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Modern Rheumatology Jul 2023To examine the age at onset and initial symptoms as clinical features of ankylosing spondylitis in Japanese patients.
OBJECTIVES
To examine the age at onset and initial symptoms as clinical features of ankylosing spondylitis in Japanese patients.
METHODS
This retrospective study included 60 Japanese patients diagnosed with ankylosing spondylitis at our institute between January 2004 and June 2021. Initial symptoms were considered pain in axial joints and/or extra-axial joints. If a patient had initial symptoms at multiple sites, each site was counted. We assessed trends for the number of patients and sites of initial symptoms according to age at onset.
RESULTS
Mean age (± standard deviation) at onset was 28.9 (± 14.3) years. Approximately one-third of patients experienced onset before age 20. The back was the most common site of initial symptoms (36.7%), followed by the hip (26.7%), knee (15%), buttocks (15%), neck (10%), finger (6.7%), shoulder (3.3%), and others (including overlapping sites). Thirty-two (53.3%) and 25 (41.7%) patients had initial symptoms only in axial joints and only in extra-axial joints, respectively. The proportion of patients with initial symptoms only in extra-axial joints significantly decreased with increasing age (p = .024).
CONCLUSIONS
Sites of initial symptoms were frequently the back, hip, knee, and buttocks, and 41.7% had initial symptoms only in extra-axial joints. Younger onset patients frequently had extra-axial involvement.
Topics: Humans; Adolescent; Young Adult; Adult; Spondylitis, Ankylosing; Retrospective Studies; East Asian People; Knee Joint; Pain; Age of Onset
PubMed: 35919934
DOI: 10.1093/mr/roac081 -
Canadian Journal of Ophthalmology.... Oct 2023To determine normal globe position values, interzygomatic distance (IZD), and globe axial length and width on computed tomography in an Australian cohort.
OBJECTIVE
To determine normal globe position values, interzygomatic distance (IZD), and globe axial length and width on computed tomography in an Australian cohort.
DESIGN
Retrospective cohort study.
PARTICIPANTS
Patients who underwent computed tomography of the orbits. Patients with bilateral disease, previous orbital surgery, or poor scan quality were excluded.
METHODS
An axial slice through the midglobe was used to conduct the globe position measurements. Anterior globe position was defined as the perpendicular distance from the anterior globe margin to the interzygomatic line and posterior globe position as the perpendicular distance from the posterior globe margin to the interzygomatic line.
RESULTS
The normal measurements (mean ± SD) were IZD, 97.4 ± 4.1 mm; anterior globe position, 18.8 ± 2.8 mm; posterior globe position, 6.2 ± 2.9 mm; axial globe length, 24.9 ± 1.1 mm; and axial globe width, 25.9 ± 1.2 mm. A significant positive correlation was seen between the IZD and the anterior globe position (r = 0.15, p = 0.03), axial globe length (r = 0.33, p < 0.01), and axial globe width (r = 0.30, p < 0.01).
CONCLUSION
This normative globe position data may be used to diagnose radiologic exophthalmos or enophthalmos.
Topics: Humans; Retrospective Studies; Australia; Orbit; Tomography, X-Ray Computed
PubMed: 35640671
DOI: 10.1016/j.jcjo.2022.05.004 -
The Journal of Clinical Endocrinology... Oct 2023Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome caused by excessive production of fibroblast growth factor 23 (FGF23) by a tumor. After successful...
CONTEXT
Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome caused by excessive production of fibroblast growth factor 23 (FGF23) by a tumor. After successful tumor resection, patients can recover from hypophosphatemia quicky. However, data on the changes in bone mineral density (BMD) and microstructure in the short term after surgery remained unclear.
OBJECTIVE
This work aimed to investigate the postoperative changes in BMD and microstructure both in peripheral and axial bone in TIO patients.
METHODS
We evaluated BMD and microarchitecture in 22 TIO patients using high-resolution peripheral quantitative computed tomography (HR-pQCT) and dual-energy x-ray absorptiometry (DXA) before and 3 months after surgery in this retrospective study.
RESULTS
In this study, a total of 22 TIO patients who had recovered serum phosphate levels postoperatively were enrolled. After surgery, areal BMD (aBMD) increased by 21.6% in the femoral neck, by 18.9% in the total hip, and by 29.5% in the lumbar spine. Moreover, TBS increased by 14.1% (all P < .001). In contrast, trabecular or cortical volumetric BMD (vBMD), and microstructure of trabecular bone (trabecular number, separation and bone volume ratio) and cortical bone (cortical thickness and porosity) at the distal radius or tibia were further deteriorated. Correlation analyses found that changes in femoral neck and total hip aBMD were both conversely associated with changes in trabecular vBMD and bone volume ratio, while positively correlated with change in trabecular separation at the distal radius.
CONCLUSION
Although aBMD and microstructure in the axial bone were improved, vBMD and microstructure in the peripheral bone were further impaired shortly after surgery. Correlation of improvement of aBMD in the total hip and femoral neck with deterioration of vBMD and microstructure at the distal radius indicated a shift in calcium from the peripheral bone to the axial bone in the short term after tumor resection in TIO patients.
Topics: Humans; Calcium; Retrospective Studies; Bone and Bones; Bone Density; Absorptiometry, Photon; Paraneoplastic Syndromes; Radius; Tibia
PubMed: 37183952
DOI: 10.1210/clinem/dgad252 -
Clinical Rheumatology Sep 2023C-reactive protein (CRP) and magnetic resonance imaging (MRI) are widely used to monitor inflammation in patients with axial spondyloarthritis (axSpA), but the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
C-reactive protein (CRP) and magnetic resonance imaging (MRI) are widely used to monitor inflammation in patients with axial spondyloarthritis (axSpA), but the relationship between CRP and MRI-detected inflammation is incompletely understood. The present study was undertaken to assess correlations between CRP and MRI-detected inflammation in axSpA.
MATERIALS AND METHODS
A systematic literature search was performed (Medline, Embase, and Cochrane Library) to identify relevant studies concerning CRP and MRI-detected inflammation in axSpA patients. The MRI-detected inflammation was evaluated by MRI-based disease activity score (DAS). The correlation between CRP and MRI-based DAS was integrated by random-effect models.
RESULTS
Eighteen studies reported a total of 1392 axSpA patients which were included in this meta-analysis. CRP was significantly associated with spinal MR DAS (r=0.226, 95%CI [0.149, 0.291], p<0.001, I=23%). We also found a moderate correlation between CRP change and spinal MR DAS change (r[ASspiMRI-a]=0.354, 95%CI [0.282, 0.422], p<0.001, I=48%; r[SPARCC]=0.544, 95%CI [0.345, 0.701], p<0.001, I=19%). CRP at baseline was negatively associated with improvement in spinal MR DAS (r= - 0.327, 95%CI [-0.397, -0.264], p<0.001, I=0%). However, no significant association was found between CRP and sacroiliac joint (SIJ) MR DAS.
CONCLUSIONS
In axSpA patients, CRP is associated with MRI-detected inflammation in the spine but not in SIJ. We speculate that CRP could be a reasonable index to reflect spinal inflammation. Therefore, we suggest it is not essential to repeat spinal MRI in a short term, while SIJ MRI may be necessary to provide additional information on inflammation. Key Points • CRP is associated with MRI-detected inflammation in the spine but not in sacroiliac joints. • CRP at baseline was negatively associated with improvement in spinal MR DAS. • It was not essential to repeat spinal MRI frequently, while SIJ MRI may be necessary to provide additional information on inflammation.
Topics: Humans; C-Reactive Protein; Spondylarthritis; Inflammation; Sacroiliac Joint; Magnetic Resonance Imaging; Axial Spondyloarthritis
PubMed: 37336841
DOI: 10.1007/s10067-023-06658-w -
Acta Neurochirurgica Oct 2023The cranio-vertebral junction (CVJ) was formerly considered a surgical "no man's land" due to its complex anatomical and biomechanical features. Surgical approaches and... (Review)
Review
The cranio-vertebral junction (CVJ) was formerly considered a surgical "no man's land" due to its complex anatomical and biomechanical features. Surgical approaches and hardware instrumentation have had to be tailored in order to achieve successful outcomes. Nowadays, thanks to the ongoing development of new technologies and surgical techniques, CVJ surgery has come to be widely performed in many spine centers. Accordingly, there is a drive to explore novel solutions and technological nuances that make CVJ surgery safer, faster, and more precise. Improved outcome in CVJ surgery has been achieved thanks to increased safety allowing for reduction in complication rates. The Authors present the latest technological advancements in CVJ surgery in terms of imaging, biomaterials, navigation, robotics, customized implants, 3D-printed technology, video-assisted approaches and neuromonitoring.
Topics: Humans; Cervical Vertebrae; Atlanto-Axial Joint; Atlanto-Occipital Joint
PubMed: 37659044
DOI: 10.1007/s00701-023-05769-2 -
Anatomical Science International Sep 2023Trabecular structures in vertebral bodies are unequally distributed in the cervical, thoracic and lumbar spine, and also within individual vertebrae. Knowledge of the...
Trabecular structures in vertebral bodies are unequally distributed in the cervical, thoracic and lumbar spine, and also within individual vertebrae. Knowledge of the microstructure of these entities could influence our comprehension and treatment of osteoporotic fractures, and even surgical procedures. Appropriate investigations may clarify the pathomechanisms of various osteoporotic fractures (fish, wedge-shaped, and flat vertebrae). We obtained three cancellous bone cylinders from the centers and margins of cervical vertebra 3 to lumbar vertebra 5, and investigated these in regard of bone volume fraction, trabecular thickness, separation, trabecular number, trabecular bone pattern factor, connectivity density, and degree of anisotropy. Using a Jamshidi needle, we obtained samples from three quadrants (QI: right-sided edge, QII: central, QIII: left-sided edge) of 242 prepared vertebrae, and investigated these on a micro-CT device. In all, 726 bone samples were taken from eleven body donors. Bone volume fraction, trabecular thickness, and the degree of anisotropy were significantly lower in QII than in QI and QIII. Trabecular pattern factor, however, was significantly higher in QII than in QI and QIII. The results helped to explain fish vertebrae. Wedge fractures and flat vertebrae are most likely caused by the complex destruction of trabecular and cortical structures. The higher bone volume fraction in the cervical spine compared to the thoracic and lumbar spine accounts for the small number of fractures in the cervical spine. The marked trabecular pattern factor in the center of thoracic and lumbar vertebrae could be a reason for the surgeon to use different screw designs for individual vertebrae.
Topics: Animals; Osteoporotic Fractures; Lumbar Vertebrae; Cervical Vertebrae; X-Ray Microtomography; Lumbosacral Region; Bone Density
PubMed: 37093524
DOI: 10.1007/s12565-023-00726-6 -
International Journal of Rheumatic... Jan 2024Magnetic resonance imaging (MRI) is a sensitive imaging modality to detect early inflammatory changes in axial spondyloarthritis (SpA). Over a decade has passed since... (Review)
Review
Magnetic resonance imaging (MRI) is a sensitive imaging modality to detect early inflammatory changes in axial spondyloarthritis (SpA). Over a decade has passed since the inclusion of MRI assessment in the 2009 Assessment of SpondyloArthritis International Society (ASAS) classification criteria for axial SpA. Evidence and clinical experience of MRI in axial SpA have accumulated rapidly since. This has led to a better understanding of the clinical utility of MRI in early diagnosis, disease activity assessment, and monitoring of treatment response in axial SpA. Furthermore, technological advancements have paved the way for the development of novel MRI sequences for the quantification of inflammation and image optimization. The field of artificial intelligence has also been explored to aid medical imaging interpretation, including MRI in axial SpA. This review serves to provide an update on the latest understanding of the evolving roles of MRI in axial SpA.
Topics: Humans; Sacroiliac Joint; Sacroiliitis; Artificial Intelligence; Spondylarthritis; Magnetic Resonance Imaging; Axial Spondyloarthritis
PubMed: 38287559
DOI: 10.1111/1756-185X.15014 -
Foot & Ankle International Sep 2023The importance of the deltoid ligament in the congruency and coupling of the tibiotalar joint is well known. The current trend is to repair it in cases of acute injuries...
BACKGROUND
The importance of the deltoid ligament in the congruency and coupling of the tibiotalar joint is well known. The current trend is to repair it in cases of acute injuries in the context of ankle fractures; however, there is limited information on how it should be reconstructed. The objective of this study was to compare different deltoid ligament repair types in an ankle fracture cadaveric model.
METHODS
Sixteen cadaveric foot-ankle-distal tibia specimens were used. All samples were prepared as a supination external rotation ankle fracture model. Axial load and cyclic axial rotations were applied on every specimen using a specifically designed frame. This test was performed without deltoid injury, with deltoid injury, and after repair. The reconstruction was performed in 4 different ways (anterior, posterior, middle, and combined). Medial clear space (MCS) was measured for each condition on simulated weightbearing (WB) and gravity stress (GS) radiographs. Reflective markers were used in tibia and talus, registering the kinematics through a motion analysis system to record the tibiotalar uncoupling.
RESULTS
After deltoid damage, in all cases the MCS increased significantly on GS radiographs, but there was no increase in the MCS on WB radiographs. After repair, in all cases, the MCS was normalized. Kinematically, after deltoid damage, the tibiotalar uncoupling increased significantly. All isolated repairs achieved a similar tibiotalar uncoupling value as its baseline condition. The combined repair resulted in a significant decrease in tibiotalar uncoupling.
CONCLUSION
Our results show that deltoid repair recovers the tibiotalar coupling mechanism in an ankle fracture model. Isolated deltoid repairs recovered baseline MCS and tibiotalar uncoupling values. Combined repairs may lead to overconstraint, which could lead to postoperative stiffness. Clinical studies are needed to prove these results and show clinically improved outcomes.
CLINICAL RELEVANCE
This study helps in finding the optimum deltoid repair to use in an acute trauma setting.
Topics: Humans; Ankle Fractures; Ligaments, Articular; Ankle; Ankle Joint; Cadaver
PubMed: 37489020
DOI: 10.1177/10711007231184844 -
The Journal of the American Academy of... Mar 2024Idiopathic scoliosis is a complex three-dimensional deformity of the spine with anterior overgrowth (hypokyphosis), coronal curvature, and axial rotation. Scoliosis... (Review)
Review
Idiopathic scoliosis is a complex three-dimensional deformity of the spine with anterior overgrowth (hypokyphosis), coronal curvature, and axial rotation. Scoliosis treatment in the skeletally immature spine is therapeutically challenging because of growth and was commonly limited to observation, bracing treatment, or fusion. Fusion accomplishes powerful deformity correction at the expense of future growth and mobility of the involved segments, increasing the risk of adjacent segment degeneration and intervertebral disk disease later in life. Anterior vertebral body tethering is a motion-preserving technique that exploits the Hueter-Volkmann principle by applying compression at the anterior and convex aspects of the curve to stimulate differential vertebral growth for gradual deformity reduction without fusion. The appropriate timing, curve magnitude, tensioning, growth prediction, indications, and limitations of tethering are being refined as this technique becomes more prevalent. Early outcome studies show that growth modulation with vertebral body tethering is safe, can achieve good results, and preserve motion in select patients.
Topics: Humans; Scoliosis; Vertebral Body; Spine; Orthopedic Procedures; Neurosurgical Procedures; Thoracic Vertebrae; Treatment Outcome; Spinal Fusion
PubMed: 38271681
DOI: 10.5435/JAAOS-D-23-00312 -
The Spine Journal : Official Journal of... Feb 2024Although the effect of lumbar spinal stenosis (LSS) on the lower extremities is well documented, limited research exists on the effect of spinal stenosis on the...
BACKGROUND CONTEXT
Although the effect of lumbar spinal stenosis (LSS) on the lower extremities is well documented, limited research exists on the effect of spinal stenosis on the posterior paraspinal musculature (PPM). Similar to neurogenic claudication, moderate to severe spinal canal compression can also interfere with the innervation of the PPM, which may result in atrophy and increased fatty infiltration (FI).
PURPOSE
This study aims to assess the association between LSS and atrophy of the PPM.
STUDY DESIGN
Retrospective cross-sectional study.
PATIENT SAMPLE
Patients undergoing MRI scans at a tertiary orthopedic center for low back pain or as part of a preoperative evaluation.
OUTCOME MEASURES
The functional cross-sectional area (fCSA) and percent fatty infiltration (FI) of the PPM at L4.
METHODS
Lumbar MRIs of patients at a tertiary orthopedic center indicated due to lower back pain (LBP) or as a presurgical workup were analyzed. Patients with previous spinal fusion surgery or scoliosis were excluded. LSS was assessed according to the Schizas classification at all lumbar levels. The cross-sectional area of the PPM was measured on a T2-weighted MRI sequence at the upper endplate of L4. The fCSA and fatty infiltration (FI) were calculated using custom software. Crude differences in FI and fCSA between patients with no stenosis and at least mild stenosis were tested with the Wilcoxon signed-rank test. To account for possible confounders, a multivariable linear regression model was used to adjust for age, sex, body mass index (BMI), and disc degeneration. A subgroup analysis according to MRI indication was performed.
RESULTS
A total of 522 (55.7% female) patients were included. The median age was 61 years (IQR: 51-71). The greatest degree of moderate and severe stenosis was found at L4/5, 15.7%, and 9.2%, respectively. Stenosis was the least severe at L5/S1 and was found to be 2% for moderate and 0.2% for severe stenosis. The Wilcoxon test showed significantly increased FI of the PPM with stenosis at any lumbar level (p<.001), although no significant decrease in fCSA was observed. The multivariable regression model showed a significant increase in FI with increased LSS at L1/2, L2/3, and L3/4 (p=.013, p<.01 and p=.003). The severity of LSS at L4/5 showed a positive association with the fCSA (p=.019). The subgroup analysis showed, the effect of LSS was more pronounced in nonsurgical patients than in patients undergoing surgery.
CONCLUSIONS
In this study, we demonstrated a significant and independent association between LSS and the composition of the PPM, which was dependent on the level of LSS relative to the PPM. In addition to neurogenic claudication, patients with LSS might be especially susceptible to axial muscle wasting, which could worsen LSS due to increased spinal instability, leading to a positive feedback loop.
Topics: Humans; Female; Middle Aged; Male; Spinal Stenosis; Retrospective Studies; Lumbar Vertebrae; Constriction, Pathologic; Cross-Sectional Studies; Magnetic Resonance Imaging; Low Back Pain; Intervertebral Disc Degeneration; Muscular Atrophy; Muscles; Paraspinal Muscles
PubMed: 37788745
DOI: 10.1016/j.spinee.2023.09.020