Lumbar Vertebral Fractures Research Articles

Bilateral renal ischemia after kyphoplasty and clodronate treatment: a case report

IntroductionThe most common adverse effects associated with bisphosphonates are renal toxicity, acute-phase reactions, gastrointestinal toxicity, osteonecrosis of the jaw, transitory fever and uveitis. We report a unique adverse case of vasculitis induced by clodronate.Case presentationA 61-year-old Caucasian woman developed bilateral renal ischemia after kyphoplasty and clodronate treatment for lumbar vertebral fracture. Tests revealed a vasculitis due to clodronate treatment. The antithrombotic and immunosuppressive drugs allowed us to reduce the extent of the renal ischemia. In the following months the increased auto-antibodies returned to the healthy physiological range, but the chronic renal failure persisted.ConclusionsDrug-induced vasculitis is an inflammation of blood vessels caused by the use of various pharmaceutical agents. The spectrum of drug-induced vasculitis can range from cutaneous rashes to fatal multi-organ involvement. To the best of our knowledge this is the first documented case of drug-induced vasculitis caused by clodronate in the literature. Previously, it was verified that clodronate injection could increase the pro-apoptotic action on immune cells. Further studies are necessary to clarify the role of bisphosphonates on drug-inducing vasculitis.

Formetric rasterstereography: a new perspective. Reply to Padulo and Ardigó

To the Editor, We would like to thank you for the opportunity to comment on the letter to the editor from Drs. Padulo and Ardigo regarding our article entitled "Influence of non-traumatic thoracic and lumbar vertebral fractures (VFs) on sagittal spine alignment assessed by radiation-free spinometry" recently published [1]. In this study, we introduced a radiation-free spinometry as a new method to "raise suspicion of new VFs radiation-free and indicate proper diagnostics, such as radiographs,MRI, or CT." Drs. Padulo and Ardigo question (1) the validity of radiationfree spinometry to assess spine parameters and (2) that spinometry showed better predictive accuracy than historical height loss (HHL) to predict vertebral fractures. Regarding the specific comments, we would like to reply as follows: (1) By questioning the validity of radiation-free spinometry compared to conventional x-rays, Drs. Padulo and Ardigo argue that our data should be viewed with caution. They implicate that radiation-free spinometry is not a sufficiently accurate device to be used in patient care. This is hard to understand, as the primary aim of our study was not to validate radiation-free spinometry but "to investigate the accuracy of spinometry to predict VFs by measuring [thoracic kyphosis] and [lumbar lordosis] based on different fracture locations and fracture grades." No data concerning the correct assessment of thoracic kyphosis or lumbar lordosis by radiation-free spinometry were presented in the study. The letter’s authors support their claim by reporting a low accuracy of the assessment of the Cobb angle and differences of 44 % between radiation-free spinometry and conventional radiographs analyzed by the Raimondi method by interpreting data from another study group [8]. In fact, compared to radiographs, Hackenberg et al. [2, 3] and Drerup and Hierholzer [4] performed validation studies based on a best-fit superimposition and differences between the lateral deviation and rotation curves of radiation-free spinometry and digitized x-rays [5, 6]. This approach takes local measurement shortcomings into account acknowledging that isolated segmental radiographic parameters might be erroneous. Given that the tilt of the single vertebrae cannot exactly be assessed it is widely accepted that the accuracy of the Cobb angle assessed by radiation-free spinometry is limited and not automatically given [2–4]. Although a comparison of radiation-free spinometry with, e.g., radiographs using Bland-Altman plots would be an adequate approach for its validation, we again want to emphasize that this was not the aim of our previous study. From our point of view, the letter’s authors rather miss the opportunity to present data or even Bland-Altman analyses of their own [7, 8]. In fact, due to the previously reported excellent interand intratester reliability of the assessment of thoracic kyphosis (intertester Cronbach’s α=0.979; intratester Cronbach’s α=0.920) and lumbar lordosis (intertester Cronbach’s α=0.992; intratester Cronbach’s α=0.955) with radiation-free spinometry, we feel confident in our results and conclusions [9]. Second, their claim that patients "deserve [...] reduced exposure to ionizing radiation" questioning overall application of radiation-free spinometry in patient care should be viewed with caution. We suggested that the combined assessment of thoracic kyphosis and lumbar lordosis by radiation-free spinometry could help raise suspicion for VFs und The letter referred to here can be found at DOI 10.1007/s00198-0142621-9.

How does the way a weight is carried affect spinal loads?

People often have to carry a weight which increases the spinal load. Few in vivo measured spinal loading data exist for carrying a weight. The aim of this study was to measure the force increase on a vertebral body replacement (VBR) caused by carrying weights in different ways. A telemeterised VBR allowing the measurement of six load components was implanted in five patients suffering from lumbar vertebral body fractures. The patients carried different weights laterally in one or both hands, in front of the body and in a backpack. The force increase with respect to standing was more than twice as high for carrying a weight in front of the body compared with carrying it laterally. A weight of 10 kg in a backpack led to an average force increase of only 35 N. The position of the carried weight relative to the spine strongly affected the spinal load.

Results of fusion and instrumentation of thoracic and lumbar vertebral fractures in children: a prospective ten-year study

Researches on the results of surgical treatment of thoracolumbar spine fractures are infrequent. The aim of this study was to determine midterm outcomes of surgical treatment of these fractures in a prospective survey. A case series study on pediatric patients with the diagnosis of thoracic and/or lumbar vertebral fractures was conducted over a ten-year period. Surgically treated patients were evaluated in the follow-up period, based on back pain, independent function, neurological status, and radiographic indices. There were 102 pediatric individuals, 61 boys and 41 girls, aged 3-17 years (mean 12 years of age) with thoracic and/or lumbar spinal fractures. Motor vehicle accident was the most common mechanism of injury (45.0 %). L1 was the most frequent level of fractured vertebra (24.4 %), and pelvic fracture was the most common associated orthopedic injury (21.5 %). Totally, 20 patients underwent surgery, but only fifteen (14 boys and one girl) participated in follow-up (mean 49 months; range 12-81 months). Posterior spinal fusion and instrumentation was accomplished in 12 cases. Three patients were operated by anterior approach and fusion followed by posterior fusion and instrumentation because of delay in diagnosis. There were no major perioperative complications. Two cauda equina syndromes and two incomplete spinal cord injuries improved back to normal. Five cases (33.3 %) reported occasional back pain, and all patients were functionally independent. Radiographic indices improved significantly. Spinal fusion and instrumentation in pediatric patients with unstable thoracolumbar vertebral fractures with or without spinal cord injuries have favorable radiographic and functional outcomes.

Finite Element Analysis of Osteoporotic Vertebrae with First Lumbar (L1) Vertebral Compression Fracture

The aim of this work is to assess the biomechanical response or load transfer response between osteoporotic (with first lumbar (L1) vertebral compression fracture) and healthy vertebrae in five vertebral physiological motions namely as compression, flexion, extension, lateral bending and axial rotation. For this purpose, an image-basedheterogeneous three-dimensional patient-specific of lumbar and thoracic spinal unit (T12-L2) finite element models for healthy and osteoporotic subjects were created. The finite element analysis have shown that one of the most significant effects of osteoporosis is the tendency to produce higher stress and strain in the cancellous region of the vertebral body. The maximum stress and strain was 4.53 fold (compression) and 5.43 fold (axial rotation) higher for the osteoporotic than the healthy subject, respectively, under the similar loading activity. Uneven stress distribution patterns also have been detected in the osteoporotic vertebrae rather than the healthy vertebrae. All of these characteristicsare reflected by a reduced structural strength and bone mass which might lead to an increased risk of fracture. These results strengthen the paradigm of a strong relationship between osteoporosis and its high susceptibility to fracture.

Fat Embolism Syndrome: An Autopsy-Proven Case Involving a Patient on Dialysis and Systemic Scleroderma

A 66-year-old woman receiving continuous ambulatory peritoneal dialysis developed acute respiratory distress 12 hours after a fall. Blood gas analysis revealed hypoxia (PaO2 67.7 torr) and metabolic acidosis with an increased anion gap, consistent with lactic acidosis (lactate, 86.5 mg/dL; normal range, 4.0–16.0). Magnetic resonance imaging showed a lumbar vertebral body fracture. On the fourth hospital day, the patient died of multiorgan failure and disseminated intravascular coagulation. Postmortem studies revealed fat emboli in the systemic circulation, ie, fat embolism syndrome. Diagnosing fat embolism syndrome can be difficult in patients on dialysis or in those with collagen vascular or pulmonary diseases.

Dichotomizing Sensory Nerve Fibers Innervating Both the Lumbar Vertebral Body and the Area Surrounding the Iliac Crest

Animal study. To determine the existence of dichotomizing sensory nerve fibers innervating both the lumbar vertebral body and the area surrounding the iliac crest (ASIC). Elderly patients with osteoporosis sometimes experience lumbar vertebral fracture and may feel diffuse nonlocalized pain in the back, the lateral portion of the trunk, and the ASIC. The pattern of sensory innervation of vertebral bodies remains unclear. DRG neurons with dichotomizing axons have been reported and are thought to be related to referred pain. The purpose of this study was to investigate the existence of dichotomizing axons to the lumbar vertebral bodies and the ASIC in rats. Two kinds of neurotracers (1,1´-dioctadecyl-3,3,3´,3´-tetramethylindocarbocyanine perchlorate [DiI] and Fluoro-Gold [FG]) were used. DiI crystals were placed in the left ASIC, and FG was applied into the L2 vertebral body in 10 rats. Four weeks later, left DRGs from L1 to L6 were resected, sectioned, and observed under a fluorescence microscope. DiI-labeled DRG neurons innervating the ASIC and FG-labeled DRG neurons innervating the vertebral L2 body were distributed from L1 to L6. The ratio of total double-labeled per total DiI-labeled DRG neurons was 10.2%, and that of total double-labeled per total FG-labeled DRG neurons was 14.7%. These double-labeled DRG neurons innervating the L2 vertebral body had other axons that extended to the ASIC. This finding provides a possible neuroanatomical explanation for referred pain in the ASIC from vertebral bodies.

Bone Marrow Edema in Vertebral Compression Fractures: Detection with Dual-Energy CT

To assess the use of the dual-energy computed tomographic (CT) virtual noncalcium technique in the evaluation of bone marrow edema in vertebral compression fractures. This prospective study was approved by the institutional review board; informed consent was obtained from all patients. Sixty-three consecutive patients with 112 thoracic and/or lumbar vertebral compression fractures were studied between January 2011 and April 2012. All patients underwent both dual-energy CT (100 kV and Sn140 kV, where Sn indicates the use of a 0.4-mm tin filter) and magnetic resonance (MR) imaging. Dual-energy CT data were postprocessed by using a three-material decomposition algorithm for generating noncalcium images of the collapsed bodies. Two radiologists evaluated for the presence of abnormal attenuation alterations in the bone marrow by using color-coded maps and measured CT numbers on noncalcium grayscale images. Bone sclerosis and intravertebral air were evaluated with CT scans. MR images served as the reference standard. CT numbers were subjected to receiver operating characteristic curve analysis. MR imaging depicted 46 edematous and 66 nonedematous vertebral compression fractures. Eighty-two bodies were classified as having less than 50% sclerosis and/or air. Significant differences in noncalcium CT numbers between edematous and nonedematous vertebral compression fractures were found for both readers (P < .0001). CT numbers for the diagnosis of bone marrow edema on the basis of MR imaging revealed areas under the receiver operating characteristic curve of 0.799 and 0.841 for readers 1 and 2, respectively (P = .56). Use of a cutoff value of -80 to differentiate edematous vertebral bodies resulted in a sensitivity of 96.3%, specificity of 98.2%, and accuracy of 97.6% in the group of vertebral bodies with less than 50% sclerosis and/or air. Dual-energy CT virtual noncalcium images were able to depict bone marrow in the collapsed vertebral bodies, especially in those with less than 50% sclerosis and/or air.

Auswanderung der PMMA-Zementplombe als seltene Komplikation der Kyphoplastie - Kasuistik und Übersichtsarbeit

For vertebral body fractures combined with strong back pain, the kyphoplasty is an established method for pain reduction. A balloon effects an excavation in the vertebral body, which will be filled up with cement. We distinguish between cements of polymethyl metacrylate (PMMA) and calcium phosphate. Their diverse chemical qualities enable different indications. A 72-year-old male patient with refractory back pain after a lumbar vertebral body fracture was treated with a kyphoplasty operation. After four days the patient went home with clearly less pain. After two months the patient had a bagatelle trauma at home, which caused an exacerbation of the back pain. In computered tomography we saw a disruption of the PMMA cement plombage forwards and also a kyphosis of the lumbar vertebrae. Therefore we had to operate on the patient two more times. The first time we stabilised the spine from dorsal via an internal fixator. The additive ventral fixation was at that time declined by the patient. Because of the persistency of the back pain after operation combined with a sense of instability, we were ten days after the first revision allowed to stabilise the patient from ventrally with a Harms cage. At the first-year follow-up the patient was still free of pain. Injuries of the vertebral body frame cannot be operated exclusively with kyphoplasty. The reason for this is the instability of the vertebral body despite the injection of the PMMA cement. We advise to stabilise the spine in such cases with a dorsal internal fixator additively.

High hip fracture risk in men with severe aortic calcification: MrOS study

A significant link between cardiovascular disease and osteoporosis is established in postmenopausal women, but data for men are scarce. We tested the hypothesis that greater severity of abdominal aortic calcification (AAC) was associated with an increased risk of nonspine fracture in 5994 men aged ≥ 65 years. AAC was assessed on 5400 baseline lateral thoracolumbar radiographs using a validated visual semiquantitative score. Total hip bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry. Incident nonspine fractures were centrally adjudicated. After adjustment for age, body mass index (BMI), total hip BMD, fall history, prior fracture, smoking status, comorbidities, race, and clinical center, the risk of nonspine fracture (n=805) was increased among men with higher AAC (hazard ratio [HR] quartile 4 [Q4] [AAC score ≥ 9] versus quartile 1 [Q1] [0-1], 1.36; 96% confidence interval [CI], 1.10-1.68). This association was due to an increased risk of hip fracture (n=178) among men with higher AAC (HR Q4 versus Q1, 2.33; 95% CI, 1.41-3.87). By contrast, the association between AAC and the risk of nonspine, nonhip fracture was weaker and not significant (HR Q4 versus Q1, 1.22; 95% CI, 0.96-1.55). The findings regarding higher AAC and increased risk of fracture were not altered in additional analyses accounting for degree of trauma, estimated glomerular filtration rate, presence of lumbar vertebral fractures (which may bias AAC assessment), preexisting cardiovascular disease, ankle brachial index, or competing risk of death. Thus, in this large cohort of elderly men, greater AAC was independently associated with an increased risk of hip fracture, but not with other nonspine fractures. These findings suggest that AAC assessment may be a useful method for identification of older men at high risk of hip fracture.

Infection after vertebroplasty or kyphoplasty. A series of nine cases and review of literature

Background contextPercutaneous augmentation with bone cement is a widely accepted modality of treatment for thoracic and lumbar vertebral osteoporotic fractures. Infection after vertebroplasty or kyphoplasty is a serious, yet, rarely reported complication. PurposeTo present a case series with a long-term follow-up of spinal infection after vertebroplasty/kyphoplasty with analysis of preoperative condition, risk factors, diagnostic findings, time before reoperation, causative organism, treatment, and outcome. Study designA retrospective, uncontrolled clinical case series in a single institution. Patient sampleBetween January 1997 and June 2012, 1,307 patients underwent percutaneous vertebroplasty or kyphoplasty. Six cases had postoperative infection (0.46%) and three additional cases were referred from other institutions for salvage treatment. Outcome measuresPerioperative assessment included visual analog scale, clinical, laboratory, and imaging findings, and activities of daily living at the end of the follow-up. MethodsNine patients were included: six females and three males (mean age 73.8 years). Comorbidities were found in all patients. Kyphoplasty had been done in five patients and vertebroplasty in four. ResultsThe interval between augmentation and revision surgery ranged from 10 to 395 days with a mean of 118.4 days. Three cases with early infection presented within 1 month. Infection parameters were high in all patients at readmission. All patients were treated surgically except one case who died before the planned revision surgery. In all cases, debridement and corpectomy were done through anterior approaches combined with posterior instrumentation. The most common causative organism was Staphylococcus aureus in three cases. Mean follow-up period after the revision surgery was 26.68 months, excluding two patients who died early in the follow-up (within 4 months). This amounts to a mortality rate of 33.3% perioperatively. At the end of follow-up, two patients had unrestricted activities and one patient required a walker. Of three paraparetic patients, two improved functionally and could walk unassisted and one improved but still used a wheelchair. ConclusionsAlthough vertebroplasty and kyphoplasty are minimally invasive interventions, postoperative infection can develop into life-threatening complications. This should be accounted for, in decision making in the elderly age group most commonly affected by osteoporotic fractures and especially in suspicious and high-risk immune-compromised patients.

Bone Marrow Edema in Vertebral Compression Fractures: Detection with Dual-Energy CT

To assess the use of the dual-energy computed tomographic (CT) virtual noncalcium technique in the evaluation of bone marrow edema in vertebral compression fractures. This prospective study was approved by the institutional review board; informed consent was obtained from all patients. Sixty-three consecutive patients with 112 thoracic and/or lumbar vertebral compression fractures were studied between January 2011 and April 2012. All patients underwent both dual-energy CT (100 kV and Sn140 kV, where Sn indicates the use of a 0.4-mm tin filter) and magnetic resonance (MR) imaging. Dual-energy CT data were postprocessed by using a three-material decomposition algorithm for generating noncalcium images of the collapsed bodies. Two radiologists evaluated for the presence of abnormal attenuation alterations in the bone marrow by using color-coded maps and measured CT numbers on noncalcium grayscale images. Bone sclerosis and intravertebral air were evaluated with CT scans. MR images served as the reference standard. CT numbers were subjected to receiver operating characteristic curve analysis. MR imaging depicted 46 edematous and 66 nonedematous vertebral compression fractures. Eighty-two bodies were classified as having less than 50% sclerosis and/or air. Significant differences in noncalcium CT numbers between edematous and nonedematous vertebral compression fractures were found for both readers (P < .0001). CT numbers for the diagnosis of bone marrow edema on the basis of MR imaging revealed areas under the receiver operating characteristic curve of 0.799 and 0.841 for readers 1 and 2, respectively (P = .56). Use of a cutoff value of -80 to differentiate edematous vertebral bodies resulted in a sensitivity of 96.3%, specificity of 98.2%, and accuracy of 97.6% in the group of vertebral bodies with less than 50% sclerosis and/or air. Dual-energy CT virtual noncalcium images were able to depict bone marrow in the collapsed vertebral bodies, especially in those with less than 50% sclerosis and/or air.

Cauda Equina Syndrome Caused by Lumbar Vertebral Fracture in an Elderly Patient with Ankylosing Spondylitis

AbstractBackground: Cauda equina syndrome [CES] in patients with ankylosing spondylitis [AS] is an important neurological complication characterized by low back and leg pain, impotence, urinary incontinence, sensory deficits, and motor dysfunction. Vertebral fractures in the course of AS have been found most often in the cervical region, followed in prevalence by the thoracic region but only rarely in the lumbosacral region.Findings: We present an elderly patient with AS who developed spondylolisthesis at the L4–L5 level and CES following a low-energy fracture.Conclusion: Vertebral fractures in course of AS is especially more common in elderly patients with long-standing disease. Early diagnosis and treatment might improve the clinical outcome and might prevent complications.

FRI0152 Low back pain in rheumatoid arthritis patients correlated with das28-esr

BackgroundLow back pain (LBP) is one of the most common problems leading to health disabilities; the 1-month prevalence of LBP in general population has been reported to be 30%. Female...

DXA parameters: Beyond bone mineral density

Dual-energy X-ray absorptiometry (DXA) is the reference standard for measuring bone mineral density (BMD) to diagnose osteoporosis. However, BMD measurement alone does not reliably predict the fracture risk. DXA can be used to assess other parameters (e.g. presence of vertebral fractures, bone microarchitecture, bone geometry, and body composition) simultaneously with BMD measurements, to help identify individuals at high fracture risk. Among these parameters, some are suitable for use in clinical practice, whereas others are reserved for research. Vertebral fracture assessment (VFA) is a very low radiation-dose method for detecting thoracic and lumbar vertebral fractures. Compared to standard radiography, VFA can be used in a broader population to detect asymptomatic vertebral fractures. The very good negative predictive value of VFA leads, in one-third of cases, to changes in patient management (drug treatment and prescription of radiographs). The trabecular bone score (TBS) is a noninvasively measured texture parameter that correlates with 3D bone microarchitecture parameters independently from BMD and that can be determined from lumbar-spine DXA images. Several cross-sectional studies and a prospective study established that the TBS was effective in identifying individuals with fractures. Additional studies will have to be performed to determine whether TBS determination can be recommended for everyday practice when treatment decisions are difficult.

Characterization of spinal injuries sustained by American service members killed in Iraq and Afghanistan

This study sought to characterize spine injuries among soldiers killed in Iraq or Afghanistan whose autopsy results were stored by the Armed Forces Medical Examiner System. The Armed Forces Medical Examiner System data set was queried to identify American military personnel who sustained a spine injury in conjunction with wounds that resulted in death during deployment in Iraq or Afghanistan from 2003 to 2011. Demographic and injury-specific characteristics were abstracted for each individual identified. The raw incidence of spinal injuries was calculated and correlations were drawn between the presence of spinal trauma and military specialty, mechanism and manner of injury, and wounds in other body regions. Significant associations were also sought for specific injury patterns, including spinal cord injury, atlantooccipital injury, low lumbar vertebral fractures, and lumbosacral dissociation. Statistical calculations were performed using χ statistic, z test, t test with Satterthwaite correction, and multivariate logistic regression. Among 5,424 deceased service members, 2,089 (38.5%) were found to have sustained at least one spinal injury. Sixty-seven percent of all fatalities with spinal injury were caused by explosion, while 15% occurred by gunshot. Spinal fracture was the most common type of injury (n = 2,328), while spinal dislocations occurred in 378, and vertebral column transection occurred in 223. Fifty-two percent sustained at least one cervical spine injury, and spinal cord injury occurred in 40%. Spinal cord injuries were more likely to occur as a result of gunshot (p < 0.001), while atlantooccipital injuries (p < 0.001) and low lumbar fractures (p = 0.01) were significantly higher among combat specialty soldiers. No significant association was identified between spinal injury risk and the periods 2003 to 2007 and 2008 to 2011, although atlantooccipital injuries and spinal cord injury were significantly reduced beginning in 2008 (p < 0.001). The results of this study indicate that the incidence of spinal trauma in modern warfare seems to be higher than previously reported. Epidemiologic study, level III.

Facet Joint Signal Change on MRI at Levels of Acute/Subacute Lumbar Compression Fractures

The prevalence of facet joint signal change in acute/subacute lumbar vertebral body compression fractures is unknown. We hypothesized that facet joint signal change on MR imaging is more common in facet joints associated with an acute/subacute lumbar compression fracture than those associated with normal vertebral bodies or ones that have a chronic compression fracture. Three neuroradiologists and a neuroradiology fellow retrospectively graded facet joint inflammatory change on MR imaging in 900 facet joints in 75 patients with at least 1 painful osteoporotic lumbar compression fracture. Facet joint signal change was assessed on T2-weighted images with chemical fat-saturation, STIR images, and/or gadolinium-enhanced T1-weighted images with chemical fat-saturation. Each facet joint from the T12/L1 to L5/S1 level was assessed individually. An overall facet joint signal-change score, which is a composite measure of the grade of signal change for all 4 facet joints associated with a given lumbar vertebral level, was devised, and statistical significance was assessed via Wilcoxon rank sum tests. The overall facet joint signal-change scores were significantly higher at vertebral body levels affected by an acute/subacute compression fracture compared with control levels, which were associated with either normal bodies or chronic compression fractures. Our findings suggest an association between facet joint signal change on MR imaging and acute/subacute lumbar vertebral body compression fractures.

The Interleukin 8 Expression and its Possible Relationship with Degenerated and Injured Human Intervertebral Discs

Purpose: Cervicaland Lumbar degenerative disc diseases (DDD) are a common disease of advanced age characterized by progressive changes in the intervertebral disc and associated structures. There have been great efforts for years to explain its pathophysiological mechanism(s). This study aims to provide the expression of IL-8 in a population of patients with lumbar disc herniation, cervical stenosis and vertebral fracture. Material and methods: We compared the level of IL-8 expression in the non-degenerated and degenerated intervertebral disc samples obtained from patients who underwent surgery for vertebral fracture (non degenerated disc), lumbar disc herniation and cervical stenosis (degenerated disc), whose clinical and radiological features were suggestive of disc degeneration. IL-8 expression was studied by using the western blot, immunohistochemistry and enzyme linked immune absorbent assay methods. This study includes comparison of IL-8 concentration in groups based on patient’s age and diagnosis. Results: Significantly higher levels of IL-8 expressions were found in patient with advance age, more in vertebral fracture as compared to lumbar disc herniationand cervical stenosis patients. Conclusion: The findings suggest that both local inflammatory responses occur in lumbar disc herniation, cervical stenosis and vertebral fracture patients. Using specific cytokines either by local or systemic application may reverse the degenerative process.

Bone microarchitecture in ankylosing spondylitis and the association with bone mineral density, fractures, and syndesmophytes

IntroductionOsteoporosis of the axial skeleton is a known complication of ankylosing spondylitis (AS), but bone loss affecting the peripheral skeleton is less studied. This study on volumetric bone mineral density (vBMD) and bone microarchitecture in AS was conducted to compare peripheral vBMD in AS patients with that in healthy controls, to study vBMD in axial compared with peripheral bone, and to explore the relation between vertebral fractures, spinal osteoproliferation, and peripheral bone microarchitecture and density.MethodsHigh-resolution peripheral quantitative computed tomography (HRpQCT) of ultradistal radius and tibia and QCT and dual-energy x-ray absorptiometry (DXA) of lumbar spine were performed in 69 male AS patients (NY criteria). Spinal radiographs were assessed for vertebral fractures and syndesmophyte formation (mSASSS). The HRpQCT measurements were compared with the measurements of healthy controls.ResultsThe AS patients had lower cortical vBMD in radius (P = 0.004) and lower trabecular vBMD in tibia (P = 0.033), than did the controls. Strong correlations were found between trabecular vBMD in lumbar spine, radius (rS = 0.762; P < 0.001), and tibia (rS = 0.712; P < 0.001).When compared with age-matched AS controls, patients with vertebral fractures had lower lumbar cortical vBMD (-22%; P = 0.019), lower cortical cross-sectional area in radius (-28.3%; P = 0.001) and tibia (-24.0%; P = 0.013), and thinner cortical bone in radius (-28.3%; P = 0.001) and tibia (-26.9%; P = 0.016).mSASSS correlated negatively with trabecular vBMD in lumbar spine (rS = -0.620; P < 0.001), radius (rS = -0.400; p = 0.001) and tibia (rS = -0.475; p < 0.001) and also with trabecular thickness in radius (rS = -0.528; P < 0.001) and tibia (rS = -0.488; P < 0.001).Adjusted for age, syndesmophytes were significantly associated with decreasing trabecular vBMD, but increasing cortical vBMD in lumbar spine, but not with increasing cortical thickness or density in peripheral bone. Estimated lumbar vBMD by DXA correlated with trabecular vBMD measured by QCT (rS = 0.636; P < 0.001).ConclusionsLumbar osteoporosis, syndesmophytes, and vertebral fractures were associated with both lower vBMD and deteriorated microarchitecture in peripheral bone. The results indicate that trabecular bone loss is general, whereas osteoproliferation is local in AS.

Teriparatide may accelerate healing in delayed union of lumbar vertebral fracture with old thoracic spinal cord injury. A case report

Teriparatide may accelerate healing in delayed union of lumbar vertebral fracture with old thoracic spinal cord injury. A case report