Neoadjuvant teriparatide therapy targeting the osteoporotic spine: influence of administration period from the perspective of bone histomorphometry

2021 ◽  
pp. 1-11
Author(s):  
Kimihiko Sawakami ◽  
Kei Watanabe ◽  
Kazuhiro Hasegawa ◽  
Noriaki Yamamoto ◽  
Taketoshi Shimakura ◽  
...  
Keyword(s):  
Spinal Fusion ◽  
Oswestry Disability Index ◽  
Bone Histomorphometry ◽  
Early Stage ◽  
Therapy Group ◽  
Fold Increase ◽  
Clinical Results ◽  
Bone Fragility ◽  
Treatment Groups ◽  
Spinal Fusion Surgery

OBJECTIVE Teriparatide (TPTD) is a potent promoter of early-stage osteogenesis and may be a useful adjuvant therapy to reduce complications related to bone fragility in spinal surgery patients with osteoporosis. However, effective neoadjuvant TPTD therapy regimens remain poorly understood. This study aimed to examine the effect of preoperative TPTD administration on cancellous bone with bone histomorphometry and to clarify the timing of preoperative TPTD administration for patients with spinal fusion and osteoporosis. METHODS In this longitudinal multicenter study, 57 patients with spinal fusion and osteoporosis, who consented to undergo iliac biopsy, were allocated to the following treatment groups: neoadjuvant TPTD therapy group (n = 42) and no neoadjuvant therapy (NTC) group (n = 15). Patients in the TPTD group were categorized into subgroups on the basis of duration of preoperative TPTD administration, as follows: 1 month (n = 9), 2 months (n = 8), 3 months (n = 9), 4 months (n = 7), and 6 months (n = 9). All patient samples were preoperatively double labeled with tetracycline, and iliac biopsies were performed during spinal fusion surgery. Histomorphometric analyses were performed on nondecalcified, thin-sliced specimens. Specimens were classified on the basis of TPTD administration duration and subsequently compared with those of the NTC group. Postoperative complications and Oswestry Disability Index scores were evaluated at 1 and 2 years after surgery. RESULTS There were no demographic differences between groups. Mineralizing surface/bone surface, a key parameter of dynamic bone formation, started to increase after 1 month of TPTD administration; this increase became significant after 3 months of administration and peaked at 4 months, with a 6-fold increase relative to that of the NTC group. The patients who received preoperative TPTD for 3 months or more had superior clinical results in terms of the osteoporotic complication rate and Oswestry Disability Index scores, except for bisphosphonate-pretreated patients. CONCLUSIONS When considering neoadjuvant TPTD therapy, the authors recommend at least 3 months of preoperative administration to provide a more substantial anabolic effect from the early postoperative stage.

scholarly journals Surgical and Clinical Results of Minimally Invasive Spinal Fusion Surgery in an Unselected Patient Cohort of a Spinal Care Unit

2018 ◽  
Vol 10 (3) ◽  
pp. 192-197 ◽  
Author(s):  
Wolfgang Senker ◽  
Andreas Gruber ◽  
Matthias Gmeiner ◽  
Harald Stefanits ◽  
Kirsten Sander ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Spinal Fusion ◽  
Clinical Results ◽  
Fusion Surgery ◽  
Patient Cohort ◽  
Spinal Fusion Surgery ◽  
Unselected Patient

scholarly journals The effect of platelet-rich plasma on the fusion rate and clinical outcome of spinal fusion surgery: A systematic review and meta-analysis

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243204
Author(s):  
Ying-feng Cai ◽  
Tian-Zhao Tian ◽  
Li-Ye Chen ◽  
Bao-Xin Liu ◽  
Jian-Peng Zhou ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Cohort Studies ◽  
Spinal Fusion ◽  
Complication Rate ◽  
Platelet Rich Plasma ◽  
Meta Analysis ◽  
Clinical Results ◽  
Fusion Rate ◽  
Fusion Surgery ◽  
Spinal Fusion Surgery

Background Platelet-rich plasma (PRP) is widely used in many orthopedic surgeries and spinal disease treatments; however, the effect of PRP on spinal fusion remains controversial. Questions/Purposes To assess the fusion rate and clinical results of PRP compared with non-PRP administration in the treatment of spinal fusion with regard to decreasing pain and improving healing and function. Patients and methods Studies comparing PRP to non-PRP treatment with respect to the fusion rate and clinical outcome in patients who underwent spinal fusion surgery were included. Result Three randomized controlled trials (RCTs) and 7 prospective cohort studies were identified. The spinal fusion rate was not significantly different between the groups in all RCTs or cohort studies at the final follow-up. In comparison, PRP significantly reduced pain after surgery as evaluated in the RCT analysis and the complication rate did not differ significantly between the two groups. Conclusion According to the available studies, PRP does not contribute to the union rate, relieve pain or increase the complication rate in spinal fusion surgery. As clinical heterogeneity exists in these studies, further large, well-designed RCTs that focus on the standard assessment of PRP are needed.

scholarly journals Are the Roland Morris Disability Questionnaire and Oswestry Disability Index interchangeable in patients after lumbar spinal fusion?

2021 ◽  
pp. 1-7
Author(s):  
R.F.M.R. Kersten ◽  
J. Fikkers ◽  
N. Wolterbeek ◽  
F.C. Öner ◽  
S.M. van Gaalen
Keyword(s):  
Back Pain ◽  
Spinal Fusion ◽  
Outcome Measures ◽  
Oswestry Disability Index ◽  
Roland Morris Disability Questionnaire ◽  
Leg Pain ◽  
Lumbar Spinal Fusion ◽  
Patient Reported ◽  
Disability Questionnaire ◽  
Lumbar Spinal

BACKGROUND: Low back pain is a common health problem for which there are several treatment options. For optimizing clinical decision making, evaluation of treatments and research purposes it is important that health care professionals are able to evaluate the functional status of patients. Patient reported outcome measures (PROMs) are widely accepted and recommended. The Roland Morris Disability Questionnaire (RMDQ) and the Oswestry Disability Index (ODI) are the two mainly used condition-specific patient reported outcomes. Concerns regarding the content and structural validity and also the different scoring systems of these outcome measures makes comparison of treatment results difficult. OBJECTIVE: Aim of this study was to determine if the RMDQ and ODI could be used exchangeable by assessing the correlation and comparing different measurement properties between the questionnaires. METHODS: Clinical data from patients who participated in a multicenter RCT with 2 year follow-up after lumbar spinal fusion were used. Outcome measures were the RMDQ, ODI, Short Form 36 – Health Survey (SF-36), leg pain and back pain measured on a 0–100 mm visual analogue scale (VAS). Cronbach’s alpha coefficients, Spearman correlation coefficients, multiple regression analysis and Bland-Altman plots were calculated. RESULTS: three hundred and seventy-six completed questionnaires filled out by 87 patients were used. The ODI and RMDQ had both a good level of internal consistency. There was a very strong correlation between the RMDQ and the ODI (r= 0.87; p< 0.001), and between the VAS and both the ODI and RMDQ. However, the Bland-Altman plot indicated bad agreement between the ODI and RMDQ. CONCLUSIONS: The RMDQ and ODI cannot be used interchangeably, nor is there a possibility of converting the score from one questionnaire to the other. However, leg pain and back pain seemed to be predictors for both the ODI and the RMDQ.

Fatal pulmonary fat embolism after posterior spinal fusion surgery

2006 ◽  
Vol 11 (2) ◽  
pp. 217-220 ◽  
Author(s):  
Yoshimasa Takahashi ◽  
Ken’ichiro Narusawa ◽  
Kenji Shimizu ◽  
Masakazu Takata ◽  
Toshitaka Nakamura
Keyword(s):  
Spinal Fusion ◽  
Posterior Spinal Fusion ◽  
Fat Embolism ◽  
Fusion Surgery ◽  
Spinal Fusion Surgery ◽  
Pulmonary Fat Embolism

Diagnosis and management of hook of hamate fractures

2017 ◽  
Vol 43 (5) ◽  
pp. 539-545 ◽  
Author(s):  
Assaf Kadar ◽  
Allen T. Bishop ◽  
Marissa A. Suchyta ◽  
Steven L. Moran
Keyword(s):  
Case Series ◽  
Clinical Results ◽  
Clinical Findings ◽  
Advanced Imaging ◽  
Level Of Evidence ◽  
Historical Case ◽  
Treatment Groups ◽  
Diagnosis And Management ◽  
Time To Diagnosis ◽  
Hook Of Hamate

The purpose of this study was to evaluate the time to diagnosis and management of hook of hamate fractures in an era of advanced imaging. We performed a retrospective study of 51 patients treated for hook of hamate fractures. Patients were sent a quickDASH questionnaire regarding the outcomes of their treatment. Hook of hamate fractures were diagnosed with advanced imaging at a median of 27 days. Clinical findings of hook of hamate tenderness had better sensitivity than carpal tunnel-view radiographs. Nonunion occurred in 24% of patients with non-operative treatment and did not occur in the operative group. Both treatment groups achieved good clinical results, with a grip strength of 80% compared with the non-injured hand and a median quickDASH score of 2. Advanced imaging improved the time to diagnosis and treatment compared to historical case series. Nonunion is common in patients treated non-operatively. Level of evidence: IV

scholarly journals Inhaled H2 or CO2 Do Not Augment the Neuroprotective Effect of Therapeutic Hypothermia in a Severe Neonatal Hypoxic-Ischemic Encephalopathy Piglet Model

2020 ◽  
Vol 21 (18) ◽  
pp. 6801
Author(s):  
Viktória Kovács ◽  
Gábor Remzső ◽  
Valéria Tóth-Szűki ◽  
Viktória Varga ◽  
János Németh ◽  
...  
Keyword(s):  
Caudate Nucleus ◽  
Therapeutic Hypothermia ◽  
Neuroprotective Effect ◽  
Fold Increase ◽  
Hypoxic Ischemic Encephalopathy ◽  
Mrna Levels ◽  
Treatment Groups ◽  
Apoptosis Inducing Factor ◽  
Co2 Treatment ◽  
Ischemic Encephalopathy

Hypoxic-ischemic encephalopathy (HIE) is still a major cause of neonatal death and disability as therapeutic hypothermia (TH) alone cannot afford sufficient neuroprotection. The present study investigated whether ventilation with molecular hydrogen (2.1% H2) or graded restoration of normocapnia with CO2 for 4 h after asphyxia would augment the neuroprotective effect of TH in a subacute (48 h) HIE piglet model. Piglets were randomized to untreated naïve, control-normothermia, asphyxia-normothermia (20-min 4%O2–20%CO2 ventilation; Tcore = 38.5 °C), asphyxia-hypothermia (A-HT, Tcore = 33.5 °C, 2–36 h post-asphyxia), A-HT + H2, or A-HT + CO2 treatment groups. Asphyxia elicited severe hypoxia (pO2 = 19 ± 5 mmHg) and mixed acidosis (pH = 6.79 ± 0.10). HIE development was confirmed by altered cerebral electrical activity and neuropathology. TH was significantly neuroprotective in the caudate nucleus but demonstrated virtually no such effect in the hippocampus. The mRNA levels of apoptosis-inducing factor and caspase-3 showed a ~10-fold increase in the A-HT group compared to naïve animals in the hippocampus but not in the caudate nucleus coinciding with the region-specific neuroprotective effect of TH. H2 or CO2 did not augment TH-induced neuroprotection in any brain areas; rather, CO2 even abolished the neuroprotective effect of TH in the caudate nucleus. In conclusion, the present findings do not support the use of these medical gases to supplement TH in HIE management.

PD-0179: Clinical results of partial- and whole breast irradiation in early stage breast cancer

2020 ◽  
Vol 152 ◽  
pp. S87-S88
Author(s):  
J. Haussmann ◽  
B. Wilfried ◽  
S. Corradini ◽  
B. Tamaskovics ◽  
E. Boelke ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Clinical Results ◽  
Early Stage Breast Cancer ◽  
Whole Breast Irradiation ◽  
Breast Irradiation

scholarly journals FGF23, a novel muscle biomarker detected in the early stages of ALS

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ying Si ◽  
Mohamed Kazamel ◽  
Michael Benatar ◽  
Joanne Wuu ◽  
Yuri Kwon ◽  
...  
Keyword(s):  
Biomarker Discovery ◽  
Clinical Symptoms ◽  
Early Stage ◽  
Fold Increase ◽  
Progressive Increase ◽  
Molecular Signature ◽  
Muscle Membrane ◽  
Sequencing Project ◽  
Progressive Muscle Weakness ◽  
End Stage

AbstractAmyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease characterized by progressive muscle weakness. Skeletal muscle is a prime source for biomarker discovery since it is one of the earliest sites to manifest disease pathology. From a prior RNA sequencing project, we identified FGF23 as a potential muscle biomarker in ALS. Here, we validate this finding with a large collection of ALS muscle samples and found a 13-fold increase over normal controls. FGF23 was also increased in the SOD1G93A mouse, beginning at a very early stage and well before the onset of clinical symptoms. FGF23 levels progressively increased through end-stage in the mouse. Immunohistochemistry of ALS muscle showed prominent FGF23 immunoreactivity in the endomysial connective tissue and along the muscle membrane and was significantly higher around grouped atrophic fibers compared to non-atrophic fibers. ELISA of plasma samples from the SOD1G93A mouse showed an increase in FGF23 at end-stage whereas no increase was detected in a large cohort of ALS patients. In conclusion, FGF23 is a novel muscle biomarker in ALS and joins a molecular signature that emerges in very early preclinical stages. The early appearance of FGF23 and its progressive increase with disease progression offers a new direction for exploring the molecular basis and response to the underlying pathology of ALS.

Spinal-Fusion Surgery — The Case for Restraint

2004 ◽  
Vol 350 (7) ◽  
pp. 722-726 ◽  
Author(s):  
Richard A. Deyo ◽  
Alf Nachemson ◽  
Sohail K. Mirza
Keyword(s):  
Spinal Fusion ◽  
Fusion Surgery ◽  
Spinal Fusion Surgery
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