters: cervical-diaphyseal angle, pelvic tilt angle, pelvic tilt angle, sacral tilt angle, thoracic kyphosis, lumbar lordosis, and sagittal vertical axis deviation (p 0.05). The Sharp angle, migration index, Wiberg angle, and thoracic kyphosis were normal. Measurements of the frontal radiographic parameters of the right and left hip joints do not differ significantly from each other. The pelvic tilt showedapositive and strong correlation with pelvic tilt (p= 0.71).Apositive and moderate correlation was found determined betweenasequential chain of related elements of the axial skeleton, namely, sacral inclination-lumbar lordosis (p= 0.66) and lumbar lordosis-thoracic kyphosis (p= 0.41). The deviation of the sagittal vertical axis negatively correlated with lumbar lordosis (p= 0.69) and thoracic kyphosis (p= 0.38). The results demonstrateanegative and weak correlation between SDA and sacral tilt (p= 0.40).&#x0D; CONCLUSIONS:The results of this study indicateacorrelation between the inclination of the sacrum and the lumbar spine in patients with cerebral palsy, which confirms the main theories of the formation of excessive lumbar lordosis of the spine in these patients and allows us to develop pathogenetic preventive measures against spinal deformities. In this study, we failed to identifyasignificant relationship between the frontal radiographic parameters of the hip joint and sagittal pelvic-vertebral profile. However, hip joint instability inachild with cerebral palsy can playasignificant role in the occurrence and development of sagittal spinal deformities.

Incidental findings detected on magnetic resonance imaging scans of the cervical, thoracic and lumbar spine of patients prediagnosed with discopathy

Objective: To determine the frequency and types of incidental findings on magnetic resonance imaging (MRI) scans of the cervical,&#x0D; thoracic, and lumbar spine in patients with intervertebral discopathy.&#x0D; Patients and Methods: This retrospective study included 1000 patients (513 females and 487 males, with a mean age of 50.5 years)&#x0D; with clinically suspected intervertebral discopathy who underwent MRI. Any abnormal findings and congenital anomalies/anatomical&#x0D; variations unrelated to the primary complaint were referred to as incidental findings. Frequency distributions of the assessed imaging&#x0D; characteristics were calculated.&#x0D; Results: Of the 1000 patients, 192 (19.2%) patients were presented with incidental findings. The positive findings in the thoracic spine&#x0D; (26%) were higher than those in the lumbar (19.8%) and cervical spine (13.7%). The study found vertebral haemangioma to be the&#x0D; most common finding, followed by Schmorl’s nodes in the thoracic and lumbar spine. Thyroid nodules constituted the most common&#x0D; finding in the cervical spine, followed by vertebral haemangioma. Renal cysts in the thoracic and lumbar spine and thyroid nodules in&#x0D; the cervical spine were the most frequent extraspinal findings.&#x0D; Conclusion: Incidental findings are commonly detected during MRI examination of intervertebral discs, and most are benign findings.&#x0D; However, incidental findings including clinically essential findings can alter the patient’s treatment or affect the patient’s life. Therefore,&#x0D; it is crucial to systematically evaluate MRIs without focusing solely on the spine and report incidental findings detected on MRI.

Comparative analysis of the effectiveness and safety of anesthetic care during neurosurgical interventions on the lumbar spine in patients with high-risk factors

The effectiveness and safety of providing anesthetic care during neurosurgical interventions on the spine in patients with high-risk factors are compared. The prospective comparative study included patients who had a high operational and anesthesiological risk according to the authors decision support system ( 8 points). All patients underwent open dorsal decompressive and stabilizing interventions from 2021 to 2023. Depending on the type of anesthesia and method of postoperative analgesia, three groups of patients were distinguished: in Group 1 (n = 41), intravenous anesthesia based on propofol and fentanyl was used; in Group 2 (n = 40), prolonged epidural analgesia with ropivacaine was additionally performed for 3 days after surgery; and in Group 3 (n = 43), multimodal analgesia was combined with preoperative intramuscular administration of ketoprofen and infiltration of the paraspinal muscles, subcutaneous fat, and skin with ropivacaine before access; intraoperative administration of dexmedetomidine; and postoperative administration of paracetamol. Comparative analysis included assessment of perioperative hemodynamic parameters, intensity of postoperative pain, perioperative use of opioids, dynamics of recovery of psychomotor functions, side effects of anesthesia, and postoperative surgical complications. It was found that the patients of Group 3, compared with the patients of Groups 1 and 2, had no significant changes in hemodynamics, obtained better results in the rate of recovery of psychomotor functions, and received a smaller intraoperative amount of opioid drugs. In Groups 2 and 3, a minimum level of postoperative local pain syndrome and a lower need for analgesics were recorded. The number of side effects of anesthesia in Group 1 was 29.3%; in Group 2, 27.5%; and in Group 3, 9.3% (p = 0.01). The number of postoperative surgical complications was comparable: Group 1, 7.3%; Group 2, 7.5%; and Group 3, 4.7% (p = 0.56). Thus, the use of complex perioperative anesthesia, in comparison with traditional anesthesia, including prolonged epidural analgesia, has advantages in the absence of depression of perioperative hemodynamic parameters and fewer side effects of anesthesia and postoperative surgical complications.

Safety and clinical efficacy of endoscopic procedures for the treatment of adjacent segmental disease after lumbar fusion: A systematic review and meta-analysis.

Adjacent segment disease (ASD) is a common complication after lumbar fusion and is still traditionally treated by open surgery. In recent years, with the development of minimally invasive techniques, percutaneous endoscopic surgery(PES) has been used for the treatment of ASD after lumbar fusion due to its unique benefits. Nevertheless, it remains unclear about its significant clinical efficacy and advantages over conventional open surgery. To evaluate the clinical efficacy and safety of PES in the treatment of ASD after lumbar fusion. A systematic review and meta-analysis studies about the role of PES in managing ASD after lumbar fusion. A systematic search review was conducted in PubMed, EMBASE, Cochrane Library, Web of Science, CNKI, VIP, WanFang, and SinoMed databases from the start of their construction to 15 November 2021. Eligible studies included references to clinical trials of PES for ASD after open lumbar fusion. Observations included pain relief, recovery of postoperative function, overall excellent rates, and indicators of the advantages of minimally invasive surgery compared to conventional surgery. Postoperative complications and recurrence rates were also recorded. A total of 24 studies, including 20 single-arm studies and 4 clinical control studies, all involving 928 patients were included. A total of 694 patients were included in the single-arm analysis. The results of the single-arm meta-analysis showed that PES could significantly reduce low back and leg pain and improve the functional status of the lumbar spine in patients with ASD after open lumbar fusion compared to preoperatively, and had good clinical efficacy after surgery. A total of 234 patients were included in the four clinically controlled studies, and the results of the meta-analysis showed that PES could clearly reduce pain and improve lumbar function, with no significant difference in efficacy between PES and open surgery. However, PES has a lower surgical incision, less intraoperative bleeding, and shorter operative time and length of hospital stay compared to open surgery. Moreover, it has a lower rate of postoperative recurrence as well as complications and a longer duration of efficacy. On the basis of the available clinical literature and the results of this study, PES could achieve satisfactory clinical effects in ASD treatment after lumbar fusion. Compared with conventional open surgery, PES can not only obtain similar clinical results, but also had the advantages of less trauma and faster recovery. Nevertheless, a randomized controlled study is still needed to validate the findings of this study. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42022298387.

Radiographic Investigation of Lumbar Vertebrae in Patients with Flexion and Extension Movement Disorder Syndrome.

The kinesiopathology model is a new rehabilitation model classifying, evaluating, and treating patients with non-specific back pain. Sahrmann proposed this model based on movement disorder syndromes. The present cross-sectional study aimed to evaluate the radiograph of the linear and angular displacement of the lumbar spine in patients with lumbar flexion impairment syndrome (LFIS) and lumbar extension impairment syndrome (LEIS). In this study, 50 adults aged 18-46 years were enrolled, including 25 patients with LFIS and 25 with LEIS. The eligible participants were referred to the radiology department for radiography in the common position of neutral, full extension, and full flexion position while standing. The White and Panjabi's method was used to measure the linear and angular displacements. Moreover, pain intensity was assessed using the visual analogue scale, and functional disability was investigated using a modified Oswestry Disability Questionnaire. The parameter of the linear displacement at the L3-L4 level was significantly different between the two groups (P=0.02). The mean duration of low back pain was longer in the LEIS, compared to the LFIS group (P=0.01). In patients with LEIS, compensatory responses occur that cause less linear displacement at the L3-L4 level, compared to the patients with LFIS. Therefore, it is important to design appropriate exercises to better control the linear displacement at the L3-L4 level during the full range of motion in patients with LFIS.

Association Between Coronary Artery Calcium Score and Bone Mineral Density in Type 2 Diabetes Mellitus with Different Visceral Fat Area.

The relationship between coronary artery calcification and bone mineral density (BMD) in T2DM is still unclear. The aim of this study is to analyze the association between coronary artery calcium score (CACs) and BMD in T2DM with different visceral fat area (VFA), and further to explore the clinical significance of CACs in predicting osteoporosis in T2DM patients. A total of 479 T2DM patients aged ≥50 years were included. Agatston was applied to calculate CACs to evaluate the degree of coronary artery calcification. Dual-energy X-ray absorptiometry (DXA) was used to measure BMD. According to VFA, all subjects were divided into VFA <100cm2 and VFA ≥100cm2 group. Adjusted regression analysis was performed to analyze the association between CACs and BMD. ROC curve was used to analyze the optimal cut-off value of CACs for screening osteoporosis. The baseline showed that in VFA ≥100cm2 group, CACs increased significantly than that in VFA <100cm2 group (212.1±195.9 vs 139.3±141.8, p<0.001) and total hip BMD decreased obviously (0.968±0.19 vs 1.021±0.184, p=0.01). After multivariable adjustment, CACs was not significantly associated with BMD in all patients (p>0.05). However, CACs was negatively associated with BMD of total hip and lumbar spine in patients with VFA ≥100cm2 (total hip β=-0.087 p=0.01; lumbar spine β=-0.052 p=0.005), but not VFA <100cm2. ROC curve analysis showed that the optimal cut-off value of CACs for screening osteoporosis was 191.505. The present study implied that associations between CACs and BMD varied by the visceral fat deposition. It is critical to evaluate the condition of visceral fat accumulation for exploring the complex interplay of coronary artery calcification and BMD in T2DM patients. It may be of some clinical value for CACs in predicting osteoporosis in T2DM with visceral obesity.

Cortical screw placement with a spinous process clamp guide: a cadaver study accessing accuracy

Background and objectiveThe Cortical Bone Trajectory (CBT) technique provides an alternative method for fixation in the lumbar spine in patients with osteoporosis. An accuracy CBT screw placement could improve mechanical stability and reduce complication rates.PurposeThe purpose of this study is to explore the accuracy of cortical screw placement with the application of implanted spinous process clip (SPC) guide.Methods and materialsFour lumbar specimens with T12-S1 were used to access the accuracy of the cortical screw. The SPC-guided planning screws were compared to the actual inserted screws by superimposing the vertebrae and screws preoperative and postoperative CT scans. According to preoperative planning, the SPC guide was adjusted to the appropriate posture to allow the K-wire drilling along the planned trajectory. Pre and postoperative 3D-CT reconstructions was used to evaluate the screw accuracy according to Gertzbein and Robbins classification. Intraclass correlation coefficients (ICCs) and Bland–Altman plots were used to examine SPC-guided agreements for CBT screw placement.ResultsA total of 48 screws were documented in the study. Clinically acceptable trajectory (grades A and B) was accessed in 100% of 48 screws in the planning screws group, and 93.8% of 48 screws in the inserted screws group (p = 0.242). The incidence of proximal facet joint violation (FJV) in the planning screws group (2.1%) was comparable to the inserted screws group (6.3%) (p = 0.617). The lateral angle and cranial angle of the planned screws (9.2 ± 1.8° and 22.8 ± 5.6°) were similar to inserted screws (9.1 ± 1.7° and 23.0 ± 5.1°, p = 0.662 and p = 0.760). Reliability evaluated by intraclass correlation coefficients and Bland–Altman showed good consistency in cranial angle and excellent results in lateral angle and distance of screw tip.ConclusionsCompared with preoperative planning screws and the actually inserted screws, the SPC guide could achieve reliable execution for cortical screw placement.

Efficacy of generic teriparatide and alendronate in Chinese postmenopausal women with osteoporosis: a prospective study

SummaryThe efficacy of generic teriparatide in improving BMD at lumbar spine in patients with osteoporosis was similar to that of alendronate. It provided a new choice for osteoporosis treatment in Chinese population.IntroductionTo determine whether the efficacy of generic teriparatide is noninferior to alendronate for Chinese postmenopausal women with osteoporosis.MethodsEligible patients were randomly assigned (2:1) in a 48-week, open-label design to receive 20 µg sc daily teriparatide or 70 mg oral weekly alendronate. Primary outcome was percentage change in BMD at the lumbar spine from baseline to 48 weeks and was assessed for non-inferiority. The same outcome was further assessed for superiority as a secondary endpoint.ResultsThree hundred ninety-one and 196 participants were randomly assigned to the teriparatide or alendronate group, of whom 379 and 194 receiving at least one dose of teriparatide and alendronate treatment were eligible for the efficacy analysis. Teriparatide was non-inferior to alendronate for BMD change at lumbar spine (treatment difference: 0.7%, 95% CI: − 0.3 to 1.7%), which excluded the predefined non-inferiority margin of − 1.5%. However, teriparatide was not statistically superior to alendronate in improving BMD at lumbar spine (P = 0.169). At 48 weeks, changes in BMD at total hip were − 1.0% and 2.2% in teriparatide and alendronate group, respectively (P < 0.001). The incidence of new fracture showed no statistical difference between groups (P = 0.128). Serum P1NP and β-CTX levels significantly increased in the teriparatide group and markedly decreased in alendronate group (all P < 0.001 vs baseline). The adverse events (AEs) and serious AEs were more common in the teriparatide group than in the alendronate group, which were mainly teriparatide-related hypercalcemia, elevated alkaline phosphatase or parathyroid hormone, dizziness, and arthralgia.ConclusionsTeriparatide was not inferior to alendronate in increasing BMD at lumbar spine in Chinese postmenopausal women, and they achieved these effects through different mechanisms.

Electromyography in muscle activation lumbar region in a comparison between manual therapy and photobiomodulation associated with kinesiotherapy in individuals with low back pain

Introduction: About 10 million people have low back pain (LBP) disability in Brazil, and several therapies are used to treat this condition, such as kinesiotherapy, manual therapy (MT) and photobiomodulation-PBM. Although studies have investigated the use of these methods in LBP, research seeking to evaluate the efficacy of the association between techniques is still needed. Objective: To evaluate the activation of the muscles lumbar region with the influence of PBM and MT associated with kinesiotherapy in the treatment of LBP. Methods: Twenty individuals with chronic LBP were randomly divided into two groups. The first group (MT) received vertebral mobilization associated with a kinesiotherapy exercise program, while the second group (830nm-PBM) received PBM associated with the exercise program, twice a week for 8 weeks. It was performed an evaluation of pain perceived by the visual analogic scale (VAS), lumbar disability by the Oswestry questionnaire, muscle strength by strain gauge and activation through surface electromyography, before and after the treatment protocol. EMG data analysis was performed by MatLab® software. The ANOVA two-way test was used (degree of significance p≤0.05), and the effects size by Hedge test. Results: Considering pain, the two groups presented a significant result (p&lt;0.05). In muscle activation only the multifidus obtained different during side bridge (p&lt;0.05) when compared intragroups. But none of the variables were different when evaluating intergroups. Conclusion: Both MT and PBM associated with kinesiotherapy for 8 weeks are effective in reducing pain, improving motor control and stability of the lumbar spine in patients with chronic LBP.

МІСЦЕ ЛЕФЛУНОМІДА В ХВОРОБОМОДИФІКУЮЧІЙ ТЕРАПІЇ РЕВМАТОЇДНОГО АРТРИТУ: НОВІ АКЦЕНТИ

A new mechanism of lefl unomide (LEF) action was recently discovered, namely its ability to infl uence the intracellular mechanism of the infl ammatory process by inhibiting JAK kinases, which brings it closer to the new most eff ective group for treatment of rheumatoid arthritis (RA) – Janus kinase inhibitors. The article presents data from both our own and other authors’ studies on the eff ectiveness and safety of the drug in comparison with other synthetic and biological basic agents. The aim of our study was a comparative evaluation of LEF, methotrex- ate (MTX), sulfasalazine (SS) and their combinations (CDT) in 402 patients with RA. Obtained results showed advantages of LEF and СDT over the use of SS (at any RA duration) and MTX (at late RA). Adverse events were the lowest in the SS group, and disease-modifying anti-rheumatic drug (DMARD) discontinuation due to complications was the lowest in the LEF group. Based on the results of multifactor regression analysis, we developed a scheme of individualized selection of the most eff ective DMARD depending on the initial characteristics of RA patients. The article also presents international study data. It analyses the comparative effi cacy of LEF (10-20 mg/d) and low doses of rituximab (500 mg twice daily) in patients refractory to MTX therapy; effi cacy of LEF in monotherapy (5-40 mg/d) and combination with other DMARD; LEF at a dose of 100 mg/week and MTX at a dose of 10 mg/week; LEF at a dose of 50 mg once a week and 10 mg daily. The eff ect of LEF on uric acid levels and bone mineral density of the lumbar spine in patients with RA was studied.

POS1005 ACTIVE INFLAMMATORY LESIONS OF THE SPINE IN SACROILIAC JOINTS MRI (SIJs-MRI): AN OVERLOOKED FINDING BY RADIOLOGISTS.

BackgroundEstablishing a diagnosis for axial spondylarthritis (axSpA) is based on the combined presence of several clinical and laboratory features in association with imaging: the presence of active inflammatory lesions (bone marrow edema, BME) in sacroiliac joints (SIJs), also associated with structural lesions, is the main element in favor of a diagnosis of axSpA and SIJ MRI is currently the main recommended technique for detecting inflammation, enabling early diagnosis in patients with normal radiographic findings. MRI of the spine is generally not recommended for axSpA diagnosis, since spine involvement is considered less sensitive and specific. Several studies explored the incremental value of spine MRI for diagnosing patients with axSpA, especially when the findings of SI are equivocal, and “predicting” clinical disease activity.ObjectivesTo evaluate the effectiveness of the MRI study dedicated to SIJs to identify the inflammatory involvement of the lumbar spine in patients with active sacroiliitis and clinical diagnosis of axSpA.MethodsMRI of 96 patients (26 M, 70 F, mean age 48 years) with SIJs-MRI positive for inflammatory involvement according to ASAS criteria, were evaluated retrospectively. The presence of signs of inflammation of posterior spinal elements and vertebral bodies included in the field of vision (FOV) was therefore researchedResultsOf 96 patients with active sacroiliitis, 88 had concomitant inflammatory lesions of the lumbar spine. Facet capsulitis (87.6 %) and posterior enthesitis (42.2 %) were the most common lesions and these lesions frequently coexisted (39.3%). Twelve patients with facet capsulitis presented also facet arthritis. Only 20 out of 96 patients (22%) had vertebral bodies inflammatory lesions: 15 corner inflammatory lesions and 5 aseptical spondylodiscitis.ConclusionOn the basis of current working consensus MRI examination of the spine is not recommended for axSpA diagnosis, because it is considered less sensitive and specific. However the high prevalence (91.7%) of spinal inflammatory changes in patients with active sacroiliitis suggests that these features can be used as an additional element in favor of diagnosis, especially in doubtful cases. This evaluation takes little reporting time, without any increase in MRI execution time.

Increased vertebral body area, disc and facet joint degeneration throughout the lumbar spine in patients with lumbosacral transitional vertebrae.

Lumbosacral transitional vertebrae (LSTV), developmental spinal canal stenosis, lumbar disc and facet joint degeneration are all common lumbar spine conditions. This study explores the relationship between these entities. Five hundred and five patients (254 females, 251 males), mean age 57 ± 13 years, who underwent abdominopelvic CT examinations were studied. Vertebral body cross-sectional area (CSA), spinal canal CSA, width and depth were measured from L1 to L5. The presence of LSTV was documented and the severity of disc/facet joint degeneration graded. LSTV was present in 155 (31%) of 505 patients, being twice as common in males than in females. After controlling for age, height and weight, vertebral body CSAs from L1 to L5 in male LSTV patients were, on average, 9.8% larger than those in male non-LSTV patients (p < 0.0001 for all) while vertebral body areas at L3 and L4 were 4.5% larger in female LSTV patients than in non-LSTV female patients. Disc degeneration from L2/3 to L5/S1 and facet joint degeneration from L2/3 to L4/5 were more severe in LSTV patients. LSTV Castellvi Type II patients appear to be most prone to disc and facet degeneration. LSTV patients, and particularly male patients, have an increased vertebral body CSA compared to non-LSTV patients throughout the lumbar spine. LSTV patients also have more severe disc and facet joint degeneration. The increase in vertebral body area may be contributing to the increased lumbar and facet joint degeneration seen in LSTV patients. • LSTV patients have increased vertebral body cross-sectional area throughout their lumbar spine compared to non-LSTV patients. This vertebral body area increase was more pronounced in male patients and also apparent in younger patients with LSTV. • LSTV patients have increased disc and facet joint degeneration affecting most of the lumbar spine than non-LSTV patients. • Increased vertebral body area may contribute to the increased lumbar disc and facet joint degeneration seen in LSTV patients.

Clinical study on improving the strength and activity of lumbar spine with Qiang Jin exercises

To observe the effect of Qiang Jin exercises on the muscle strength and activity of lumbar spine in patients with lumbar disc herniation. From March 2016 to September 2017, at the Department of Orthopaedics, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, a total of 110 subjects were enrolled, and 98 eligible subjects were screened. The subjects were randomized by stratified randomization and divided into experimental group and control group, 49 cases in each group, 25 males and 24 females in the experimental group, 25 males and 24 females in the control group. The experimental group exercised with Qiang Jin exercises, one time each morning and evening, each time10 sets were made;the control group used classic rehabilitation training, training twice a week, and three months was a course of treatment. After 12 weeks of training, the muscle strength and activity of the lumbar spine were evaluated and compared with the muscle strength and activity of the lumbar spine before training. The experimental group and the control group had different muscle strength and activity of the lumbar spine before and after treatment (P<0.05). There was no significant difference between two groups after treatment(P>0.05). Qiang Jin exercises can effectively improve the muscle strength and activity of the lumbar spine and improve the daily living ability of patients.