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Natural posture for pain-free living : the practice of mindful alignment
\"How to restore healthy posture from childhood for relief from chronic pain, easy flexibility, and enduring strength and vitality well into old age\"-- Provided by publisher.
Book
Teriparatide improves volumetric bone mineral density and fine bone structure in the UIV+1 vertebra, and reduces bone failure type PJK after surgery for adult spinal deformity
Summary
We conducted a prospective comparative study of the effect of teriparatide therapy for preventing vertebral-failure-type PJK after reconstructive surgery for adult spinal deformity. Prophylactic teriparatide improved the volumetric bone mineral density and fine bone structure of the vertebra above the upper-instrumented vertebra and reduced the incidence of vertebral-failure-type PJK.
Introduction
Proximal junctional kyphosis (PJK) is a complication after corrective surgery for spinal deformity. This study sought to determine whether teriparatide (TP) is an effective prophylactic against PJK type 2 (vertebral fracture) in surgically treated patients with adult spinal deformity (ASD).
Methods
Forty-three patients who started TP therapy immediately after surgery and 33 patients who did not receive TP were enrolled in this prospective case series. These patients were female, over 50, surgically treated for ASD, and followed for at least 2 years. Preoperative and postoperative standing whole-spine X-rays and dual-energy X-ray absorptiometry scans, and multidetector CT images obtained before and 6 months after surgery were used to analyze the bone strength in the vertebra above the upper-instrumented vertebra (UIV+1).
Results
Mean age was 67.9 years. After 6 months of treatment, mean hip-bone mineral density (BMD) increased from 0.721 to 0.771 g/cm
2
in the TP group and decreased from 0.759 to 0.729 g/cm
2
in the control group. This percent BMD change between groups was significant (
p
< 0.05). The volumetric BMD (326 to 366 mg/cm
3
) and bone mineral content (BMC) (553 to 622 mg) at UIV+1 were also significantly increased in TP group. The bone volume/tissue volume ratio increased from 46 to 54 % in the TP group, and the trabecular bone thickness and number increased by 14 and 5 %, respectively. At the 2-year follow-up, the PJK type 2 incidence was significantly lower in the TP group (4.6 %) than in the control group (15.2 %;
p
= .02).
Conclusions
Prophylactic TP treatment improved the volumetric BMD and fine bone structure at UIV+1 and reduced the PJK-type 2 incidence.
Journal Article
Both structural damage and inflammation of the spine contribute to impairment of spinal mobility in patients with ankylosing spondylitis
Objective To study the relationship between spinal mobility, radiographic damage of the spine and spinal inflammation as assessed by MRI in patients with ankylosing spondylitis (AS). Methods In this subanalysis of the Ankylosing Spondylitis Study for the Evaluation of Recombinant Infliximab Therapy cohort, 214 patients, representing an 80% random sample, were investigated. Only baseline data were used. MRI inflammation was assessed by the AS spinal MRI activity (ASspiMRI-a) score, structural damage by the modified Stoke AS Spine Score (mSASSS) and spinal mobility by the linear definition of the Bath Ankylosing Spondylitis Metrology Index (BASMI). Univariate correlations were calculated on baseline values using Spearman rank correlation. Independent associations between the variables of interest were investigated by multivariate linear regression analysis. Associations with clinical disease activity, C-reactive protein, disease duration, age, gender, body mass index and HLA-B27 status were also investigated. Subanalyses were performed according to disease duration. Results BASMI correlated moderately well with mSASSS (Spearman's ρ=0.6) and weakly with ASspiMRI-a (ρ=0.3). A best-fit model for BASMI included both mSASSS (regression coefficient (B)=0.865, p<0.001) and ASspiMRI-a (B=0.236, p=0.018). In patients with a disease duration ≤3 years, B was greater for ASspiMRI-a than for mSASSS (0.595 vs 0.380), while in patients with a disease duration >3 years B was greater for mSASSS than for ASspiMRI-a (0.924 vs 0.156). Conclusion Spinal mobility impairment in AS is independently determined both by irreversible spinal damage and by reversible spinal inflammation. Spinal mobility impairment is more influenced by spinal inflammation in early disease, and by structural damage in later disease.
Journal Article
Healthy posture for babies and children : tools for helping children to sit, stand, and walk naturally
\"With a multitude of easy-to-follow principles and exercises--far more fun and effective than the futile mantra of \"sit up straight\"--Kathleen Porter provides a detailed road map for parents, teachers, and health professionals to learn how to guide children back to their natural posture by inhabiting their bodies mindfully for a lifetime of easy movement, strength, and energetic vitality--the hallmarks of enduring good health\"-- Provided by publisher.
Book
IDENTIFYING ACTIONABLE INFORMATION: PREVENTABLE 30-DAY NEUROSURGICAL READMISSIONS
BackgroundHospital readmissions within 30 days after discharge are increasingly recognized as markers of inpatient quality of care and significant contributors to rising healthcare expenditures. Identifying potentially preventable readmission causes and developing targeted interventions is a national priority.ObjectivesTo determine rate, reasons, and potential for prevention for 30-day unplanned neurosurgical readmissions at Yale-New Haven Hospital.MethodsOver a 6-month period, all patients who had been discharged from YNHH after receiving care from the Department of Neurosurgery and readmitted within 30 days were retrospectively identified. In-depth chart analysis was performed to uncover relevant medical/social history and admission/readmission details.ResultsDuring 6 months, 84 (6.6%) of 1,279 patients were readmitted within 30 days. Reasons for readmission were categorized into miscellaneous (34%), non-surgical site infections (15%), postoperative wound complications (14%), intracranial hemorrhage (13%), neurological deficits: brain (10%), CSF device malfunction (8%), neurological deficits: spine (4%), and ischemic CNS events (2%). Most complications were moderate (54%) or mild (31%). Overall, 17% of readmissions were determined to be likely preventable, 10% – potentially preventable, 73% – not preventable. Notably, 42% of postoperative wound complications and 32% of brain-related neurological deficits could have been prevented. 49% of readmissions were related to initial hospitalization and 12% resulted from inappropriate post-discharge care; 34% and 88% of those, respectively, were preventable.ConclusionsOverall, 27% of 30-day neurosurgical readmissions were determined to be potentially preventable. Underlying reasons were identified and will be used to design targeted interventions. Preventing postoperative wound complications and providing appropriate discharge arrangements/instructions are the most promising areas of improvement.
Journal Article
On thin ice
The way twelve-year-old Ked Eakins of Norton, Maine, sees it, his life has been stolen from him, piece by piece--first by kyphosis, a spinal abnormality which has made him a social outcast at school and a target for the school bully; by his friends who have recently abandoned him; by his mother, who left for the West Coast taking the insurance which might have saved him with her; and by his father, who's a gambling addict who has lost the rent money. But Ked is a builder, and using the school's Maker Space he intends to build his life back, and maybe make a few real friends, and save his father while he's at it.
Book
Intraosseous basivertebral nerve ablation for the treatment of chronic low back pain: a prospective randomized double-blind sham-controlled multi-center study
PurposeTo evaluate the safety and efficacy of radiofrequency (RF) ablation of the basivertebral nerve (BVN) for the treatment of chronic low back pain (CLBP) in a Food and Drug Administration approved Investigational Device Exemption trial. The BVN has been shown to innervate endplate nociceptors which are thought to be a source of CLBP.MethodsA total of 225 patients diagnosed with CLBP were randomized to either a sham (78 patients) or treatment (147 patients) intervention. The mean age within the study was 47 years (range 25–69) and the mean baseline ODI was 42. All patients had Type I or Type II Modic changes of the treated vertebral bodies. Patients were evaluated preoperatively, and at 2 weeks, 6 weeks and 3, 6 and 12 months postoperatively. The primary endpoint was the comparative change in ODI from baseline to 3 months.ResultsAt 3 months, the average ODI in the treatment arm decreased 20.5 points, as compared to a 15.2 point decrease in the sham arm (p = 0.019, per-protocol population). A responder analysis based on ODI decrease ≥ 10 points showed that 75.6% of patients in the treatment arm as compared to 55.3% in the sham control arm exhibited a clinically meaningful improvement at 3 months.ConclusionPatients treated with RF ablation of the BVN for CLBP exhibited significantly greater improvement in ODI at 3 months and a higher responder rate than sham treated controls. BVN ablation represents a potential minimally invasive treatment for the relief of chronic low back pain.Graphical abstractThese slides can be retrieved under Electronic Supplementary Material.
Journal Article
MRI vertebral corner inflammation followed by fat deposition is the strongest contributor to the development of new bone at the same vertebral corner: a multilevel longitudinal analysis in patients with ankylosing spondylitis
ObjectivesTo study the sequential relationship between MRI vertebral corner inflammation (VCI), vertebral corner fat deposition (VCFD) and the development/growth of radiographic syndesmophytes at the same vertebral corner (VC).MethodsBaseline, 24 and 102 weeks spinal MRIs were assessed for the presence/absence of VCI and VCFD. Anterior VCs of lateral radiographs of the cervical and lumbar spine (baseline and 102 weeks) were assessed for the development of new bone (syndesmophyte formation or syndesmophyte formation/growth combined). Data from 161 to 177 patients were analysed at the VC level using two-way and multilevel analyses adjusting for within-patient correlation and MRI reader (generalised estimating equations for binomial outcomes).ResultsThe presence of VCI (adjusted (adj) OR 1.75 to 1.98) as well as the presence of VCFD (adjOR 1.60 to 2.32) at any time point (TP) were significantly associated with the development of new bone. The combination of VCI and VCFD at the same VC increased the strength of the association, both for the sequential or simultaneous presence of VCI and VCFD across the three TPs (adjOR 2.12 to 2.73), as well as for the development of new VCFD preceded by VCI at a previous TP (adjOR 2.12 to 3.01). The complete absence of both VCI and VCFD across the three TPs ‘protected’ against new bone formation (adjOR 0.45 to 0.62). However, 40–66% of new bone still developed in VCs without MRI inflammation or fat degeneration at any of the three TPs.ConclusionsBoth VCI and VCFD contribute to new bone formation in ankylosing spondylitis (AS), especially if VCI precedes VCFD. However, VCI, VCFD and this particular sequence of events only partially explain the development of new bone in AS.
Journal Article
Fully Endoscopic Spine Separation Surgery in Metastatic Disease—Case Series, Technical Notes, and Preliminary Findings
Objective: This report aims to describe the surgical methodology and potential effectiveness of endoscopic separation surgery (ESS) in patients with metastatic spine disease. This concept may reduce the invasiveness of the procedure, which can potentially speed up the wound healing process and, thus, the possibility of faster application of radiotherapy. Materials and Methods: In this study, separation surgery for preparing patients for stereotactic body radiotherapy (SBRT) was performed with fully endoscopic spine surgery (FESS) followed by percutaneous screw fixation (PSF). Results: Three patients with metastatic spine disease in the thoracic spine were treated with fully endoscopic spine separation surgery. The first case resulted in the progression of paresis symptoms that resulted in disqualification from further oncological treatment. The remaining two patients achieved satisfactory clinical and radiological effects and were referred for additional radiotherapy. Conclusions: With advancements in medical technology, such as endoscopic visualization, and new tools for coagulation, we can treat more and more spine diseases. Until now, spine metastasis was not an indication for the use of endoscopy. This method is very technically challenging and risky, especially at such an early stage of application, due to variations in the patient’s condition, morphological diversity, and the nature of metastatic lesions in the spine. Further trials are needed to determine whether this new approach to treating patients with spine metastases is a promising breakthrough or a dead end.
Journal Article