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European Spine Journal : Official... Nov 2023This paper presents a comparison of quantitative computed tomography (QCT) and dual-energy X-ray absorptiometry (DXA) in osteoporosis with vertebral fracture and... (Meta-Analysis)
Meta-Analysis Review
The correlation between osteoporotic vertebrae fracture risk and bone mineral density measured by quantitative computed tomography and dual energy X-ray absorptiometry: a systematic review and meta-analysis.
UNLABELLED
This paper presents a comparison of quantitative computed tomography (QCT) and dual-energy X-ray absorptiometry (DXA) in osteoporosis with vertebral fracture and osteoporosis without fracture. It has been proved that the volumetric bone mineral density (vBMD) measured by QCT exhibits a stronger correlation with fracture risk than areal bone mineral density (aBMD) measured by DXA.
PURPOSE
This study aims to systematically evaluate the ability of QCT and DXA to distinguish between osteoporosis with vertebral fracture and osteoporosis without fracture according to vBMD and aBMD.
METHODS
We conducted a primary literature search of the online databases up to 3 July, 2022, in both English and Chinese publications, combining synonyms for "QCT", "DXA" and "osteoporosis". The Newcastle-Ottawa scale (NOS) was employed to evaluate the quality of the selected articles. vBMD obtained through QCT and aBMD obtained through DXA were extracted, and were analyzed by Review Manager 5.4 and RStudio.
RESULTS
Six studies with 610 individuals aged 45 to 90, of which 179 had vertebral fractures, were included in the final analysis. The weighted mean difference (WMD) between osteoporosis with vertebral fracture and osteoporosis without fracture for vBMD was - 27.08 (95% CI - 31.24 to - 22.92), while for aBMD was - 0.05 (95% CI - 0.08 to - 0.03).
CONCLUSIONS
Both vBMD detected by QCT and aBMD detected by DXA could discriminate fracture status in the spine, and vBMD performed a stronger correlation with fracture risk.
TRIAL REGISTRATION
PROSPERO 2022 CRD42022349185.
Topics: Humans; Bone Density; Absorptiometry, Photon; Spinal Fractures; Osteoporotic Fractures; Osteoporosis; Spine; Tomography, X-Ray Computed; Lumbar Vertebrae
PubMed: 37740786
DOI: 10.1007/s00586-023-07917-9 -
JAMA Neurology May 2024Guidelines recommend seizure prophylaxis for early posttraumatic seizures (PTS) after severe traumatic brain injury (TBI). Use of antiseizure medications for early... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Guidelines recommend seizure prophylaxis for early posttraumatic seizures (PTS) after severe traumatic brain injury (TBI). Use of antiseizure medications for early seizure prophylaxis after mild or moderate TBI remains controversial.
OBJECTIVE
To determine the association between seizure prophylaxis and risk reduction for early PTS in mild and moderate TBI.
DATA SOURCES
PubMed, Google Scholar, and Web of Science (January 1, 1991, to April 18, 2023) were systematically searched.
STUDY SELECTION
Observational studies of adult patients presenting to trauma centers in high-income countries with mild (Glasgow Coma Scale [GCS], 13-15) and moderate (GCS, 9-12) TBI comparing rates of early PTS among patients with seizure prophylaxis with those without seizure prophylaxis.
DATA EXTRACTION AND SYNTHESIS
The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) reporting guidelines were used. Two authors independently reviewed all titles and abstracts, and 3 authors reviewed final studies for inclusion. A meta-analysis was performed using a random-effects model with absolute risk reduction.
MAIN OUTCOME MEASURES
The main outcome was absolute risk reduction of early PTS, defined as seizures within 7 days of initial injury, in patients with mild or moderate TBI receiving seizure prophylaxis in the first week after injury. A secondary analysis was performed in patients with only mild TBI.
RESULTS
A total of 64 full articles were reviewed after screening; 8 studies (including 5637 patients) were included for the mild and moderate TBI analysis, and 5 studies (including 3803 patients) were included for the mild TBI analysis. The absolute risk reduction of seizure prophylaxis for early PTS in mild to moderate TBI (GCS, 9-15) was 0.6% (95% CI, 0.1%-1.2%; P = .02). The absolute risk reduction for mild TBI alone was similar 0.6% (95% CI, 0.01%-1.2%; P = .04). The number needed to treat to prevent 1 seizure was 167 patients.
CONCLUSION AND RELEVANCE
Seizure prophylaxis after mild and moderate TBI was associated with a small but statistically significant reduced risk of early posttraumatic seizures after mild and moderate TBI. The small absolute risk reduction and low prevalence of early seizures should be weighed against potential acute risks of antiseizure medications as well as the risk of inappropriate continuation beyond 7 days.
Topics: Humans; Brain Injuries, Traumatic; Anticonvulsants; Seizures
PubMed: 38587858
DOI: 10.1001/jamaneurol.2024.0689 -
Disability and Rehabilitation.... Nov 2023Exoskeleton can assist individuals with spinal cord injuries (SCI) with simple movements and transform their lives by enhancing strength and mobility. Nonetheless, the... (Review)
Review
PURPOSE
Exoskeleton can assist individuals with spinal cord injuries (SCI) with simple movements and transform their lives by enhancing strength and mobility. Nonetheless, the current utilization outside of rehabilitation contexts is limited. To promote the widespread adoption of exoskeletons, it is crucial to consider the acceptance of these devices for both rehabilitation and functional purposes. This systematic review aims to identify the barriers or facilitators of the use of lower limbs exoskeletons, thereby providing strategies to improve interventions and increase the adoption of these devices.
METHODS
A comprehensive search was conducted in EMBASE, Web of Science, Scopus, Cochrane, and PubMed. Studies reporting barriers and facilitators of exoskeleton use were included. The studies' quality was assessed using the Mixed Methods Appraisal Tool and undertook a thematic content analysis for papers examining the barriers and facilitators.
RESULTS
Fifteen articles met the inclusion criteria. These revealed various factors that impact the utilization of exoskeletons. Factors like age, engagement in an active lifestyle, and motivation were identified as facilitators, while fear of falling and unfulfilled expectations were recognized as barriers. Physical aspects such as fatigue, neuropathic discomfort, and specific health conditions were found to be barriers.
CONCLUSION
This systematic review provides a comprehensive overview of the barriers and facilitators to the use of exoskeleton technology. There are therefore still challenges to be faced, efforts must be made to improve its design, functionality, and accessibility. By addressing these barriers, exoskeletons can significantly improve the quality of life of people with SCI.
PubMed: 38009458
DOI: 10.1080/17483107.2023.2287153 -
Maedica Dec 2023In this intriguing review, the authors dive into the complex world of atlas stenosis and its clinical impact on cervical myelopathy. The authors shed light on the...
In this intriguing review, the authors dive into the complex world of atlas stenosis and its clinical impact on cervical myelopathy. The authors shed light on the origins of atlas stenosis, highlighting how congenital abnormalities of the atlas are a result of failures in embryological development. Furthermore, diagnosis and treatment methods are described. Utilizing a detailed search of the literature in the PubMed database, the authors have compiled a comprehensive analysis of the anatomical and biological basis of this condition. After applying the exclusion criteria, 25 papers were deemed appropriate for the present review. With the help of computed tomography (CT) and magnetic resonance imaging (MRI) scans, diagnosis becomes possible, but the authors emphasize the importance of using special tests for a more accurate assessment. When it comes to treatment, surgical decompression with laminectomy or laminoplasty is the suggested approach. This highlights the severity of atlas stenosis and the need for intervention to alleviate the symptoms and prevent further neurological damage. What sets this review apart is its focus on the clinical profile of atlas stenosis. The authors discuss how the obstruction of cerebrospinal fluid flow can lead to neurological disorders and headaches. This sheds light on the broader impact this condition can have on patients' lives beyond simply the anatomical implications. In the conclusion, the authors emphasize the susceptibility of the spinal cord to injuries even with mild mechanical pressure or instability due to aging in patients with atlas stenosis. Additionally, the instabilities caused by anatomical abnormalities of the atlas further highlight the importance of considering atlas stenosis in cases of cervical trauma. Overall, this review provides a fascinating insight into the connection between atlas stenosis and cervical myelopathy. By exploring the anatomical, biological, diagnostic, and treatment aspects of this condition, the authors have contributed to the understanding of this complex and often overlooked topic.
PubMed: 38348061
DOI: 10.26574/maedica.2023.18.4.659 -
Spine May 2024Systematic Review.
STUDY DESIGN
Systematic Review.
OBJECTIVE
This systematic review aims to synthesize existing studies and highlight the significance of ergonomic considerations for spine surgeons' well-being and the impact on patient outcomes.
SUMMARY OF BACKGROUND DATA
Spine surgery is a physically demanding field that poses several risks to surgeons, particularly with musculoskeletal disorders. Despite the well-documented consequences of musculoskeletal injuries endured by surgeons, surgical ergonomics in spine surgery has received limited attention.
METHODS
Following PRISMA guidelines, a comprehensive literature search was conducted in PubMed and Embase. Studies focusing on surgeon ergonomics in spine surgery were selected. Data extracted included study details, surgeon demographics, ergonomic factors, and outcomes. Qualitative analysis was performed due to the heterogeneous nature of study designs and criteria.
RESULTS
Eleven studies met inclusion criteria. Six studies utilized surveys to explore physical challenges, prevalence rates of pain, work practices, and ergonomic tools. Two studies employed optoelectronic motion analysis to assess spinal angles of the surgeon during surgery. Two studies assesed ergonomics in different visualization methods using rapid entire body assessment (REBA). One study applied video analysis to scrutinize surgeons' neck postures during the case. The results demonstrated a varying prevalence and diverse presentations of musculoskeletal disorders, varying impact on surgical performance, and nuanced relationships between experience, workload, and ergonomic concerns.
CONCLUSION
This systematic review summarizes the heterogenous evaluations of ergonomics in spine surgery. Overall, upwards of three-quarters of spine surgeons have reported musculoskeletal discomfort, most commonly presented as back pain, neck pain, and hand/wrist discomfort. These symptoms are often exacerbated by the use of loupes, operating bed height, and extended period of times in various positions. Studies demonstrate that the physical discomfort is associated with the surgeons' mental and emotional well-being, leading to stress, burnout, and reduced job satisfaction; all of which impact patient care.
PubMed: 38809104
DOI: 10.1097/BRS.0000000000005055 -
International Journal of Molecular... Feb 2024A spinal cord injury (SCI) causes changes in brain structure and brain function due to the direct effects of nerve damage, secondary mechanisms, and long-term effects of... (Review)
Review
A spinal cord injury (SCI) causes changes in brain structure and brain function due to the direct effects of nerve damage, secondary mechanisms, and long-term effects of the injury, such as paralysis and neuropathic pain (NP). Recovery takes place over weeks to months, which is a time frame well beyond the duration of spinal shock and is the phase in which the spinal cord remains unstimulated below the level of injury and is associated with adaptations occurring throughout the nervous system, often referred to as neuronal plasticity. Such changes occur at different anatomical sites and also at different physiological and molecular biological levels. This review aims to investigate brain plasticity in patients with SCIs and its influence on the rehabilitation process. Studies were identified from an online search of the PubMed, Web of Science, and Scopus databases. Studies published between 2013 and 2023 were selected. This review has been registered on OSF under (n) 9QP45. We found that neuroplasticity can affect the sensory-motor network, and different protocols or rehabilitation interventions can activate this process in different ways. Exercise rehabilitation training in humans with SCIs can elicit white matter plasticity in the form of increased myelin water content. This review has demonstrated that SCI patients may experience plastic changes either spontaneously or as a result of specific neurorehabilitation training, which may lead to positive outcomes in functional recovery. Clinical and experimental evidence convincingly displays that plasticity occurs in the adult CNS through a variety of events following traumatic or non-traumatic SCI. Furthermore, efficacy-based, pharmacological, and genetic approaches, alone or in combination, are increasingly effective in promoting plasticity.
Topics: Humans; Spinal Cord Injuries; Spinal Cord; Brain; Neuronal Plasticity; Recovery of Function
PubMed: 38396902
DOI: 10.3390/ijms25042224 -
Cureus Apr 2024This review article explores spinal injuries in athletes participating in various sporting activities. It also highlights the various mechanisms of injuries that... (Review)
Review
This review article explores spinal injuries in athletes participating in various sporting activities. It also highlights the various mechanisms of injuries that contribute to spinal injuries in each sport. Electronic databases such as PubMed, Cochrane Library, Web of Science, Embase, MEDLINE Ovid, and Google Scholar were searched for articles from 2000 to 2022 on spine injuries in sports and radiological studies discussing the various injury patterns among athletes. Studies were scoured in accordance with the inclusion criteria, and relevant data such as the number of participants, sporting activities, spine injuries, and outcomes were retrieved. Fifteen articles that met the inclusion criteria were included in the study. Cervical spine injuries are common in athletes who participate in contact sports such as football. Similarly, athletes in collision sports such as football, rugby, and hockey are likely to suffer stingers due to traction and compression injuries. Players engaged in such as soccer, baseball, and swimming, are likely to suffer from spondylolysis. Soccer players are more prone to multiple lesions compared to athletes in sports such as baseball because the sport involves training exercises such as jogging and running without kicking any ball. In swimmers, spondylolysis is common in breaststroke and butterfly styles since they involve repeated flexion and hyperextension of the lumbar spine. CT is essential for diagnosing spondylolysis as it demonstrates the lesions more accurately. Ice hockey is associated with a significant incidence of cervical spine injuries, mostly due to players being constantly checked/pushed from behind. Spine injuries are common in elite athletes across several sports. About 10% of spinal injuries in the United States result from sports activities. In diagnosing spine injuries, imaging modalities such as MRI, CT, or plain radiographs are essential. From a radiologist's perspective, these tests help immensely in deciding which treatment is required for a particular athlete or how the injury can be optimally managed. Achieving recovery from a specific spine injury usually depends on the kind of injury and the rehabilitation process the athletes undergo before returning to play.
PubMed: 38784300
DOI: 10.7759/cureus.58780 -
The American Journal of Emergency... Sep 2023While blunt cerebrovascular injury (BCVI) is a rare complication of blunt trauma, it is associated with significant morbidity and mortality. In the pediatric population,... (Review)
Review
BACKGROUND
While blunt cerebrovascular injury (BCVI) is a rare complication of blunt trauma, it is associated with significant morbidity and mortality. In the pediatric population, unique anatomy and development require screening criteria that accurately diagnose these injuries while limiting unwarranted radiation.
METHODS
We searched Medline OVID, EMBASE, and Cochrane Library databases for studies that investigated the risk factors of BCVI in individuals younger than 18 years of age. We adhered to the Preferred Reporting Items in Systematic Reviews and Meta-Analyses (PRISMA) guidelines and assessed the quality of each study using the Newcastle-Ottawa Scale. We compared key characteristics of the papers, including incidence of BCVI, incidence of risk factors, and statistical significance of risk factors.
RESULTS
Of 1304 studies, 16 met the inclusion criteria. Of these, 15 were retrospective cohort studies and one was a retrospective case control study. Most of the studies included all pediatric blunt trauma admissions, but four only included those which underwent imaging, one only included those with cervical seatbelt sign, and one excluded those who did not survive 24-h post-admission. The ages included as pediatric varied between papers. Papers examined different risk factors and reported differing statistical significances. Though no single risk factor was found to be statistically significant in every study, cervical spine and skull fractures were found to be significant by most. Maxillofacial fractures, depressed GCS score, and stroke were found to be statistically significant by multiple studies. Twelve studies examined cervical soft tissue injury, and none found it to be statistically significant.
CONCLUSIONS
The risk factors most found to be statistically significant for BCVI were cervical spine fracture (10/16 studies), skull fracture (9/16), maxillofacial fractures (7/16), depressed GCS score (5/16), and stroke (5/16). There is a need for prospective studies on this topic.
LEVEL OF EVIDENCE
Level III, Systematic Review.
Topics: Child; Humans; Retrospective Studies; Case-Control Studies; Wounds, Nonpenetrating; Cerebrovascular Trauma; Risk Factors; Skull Fractures; Stroke
PubMed: 37327710
DOI: 10.1016/j.ajem.2023.06.006 -
Journal of Robotic Surgery Dec 2023Percutaneous vertebral augmentation (PVA), which includes percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP). Robot-assisted (RA) and... (Meta-Analysis)
Meta-Analysis Review
Percutaneous vertebral augmentation (PVA), which includes percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP). Robot-assisted (RA) and fluoroscopy-assisted (FA) are important methods for treating osteoporotic vertebral compression fractures (OVCFs), though it is still unclear which is superior. This analysis aimed to compare the efficacy and safety of RA and FA. PubMed, Web of Science, Cochrane Library, and China National Knowledge Infrastructure were systematically searched, the outcomes included surgical parameters (leakage rate, operation time, number of fluoroscopic, injection volume, inclination angle), and clinical indexes (hospital stays, Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Cobb angle, the midline height of vertebral). Thirteen articles involving 1094 patients were included. RA group produced better results than the FA group in the leakage rate (OR = 0.27; 95% CI 0.17-0.42; P < 0.00001), number of fluoroscopic (WMD = - 13.88; 95% CI - 18.47 to - 9.30; P < 0.00001), inclination angle (WMD = 5.02; 95% CI 4.42-5.61; P < 0.00001), hospital stays (WMD = - 0.32; 95% CI - 0.58 to - 0.05; P = 0.02), VAS within 3 days (WMD = - 0.19; 95% CI - 0.26 to - 0.12; P < 0.00001), Cobb angle within 3 days (WMD = - 1.35; 95% CI - 2.56 to - 0.14; P = 0.003) and Cobb angle after 1 month (WMD = - 1.02; 95% CI - 1.84 to - 0.20; P = 0.01). But no significant differences in operation time, injection volume, ODI, the midline height of vertebral, and VAS score after 1 month. Our analysis found that the RA group had lower cement leakage rates, number of fluoroscopic and hospital stays, a larger inclination angle, better short-term pain improvement, and Cobb angle improvement. It is worth acknowledging that robotic-assisted surgery holds promise for the development of spine surgery. The study was registered in the PROSPERO (CRD42023393497).
Topics: Humans; Kyphoplasty; Fractures, Compression; Spinal Fractures; Robotic Surgical Procedures; Robotics; Treatment Outcome; Osteoporotic Fractures; Retrospective Studies
PubMed: 37632602
DOI: 10.1007/s11701-023-01700-0 -
Frontiers in Neuroscience 2023Spinal cord injury (SCI) is a catastrophic condition with few therapeutic options. Astaxanthin (AST), a natural nutritional supplement with powerful antioxidant...
Spinal cord injury (SCI) is a catastrophic condition with few therapeutic options. Astaxanthin (AST), a natural nutritional supplement with powerful antioxidant activities, is finding its new application in the field of SCI. Here, we performed a systematic review to assess the neurological roles of AST in rats following SCI, and assessed the potential for clinical translation. Searches were conducted on PubMed, Embase, Cochrane Library, the Web of Science, China National Knowledge Infrastructure, WanFang data, Vip Journal Integration Platform, and SinoMed databases. Animal studies that evaluated the neurobiological roles of AST in a rat model of SCI were included. A total of 10 articles were included; most of them had moderate-to-high methodological quality, while the overall quality of evidence was not high. Generally, the meta-analyses revealed that rats treated with AST exhibited an increased Basso, Beattie, and Bresnahan (BBB) score compared with the controls, and the weighted mean differences (WMDs) between those two groups showed a gradual upward trend from days 7 (six studies, n = 88, WMD = 2.85, 95% CI = 1.83 to 3.87, < 0.00001) to days 28 (five studies, n = 76, WMD = 6.42, 95% CI = 4.29 to 8.55, < 0.00001) after treatment. AST treatment was associated with improved outcomes in spared white matter area, motor neuron survival, and SOD and MDA levels. Subgroup analyses indicated there were differences in the improvement of BBB scores between distinct injury types. The trial sequential analysis then firmly proved that AST could facilitate the locomotor recovery of rats following SCI. In addition, this review suggested that AST could modulate oxidative stress, neuroinflammation, neuron loss, and autophagy multiple signaling pathways for treating SCI. Collectively, with a protective effect, good safety, and a systematic action mechanism, AST is a promising candidate for future clinical trials of SCI. Nonetheless, in light of the limitations of the included studies, larger and high-quality studies are needed for verification.
PubMed: 37881327
DOI: 10.3389/fnins.2023.1255755