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Pain Physician Mar 2024Vertebral compression fractures (VCFs) can affect the entire spinopelvic complex and cause unpredictable patterns of back pain due to their effects on spinal tensegrity...
BACKGROUND
Vertebral compression fractures (VCFs) can affect the entire spinopelvic complex and cause unpredictable patterns of back pain due to their effects on spinal tensegrity and biomechanical compensation. They can lead to significant morbidity and mortality in the aging population and are difficult to diagnose. We aimed to establish a relationship between VCFs and sacroiliac (SI) joint pain.
OBJECTIVES
Demonstration of SI joint (SIJ) pain relief at up to 6 months after kyphoplasty (KP) in patients with VCFs and diagnosed SI dysfunction.
STUDY DESIGN
Retrospective study.
SETTING
All patients were from a private chronic pain and orthopedics practice in the northeastern United States.
METHODS
Fifty-one patients with VCFs diagnosed through imaging and SIJ dysfunction diagnosed through 2 diagnostic SIJ blocks who had failed conservative management were considered for KP. Numeric Rating Scale (NRS 11) scores were recorded at the baseline, after each SIJ block, and at 4 weeks and then 6 months after KP.
RESULTS
Forty-nine patients underwent KP. At 4 weeks after the procedure, there was an 84% average reduction in NRS scores from the baseline (P < 0.01). At 6 months after the procedure, there was an 80% reduction in NRS scores from the baseline (P < 0.01).
LIMITATIONS
Larger sample sizes and a randomized control trial would be important steps in furthering the relationship between VCFs and SIJ.
CONCLUSION
VCFs can cause a referred pain pattern to the SIJ that is best treated by KP for long-term management.
Topics: Aged; Humans; Arthralgia; Fractures, Compression; Pelvic Pain; Retrospective Studies; Sacroiliac Joint; Spinal Fractures
PubMed: 38506686
DOI: No ID Found -
BMC Musculoskeletal Disorders Mar 2024To investigate the biochemical changes in lumbar facet joint (LFJ) and intervertebral disc (IVD) with different degenerative grade by T2* mapping.
BACKGROUND
To investigate the biochemical changes in lumbar facet joint (LFJ) and intervertebral disc (IVD) with different degenerative grade by T2* mapping.
METHODS
Sixty-eight patients with low back pain (study group) and 20 volunteers (control group) underwent standard MRI protocols and axial T2* mapping. Morphological evaluation of LFJ and IVD were performed on T2-weighted imaging according to Weishaupt and Pfirrmann grading system, respectively. T2* values of LFJ and of AF (anterior annulus fibrosus), NP (nucleus pulposus), and PF (posterior annulus fibrosus) in IVD were measured. Kruskal-Wallis test and Wilcoxon rank-sum test were used to compare T2* values of subjects with different degenerative grade.
RESULTS
The mean T2* value of grade 0 LFJ (21.68[17.77,26.13]) was higher than those of grade I (18.42[15.68,21.8], p < 0.001), grade II (18.98[15.56,22.76], p = 0.011) and grade III (18.38[16.05,25.07], p = 0.575) LFJ in study group, and a moderate correlation was observed between T2* value and LFJ grade (rho=-0.304, p < 0.001) in control group. In the analysis of IVD, a moderate correlation was observed between AF T2* value and IVD grade (rho=-0.323, p < 0.001), and between NP T2* value and IVD grade (rho=-0.328, p < 0.001), while no significant difference was observed between the T2* values of PF in IVD of different grade in study group.
CONCLUSIONS
Downward trend of T2* values can be found in LFJ, AF and NP as the degenerative grade rised. But in elderly patients with low back pain, no change trend was found in LFJ due to increased fluid accumulation in the joint space.
Topics: Humans; Aged; Intervertebral Disc Degeneration; Zygapophyseal Joint; Low Back Pain; Lumbar Vertebrae; Intervertebral Disc; Magnetic Resonance Imaging
PubMed: 38504210
DOI: 10.1186/s12891-024-07265-9 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Mar 2024To evaluate the correlation between pelvic incidence (PI) angle, hip deflection angle (HDA), combined deflection angle (CDA) and osteonecrosis of the femoral head (ONFH)...
OBJECTIVE
To evaluate the correlation between pelvic incidence (PI) angle, hip deflection angle (HDA), combined deflection angle (CDA) and osteonecrosis of the femoral head (ONFH) after femoral neck fracture, in order to explore early predictive indicators for ONFH occurrence after femoral neck fracture.
METHODS
A study was conducted on patients with femoral neck fractures who underwent cannulated screw internal fixation between December 2018 and December 2020. Among them, 208 patients met the selection criteria and were included in the study. According to the occurrence of ONFH, the patients were allocated into ONFH group and non-NOFH group. PI, HDA, and CDA were measured based on the anteroposterior X-ray films of pelvis and axial X-ray films of the affected hip joint before operation, and the differences between the two groups were compared. The receiver operating characteristic curve (ROC) was used to evaluate the value of the above imaging indicators in predicting the occurrence of ONFH.
RESULTS
Among the 208 patients included in the study, 84 patients experienced ONFH during follow-up (ONFH group) and 124 patients did not experience ONFH (non-ONFH group). In the non-ONFH group, there were 59 males and 65 females, the age was 18-86 years (mean, 53.9 years), and the follow-up time was 18-50 months (mean, 33.2 months). In the ONFH group, there were 37 males and 47 females, the age was 18-76 years (mean, 51.6 years), and the follow-up time was 8-45 months (mean, 22.1 months). The PI, HDA, and CDA were significantly larger in the ONFH group than in the non-ONFH group ( <0.05). ROC curve analysis showed that the critical value of PI was 19.82° (sensitivity of 40.5%, specificity of 86.3%, <0.05); the critical value of HDA was 20.94° (sensitivity of 77.4%, specificity of 75.8%, <0.05); and the critical value of CDA was 39.16° (sensitivity of 89.3%, specificity of 83.1%, <0.05).
CONCLUSION
There is a correlation between PI, HDA, CDA and the occurrence of ONFH after femoral neck fracture, in which CDA can be used as an important reference indicator. Patients with CDA≥39.16° have a higher risk of ONFH after femoral neck fracture.
Topics: Male; Female; Humans; Adolescent; Young Adult; Adult; Middle Aged; Aged; Aged, 80 and over; Femur Head; Femoral Neck Fractures; Femur Head Necrosis; Hip Joint; Fracture Fixation, Internal; Retrospective Studies
PubMed: 38500422
DOI: 10.7507/1002-1892.202311094 -
Heliyon Mar 2024A novel type of detachable precast concrete column-column joint (DPC) is proposed in this study to solve the problems in current column-column dry connections including...
A novel type of detachable precast concrete column-column joint (DPC) is proposed in this study to solve the problems in current column-column dry connections including complex load path, uncertainty of structural stiffness of beam-column joints and inconvenience for disassembly. The dry connection technology is applied by composing of steel plate and concrete. Finite element models of DPC were created to study its structural performance including hysteresis curve, skeleton curve, ductility, and energy dissipation capacity. The benchmark models are firstly established and validated against the test data and after that a small-scale parametric study is prepared. The effect of axial pressure ratio and eccentricity distance size on the seismic performance of DPC was studied. Results indict that the optimal value of axial pressure ratio ranges from 0.5 to 0.7. With increase of the axial pressure ratio, the ductility coefficient shows a decreasing trend in general. The eccentricity has little effect on the energy dissipation capacity of the joint.
PubMed: 38495148
DOI: 10.1016/j.heliyon.2024.e27308 -
Journal of Orthopaedic Surgery and... Mar 2024Anterior cervical discectomy and fusion surgery (ACDF) is a common technique in treating degenerative cervical spondylosis. This study is to evaluate the changes of...
BACKGROUND
Anterior cervical discectomy and fusion surgery (ACDF) is a common technique in treating degenerative cervical spondylosis. This study is to evaluate the changes of cervical muscles after ACDF and analyze the correlation between related muscle changes and clinical efficacy.
METHODS
Sixty-five postoperative patients (single-level ACDF) with cervical spondylotic myelopathy from January 2013 to December 2022 were analyzed. The measured parameters include: the axial section of longus colli cross-sectional area (AxCSA), the volume of cervical longus, the ratio of long and short diameter line (RLS), the cervical extensor cross-sectional area (CESA), the vertebral body area (VBA), and the CESA/VBA. The visual analog scale (VAS), modified Japanese Orthopedic Association score (mJOA), and neck disability index (NDI) were evaluated. The changes in muscle morphology were analyzed, and the correlation analysis was conducted between morphological changes and function scores.
RESULTS
The postoperative AxCSA of surgical segment (3rd month, 12th month, and the last follow-up) was decreased compared to preoperative (141.62 ± 19.78), and the differences were significant (P < 0.05). The corresponding data reduced to (119.42 ± 20.08) mm, (117.59 ± 19.69) mm, and (117.41 ± 19.19) mm, respectively (P < 0.05). The RLS increased, and the volume of cervical longus decreased significantly after surgery (P < 0.05). Negative correlation was found between postoperative volume of cervical longus and VAS at the 3rd month (r = - 0.412), 12th month (r = - 0.272), and last follow-up (r = - 0.391) (P < 0.05). Negative correlation existed between postoperative volume of cervical longus and NDI at the 3rd month (r = - 0.552), 12th month (r = - 0.293), and last follow-up (r = - 0.459) (P < 0.05).
CONCLUSION
The volume of cervical longus decreased and its morphology changed after ACDF surgery. The mainly affected muscle was the cervical longus closing to the surgical segment. Negative correlation was found between the postoperative volume of cervical longus and function scores (VAS and NDI).
Topics: Humans; Spinal Fusion; Retrospective Studies; Diskectomy; Neck; Treatment Outcome; Cervical Vertebrae; Spondylosis; Muscles
PubMed: 38493285
DOI: 10.1186/s13018-024-04605-2 -
Scientific Reports Mar 2024The use of mobile head CT scanners in the neurointensive care unit (NICU) saves time for patients and NICU staff and can reduce transport-related mishaps, but the...
The use of mobile head CT scanners in the neurointensive care unit (NICU) saves time for patients and NICU staff and can reduce transport-related mishaps, but the reduced image quality of previous mobile scanners has prevented their widespread clinical use. This study compares the image quality of SOMATOM On.Site (Siemens Healthineers, Erlangen, Germany), a state-of-the-art mobile head CT scanner, and a conventional 64-slice stationary CT scanner. The study included 40 patients who underwent head scans with both mobile and stationary scanners. Gray and white matter signal and noise were measured at predefined locations on axial slices, and signal-to-noise ratios (SNRs) and contrast-to-noise ratios (CNRs) were calculated. Artifacts below the cranial calvaria and in the posterior fossa were also measured. In addition, image quality was subjectively assessed by two radiologists in terms of corticomedullary differentiation, subcalvarial space, skull artifacts, and image noise. Quantitative measurements showed significantly higher image quality of the stationary CT scanner in terms of noise, SNR and CNR of gray and white matter. Artifacts measured in the posterior fossa were higher with the mobile CT scanner, but subcalvarial artifacts were comparable. Subjective image quality was rated similarly by two radiologists for both scanners in all domains except image noise, which was better for stationary CT scans. The image quality of the SOMATOM On.Site for brain scans is inferior to that of the conventional stationary scanner, but appears to be adequate for daily use in a clinical setting based on subjective ratings.
Topics: Humans; Tomography Scanners, X-Ray Computed; Tomography, X-Ray Computed; Head; Skull; White Matter; Radiation Dosage
PubMed: 38493258
DOI: 10.1038/s41598-024-56089-z -
Frontiers in Endocrinology 2024This study aimed to identify disruptions in white matter integrity in type 2 diabetes mellitus (T2DM) patients by utilizing the white matter tract integrity (WMTI)...
Analysis of white matter tract integrity using diffusion kurtosis imaging reveals the correlation of white matter microstructural abnormalities with cognitive impairment in type 2 diabetes mellitus.
BACKGROUND
This study aimed to identify disruptions in white matter integrity in type 2 diabetes mellitus (T2DM) patients by utilizing the white matter tract integrity (WMTI) model, which describes compartment-specific diffusivities in the intra- and extra-axonal spaces, and to investigate the relationship between WMTI metrics and clinical and cognitive measurements.
METHODS
A total of 73 patients with T2DM and 57 healthy controls (HCs) matched for age, sex, and education level were enrolled and underwent diffusional kurtosis imaging and cognitive assessments. Tract-based spatial statistics (TBSS) and atlas-based region of interest (ROI) analysis were performed to compare group differences in diffusional metrics, including fractional anisotropy (FA), mean diffusivity (MD), axonal water fraction (AWF), intra-axonal diffusivity (D), axial extra-axonal space diffusivity (D), and radial extra-axonal space diffusivity (D) in multiple white matter (WM) regions. Relationships between diffusional metrics and clinical and cognitive functions were characterized.
RESULTS
In the TBSS analysis, the T2DM group exhibited decreased FA and AWF and increased MD, D, and D in widespread WM regions in comparison with the HC group, which involved 56.28%, 32.07%, 73.77%, 50.47%, and 75.96% of the mean WM skeleton, respectively ( < 0.05, TFCE-corrected). D detected most of the WM changes, which were mainly located in the corpus callosum, internal capsule, external capsule, corona radiata, posterior thalamic radiations, sagittal stratum, cingulum (cingulate gyrus), fornix (stria terminalis), superior longitudinal fasciculus, and uniform fasciculus. Additionally, D in the genu of the corpus callosum was significantly correlated with worse performance in TMT-A (β = 0.433, < 0.001) and a longer disease duration (β = 0.438, < 0.001).
CONCLUSIONS
WMTI is more sensitive than diffusion tensor imaging in detecting T2DM-related WM microstructure abnormalities and can provide novel insights into the possible pathological changes underlying WM degeneration in T2DM. D could be a potential imaging marker in monitoring disease progression in the brain and early intervention treatment for the cognitive impairment in T2DM.
Topics: Humans; White Matter; Diffusion Tensor Imaging; Diabetes Mellitus, Type 2; Diffusion Magnetic Resonance Imaging; Cognitive Dysfunction
PubMed: 38487342
DOI: 10.3389/fendo.2024.1327339 -
Acta Biomaterialia Apr 2024While most of current models investigating bone remodelling are based on matrix deformation, intramedullary pressure also plays a role. Bone remodelling is orchestrated... (Review)
Review
While most of current models investigating bone remodelling are based on matrix deformation, intramedullary pressure also plays a role. Bone remodelling is orchestrated by the Lacuno-Canalicular Network (LCN) fluid-flow. The aim of this review was hence to assess the influence of intramedullary pressure on the fluid circulation within the LCN. Three databases (Science Direct, Web of Science, and PubMed) were used. The first phase of the search returned 731 articles, of which 9 respected the inclusion/exclusion criteria and were included. These studies confirm the association between intramedullary pressure and fluid dynamics in the LCN. Among the included studies, 7 experimental studies using animal models and 2 numerical models were found. The studies were then ranked according to the nature of the applied loading, either axial compression or direct cyclic intramedullary pressure. The current review revealed that there is an influence of intramedullary pressure on LCN fluid dynamics and that this influence depends on the magnitude and the frequency of the applied pressure. Two studies confirmed that the influence was effective even without bone matrix deformation. While intramedullary pressure is closely associated with LCN fluid, there is a severe lack of studies on this topic. STATEMENT OF SIGNIFICANCE: Since the 1990's, numerical models developed to investigate fluid flow in bone submicrometric porous network are based on the flow induced by matrix deformation. Bone fluid flow is known to be involved in cells stimulation and hence directly influences bone remodeling. Different studies have shown that intramedullary pressure is also associated with bone mechanosensitive adaptation. This pressure is developed in bone due to blood circulation and is increased during loading or muscle stimulation. The current article reviews the studies investigating the influence of this pressure on bone porous fluid flow. They show that fluid flow is involved by this pressure even without bone matrix deformation. The current review article highlights the severe lack of studies about this mechanism.
Topics: Animals; Bone and Bones; Bone Matrix; Bone Remodeling; Hydrodynamics; Models, Animal; Osteocytes
PubMed: 38484832
DOI: 10.1016/j.actbio.2024.03.003 -
Medical Archives (Sarajevo, Bosnia and... 2024Chordoma is a rare malignant neoplasm that predominantly arises from the axial skeleton, but can also develop in unusual locations. However, there are also rare cases of...
BACKGROUND
Chordoma is a rare malignant neoplasm that predominantly arises from the axial skeleton, but can also develop in unusual locations. However, there are also rare cases of "NOS" chordoma involving the oropharyx and epithelial-myoepithelial carcinoma of the parotid gland in the same patient. According to contemporary research, chordoma is a rare malignant neoplasm that arises from the embryonic remnants of the notochord. and typically involves the clivus, sacrococcygeal bones or vertebrae. Studies have shown that the incidence of chordoma has been estimated to be one per one million people per year. Chordoma can occur at any age, but most commonly it is diagnosed in the 40-60 year old age group with the male predominance.
OBJECTIVE
The aim of this article was to review the case of a 74-year-old female patient with epithelial-myoepithelial carcinoma of the parotid gland and a case of "NOS" chordoma involving the oropharyx.
METHODS
Diagnostic methods were used to examine a female patient with two primary malignant tumors: CT neck scan, CT of paranasal sinuses, ultrasound examination, scintigraphy and operative finding.
CASE PRESENTZATION
Due to the anatomy complexity, complete resection of the tumor through a transoral-transpharyngeal approach was not possible. Intraoperative palpation of the mass revealed well defined submucosal lesion 20x43x46mm beginning at the level of the oro- and hypopharynx and extending superiorly to the nasopharynx, and posteriorly into the spinal canal and intervertebral foramen causing near complete occlusion of the oro and hypopharynx. The patient also underwent extracapsular dissection of the parotid tumor. Postoperative palliative radiotherapy was performed.
CONCLUSION
Surgical treatment remains the mainstay of treatment for EMC and radiation is imperative for patients who refuse surgery and for those with advanced or inoperable diseases.
Topics: Humans; Male; Female; Aged; Adult; Middle Aged; Chordoma; Oropharynx; Spine; Carcinoma
PubMed: 38481587
DOI: 10.5455/medarh.2024.78.68-70