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Day: January 31, 2019

Comparison of low level laser, ultrasonic therapy and association in joint pain in Wistar rats.

By London Spine
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Comparison of low level laser, ultrasonic therapy and association in joint pain in Wistar rats.

Rev Bras Reumatol. 2014 Jan;54(1):7-12

Authors: Coradini JG, Mattjie TF, Bernardino GR, Peretti AL, Kakihata CM, Errero TK, Escher AR, Bertolini GR

Abstract
Introduction: Both therapeutic ultrasound as a low level laser therapy are used to control musculoskeletal pain, despite controversy about its effects, yet the literature is poor and also presents conflicting results on possible cumulative effects of techniques association. The aim was to compare the antinociceptive effects of low level laser therapy, therapeutic ultrasound and the association. Methods: 24 Wistar rats were divided into: GPL – induction of hyperesthesia in the right knee, and untreated; GUS – treated with therapeutic ultrasound (1 MHz, 0.4 W / cm2) GL – low intensity laser (830 nm, 8 J/cm2); GL+US – treated with both techniques. To produce the hyperesthesia 100 μl of 5% formalin solution were injected into the tibiofemoral joint space, which was assessed by von Frey filament digital before (EV1), 15 (EV2), 30 (EV3) and 60 (EV4) minutes after induction. Results: In comparison within groups, for the withdrawal threshold when the fi lament was applied to the knee, the back to baseline was observed only for GUS. Comparisons between groups were not different in EV3, and GL was higher than GPL. In EV4 the three groups effectively treated were higher than placebo. On withdrawal threshold on the plantar surface, GL showed return to baseline values already in EV3, and GUS and GL+US returned in EV4. Comparing the groups in EV3 there was a significantly lower threshold to compare GPL with GL and GUS (p <0.05), and there was only EV4 differences when comparing GPL with GUS. Conclusion: Both modalities showed antinociceptive effects.

PMID: 24878785 [PubMed – as supplied by publisher]

Percutaneous vertebroplasty for painful spinal metastasis with epidural encroachment.

By London Spine
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Percutaneous vertebroplasty for painful spinal metastasis with epidural encroachment.

J Surg Oncol. 2014 Mar 24;

Authors: Sun G, Li L, Jin P, Liu XW, Li M

Abstract
BACKGROUND AND OBJECTIVES: Spinal metastasis with epidural encroachment is regarded by several authors to be a contraindication to percutaneous vertebroplasty (PVP) because of the risk of increasing symptomatic leakage of cement. This analysis aims to evaluate the safety and efficacy of PVP in patients with painful spinal metastasis and encroachment of epidural space.
METHODS: A retrospective study was conducted to review 43 consecutive patients with spinal metastasis that underwent PVP, for a total of 69 affected levels. All patients had at least 1 level associated with epidural encroachment related to metastasis. Among these patients, 14 had signs of spinal cord or cauda equina compression. Pain intensity was scored on a visual-analog scale (VAS). The analgesic efficacy was defined as at least 50% improvement in pain score as compared with the pre-procedure baseline and post-procedure. Clinical improvement of neurological compressive symptoms was defined as a decrease in ASIA impairment scale from baseline of 1 point or more.
RESULTS: The analgesic efficacy was achieved in 89.7% of survival patients at 1 month, 87.5% at 3 months, 86.9% at 6 months, and 84.6% at 1 year. Small amount cement leakages were detected in 69.6% of treated levels without clinical complications. No deterioration of spinal cord or cauda equina compression symptoms was observed after a PVP in any patients. The different grade of epidural encroachment of the lesions was not correlated with filling volume or extraosseous leakage (P > 0.05). The treated levels with epidural encroachment showed a statistically significant relationship to spinal-canal leakage (P < 0.05).
CONCLUSIONS: PVP can be performed safely and effectively in patients with painful spinal metastasis and epidural encroachment. J. Surg. Oncol. © 2014 Wiley Periodicals, Inc.

PMID: 24665071 [PubMed – as supplied by publisher]

D-dimer Screening for Deep Venous Thrombosis in Traumatic Cervical Spinal Injuries.

By London Spine
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D-dimer Screening for Deep Venous Thrombosis in Traumatic Cervical Spinal Injuries.

Spine J. 2015 Jun 27;

Authors: Masuda M, Ueta T, Shiba K, Iwamoto Y

Abstract
BACKGROUND CONTEXT: Deep venous thrombosis (DVT) in spinal cord injury (SCI) patients is a life-threatening comorbidity. Despite its seriousness, prophylaxis and screening for DVT in SCI patients is still not sophisticated.
PURPOSE: This study aimed to (i) define the epidemiology and incidence of DVT in acute traumatic cervical SCI in a Japanese population; (ii) determine the best timing for DVT screening; and (iii) determine the optimal D-dimer threshold level for use as an easy and minimally invasive screening tool.
STUDY DESIGN: A prospective clinical study.
PATIENT SAMPLE: Acute traumatic cervical SCI patients who were admitted to our facility within two weeks after injury.
OUTCOME MEASURE: Multivariate logistic regression was performed for outcome measure.
METHODS: We enrolled 268 patients (223 men and 45 women), between April 2007 and December 2012. After excluding early drop-out patients, 211 patients remained. Assessment for neurological status and blood chemistry, especially blood coagulation levels (prothrombin time, prothrombin time-international normalized ratio, activated partial thromboplastin time, and serum D-dimer) was performed every week until one month after injury. Ultrasonography was performed for DVT detection every two weeks. This study was funded by The General Insurance Association of Japan, The Japan Labour Health and Welfare Organization, and The Japan Orthopedics and Traumatology Foundation, and there was no conflict of interest.
RESULTS: DVTs were detected in 22 patients (10.4% of patients studied). All DVT-positive patients demonstrated severe paralysis classified as C or greater on the ASIA Impairment Scale. Multivariate logistic regression of clinical and laboratory parameters revealed that only the D-dimer level at two weeks after injury was an accurate predictor of DVT formation. The optimal threshold of D-dimer for prediction was determined to be 16 μg/dL. The sensitivity and specificity for detecting DVT were 77.3% and 69.2%, respectively.
CONCLUSION: D-dimer levels may be used to predict the likelihood of DVT development in patients with acute cervical SCI. Furthermore, the optimal timing for screening test by D-dimer is two weeks after injury and optimal threshold level for D-dimer for diagnosing DVT is 16 μg/dL. Such a screening test would be cost-efficient and simple to administer, and could then be followed with additional investigations, such as ultrasonography or venography.

PMID: 26130085 [PubMed – as supplied by publisher]

Treatment of cervical subaxial injury in the very young child.

By Kamruz Zaman
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Treatment of cervical subaxial injury in the very young child.

Eur Spine J. 2017 Oct 30;:

Authors: Özbek Z, Özkara E, Vural M, Arslantaş A

Abstract
INTRODUCTION: Infant’s cervical spine has serious differences compared to other pediatric age groups and adults. Anatomical and biomechanical constitution of an infant is unique, and the pediatric spine gradually begins to resemble the structure of the adult spine after age 10. In addition, clinical presentation of the cervical spinal traumas has many distinctions from birth to the end of adolescence. In young children, cervical spine traumas are mainly localized in the upper cervical region. Trauma localized in subaxial cervical region and fracture-dislocations are rare in infants.
CASE REPORT: Here, we present a case history of a 7-month-old infant with surgically treated severe subaxial flexion-distraction injury. Neurologic examination revealed complete loss of motor function below C5. A whole-body CT was taken and we observed that C5-6 dislocated anteriorly approximately one vertebra size and also unilateral facet joint was locked. The patient was intubated and closed reduction was attempted with fluoroscopy under general anesthesia, but it was unsuccessful. Whereupon C5-6 microdiscectomy was performed with the anterior approach and fixation was provided with the craniofacial miniplate. Despite anterior stabilization, exact posterior alignment could not been achieved so, posterior approach was added to the surgery. At 12 month follow-up, the patient improved from quadriparesis to paraparesis and we achieved a satisfactory radiological outcome.

PMID: 29086032 [PubMed – as supplied by publisher]

Pelvic sacral and hemi lumbar spine resection of low grade pelvic chondrosarcoma: a multistage procedure involving vascular bypass, spine fixation and vascular exclusion.

By London Spine
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Pelvic sacral and hemi lumbar spine resection of low grade pelvic chondrosarcoma: a multistage procedure involving vascular bypass, spine fixation and vascular exclusion.

Orthop Traumatol Surg Res. 2013 Nov;99(7):875-9

Authors: Zoccali C, Marolda G, Di Francesco A, Favale L, Salducca N, Biagini R

Abstract
Peripheral chondrosarcoma is a rare tumor particularly insidious when arising from the pelvis, becoming symptomatic later in time when surgery may be too difficult and dangerous due to this complex area. In the present case, the tumor arose from an exostosis located on the medial surface of the left iliac wing. Its diameter was 25 cm × 20 cm × 15 cm, adhering to the last three vertebrae, involving the left iliac vein and artery, displacing the left ureter. In a similar case, a hindquarter amputation is indicated but, if the patient refuses, a resection remains possible. In this paper, we describe a multistage technique consisting of an extra-anatomic vascular bypass, a lumbar stabilization, a neurovascular bundles anterior isolation and a postero-lateral resection of this mass. After a five-year follow-up, the patient is alive and able to stand and walk with support, after undergoing twice lung metastasis removal.

PMID: 24074762 [PubMed – indexed for MEDLINE]