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PloS One 2022Roughly 400,000 people in the U.S. are living with bone metastases, the vast majority occurring in the spine. Metastases to the spine result in fractures, pain,...
Roughly 400,000 people in the U.S. are living with bone metastases, the vast majority occurring in the spine. Metastases to the spine result in fractures, pain, paralysis, and significant health care costs. This predilection for cancer to metastasize to the bone is seen across most cancer histologies, with the greatest incidence seen in prostate, breast, and lung cancer. The molecular process involved in this predilection for axial versus appendicular skeleton is not fully understood, although it is likely that a combination of tumor and local micro-environmental factors plays a role. Immune cells are an important constituent of the bone marrow microenvironment and many of these cells have been shown to play a significant role in tumor growth and progression in soft tissue and bone disease. With this in mind, we sought to examine the differences in immune landscape between axial and appendicular bones in the normal noncancerous setting in order to obtain an understanding of these landscapes. To accomplish this, we utilized mass cytometry by time-of-flight (CyTOF) to examine differences in the immune cell landscapes between the long bone and vertebral body bone marrow from patient clinical samples and C57BL/6J mice. We demonstrate significant differences between immune populations in both murine and human marrow with a predominance of myeloid progenitor cells in the spine. Additionally, cytokine analysis revealed differences in concentrations favoring a more myeloid enriched population of cells in the vertebral body bone marrow. These differences could have clinical implications with respect to the distribution and permissive growth of bone metastases.
Topics: Animals; Bone Marrow; Bone Neoplasms; Bone and Bones; Humans; Male; Mice; Mice, Inbred C57BL; Spine; Tumor Microenvironment
PubMed: 35476843
DOI: 10.1371/journal.pone.0267642 -
World Neurosurgery Apr 2022To consolidate the current literature related to atlantoaxial osteoarthritis (AAOA) and improve systematic understanding of this clinical syndrome among spine surgeons. (Review)
Review
OBJECTIVE
To consolidate the current literature related to atlantoaxial osteoarthritis (AAOA) and improve systematic understanding of this clinical syndrome among spine surgeons.
METHODS
A comprehensive literature search was performed using PubMed, Ovid MEDLINE, and EMBASE databases and the following search terms: ("C1-C2" OR "C1-2" OR "atlantoaxial" OR "atlanto-axial" OR "C2" OR "C1" OR "atlas" OR "axis") AND ("osteoarthritis"). All articles of any study design addressing AAOA were considered for inclusion. Two authors independently read article titles and abstracts, and the full text of included relevant articles.
RESULTS
There were 54 articles reviewed and consolidated in this narrative review. These articles are roughly divided into the following 5 subcategories: epidemiology and etiology, clinical presentation, radiographic findings, conservative treatment, and surgical indications and treatment options.
CONCLUSIONS
AAOA is a clinically common but often overlooked syndrome characterized by persistent occipitocervical pain. The most common cause of AAOA is joint degeneration, which is closely related to age and occupation. AAOA is initially managed with conservative treatment. Atlantoaxial fusion is an option for patients with severe pain who are unresponsive to conservative treatment.
Topics: Atlanto-Axial Joint; Humans; Osteoarthritis; Pain; Spinal Fusion; Spine
PubMed: 35092813
DOI: 10.1016/j.wneu.2022.01.081 -
Skeletal Radiology Oct 2022The sacroiliac joint (SIJ) is an amphiarthrosis composed of a posterior syndesmosis and an anterior cartilaginous portion, with limited yet present mobility. Its main... (Review)
Review
The sacroiliac joint (SIJ) is an amphiarthrosis composed of a posterior syndesmosis and an anterior cartilaginous portion, with limited yet present mobility. Its main function is to transmit the load from the axial skeleton to the lower limbs and vice-versa; it is susceptible to early mechanical and degenerative changes which are much more common than inflammatory sacroiliitis. Magnetic resonance imaging (MRI) has increasingly been used to evaluate these changes, and while subchondral bone marrow edema (BME) is a common finding related to both, care must be taken when applying the ASAS research MRI definition for sacroiliitis without considering lesion BME topography, size and depth, concomitant structural damage and, of course, the clinical picture. In this review, we will discuss the anatomy and biomechanics of the SIJ, the noninflammatory causes of SIJ subchondral BME, and how these concepts combined can be used to increase our diagnostic confidence.
Topics: Bone Marrow Diseases; Edema; Humans; Magnetic Resonance Imaging; Sacroiliac Joint; Sacroiliitis; Spondylarthritis
PubMed: 35556157
DOI: 10.1007/s00256-022-04067-9 -
European Spine Journal : Official... May 2020CT myelography has been used since 1976 to diagnose neural compression in the axial skeleton. With the advent of routine MRI, its role in accurately diagnosing neural...
PURPOSE
CT myelography has been used since 1976 to diagnose neural compression in the axial skeleton. With the advent of routine MRI, its role in accurately diagnosing neural compression has been questioned as its normal appearances are not defined in the study. In this study, we examine a series of CT myelograms to define the normal appearances of the neural elements of the spine.
METHODS
The CT myelograms of patients with unilateral symptoms were examined by four independent physicians. The lateral extent of contrast was examined and recorded. Concordance between the recorded extents was assessed using kappa scores.
RESULTS
Thirty-six scans were reviewed. Kappa analysis shows that there is a fair agreement in the lateral extent of contrast at L1, L3 and L4. At L2 and L5, agreement is slight.
CONCLUSION
The interpretation of CT myelography shows significant interobserver variability. As a result, the usefulness of this diagnostic tool can be questioned, and if misinterpreted, it could lead to questionable diagnoses and inadvertently erroneous management if used in isolation. These slides can be retrieved under Electronic Supplementary Material.
Topics: Humans; Lumbar Vertebrae; Magnetic Resonance Imaging; Myelography; Spinal Stenosis; Tomography, X-Ray Computed
PubMed: 31901999
DOI: 10.1007/s00586-019-06287-5 -
BMC Musculoskeletal Disorders May 2022Hyperplasia of the hematopoietic bone marrow in the appendicular skeleton is common. In contrast, focal hematopoietic islands within the axial skeleton are a rare entity...
BACKGROUND
Hyperplasia of the hematopoietic bone marrow in the appendicular skeleton is common. In contrast, focal hematopoietic islands within the axial skeleton are a rare entity and can confuse with osteoblastic metastases. This study aimed to characterize typical MRI and CT findings of hematopoietic islands in distinction from osteoblastic metastases to help both radiologists and clinicians, on the one hand, not to overdiagnose this entity and, on the other hand, to decide on a reasonable work-up.
METHODS
We retrospectively analyzed the imaging findings of 14 hematopoietic islands of the axial skeleton in ten patients (nine females, median age = 65.5 years [range, 49-74]) who received both MRI and CT at initial diagnosis between 2006 and 2020. CT-guided biopsy was performed in five cases to confirm the diagnosis, while the other five patients received long-term MRI follow-up (median follow-up = 28 months [range, 6-96 months]). Diffusion-weighted imaging was available in three, chemical shift imaging respectively F- fluorodeoxyglucose PET/CT in two, and Technetium 99 m skeletal scintigraphy in one of the patients.
RESULTS
All lesions were small (mean size = 1.72 cm) and showed moderate hypointense signals on T1- and T2-weighted MRI sequences. They appeared isointense to slightly hyperintense on STIR images and slightly enhanced after gadolinium administration. To differentiate this entity from osteoblastic metastases, CT provides important additional information, as hematopoietic islands do not show sclerosis.
CONCLUSIONS
Hematopoietic islands within the axial skeleton can occur and mimic osteoblastic metastases. However, the combination of MRI and CT allows for making the correct diagnosis in most cases.
Topics: Aged; Bone Neoplasms; Bone and Bones; Female; Fluorodeoxyglucose F18; Gadolinium; Humans; Magnetic Resonance Imaging; Middle Aged; Positron Emission Tomography Computed Tomography; Retrospective Studies
PubMed: 35550061
DOI: 10.1186/s12891-022-05402-w -
World Neurosurgery Jun 2020The interlaminar fusion combination involving C1-C2 screwing fixation is one of the most effective techniques for atlantoaxial dislocation or subluxation, and the bone...
OBJECTIVE
The interlaminar fusion combination involving C1-C2 screwing fixation is one of the most effective techniques for atlantoaxial dislocation or subluxation, and the bone graft is usually stabilized by wiring constructs. However, some adverse events were reported during the insertion of sublaminar wiring, such as accidentally damaging the spinal cord or dura. Thus we used the miniplate to stabilize the harvest bone graft on the C1-C2 laminar, which led to a shorter operation time and prevented spinal canal violation. This study investigated the safety and efficacy of the novel surgical technique, namely miniplate-augmented interlaminar fusion.
METHODS
We retrospectively reviewed 43 patients who underwent posterior atlantoaxial fusion with the miniplate-augmented iliac crest autograft at our institute. Complications related to surgery were recorded and calculated. After operation, patients were followed up through routine radiography to examine whether the fusion of the atlantoaxial segment was achieved. Success of fusion was defined as follows: 1) the presence of bone bridging between the bone graft and both the atlas and axis; and 2) the absence of movement of the atlantoaxial spinous process on flexion-extension radiography, which meant that the variation of length measured in 2 views, respectively, was <1 mm. The first time when radiography showed successful fusion after surgery was termed as fusion time and was recorded individually. In addition, overall fusion rates and mean fusion times were analyzed.
RESULTS
Of 43 patients, long-term follow-up data were available for 31 patients, whereas the remaining 12 patients had dropped out (mean follow-up duration, 24.91 months; range, 6-72 months). Among 31 patients, 22 (70.96%) were women and 9 (29.03%) were men. The mean age was 63.33 years. Regarding the etiology, atlantoaxial dislocations or subluxations were caused due to degeneration, rheumatoid arthritis, odontoid fracture, trauma, and os odontoideum in 14 (45%), 3 (10%), 5 (16%), 8 (26%), and 1 (3%) patient(s), respectively. Successful fusion was achieved in 30 (96.77%) patients, with a mean fusion time of 6.23 months, whereas only 1 (3.23%) patient did not meet the fusion criteria. No complications related to the miniplate occurred. We noted vertebral artery rupture not requiring blood transfusion in 1 patient, aspiration pneumonia in 1 patient, urinary tract infection in 1 patient, anemia requiring transfusion in 1 patient, and leg dysesthesia in 1 patient. No neurologic deficit was found.
CONCLUSIONS
Miniplate-augmented interlaminar fusion with C1-C2 screwing resulted in excellent fusion rates with a considerably low probability of complications. Hence this novel technique for bone graft fixation with atlantoaxial screwing has a good efficacy and safety and can serve as an alternative for bone graft fixation during C1-C2 fusion.
Topics: Adult; Aged; Aged, 80 and over; Atlanto-Axial Joint; Bone Screws; Bone Transplantation; Cervical Vertebrae; Congenital Abnormalities; Female; Follow-Up Studies; Humans; Ilium; Internal Fixators; Joint Dislocations; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Spinal Fusion; Treatment Outcome
PubMed: 32173550
DOI: 10.1016/j.wneu.2020.03.023 -
Arthroscopy : the Journal of... Jun 2022Femoral torsion is an important measure in patients with femoroacetabular impingement presenting with limited hip range of motion. However, femoral torsion may be...
Editorial Commentary: Differences in Femoral Torsion Measurements Based on Axial Versus Axial-Oblique Magnetic Resonance Imaging Sequences-Let's Begin to Standardize Hip-Preservation Techniques to Improve Research and Clinical Outcomes.
Femoral torsion is an important measure in patients with femoroacetabular impingement presenting with limited hip range of motion. However, femoral torsion may be measured using computed tomography or magnetic resonance imaging and on axial or axial-oblique sequences. Recent research shows that femoral torsion measurements differ based on the magnetic resonance imaging sequences on which this parameter is measured. In some cases, this may be clinically relevant in the sense that a derotational femoral osteotomy may be considered when otherwise it would not be. As more research is published within the specialized field of hip preservation surgery, we must begin to standardize our research and clinical techniques such that outcomes may be appropriately compared across studies.
Topics: Arthroscopy; Bone Diseases; Femoracetabular Impingement; Femur; Hip Joint; Humans; Magnetic Resonance Imaging; Tomography, X-Ray Computed
PubMed: 35660181
DOI: 10.1016/j.arthro.2021.12.024 -
Computer Methods and Programs in... Aug 2023Screw loosening remains a prominent problem for osteoporotic patients undergoing pedicle screw fixation surgeries but its underlying mechanisms are not fully understood....
BACKGROUND AND OBJECTIVE
Screw loosening remains a prominent problem for osteoporotic patients undergoing pedicle screw fixation surgeries but its underlying mechanisms are not fully understood. This study sought to examine the interactive effect of craniocaudal or axial cyclic loading (toggling) and osteoporosis on screw fixation.
METHODS
QCT-based finite element models of normal (n = 7; vBMD = 156 ± 13 mg/cm) and osteoporotic vertebrae (n = 7; vBMD = 72 ± 6 mg/cm) were inserted with pedicle screws and loaded with or without craniocaudal toggling. Among them, a representative normal vertebra (age: 55; BMD: 140 mg/cm) and an osteoporotic vertebra (age: 64; BMD: 79 mg/cm) were also loaded with or without axial toggling. The individual and interactive effects of craniocaudal toggling and osteoporosis on screw fixation strength (the force when the pull-up displacement of the screw head reached 1 mm) and bone tissue failure (characterized by equivalent plastic strain) were examined by repeated measure ANOVA.
RESULTS
A significant interactive effect between craniocaudal toggling and osteoporosis on screw fixation strength was detected (p = 0.008). Specifically, craniocaudal toggling led to a marked decrease in the fixation strength (68%, p < 0.05) and stiffness (83%, p < 0.05) only in the osteoporotic vertebrae but had no effect on screw fixation strength and stiffness of the normal vertebrae (p > 0.05). Likewise, most of the bone tissues around the screw in the osteoporotic vertebrae yielded following craniocaudal toggling whereas this result was not seen in the normal vertebrae. The axial toggling had no significant effect on bone tissue failure as well as pedicle screw fixation in normal or osteoporotic vertebrae.
CONCLUSIONS
Craniocaudal toggling substantially reduces the screw fixation strength of the osteoporotic vertebrae by progressively increasing tissue failure around the screw, and therefore may contribute to the higher rates of screw loosening in osteoporotic compared to normal patients, whereas axial toggling is not a risk factor for pedicle screw loosening in normal or osteoporotic patients.
Topics: Humans; Middle Aged; Spine; Osteoporosis; Pedicle Screws; Lumbar Vertebrae; Biomechanical Phenomena
PubMed: 37263117
DOI: 10.1016/j.cmpb.2023.107625 -
Orthopaedic Surgery Jun 2021Measure and systematically evaluate the distribution of microhardness in the human skeleton.
OBJECTIVES
Measure and systematically evaluate the distribution of microhardness in the human skeleton.
METHODS
Three fresh corpses were obtained, aged 62 (male), 45 (female), and 58 years (male). Soft tissues were removed, and all axial and unilateral appendicular bones were freshly harvested. All three skeletons were examined by X-ray and computed tomography (CT) to exclude skeletal pathology. Only bones from donors with no known skeletal pathology were included in the study. Axial and unilateral appendicular skeleton bones from each of the three donors were obtained, except for ear ossicles, hyoid bone, tailbone, and 14 phalanges of the foot, for which samples were difficult to obtain. Precision bone specimens with a thickness of 3 mm, which were cut with a Buehler IsoMet 11-1280-250 low-speed diamond saw (Buehler, USA), were obtained from all important anatomic sites in a direction perpendicular to the mechanical axis of each bone. Micro-indentation (the Vickers hardness test) was performed on the surface of each specimen using a microhardness tester with a diamond indenter. Hardness value (HV) was computed for each indentation. Each bone specimen was divided into several regions of interest. Indentations were carefully made and computed. Then we analyzed the data to identify hardness distribution rules at different anatomic sites.
RESULTS
In total, 5360 indentations were made in 1072 regions of interest in each donor. Hardness of the axial and appendicular bones were all inhomogeneous depending on the anatomic sites, but the distribution of microhardness followed certain rules. The mean hardness value ranged from 24.46 HV (HV = hardness value, kgf/mm ) for the sacrum to 53.20 HV for the shaft of the tibia. The diaphysis was harder than the metaphysis, and the proximal and distal epiphysis had lower values (8.85%- 40.39%) than the diaphysis. Among the long bone diaphyses, the tibia cortical bone (51.20 HV) was the hardest, harder than the humerus (47.25 HV), the ulna (43.26 HV), the radius (42.54 HV), and the femur (47.53 HV). However, in some anatomic sites such as the lumbar vertebra (cortical bone 32.86 HV, cancellous bone 31.25 HV), the cortical shells were sometimes not harder than the internal cancellous bones. The lumbar vertebra (32.86 HV) was harder than the cervical vertebra (28.51 HV) and the thoracic vertebra (29.01 HV).
CONCLUSIONS
The distribution of microhardness in the human skeleton follows certain rules. These distribution rules could be used to predict the mechanical properties of bone and progress in this field could provide data for the basis of a new three-dimensional printing technique, which may lead to new perspectives for custom-made implants.
Topics: Biomechanical Phenomena; Bone and Bones; Cadaver; Female; Hardness; Humans; Male; Middle Aged
PubMed: 33973714
DOI: 10.1111/os.12841 -
The Canadian Veterinary Journal = La... Dec 2020
Topics: Animals; Atlanto-Axial Joint; Cervical Vertebrae
PubMed: 33299238
DOI: No ID Found