Osteoporotic Fractures and Vertebral Body Reshaping in Children with Glucocorticoid-Treated Rheumatic Disorders

Purpose To evaluate the incidence and predictors of osteoporotic fractures and potential for recovery over six years following glucocorticoid (GC) initiation in children with rheumatic disorders. Methods Children with GC-treated rheumatic disorders were evaluated through a prospective inception cohort study led by the Canadian STeroid-induced Osteoporosis in the Pediatric Population (STOPP) Consortium. Clinical outcomes included lumbar spine bone mineral density (LS BMD), vertebral fractures (VF), non-VF, and vertebral body reshaping. Results 136 children with GC-treated rheumatic disorders were enrolled (mean age 9.9 years, SD 4.4). The six-year cumulative fracture incidence was 16.3% for VF, and 10.1% for non-VF. GC exposure was highest in the first six months, and 24/38 VF (63%) occurred in the first two years. Following VF, 16/19 children (84%) had complete vertebral body reshaping. Increases in disease activity and body mass index z-scores in the first year and declines in LS BMD z-scores in the first six months predicted incident VF over the six years, while higher average daily GC doses predicted both incident VF and non-VF. LS BMD z-scores were lowest at 6 months (mean -0.9, SD 1.2) and remained low by six years even when adjusted for height z-scores (-0.6, SD 0.9). Conclusions VF occurred early and were more common than non-VF in children with GC-treated rheumatic disorders. Eight-four percent of children with VF underwent complete vertebral body reshaping, while vertebral deformity persisted in the remainder of children. On average, LS BMD z-scores remained low at six years, consistent with incomplete recovery.

The Role of Instrumentation in the Healing Process of Spinal Tuberculosis: An Experimental Study

Introduction: Tuberculosis is still commonly found in many developing countries. Spinal tuberculosis can cause vertebral deformity and neurological disorders. It was discovered thousands years ago and its management was aimed to eradicate infection and maintain the integrity of the vertebrae. Previously, the management of spinal TB was using drugs and external stabilization. Surgical techniques were developed afterwards to clean the infected vertebral segment. Because of the vertebral deformity remained inevitable and had impacts on neurological disorders, new paradigm had been developed by using instrumentation to stabilize the deformity of infected vertebral segment and to restore and maintain neurological function. TGF-β has a major role in angiogenesis in bone healing process. Spinal TB instrumentation uses metal devices composed of ions and particles that can interact each other so it could produce physical and chemical energy that is transmitted to the vertebrae. The energy is expected to enhance the biomolecular and biocellular activity of the body's immune cells so the healing process could be better. Methods: An experimental study was carried out on New Zealand Rabbits which were given TB H37Rv strain infection in the vertebral body. Samples were divided into five groups namely control rabbits, infected rabbits without intervention, infected rabbits treated by instrumentation, infected rabbits given anti-tuberculosis drugs and infected rabbits treated by instrumentation and given drugs. Then the cytokine levels of TGF-β were evaluated and compared. Results: The results showed a significant TGF- β level increase in infected rabbits given drugs alone and instrumentation alone compared to infected rabbits without intervention. There was a significant TGF- β increase in infected rabbits given drugs and treated by instrumentation compared to control rabbits and rabbits who received drugs only. Conclusions: Instrumentation can improve the healing process in spinal tuberculosis by increasing the body's cytokine levels.

Characteristics of surgical treatment of patients with comorbidities in scoliotic disease

A large number of studies deal with the study of the etiology and pathogenesis of scoliotic disease, since it is the most common disease among all the pathologies of the supporting-motor system. Scoliosis is more common in patients aged 4 to 17. Its frequency in the adult population reaches 18.2 cases per 1000 of population. The developed and widely applicable non-surgical therapy of moderate, progressive, and severe extent of disease do not always lead to positive outcomes. A variety of surgical methods for treating scoliosis is successfully used nowadays. Modern types of fixing hardware, including two-leg growing systems, most often used in practice, allow simultaneous correction of vertebral deformity in three planes and reliably stabilize the spinal column in a position closest to the physiological one. Since most organs and systems of the body are affected by scoliosis, it is necessary to take into account the characteristics of the comorbid background of patients for successful surgical treatment and effective postoperative rehabilitation. Comorbidity creates special requirements for surgical and rehabilitation approach to achieve biomechanically correct fitting of the structure and its rigid fixation on the supporting osseous structures. The aim of the study was to identify the most common comorbidities in patients with scoliosis admitted for surgical treatment, to highlight the features of surgical treatment and rehabilitation of these groups of patients. Material and methods. We studied 118 case histories of patients admitted for surgical treatment of scoliosis, monitoring characteristics of the periods of treatment and rehabilitation after surgical correction of vertebral deformity. Results. Degenerative vertebral diseases, cardiovascular development abnormalities and diseases of the gastrointestinal tract were noted with the highest frequency as diseases associated with scoliosis. The characteristics of surgical approach in the correction of vertebral deformity depending on the identified comorbidity are generalized. Conclusions. The revealed comorbidity pattern indicates the fundamental generality of the etiology of scoliosis and these diseases, as well as the pathogenetic role of vertebral deformities in the development of a number of diseases. This fact must be taken into account when planning approaches to surgical interference and individual rehabilitation program in the early postoperative period.

Monsters with a shortened vertebral column: A population phenomenon in radiating fish Labeobarbus (Cyprinidae)

The phenomenon of a massive vertebral deformity was recorded in the radiating Labeobarbus assemblage from the middle reaches of the Genale River (south-eastern Ethiopia, East Africa). Within this sympatric assemblage, five trophic morphs—generalized, lipped, piscivorous and two scraping feeders—were reported between 1993 and 2019. In 2009, a new morph with prevalence of ~10% was discovered. The new morph, termed ‘short’, had an abnormally shortened vertebral column and a significantly deeper body. This type of deformity is common in farmed Atlantic salmon and other artificially reared fish, but is rare in nature. In the Genale Labeobarbus assemblage, the deformity was present exclusively within the generalized and lipped morphs. The short morph had between seven and 36 deformed (compressed and/or fused) vertebrae. Their body depth was positively correlated with number of deformed vertebrae. In another collection in 2019, the short morph was still present at a frequency of 11%. Various environmental and genetic factors could contribute to the development of this deformity in the Genale Labeobarbus, but based on the available data, it is impossible to confidently identify the key factor(s). Whether the result of genetics, the environment, or both, this deep-bodied phenotype is assumed to be an anti-predator adaptation, as there is evidence of its selective advantage in the generalized morph. The Genale monstrosity is the first reported case of a massive deformity of the vertebral column in a natural population of African fishes.

Presence of sarcopenia does not affect the clinical results of balloon kyphoplasty for acute osteoporotic vertebral fracture

Sarcopenia has been associated with poor clinical outcomes in several diseases. Herein, the clinical results of balloon kyphoplasty (BKP) for acute osteoporotic vertebral fracture (OVF) treatment were assessed and compared between sarcopenia and non-sarcopenia patients. Sixty patients who underwent BKP for treatment of acute OVF with poor prognostic factors between April 2016 and September 2017 and were assessed for sarcopenia were enrolled. Clinical results (back pain on visual analogue scale [VAS]; short-form [SF] 36; vertebral deformity; activities of daily living levels; and incidence of adjacent vertebral fractures) were compared between the two groups at 6 months post-BKP. Data analysis revealed that back pain on VAS, SF-36 scores, and vertebral deformity improved from baseline to 6 months after BKP. Thirty-nine patients (65.0%) were diagnosed with sarcopenia and demonstrated a lower body mass index (21.2 vs. 23.3 kg/m2, p = 0.02), skeletal muscle mass index (5.32 vs. 6.55 kg/m2, p < 0.01), hand-grip strength (14.7 vs. 19.2 kg, p = 0.01), and bone mineral density of the femoral neck (0.57 vs. 0.76 g/cm2, p < 0.01) than those of patients without sarcopenia. However, no significant differences were observed in the clinical results between these groups. Therefore, BKP’s clinical results for the treatment of acute OVF are not associated with sarcopenia.

Predictors of Vertebral Deformity in Long-Term Survivors of Childhood Acute Lymphoblastic Leukemia: The PETALE Study

Background The prevalence of vertebral deformities in long-term survivors of childhood acute lymphoblastic leukemia (ALL) is unknown. Our objectives were to identify the prevalence of vertebral deformities and their risk factors among long-term childhood ALL survivors. Methods/Results We recruited 245 (49% male) long-term childhood ALL survivors from the Preventing Late Adverse Effects of Leukemia Cohort (French-Canadian ALL survivors treated between the years 1987 and 2010 with the Dana Farber Cancer Institute clinical trials protocols, who did not experience disease relapse and/or receive hematopoietic stem cell transplant). Median age at recruitment was 21.7 years (range, 8.5-41) and median time since diagnosis was 15.1 years (range, 5.4-28.2). All participants underwent spine radiograph and dual-energy X-ray absorptiometry scans. The prevalence of vertebral deformity was 23% with 88% classified as grade 1 according to the Genant method. The majority of vertebral deformities were clinically silent. Regression analysis confirmed male sex (risk ratio [RR] = 1.94; 95% confidence interval [CI], 1.16-3.24; P = 0.011), higher glucocorticoid cumulative dose (RR = 1.05; 95% CI, 1.00-1.10; P = 0.032), and back pain (RR = 2.44; 95% CI, 1.56-3.84; P &lt; 0.001) as predictors of prevalent vertebral deformity. Sex differences in vertebral deformity predictors emerged. Conclusions We report a significant prevalence of vertebral deformities in this young cohort. Male sex, cumulative glucocorticoid dose, and back pain were identified as predictors of prevalent vertebral deformity. Back pain emerging as a strong predictor of vertebral deformity underscores the importance of ongoing bone health surveillance in survivors with persistent vertebral deformities treated with these earlier protocols.