Expert’s comment concerning Grand Rounds case entitled “A traumatic, high-energy and unstable fracture of the C5 vertebra managed with kyphoplasty: a previously unreported case” (by Nasir A. Quraishi and Sherief Elsayed).

By London Spine

Expert’s comment concerning Grand Rounds case entitled “A traumatic, high-energy and unstable fracture of the C5 vertebra managed with kyphoplasty: a previously unreported case” (by Nasir A. Quraishi and Sherief Elsayed).

Eur Spine J. 2011 Sep 1;

Authors: Heini PF

Abstract
Case presentation of a cervical spine fracture treated by kyphoplasty. The review of the case, especially the careful re-assessment of the x-rays reveals that the treatment goals have not been achieved (motion preservation, functional restoration of the vertebral body). The case report is an excellent example of our biased viewpoint in assessing our efforts.

PMID: 21881867 [PubMed – as supplied by publisher]

A Whitacre-type spinal needle does not prevent intravascular injection during cervical nerve root injections.

By London Spine

A Whitacre-type spinal needle does not prevent intravascular injection during cervical nerve root injections.

South Med J. 2010 Jul;103(7):679-82

Authors: Candido KD, Ghaly RF, Mackerley S, Knezevic NN

We present a case of intravascular injection in a 41-year-old female during cervical selective nerve root injection using a 22-gauge 3.5-inch Whitacre-type pencil-point subarachnoid needle with a curve placed at the distal tip positioned using continual live fluoroscopic guidance. After negative aspiration for blood and cerebrospinal fluid and no elicited paresthesias during the procedure, 1 mL of contrast was injected. Initial imaging at C6 captured the outline of the nerve root along with a significant amount of transient vascular runoff. This case report demonstrates that Whitacre-type spinal needles do not prevent vascular injection, and that aspiration of the needle is not a reliable sign of intravascular injection.

PMID: 20531058 [PubMed – indexed for MEDLINE]

‘I am afraid to make the damage worse’ – fear of engaging in physical activity among patients with neck or back pain – a gender perspective.

By London Spine

‘I am afraid to make the damage worse’ – fear of engaging in physical activity among patients with neck or back pain – a gender perspective.

Scand J Caring Sci. 2013 Apr 12;

Authors: Stenberg G, Fjellman-Wiklund A, Ahlgren C

Abstract
RATIONALE: Neck and back pain are major public health problems in Western societies and cause considerable disability and health service use. Swedish women report more severe neck and back pain compared with Swedish men. Most studies on the aetiology of gender differences in pain deal with biological mechanisms, and less with the role of psychological and sociocultural factors. ‘Pain beliefs’ is a sociocultural factor and can be expressed in different ways among women and men. It is important to know what pain beliefs are held by neck and back pain patients, especially when medical guidelines recommend that back pain patients stay physically active. AIM: Exploring pain beliefs in relation to physical activity among neck and back pain patients consulting primary health care. METHOD: Twelve patients (seven women, five men) consulting primary health care for an initial episode of neck or back pain were interviewed before their first appointment with a physiotherapist or general practitioner and 3 months later. The interviews covered patient experiences of neck or back pain, consequences, strategies and treatment experiences. The interviews were analysed with qualitative content analysis from a gender perspective. RESULT: One theme ‘Fear of hurting the fragile body’ was expressed by all neck or back pain patients. Five categories were identified ‘The mechanical body’, ‘Messages about activity’, ‘Earlier experiences of pain and activity’, ‘To be a good citizen’ and ‘Support to be active’ supported or undermined beliefs about pain and physical activity. Gender expressions occurred in the categories ‘Messages about activity’, ‘To be a good citizen’ and ‘Support to be active’. CONCLUSIONS: Neck or back pain patients in the study saw the body as fragile and were afraid of hurting it. Notions of gender had an impact on the given advice about activity and on how patients perceived the message about staying active.

PMID: 23578006 [PubMed – as supplied by publisher]

Determinants of satisfaction with individual health in male and female patients with chronic low back pain.

By London Spine
Related Articles

Determinants of satisfaction with individual health in male and female patients with chronic low back pain.

J Rehabil Med. 2012 Jul;44(8):658-63

Authors: Pieber K, Stein KV, Herceg M, Rieder A, Fialka-Moser V, Dorner TE

Abstract
OBJECTIVE: To examine health satisfaction and its predictors in subjects with and without chronic low back pain.
SUBJECTS: Data for subjects aged 15-64 years were sourced from an Austrian representative population-based nationwide survey including 6,194 men and 6,183 women. Methods: Health satisfaction and its determinants were assessed using the World Health Organization Quality of Life Questionnaire-Short Form (WHOQOL-BREF).
RESULTS: Prevalence of chronic low back pain was 8.0% (range 7.6-8.3%; 95% confidence interval (CI)) in men and 8.8% (range 8.5-9.2%) in women. The proportion of men, with and without chronic low back pain, who were dissatisfied with their health was 22.5% and 5.7% (p < 0.001), respectively, and in women 28.3% and 5.4% (p < 0.001), respectively. In subjects with chronic low back pain a multi-variate analysis revealed “not needing medical treatment to function in daily life” with odds ratio (OR) (95% CI) of 6.3 (2.6-15.3) and 4.2 (2.1-8.5) as the strongest predictor for health satisfaction in men and women, respectively. In men additionally “satisfaction with one’s sex life” and “satisfaction with work capacity”, OR: 6.6 (2.9-14.8) and 3.7 (1.5-9.3)were predictors for health satisfaction. In women, however “satisfaction with living conditions” OR: 3.7 (1.7-7.9) was an additional predictor.
CONCLUSION: Important determinants for health satisfaction are aspects of life such as independence and managing daily activities. These aspects can be influenced by existing therapy options.

PMID: 22729793 [PubMed – indexed for MEDLINE]

Reduction and fixation of displaced U-shaped sacral fractures using lumbopelvic fixation: technical recommendations.

By Kamruz Zaman
Related Articles

Reduction and fixation of displaced U-shaped sacral fractures using lumbopelvic fixation: technical recommendations.

Eur Spine J. 2017 Nov 06;:

Authors: Piltz S, Rubenbauer B, Böcker W, Trentzsch H

Abstract
PURPOSE: U-shaped sacral fractures are extremely rare injuries that usually occur as a result of falls from considerable heights. Almost all treatment methods described to date aim solely at stabilizing the fracture but do not contribute to supporting the reduction of such fractures. Using existing implants the purpose of this study is to present a surgical technique that facilitates both the reduction and the stabilization of these injuries. The presented technique was evaluated in a series of three cases.
METHODS: Polyaxial pedicle screws were placed through vertebral bodies L4 and L5. Two long pedicle screws were implanted in the posterior iliac spine. The lumbar pedicle screws were held with two longitudinal rods, and the pelvic screws with one transverse connecting rod. The lumbar longitudinal and pelvic transverse rods were connected via two hinge-like connecting elements. First, distraction was performed between lumbar pedicle screws L5 and the sacral transverse rod. Lordosis was then restored via the hinge joint, thereby eliminating kyphosis. After tightening all moving elements, the fracture was reduced and stabilized.
RESULTS: Computed tomography documented anatomical reduction and fracture healing was achieved in all cases. Two of three patients could be fully mobilized immediately; mobilization of the third patient was delayed due to multiple injuries. Two patients showed neurological symptoms. In one case, complete remission was achieved within 3 weeks, while in the other patient a clear improvement was observed. In all cases, the implant was removed after 8-12 months. There were no post-operative complications, such as infections, wound-healing disorders, neurological deterioration, implant failure, or premature loosening.
CONCLUSIONS: The surgical procedure was successful, since it considerably facilitated reduction, thereby shortening surgery time. The stabilization was sufficient to fully mobilize the patients. The procedure is based on existing implant components and is thus routinely available.

PMID: 29110219 [PubMed – as supplied by publisher]

Bone matrix mineralization is preserved during early perimenopausal stage in healthy women: a paired biopsy study.

By London Spine

Bone matrix mineralization is preserved during early perimenopausal stage in healthy women: a paired biopsy study.

Osteoporos Int. 2015 Dec 9;

Authors: Misof BM, Roschger P, Blouin S, Recker R, Klaushofer K

Abstract
Bone matrix mineralization based on quantitative backscatter electron imaging remained unchanged during the first year of menopause in paired transiliac biopsy samples from healthy women. This suggests that the reported early perimenopausal reductions in bone mineral density are caused by factors other than decreases in the degree of mineralization.
INTRODUCTION: It is unknown whether perimenopausal loss of bone mass is associated with a drop in bone matrix mineralization.
METHODS: For this purpose, we measured the bone mineralization density distribution (BMDD) by quantitative backscatter electron imaging (qBEI) in n = 17 paired transiliac bone biopsy samples at premenopausal baseline and 12 months after last menses (obtained at average ages of 49 ± 2 and 55 ± 2 years, respectively) in healthy women. For interpretation of BMDD outcomes, previously measured bone mineral density (BMD) and biochemical and histomorphometric markers of bone turnover were revisited for the present biopsy cohort.
RESULTS: Menopause significantly decreased BMD at the lumbar spine (-4.5 %) and femoral neck (-3.8 %), increased the fasting urinary hydroxyproline/creatinine ratio (+60 %, all p < 0.01) and histomorphometric bone formation rate (+25 %, p < 0.05), but affected neither cancellous nor cortical BMDD variables (paired comparison p > 0.05). Mean calcium concentrations of cancellous (Cn.CaMean) and cortical bone (Ct.CaMean) were within normal range (p > 0.05 compared to established reference data). Ct.CaMean was significantly correlated with Cn.CaMean before (R = 0.81, p < 0.001) and after menopause (R = 0.80, p < 0.001) and to cortical porosity of mineralized tissue (Ct.Po.) after menopause (R = -0.57, p = 0.02).
CONCLUSIONS: Surprisingly, the BMDD was found not affected by the changes in bone turnover rates in this cohort. This suggests that the substantial increase in bone formation rates took place shortly before the second biopsy, and the bone mineralization changes lag behind. We conclude that during the first year after the last menses, the degree of bone matrix mineralization is preserved and does not contribute to the observed reductions in BMD.

PMID: 26650378 [PubMed – as supplied by publisher]