Lumbar spinal stenosis.

By London Spine

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Lumbar spinal stenosis.
Instr Course Lect. 2013;62:383-96
Authors: Lee JY, Whang PG, Lee JY, Phillips FM, Patel AA
Abstract
Lumbar spinal stenosis affects many patients and is one of the most …

CT for all or selective approach? Who really needs a cervical spine CT after blunt trauma.

By London Spine
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CT for all or selective approach? Who really needs a cervical spine CT after blunt trauma.

J Trauma Acute Care Surg. 2013 Apr;74(2):1098-101

Authors: Duane TM, Young A, Mayglothling J, Wilson SP, Weber WF, Wolfe LG, Ivatury RR

Abstract
BACKGROUND: Computed tomography (CT) is the standard to screen blunt trauma patients for cervical spine (c-spine) fractures, yet there remains a reluctance to scan all trauma team activations because of radiation exposure and cost. The purpose of this study was to identify predictors of positive CT in an effort to decrease future CT use without compromising patient care.
METHODS: We performed a prospective study in which we documented 18 combined NEXUS and Canadian c-spine criteria on 5,182 patients before CT comparing those with and without fractures to identify predictors of injury. Clinical examination was considered positive if any of the 18 criteria were positive.
RESULTS: There were 324 patients with a fracture, for an incidence rate of 6.25%. Fracture patients were older (43.89 ± 18.83 years vs. 38.42 ± 17.45 years, p <; 0.0001), with a lower GCS (Glasgow Coma Scale) score (13.49 ± 3.49 vs. 14.32 ± 2.34, p < 0.0001), than nonfracture patients. Clinical examination had a 100% (324 of 324) sensitivity, 0.62% (30 of 4,858) specificity, 6.29% (324 of 5,152) positive predictive value, and 100% (30 of 30) negative predictive value. A total of 77.8% (14 of 18) criteria were significantly associated with fracture by univariate analysis, seven of which were independent predictors of fracture by logistic regression (midline tenderness, GCS score < 15, age ≥65 years, paresthesias, rollover motor vehicle collision, ejected, never in sitting position in emergency department). Evaluation of these seven factors demonstrated a sensitivity of 99.07% (321 of 324), positive predictive value of 6.95% (321 of 4,617), specificity of 11.57% (562 of 4,858), and negative predictive value of 99.47% (562 of 565).
CONCLUSION: Although sensitive, the standard clinical criteria used to determine patients who need radiographs lack specificity. Based on these results, more narrow criteria should be validated in an effort to limit the number of c-spine CTs while not compromising patient care.
LEVEL OF EVIDENCE: Prognostic study, level II; diagnostic study, level II.

PMID: 23511130 [PubMed – in process]

Osteolysis in transforaminal lumbar interbody fusion with bone morphogenetic protein-2.

By London Spine

Osteolysis in transforaminal lumbar interbody fusion with bone morphogenetic protein-2.

Spine (Phila Pa 1976). 2011 Apr 15;36(8):672-6

Authors: Knox JB, Dai JM, Orchowski J

STUDY DESIGN.: Retrospective radiographic review. OBJECTIVE.: To determine the incidence of osteolysis, graft subsidence, and cage migration after recombinant human bone morphogenetic protein-2 (rhBMP-2) use with transforaminal lumbar interbody fusion (TLIF). SUMMARY OF BACKGROUND DATA.: Osteolysis after TLIF is a recently described phenomenon associated with rhBMP-2 use. Although this is typically a self-limiting condition, complications such as graft subsidence and cage migration have been described. The incidence of this is not well defined and most studies use plain radiographs for diagnosis rather than more advanced imaging. This study serves to quantify the risk of osteolysis and its associated graft complications with routine use of computed tomography. METHODS.: A total of 58 patients who underwent primary TLIF from a single surgeon between 2004 and 2007 underwent routine postoperative computed tomographic scan. Seventy-seven levels of fusion were evaluated for osteolysis. All patients received the same dose of rhBMP-2 of 5 mg per level. Imaging was performed immediately postoperative and again at an average of 4.3 months postoperative (range = 2.4-9.0 months). These images were evaluated for the presence of osteolysis, graft subsidence, and cage migration. These changes were then graded according to their severity. RESULTS.: Osteolysis was found in 16 of the 58 (27.6%) patients and 19 of the 77 (24.7%) levels treated. No significant difference was found between single and two-level fusions. The degree of osteolysis ranged from 3 to 20 mm with an average of 12.5 mm. The osteolysis was characterized as severe (>1 cm) in 12 of the 19 levels. Of the patients with osteolysis, 31.6% demonstrated graft subsidence all of which occurred with severe osteolytic defects. Migration of the intervertebral cage was found in 8.8% of patients. CONCLUSION.: rhBMP-2 use with TLIF is associated with a significant risk of postoperative osteolysis. Patients who demonstrated postoperative osteolysis were associated with significant risk of subsidence or migration of the intervertebral cage. The clinical implications of these changes are not currently known.

PMID: 21217443 [PubMed – indexed for MEDLINE]

Quality of life following surgical treatment of benign parotid disease.

By London Spine

Quality of life following surgical treatment of benign parotid disease.

Indian J Otolaryngol Head Neck Surg. 2013 Jul;65(Suppl 1):105-11

Authors: Gunsoy B, Vuralkan E, Sonbay ND, Simsek G, Tokgoz SA, Akin I

Abstract
To evaluate the quality of life after surgery for benign neoplastic disease of the parotid gland. Forty-nine patients who underwent surgery for benign parotid disease between January 2004 and December 2008 were included in this retrospective study. EORTC QLQ-C30 and EORTC QLQ-H&N35 questionnaires were used to determine the quality of life. The variables of these questionnaires were compared with age, gender, educational status, histopathologic diagnosis and Frey syndrome. A statistically significant correlation was noted between the female gender and post-surgical pain, sleeplessness and the use of non-steroid anti-inflammatory drugs (p < 0.001). There was a significant difference between age and difficulties in moving the mouth (p < 0.001). Frey syndrome related to social functions, economical difficulties, speech defect, reduced sexuality, and nutritional parameters were found to be statistically significant (p < 0.001). Frey syndrome is the most common complication that affects the quality of life in patients who had parotidectomy due to a benign parotid disease. Therefore, all patients should be informed about Frey syndrome before parotidectomy.

PMID: 24427625 [PubMed]

Comparative evaluation of local infiltration of articaine, articaine plus ketorolac, and dexamethasone on anesthetic efficacy of inferior alveolar nerve block with lidocaine in patients with irreversible pulpitis.

By London Spine

Comparative evaluation of local infiltration of articaine, articaine plus ketorolac, and dexamethasone on anesthetic efficacy of inferior alveolar nerve block with lidocaine in patients with irreversible pulpitis.

J Endod. 2011 Apr;37(4):445-9

Authors: Aggarwal V, Singla M, Rizvi A, Miglani S

The inferior alveolar nerve block (IANB) has a poor success rate in patients with irreversible pulpitis. The purpose of this study was to evaluate the effect of ketorolac and dexamethasone infiltration along with standard IANB on the success rate.

PMID: 21419287 [PubMed – indexed for MEDLINE]

Plasma sphingosine 1-phosphate levels and the risk of vertebral fracture in postmenopausal women.

By London Spine
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Plasma sphingosine 1-phosphate levels and the risk of vertebral fracture in postmenopausal women.

J Clin Endocrinol Metab. 2012 Oct;97(10):3807-14

Authors: Kim BJ, Koh JM, Lee SY, Lee YS, Lee SH, Lim KH, Cho EH, Kim SW, Kim TH, Kim SY, Kim GS

Abstract
CONTEXT: Although sphingosine 1-phosphate (S1P) plays diverse roles in bone metabolism, the most prominent role seems to be the augmentation of bone resorption.
OBJECTIVE: The objective of the study was to investigate the possibility of using S1P as a predictor for osteoporotic vertebral fracture (VF) risk.
DESIGN AND SETTING: This was a case-control study conducted in a clinical unit in Korea.
PARTICIPANTS: Sixty-nine cases having radiological VF and 69 age- and body mass index-matched controls among 460 eligible postmenopausal women participated in the study.
MAIN OUTCOME MEASURES: Lateral thoracolumbar radiographs, bone mineral density (BMD), bone turnover markers, and plasma S1P levels were obtained from all subjects.
RESULTS: S1P levels were markedly higher in subjects with VF (7.49±3.44 μmol/liter) than in those without VF (5.58±2.01 μmol/liter; P=0.001) and increased in a dose-response manner as the number of VF increased (P for the trend<0.001), even after adjustment for lumbar spine BMD and potential confounders. The odds ratio for VF was markedly higher in subjects in the highest S1P quartile category compared with those in the lowest S1P quartile category after adjustment for confounders (odds ratio 9.33, 95% confidence interval 2.68-32.49). S1P levels were inversely correlated with BMD at various sites (P=0.015 to 0.044), whereas they were positively correlated with bone resorption markers (P=0.016 to 0.098).
CONCLUSION: These findings suggest that plasma S1P may be a potential biomarker for the risk of VF, independent of BMD, in postmenopausal women.

PMID: 22879631 [PubMed – indexed for MEDLINE]

Back pain in Portuguese schoolchildren: prevalence and risk factors.

By London Spine
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Back pain in Portuguese schoolchildren: prevalence and risk factors.

Eur J Public Health. 2013 Jun;23(3):499-503

Authors: Trigueiro MJ, Massada L, Garganta R

Abstract
BACKGROUND: Regarding children aged ≤ 10 years, only a few international studies were conducted to determine the prevalence of and risk factors for back pain. Although other studies on the older Portuguese children point to prevalence between 17% and 39%, none exists for this specific age-group. Thus, the aim of this study was conducted to establish the prevalence of and risk factors for back pain in schoolchildren aged 7-10 years.
METHODS: A cross-sectional survey among 637 children was conducted. A self-rating questionnaire was used to verify prevalence and duration of back pain, life habits, school absence, medical treatments or limitation of activities. For posture assessment, photographic records with a bio-photogrammetric analysis were used to obtain data about head, acromion and pelvic alignment, horizontal alignment of the scapulae, vertical alignment of the trunk and vertical body alignment.
RESULTS: Postural problems were found in 25.4% of the children, especially in the 8- and 9-year-old groups. Back pain occurs in 12.7% with the highest values among the 7- and 10-year-old children. The probability of back pain increased 7 times when the children presented a history of school absences, 4.3 times when they experienced sleeping difficulties, 4.4 times when school furniture was uncomfortable, 4.7 times if the children perceived an occurrence of parental back pain and 2.5 times when children presented incorrect posture.
CONCLUSIONS: The combination of school absences, parental pain, sleeping difficulties, inappropriate school furniture and postural deviations at the sagittal and frontal planes seem to prove the multifactorial aetiology of back pain.

PMID: 22874731 [PubMed – indexed for MEDLINE]