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BMC Geriatrics Mar 2023Polypharmacy is a growing public health problem occurring in all healthcare settings worldwide. Elderly patients with lumbar spinal canal stenosis (LSS) who manifest low...
BACKGROUND
Polypharmacy is a growing public health problem occurring in all healthcare settings worldwide. Elderly patients with lumbar spinal canal stenosis (LSS) who manifest low back and neuropathic pain and have a high frequency of comorbidity are predicted to take many drugs. However, no studies have reported polypharmacy in elderly patients with LSS. Thus, we aimed to review the polypharmacy among elderly LSS patients with elective surgeries and examine how the surgical treatment reduces the polypharmacy.
METHODS
We retrospectively enrolled all the patients aged ≥ 65 years who underwent spinal surgery for LSS between April 2020 and March 2021. The prescribed drugs of participants were directly checked by pharmacists in the outpatient department preoperatively and 6-month and 1-year postoperatively. The baseline characteristics were collected beside the patient-based outcomes including Roland-Morris Disability Questionnaire, Zurich Claudication Questionnaire, and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ). The cutoff number of drugs for polypharmacy was defined as 6. The prescription drugs were divided into 9 categories: drugs for neuropsychiatric, cardiovascular, respiratory, digestive, endocrine metabolic, and urinary renal diseases; blood products; pain relief medication; and others.
RESULTS
A total of 102 cases were finally analyzed, with a follow-up rate of 78.0%. Of the participants, the preoperative polypharmacy prevalence was 66.7%. The number of drugs 6-month and 1-year postoperatively was significantly less than the preoperative one. The proportions of polypharmacy at 6 months and 1 year after surgery significantly decreased to 57.8% and 55.9%, respectively. When the prescribed drugs were divided into 9 categories, the number of drugs for pain relief and digestive diseases was significantly reduced after surgery. The multi-variable analysis revealed that a higher score in the psychological disorder of JOABPEQ was associated with 3 or more drugs decreased 1-year postoperatively (OR, 2.5; 95% CI: 1.0-6.1).
CONCLUSION
Polypharmacy prevalence was high among elderly LSS patients indicated for lumbar spinal surgery. Additionally, our data showed that lumbar spinal surgery was effective in reducing polypharmacy among elderly LSS patients. Finally, the multi-variable analysis indicated that better psychological condition was associated with the reduction of prescribed drugs after lumbar spinal surgery.
Topics: Aged; Humans; Retrospective Studies; Decompression, Surgical; Constriction, Pathologic; Polypharmacy; Lumbar Vertebrae; Spinal Stenosis; Spinal Canal; Pain; Treatment Outcome
PubMed: 36964497
DOI: 10.1186/s12877-023-03853-x -
European Spine Journal : Official... May 2009Load and activity changes of the spine typically cause symptoms of nerve root compression in subjects with spinal stenosis. Protrusion of the intervertebral disc has...
Load and activity changes of the spine typically cause symptoms of nerve root compression in subjects with spinal stenosis. Protrusion of the intervertebral disc has been regarded as the main cause of the compression. The objective was to determine the changes in the size of the lumbar spinal canal and especially those caused by the ligamentum flavum and the disc during loaded MRI. For this purpose an interventional clinical study on consecutive patients was made. The lumbar spines in 24 supine patients were examined with MRI: first without any external load and then with an axial load corresponding to half the body weight. The effect of the load was determined through the cross-sectional areas of the spinal canal and the ligamentum flavum, the thickness of ligamentum flavum, the posterior bulge of the disc and the intervertebral angle. External load decreased the size of the spinal canal. Bulging of the ligamentum flavum contributed to between 50 and 85% of the spinal canal narrowing. It was concluded that the ligamentum flavum, not the disc had a dominating role for the load induced narrowing of the lumbar spinal canal, a finding that can improve the understanding of the patho-physiology in spinal stenosis.
Topics: Adult; Female; Humans; Intervertebral Disc; Ligamentum Flavum; Lumbosacral Region; Magnetic Resonance Imaging; Male; Middle Aged; Radiculopathy; Radiography; Spinal Canal; Spinal Stenosis; Weight-Bearing
PubMed: 19277726
DOI: 10.1007/s00586-009-0919-7 -
Journal of Orthopaedic Research :... Mar 2011Activating mutations in FGFR3 cause the most common forms of human dwarfism: achondroplasia and thanatophoric dysplasia. In mouse models of achondroplasia, recent...
Activating mutations in FGFR3 cause the most common forms of human dwarfism: achondroplasia and thanatophoric dysplasia. In mouse models of achondroplasia, recent studies have implicated the ERK MAPK pathway, a pathway activated by FGFR3, in creating reduced bone growth. Our recent studies have indicated that increased Fgfr3 and ERK MAPK signaling in chondrocytes also causes premature synchondrosis closure in the cranial base and vertebrae, accounting for the sometimes fatal stenosis of the foramen magnum and spinal canal in achondroplasia. Conversely, whether the decrease--or inactivation--of ERK1 and ERK2 promotes bone growth and delays synchondrosis closure remains to be investigated. In this study, we inactivated ERK2 in the chondrocytes of ERK1-null mice using the Col2a1-Cre and Col2a1-CreER transgenes. We found that the genetic inactivation of ERK1 and ERK2 in chondrocytes enhances the growth of cartilaginous skeletal elements. We also found that the postnatal inactivation of ERK1 and ERK2 in chondrocytes delays synchondrosis closure and enlarges the spinal canal. These observations make ERK1 and ERK2 an attractive target for the treatment of achondroplasia and other FGFR3-related skeletal syndromes.
Topics: Achondroplasia; Animals; Bone Development; Chondrocytes; Disease Models, Animal; Gene Expression Regulation, Developmental; Gene Expression Regulation, Enzymologic; Humans; MAP Kinase Signaling System; Mice; Mice, Mutant Strains; Mitogen-Activated Protein Kinase 1; Mitogen-Activated Protein Kinase 3; Spinal Canal; Spine; Tibia
PubMed: 20922792
DOI: 10.1002/jor.21262 -
Calcified Tissue International Aug 2010The treatment of osteoporotic patients with teriparatide is associated with a significant increase in bone formation and gain of bone mass. The purpose of this post hoc... (Randomized Controlled Trial)
Randomized Controlled Trial
The treatment of osteoporotic patients with teriparatide is associated with a significant increase in bone formation and gain of bone mass. The purpose of this post hoc analysis was to determine if the cross-sectional area (CSA) of the spinal canal and the vertebral body is affected by teriparatide treatment. Narrowing of the spinal canal might represent a safety problem, while widening of the vertebral CSA might improve mechanical stability. High-resolution computed tomography (HRCT) scans of vertebra T12 were obtained at baseline and after 6, 12, and 24 months of teriparatide treatment (20 microg/day) from 44 postmenopausal women with established osteoporosis participating in the prospective, randomized EUROFORS study. The CSA of the spinal canal did not decrease but increased marginally by 0.9% (2.6 mm(2)) over 24 months (P < 0.001), with a range from -0.5% (-2 mm(2)) to 3.1% (+8 mm(2)). Even when analyzing the spinal CSA on a slice-by-slice basis, no clinically relevant narrowing of the spinal canal was observed. For vertebral bodies, the CSA increased by 0.7% (5.7 mm(2)) over 24 months (P < 0.001), with a range from -0.4% (-3 mm(2)) to 1.6% (+14 mm(2)). Our data do not provide evidence for safety concerns regarding spinal canal narrowing. On the other hand, the increases observed for vertebral CSA apparently also only minimally contribute to the mechanical strengthening of the vertebral body under teriparatide treatment.
Topics: Aged; Bone Density Conservation Agents; Bone Diseases, Developmental; Craniofacial Abnormalities; Female; Growth Disorders; Humans; Middle Aged; Osteoporosis; Postmenopause; Prospective Studies; Spinal Canal; Spine; Teriparatide; Thoracic Vertebrae; Tomography, X-Ray Computed
PubMed: 20571786
DOI: 10.1007/s00223-010-9386-8 -
European Spine Journal : Official... Mar 2014To determine the reliability of pedicle screws placed in children younger than 7 years of age, and to evaluate the effect of pedicle screw insertion on further growth of...
PURPOSE
To determine the reliability of pedicle screws placed in children younger than 7 years of age, and to evaluate the effect of pedicle screw insertion on further growth of the vertebra and spinal canal.
METHODS
A retrospective study of 35 consecutive patients through Jan 2003-Dec 2010 for congenital scoliosis in <7 years children was performed at one spine center. Patients undergoing pedicle screw instrumentation of at least two levels, which had been followed-up for at least 24 months were included. Measurements were performed in instrumented and adjacent non-instrumented levels. The effect of pedicle screw insertion on further growth was evaluated.
RESULTS
The average age at surgery was 4.4 year (53 months, range, 23-84 months). 190 segments in 35 patients met the inclusion criteria. 77 segments had no screws and 113 had at least one screw. There was a significant difference between the pre-operative and final follow-up values of the measurement of spinal canal and vertebral body parameters (P < 0.001). No significant difference existed between growth rates of vertebral bodies and the sagittal diameters of spinal canal with or without screws. The growth rates of vertebral bodies in lumbar spine were higher than in thoracic spine in both instrumented and adjacent groups.
CONCLUSION
Pedicle screw instrumentation does not cause a retardation effect on the development of vertebral bodies and the spinal canal in children at an early age. It is a safe and reliable procedure to achieve a stable fixation.
Topics: Bone Screws; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Infant; Lumbar Vertebrae; Male; Radiography; Reproducibility of Results; Retrospective Studies; Spinal Canal; Spinal Fusion; Spine; Thoracic Vertebrae
PubMed: 24221917
DOI: 10.1007/s00586-013-3035-7 -
Journal of Magnetic Resonance Imaging :... Dec 2011To develop a method for derivation of the cranial-spinal compliance distribution, assess its reliability, and apply to obese female patients with a diagnosis of...
PURPOSE
To develop a method for derivation of the cranial-spinal compliance distribution, assess its reliability, and apply to obese female patients with a diagnosis of idiopathic intracranial hypertension (IIH).
MATERIALS AND METHODS
Phase contrast-based measurements of blood and cerebrospinal fluid (CSF) flows to, from, and between the cranial and spinal canal compartments were used with lumped-parameter modeling to estimate systolic volume and pressure changes from which cranial and spinal compliance indices are obtained. The proposed MRI indices are analogous to pressure volume indices (PVI) currently being measured invasively with infusion-based techniques. The consistency of the proposed method was assessed using MRI data from seven aged healthy subjects. Measurement reproducibility was assessed using five repeated MR scans from one subject. The method was then applied to compare spinal canal compliance contribution in seven IIH patients and six matched healthy controls.
RESULTS
In the healthy subjects, as expected, spinal canal contribution was consistently larger than the cranial contribution (average value of 69%). Measurement variability was 8%. In IIH, the spinal canal contribution is significantly smaller than normal controls (60 versus 78%, P < 0.03).
CONCLUSION
An MRI-based method for derivation of compliance indices analogous to PVI has been implemented and applied to healthy subjects. The application of the method to obese IIH patients suggests a spinal canal involvement in the pathophysiology of IIH.
Topics: Adult; Aged; Cerebrospinal Fluid; Compliance; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Models, Theoretical; Pseudotumor Cerebri; Regional Blood Flow; Reproducibility of Results; Skull; Spinal Canal
PubMed: 21972076
DOI: 10.1002/jmri.22799 -
Journal of Orthopaedics and... Sep 2013A cervical Torg ratio of 0.8 has been used as a screening tool to determine the presence of cervical spinal stenosis. However, there have been no studies done to define...
BACKGROUND
A cervical Torg ratio of 0.8 has been used as a screening tool to determine the presence of cervical spinal stenosis. However, there have been no studies done to define the Torg ratio in the lumbar spine for predicting lumbar spinal stenosis (LSS). Torg ratios have never been correlated with the actual calculated canal area as derived from anatomic specimens. The aim of this study was to provide an analysis of the utility of the lumbar Torg ratio for predicting LSS based on objective measurements of skeletal specimens.
MATERIALS AND METHODS
420 adult skeletal specimens from the Hamann Todd Collection in the Cleveland Museum of Natural History were selected. Digital calipers were used to measure the sagittal diameter (SCD), interpedicular distance, pedicle length, and vertebral body diameter. The canal area at each level was calculated using a geometric formula. A standard distribution curve for canal area and Torg ratio was created, and values that were that is less than the mean minus two standard deviations (SD) below the mean were considered stenotic. Regression analysis was performed to determine if the Torg ratio was correlated with canal area, and if a "below normal" Torg ratio was predictive of LSS.
RESULTS
The Torg ratio for 2SD below the mean was defined as 0.43 at L1, 0.43 at L2, 0.41 at L3, 0.38 at L4, 0.37 at L5. Regression analysis revealed a significant association of the Torg ratio with canal area (p < 0.01). A Torg ratio that was less than the mean - 2SD predicted canal stenosis at L2, L3, L4, and L5 (p < 0.01). Using a Torg ratio of <0.5 predicted stenosis with a sensitivity of 86% and specificity of 52% at all lumbar levels.
CONCLUSIONS
Based on the results of our study, we have defined the lower limit of the normal Torg ratio at each level. A Torg ratio of <0.5 predicts LSS and could be a useful radiological tool for LSS screening.
Topics: Adult; Aged; Aged, 80 and over; Black People; Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Predictive Value of Tests; Sensitivity and Specificity; Spinal Canal; Spinal Stenosis; Tissue Banks; White People; Young Adult
PubMed: 23575641
DOI: 10.1007/s10195-013-0237-z -
Fluids and Barriers of the CNS Jan 2020Developing novel therapeutic agents to treat amyotrophic lateral sclerosis (ALS) has been difficult due to multifactorial pathophysiologic processes at work. Intrathecal...
BACKGROUND
Developing novel therapeutic agents to treat amyotrophic lateral sclerosis (ALS) has been difficult due to multifactorial pathophysiologic processes at work. Intrathecal drug administration shows promise due to close proximity of cerebrospinal fluid (CSF) to affected tissues. Development of effective intrathecal pharmaceuticals will rely on accurate models of how drugs are dispersed in the CSF. Therefore, a method to quantify these dynamics and a characterization of differences across disease states is needed.
METHODS
Complete intrathecal 3D CSF geometry and CSF flow velocities at six axial locations in the spinal canal were collected by T2-weighted and phase-contrast MRI, respectively. Scans were completed for eight people with ALS and ten healthy controls. Manual segmentation of the spinal subarachnoid space was performed and coupled with an interpolated model of CSF flow within the spinal canal. Geometric and hydrodynamic parameters were then generated at 1 mm slice intervals along the entire spine. Temporal analysis of the waveform spectral content and feature points was also completed.
RESULTS
Comparison of ALS and control groups revealed a reduction in CSF flow magnitude and increased flow propagation velocities in the ALS cohort. Other differences in spectral harmonic content and geometric comparisons may support an overall decrease in intrathecal compliance in the ALS group. Notably, there was a high degree of variability between cases, with one ALS patient displaying nearly zero CSF flow along the entire spinal canal.
CONCLUSION
While our sample size limits statistical confidence about the differences observed in this study, it was possible to measure and quantify inter-individual and cohort variability in a non-invasive manner. Our study also shows the potential for MRI based measurements of CSF geometry and flow to provide information about the hydrodynamic environment of the spinal subarachnoid space. These dynamics may be studied further to understand the behavior of CSF solute transport in healthy and diseased states.
Topics: Adult; Amyotrophic Lateral Sclerosis; Cerebrospinal Fluid; Computer Simulation; Humans; Hydrodynamics; Magnetic Resonance Imaging; Male; Models, Biological; Spinal Canal; Subarachnoid Space
PubMed: 31959193
DOI: 10.1186/s12987-019-0164-3 -
Bioscience Reports Apr 2018The ongoing chronic inflammation and subsequent fibrosis play an important role in ligamentum flavum (LF) fibrosis and hypertrophy in patients with lumbar spinal canal...
The ongoing chronic inflammation and subsequent fibrosis play an important role in ligamentum flavum (LF) fibrosis and hypertrophy in patients with lumbar spinal canal stenosis (LSCS). Leptin is a chronic inflammatory mediator and involved in the fibrotic process in multiple organ systems. The present study aimed to investigate the role of leptin in LF fibrosis and its related regulatory mechanisms. The LF specimens were obtained during the surgery from 12 patients with LSCS (LSCS group) and 12 control patients with lumbar disc herniation (LDH) group. The morphologic changes and fibrosis score of LF were assessed by Hematoxylin and eosin (H&E) and Masson's trichrome staining respectively. The location and expression of leptin in LF tissues were determined. Then, the LF cells were cultured and exposed to recombinant human leptin (rhleptin). Collagen I and III were used as fibrosis markers and IL-6 was used as the inflammatory factor. As a result, the LF thickness and fibrosis score in the LSCS group were significantly higher than those in the LDH group (<0.05). Leptin was detected in the hypertrophied LF and its expression was substantially increased in the LSCS group and positively correlated with LF thickness and fibrosis score (<0.05). Moreover, our experiments revealed that rhleptin treated LF cells elevated the expression of collagen I and III. Finally, leptin administration induced IL-6 expression via nuclear factor-κB (NF-κB) pathway in LF cell (<0.05). Our study demonstrated novel molecular events for leptin-induced inflammation in LF tissue by promoting IL-6 expression and thus might have potential implications for clarifying the mechanism underlying LF fibrosis and hypertrophy.
Topics: Aged; Cells, Cultured; Female; Fibrosis; Humans; Hypertrophy; Interleukin-6; Leptin; Ligamentum Flavum; Lumbar Vertebrae; Male; Middle Aged; Prospective Studies; Spinal Canal; Spinal Stenosis
PubMed: 29436483
DOI: 10.1042/BSR20171214 -
European Spine Journal : Official... Jul 2010The objective of the study was to report a rare occurrence of dislocation and intrusion of two rib heads into the spinal canal at the convex apex of a post-traumatic... (Review)
Review
The objective of the study was to report a rare occurrence of dislocation and intrusion of two rib heads into the spinal canal at the convex apex of a post-traumatic thoracic scoliosis in an adult in the absence of any neurological impairment. A 47-year-old male presented with a slowly progressive, post-traumatic thoracic scoliosis and a mild aching sensation over the posterior chest wall. The lower limb neurology and bowel and bladder function were normal. There was no clinical evidence of neurofibromatosis. CT scans showed that the 8th and 9th ribs on the convex apex of the scoliotic curve had intruded into the spinal canal and were lying adjacent to the dura and spinal cord. The MRI scan did not show any cord signal intensity changes. Although rib dislocation and intrusion into the spinal canal is uncommon, images should be carefully analysed to rule out this condition in sharp angular scoliotic curves.
Topics: Accidents, Traffic; Bicycling; Clinical Protocols; Humans; Joint Dislocations; Male; Middle Aged; Radiography; Ribs; Scoliosis; Spinal Canal; Spinal Fractures; Thoracic Vertebrae
PubMed: 20582558
DOI: 10.1007/s00586-010-1321-1