[Teriparatide for conservative treatment of osteoporotic vertebral fracture: analysis of 12 cases].

By Kamruz Zaman
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[Teriparatide for conservative treatment of osteoporotic vertebral fracture: analysis of 12 cases].

Nan Fang Yi Ke Da Xue Xue Bao. 2016 Mar;36(3):414-8

Authors: Yang DH, Hu SY, Meng Y, Tong GJ, Chen JT

Abstract
OBJECTIVE: To evaluate the efficacy of conservative treatment with teriparatide for promoting bone fracture healing in patients with osteoporotic vertebral fracture.
METHODS: Twelve postmenopausal patients (aged 73±4.8 years) with osteoporotic spinal fracture confirmed by MRI or CT scanning received conservative treatment with teriparatidesc injection supplemented with calcium and analgesics for 6 months. At the beginning and at the end of the therapy, VAS score, Oswestry Disability Index (ODI), bone mass densitometry, and X-ray of the thoracic and lumbar spine, and serum P1NP and beta-CTX levels were measured. Six of the patients received a second MRI scan after the therapy to evaluate the bone healing.
RESULTS: All the 12 patients completed the treatment, during which no new fractures or adverse events occurred. At the end of the first month of treatment, analgesic was withdrawn for all the patients. The average VAS score decreased from 8±2 to 1±2 at 1 month during the therapy, and ODI was reduced from (76±12)% to (20±5)% at 1 month and further to (5±4)% at 6 month. After the 6-month therapy, the height of the fractured vertebrae (presented as the anterior to posterior wall height ratio) was insignificantly decreased from (75±20)% to (61±20)%, the BMD was increased by (20±5)%, P1NP increased significantly from 20.9±11.4 ng/mL to 80.0±41.2 ng/mL, and beta-CTX increased from 0.30±0.17 ng/mL to 0.51±0.3 ng/mL. The 6 patients re-examined with MRI demonstrated complete bone healing after the therapy.
CONCLUSION: Teriparatide is effective for conservative treatment of osteoporotic spinal fracture and can promote bone fracture healing, improve the quality of life, and prevents vertebral collapse, and can be therefore an alternative treatment to PVP or BV.

PMID: 27063174 [PubMed – indexed for MEDLINE]

Hydrocephalus in aqueductal stenosis.

By London Spine

Hydrocephalus in aqueductal stenosis.

Childs Nerv Syst. 2011 Oct;27(10):1621-42

Authors: Cinalli G, Spennato P, Nastro A, Aliberti F, Trischitta V, Ruggiero C, Mirone G, Cianciulli E

Abstract
INTRODUCTION: The sylvian aqueduct is the most common site of intraventricular blockage of the cerebro-spinal fluid. Clinical aspects, neuroradiological appearance, and treatment of hydrocephalus secondary to aqueductal stenosis are specific.
METHODS: An extensive literature review concerning etiologic, pathogenetic, clinical, and neuroradiological aspects has been performed. Therapeutic options, prognosis, and intellectual outcome are also reviewed.
CONCLUSION: The correct interpretation of the modern neuroradiologic techniques may help in selecting adequate treatment between the two main options (third ventriculostomy or shunting). In the last decades, endoscopic third ventriculostomy has become the first-line treatment of aqueductal stenosis; however, some issues, such as the cause of failures in well selected patients, long-term outcome in infant treated with ETV, and effect of persistent ventriculomegaly on neuropsychological developmental, remain unanswered.

PMID: 21928028 [PubMed – indexed for MEDLINE]

The epidemiology of traumatic cervical spine fractures: a prospective population study from Norway.

By London Spine
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The epidemiology of traumatic cervical spine fractures: a prospective population study from Norway.

Scand J Trauma Resusc Emerg Med. 2012;20:85

Authors: Fredø HL, Rizvi SA, Lied B, Rønning P, Helseth E

Abstract
AIM: The aim of this study was to estimate the incidence of traumatic cervical spine fractures (CS-fx) in a general population.
BACKGROUND: The incidence of CS-fx in the general population is largely unknown.
METHODS: All CS-fx (C0/C1 to C7/Th1) patients diagnosed with cervical-CT in Southeast Norway (2.7 million inhabitants) during the time period from April 27, 2010-April 26, 2011 were prospectively registered in this observational cohort study.
RESULTS: Over a one-year period, 319 patients with CS-fx at one or more levels were registered, constituting an estimated incidence of 11.8/100,000/year. The median age of the patients was 56 years (range 4-101 years), and 68% were males. The relative incidence of CS-fx increased significantly with age. The trauma mechanisms were falls in 60%, motorized vehicle accidents in 21%, bicycling in 8%, diving in 4% and others in 7% of patients. Neurological status was normal in 79%, 5% had a radiculopathy, 8% had an incomplete spinal cord injury (SCI), 2% had a complete SCI, and neurological function could not be determined in 6%. The mortality rates after 1 and 3 months were 7 and 9%, respectively. Among 319 patients, 26.6% were treated with open surgery, 68.7% were treated with external immobilization with a stiff collar and 4.7% were considered stable and not in need of any specific treatment. The estimated incidence of surgically treated CS-fx in our population was 3.1/100,000/year.
CONCLUSIONS: This study estimates the incidence of traumatic CS-fx in a general Norwegian population to be 11.8/100,000/year. A male predominance was observed and the incidence increased with increasing age. Falls were the most common trauma mechanism, and SCI was observed in 10%. The 1- and 3-month mortality rates were 7 and 9%, respectively. The incidence of open surgery for the fixation of CS-fx in this population was 3.1/100,000/year.
LEVEL OF EVIDENCE: This is a prospective observational cohort study and level II-2 according to US Preventive Services Task Force.

PMID: 23259662 [PubMed – in process]

Provocative discography screening improves surgical outcome.

By London Spine

Provocative discography screening improves surgical outcome.

Wien Klin Wochenschr. 2013 Aug 30;

Authors: Margetic P, Pavic R, Stancic MF

Abstract
OBJECTIVE: The objective of this study was to compare the surgical outcomes of patients operated on, with or without discography prior to operation.
METHODS: The study was designed as a randomized controlled trial, using power analysis with McNemar’s test on two correlated proportions. The study comprised of 310 patients divided into trial (207) and control (103) groups. Inclusion criteria were low back pain resistant to nonsurgical treatment for more than 6 months and conventional radiological findings showing degenerative changes without a clear generator of pain. Exclusion criteria were red flags (tumor, trauma, and infection). After standard radiological diagnostic imaging (X-ray, CT, and MR), patients filled in the Oswestry Disability Index (ODI), SF-36, Zung, and MSP questionnaires. Depending on their radiological findings, patients were included and randomly placed in the trial or control group. At the 1-year follow-up examination, patients filled in the ODI, SF-36, and Likert scale questionnaires.
RESULTS: The difference between preoperative and postoperative ODI in the control group degenerative disc disease (DDD) subgroup was 22.07 %. The difference between preoperative and postoperative ODI in the trial group DDD subgroup was 35.04 %. Differences between preoperative and postoperative ODI in the control group other indications subgroup was 26.13 %. Differences between preoperative and postoperative ODI in the trial group other indications subgroup was 28.42 %.
CONCLUSIONS: DDD treated surgically without discography did not reach the clinically significant improvement of 15 ODI points for the patients treated with fusion. Provocative discography screening with psychological testing in the trial group made improvement following fusion clinically significant.

PMID: 23989460 [PubMed – as supplied by publisher]

Variable transcriptional responsiveness of the P2?×?3 receptor gene during CFA-induced inflammatory hyperalgesia.

By London Spine
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Variable transcriptional responsiveness of the P2 × 3 receptor gene during CFA-induced inflammatory hyperalgesia.

J Cell Biochem. 2017 Dec 08;:

Authors: Nuñez-Badinez P, Sepúlveda H, Diaz E, Greffrath W, Treede RD, Stehberg J, Montecino M, van Zundert B

Abstract
The purinergic receptor P2 × 3 (P2 × 3-R) plays important roles in molecular pathways of pain, and reduction of its activity or expression effectively reduces chronic inflammatory and neuropathic pain sensation. Inflammation, nerve injury, and cancer-induced pain can increase P2 × 3-R mRNA and/or protein levels in dorsal root ganglia (DRG). However, P2 × 3-R expression is unaltered or even reduced in other pain studies. The reasons for these discrepancies are unknown and might depend on the applied traumatic intervention or on intrinsic factors such as age, gender, genetic background and/or epigenetics. In this study, we sought to get insights into the molecular mechanisms responsible for inflammatory hyperalgesia by determining P2 × 3-R expression in DRG neurons of juvenile male rats that received a Complete Freund’s Adjuvant (CFA) bilateral paw injection. We demonstrate that all CFA-treated rats showed inflammatory hyperalgesia, however, only a fraction (14-20%) displayed increased P2 × 3-R mRNA levels, reproducible across both sides. Immunostaining assays did not reveal significant increases in the percentage of P2 × 3-positive neurons, indicating that increased P2 × 3-R at DRG somas is not critical for inducing inflammatory hyperalgesia in CFA-treated rats. Chromatin immunoprecipitation (ChIP) assays showed a correlated (R2 = 0.671) enrichment of the transcription factor Runx1 and the epigenetic active mark histone H3 acetylation (H3Ac) at the P2 × 3-R gene promoter in a fraction of the CFA-treated rats. These results suggest that animal-specific increases in P2 × 3-R mRNA levels are likely associated with the genetic/epigenetic context of the P2 × 3-R locus that controls P2 × 3-R gene transcription by recruiting Runx1 and epigenetic co-regulators that mediate histone acetylation. This article is protected by copyright. All rights reserved.

PMID: 29219199 [PubMed – as supplied by publisher]