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lumbar spine - Top 30 Publications

Letter to the editor concerning "Do we have the right PROMs for measuring outcomes in lumbar spinal surgery?" by O.M. Stokes et al. Eur Spine J (2017) 26:816-824.

Role of Fat and Bone Biomarkers in the Relationship Between Ethnicity and Bone Mineral Density in Older Men.

Osteoporosis is an important health issue for older adults, and has been relatively understudied in older men. This study aimed to examine ethnic differences in bone mineral density (BMD), and elucidate the role of bone turnover markers (BTMs), fat and fat biomarkers on these ethnic differences. BMD at the lumbar spine and femoral neck, marrow fat at femoral neck, visceral adipose tissue (VAT) and subcutaneous adipose tissue, bone and fat biomarkers were evaluated in 120 healthy men aged ≥ 60 years. Indians had higher BMD values compared to Chinese at the lumbar spine (β = 20.336, SE = 4.749, p < 0.001) and the femoral neck (e (β)  = 1.105, SE = 0.032, p < 0.001), after adjusting for BTMs, fat composition and lifestyle choices. Marrow fat, VAT and adiponectin were independent predictors of BMD. However, these factors did not explain the lower BMD observed in older Chinese men. Our findings suggest that older Chinese men are at significant risk of osteoporotic fractures due to lower BMD. Fat appears to be a key factor associated with lower BMD, and warrants further longitudinal studies to elucidate the complex interactions between adipose tissue and bone strength.

Effects of mirror placement on sagittal alignment of the spine during acquisition of full-spine standing X-Rays.

The line of sight when whole-spine radiographs are taken has not been defined. In our 2012 health screening study (TOEI study), whole-spine radiographs were taken with the volunteers in the most relaxed position and with a horizontal gaze. However, in the TOEI 2014 study, a mirror was placed in front of their faces to unify their line of sight. To our knowledge, there are no reports on how the sagittal alignment changes when radiographs are taken using a mirror. The purpose of this study was to investigate how mirror placement impacted sagittal spinal alignment in whole-spine radiographs taken while standing.

The relationship between fatty liver index and bone mineral density in Koreans: KNHANES 2010-2011.

Analyses using a nationally representative cohort have revealed that high fatty liver index (FLI) is associated with low bone mineral density (BMD) regardless of insulin resistance in men, thereby supporting the deteriorated bone metabolism in nonalcoholic fatty liver disease (NAFLD).

Effect of Androgen Deprivation Therapy on Bone Mineral Density in a Prostate Cancer Cohort in New Zealand: A Pilot Study.

Reduction in bone mineral density (BMD) is a common side effect of androgen deprivation therapy (ADT). We aimed to examine the cross-sectional and longitudinal variation in BMD and associated bone markers in patients with nonmetastatic prostate cancer (PCa) managed with and without ADT.

Food engorgement in 35 dogs (2009-2013) compared with 36 dogs with gastric dilation and volvulus.

The clinical features and management of food engorgement (FE) in dogs have not been previously described. This retrospective observational study describes characteristics and outcome of 35 dogs with FE, and compares features on presentation to 36 dogs with gastric dilation and volvulus (GDV). Cases were retrospectively reviewed for history, clinical findings and outcome. Gastric distension was measured by caudal gastric margin (CGM), level with lumbar vertebrae, on a lateral abdominal radiograph. Frequent characteristics of dogs with FE included tachycardia, tachypnoea, hyperproteinaemia, increased base excess (BE), mild hypernatraemia and hyperlactataemia. There was overlap in CGM between dogs with GDV (CGM range L3 to >L6) and dogs with FE (CGM range <L2 to L5-L6). In contrast to dogs with GDV, lactate concentration in dogs with FE was not associated with CGM or BE. Dogs with FE mostly received medical intervention consisting of fluid therapy and analgesia, and all dogs survived to discharge. In conclusion, dogs with FE frequently presented with acid-base and electrolyte derangements, including hyperlactataemia. While dogs with FE can have gastric distension as severe as that seen with GDV, outcome with supportive care only is excellent.

Minimal invasive lumbar spine revision surgery at distance from the dura and postsurgical scar tissue: Extraforaminal Lumbar Interbody Fusion (ELIF).

Lumbar spine revision surgery is considered as challenging and related to longer operation time and complications because of the loss of anatomical landmarks and the formation of postoperative epidural fibrosis. Minimal invasive lumbar spinal surgery techniques have been refined over the last 5 years but the reexposure of the dura, the formation of postsurgical scar tissue and related dural tears remain a source of complications. For lumbar spinal revision surgery we advocate the minimal invasive Extraforaminal Lumbar Interbody Fusion (ELIF) technique. It employs a working corridor of 45° relative to the midline. This angle permits bypassing laterally the dural sac and postoperative epidural fibrosis so that dural tears do not occur. ELIF is performed without an expandable tubular retractor system, it is atraumatic following the natural intermuscular cleavage plane between the multifidus muscle and the longissimus thoracis muscle pars lumborum. Postoperatively the muscles do not show signs atrophy or fatty degeneration. In case of discectomy alone there is no need for the removal of the facets, if intracanalar lesions are targeted the partial removal of the superior facet is sufficient. ELIF represents an alternative to posterior lumbar interbody fusion (PLIF), conventional open transforaminal lumbar interbody fusion (TLIF), and minimal invasive (MIS) TLIF for lumbar spinal revision surgery.

A case of conus medullaris teratoma.

In this report, we present a case of an adult patient with a mature teratoma of the conus medullaris. The patient was a 29-year-old postpartum female patient who developed unexplained urinary retention. Lumbar spine magnetic resonance imaging (MRI) examination revealed an intradural partly enhancing mixed cystic and solid lesion with intralesional intrinsic T1 hyperintense components that were suppressed on fat suppressed sequences, inseparable from the conus medullaris. Surgical resection was performed and histopathology findings were consistent with a mature teratoma. The patient made a complete recovery.

Adjacent Segment Disease 44 Years Following Posterior Spinal Fusion for Congenital Lumbar Kyphosis.

Case report.

Timing of Changes in Three-Dimensional Spinal Parameters After Selective Thoracic Fusion in Lenke 1 Adolescent Idiopathic Scoliosis: Two-Year Follow-up.

Retrospective analysis of the prospectively collected data.

Postoperative Spine Dressing Changes Are Unnecessary.

There is minimal literature regarding when dressing changes should be performed. We present the dressing change protocol adopted by our institution. The purpose of this study was to provide an update of our experience with this dressing change protocol over a 15-year period.

Association of Bone Mineral Density With the Risk of Intracranial Aneurysm.

Disruption of extracellular matrix integrity is critically involved in both intracranial aneurysm and bone fragility. Furthermore, both intracranial aneurysm and osteoporosis have a female predominance, and sex hormones are considered to affect this discrepancy.

Explanatory Versus Pragmatic Trials: An Essential Concept in Study Design and Interpretation.

Randomized clinical trials often represent the highest level of clinical evidence available to evaluate the efficacy of an intervention in clinical medicine. Although the process of randomization serves to maximize internal validity, the external validity, or generalizability, of such studies depends on several factors determined at the design phase of the trial including eligibility criteria, study setting, and outcomes of interest. In general, explanatory trials are optimized to demonstrate the efficacy of an intervention in a highly selected patient group; however, findings from these studies may not be generalizable to the larger clinical problem. In contrast, pragmatic trials attempt to understand the real-world benefit of an intervention by incorporating design elements that allow for greater generalizability and clinical applicability of study results. In this article we describe the explanatory-pragmatic continuum for clinical trials in greater detail. Further, a well-accepted tool for grading trials on this continuum is described, and applied, to 2 recently published trials pertaining to the surgical management of lumbar degenerative spondylolisthesis.

A focused evaluation of lumbar spine trabecular bone score in the first year post-menarche.

Trabecular bone score, an index of lumbar spine trabecular texture, has not been explored fully in adolescent girls. Our cross-sectional analysis supported the hypothesis that "adult normal" trabecular bone score has been achieved by the end of the first year post-menarche, providing a potential screening tool, independent from bone density.

The role of the paravertebral muscles in adolescent idiopathic scoliosis evaluated by temporary paralysis.

Muscle imbalance has been suggested as implicated in the pathology of adolescent idiopathic scoliosis (AIS). The specific "pathomechanic" role of the paravertebral muscles as being scoliogenic (inducing scoliosis) or counteracting scoliosis in the initial development and maintenance of this spinal deformity has yet to be clarified in humans. In the present study, we investigated the radiographic changes of temporal paralysis using botulinum toxin A as localized injection therapy (ITB) in the psoas major muscle in AIS patients.

Nonsteroidal anti-inflammatory drugs for postoperative pain control after lumbar spine surgery: A meta-analysis of randomized controlled trials.

Nonsteroidal anti-inflammatory drugs (NSAIDs) play a role in pain relief, especially in postoperative pain caused by inflammation. They have demonstrated significant opioid dose-sparing effects, which help in reducing postoperative effects and opioid side effects. The objective of this meta-analysis was to explore the role of NSAIDs in reducing postoperative pain at different time intervals and provide reference for medication after lumbar spine surgery by a meta-analysis of randomized controlled trials (RCT).

Cause analysis of spinal surgery in ankylosing spondylitis.

To investigate the common cause of spinal surgery in ankylosing spondylitis (AS) and to develop reasonable and effective treatment programs for rhematologists.

Surgery for herniated lumbar disc in daily tobacco smokers: A multicenter observational study.

Incidence and predictive factors of spinal cord stimulation treatment after lumbar spine surgery.

Spinal cord stimulation (SCS) is recommended for the treatment of postsurgical chronic back and leg pain refractory to other treatments. We wanted to estimate the incidence and predictive factors of SCS treatment in our lumbar surgery cohort.

Impact of restricting diagnostic imaging reimbursement for uncomplicated low back pain in Ontario: a population-based interrupted time series analysis.

In 2012, the Ontario government withdrew public insurance coverage of imaging tests for uncomplicated low back pain. We studied the impact of this restriction on test ordering by physicians.

Pregnancy-related low back pain in women in turkey: prevalence and risk factors.

To investigate the prevalence of pregnancy-related low back pain (PRLBP) in women in Turkey, identify the factors associated with PRLBP and predict the risk of PRLBP.

Preliminary Experience with a Novel System of Facet Fixation to Treat Patients with Lumbar Degenerative Disease. A New Perspective in Minimally Invasive Spine Surgery?

Ratio of Endogenous Secretory Receptor for Advanced Glycation End Products to Pentosidine Predicts Fractures in Men.

Although the endogenous secretory receptor for advanced glycation end products (esRAGE) has been associated with reduced activity of pentosidine (PEN), the association between PEN, esRAGE, and fracture is poorly understood.

Effect of 2 years of endurance and high-impact training on preventing osteoporosis in postmenopausal women: randomized clinical trial.

The aim of the study was to analyze the effects of endurance and high-impact training oriented toward preventing osteoporosis in postmenopausal women with calcium and vitamin D supplementation.

Lateral Lumbar Interbody Fusion-Outcomes and Complications.

Lateral lumbar interbody fusion (LLIF) is a relatively new, minimally invasive technique for interbody fusion. The goal of this review is to provide a general overview of LLIF with a special focus on outcomes and complications.

Chiropractic care and risk for acute lumbar disc herniation: a population-based self-controlled case series study.

Chiropractic care is popular for low back pain, but may increase the risk for acute lumbar disc herniation (LDH). Low back pain is a common early (prodromal) symptom of LDH and commonly precedes LDH diagnosis. Our objective was to investigate the association between chiropractic care and acute LDH with early surgical intervention, and contrast this with the association between primary care physician (PCP) care and acute LDH with early surgery.

Estimation of in vivo inter-vertebral loading during motion using fluoroscopic and magnetic resonance image informed finite element models.

Finite element (FE) models driven by medical image data can be used to estimate subject-specific spinal biomechanics. This study aimed to combine magnetic resonance (MR) imaging and quantitative fluoroscopy (QF) in subject-specific FE models of upright standing, flexion and extension. Supine MR images of the lumbar spine were acquired from healthy participants using a 0.5 T MR scanner. Nine 3D quasi-static linear FE models of L3 to L5 were created with an elastic nucleus and orthotropic annulus. QF data was acquired from the same participants who performed trunk flexion to 60° and trunk extension to 20°. The displacements and rotations of the vertebrae were calculated and applied to the FE model. Stresses were averaged across the nucleus region and transformed to the disc co-ordinate system (S1 = mediolateral, S2 = anteroposterior, S3 = axial). In upright standing S3 was predicted to be -0.7 ± 0.6 MPa (L3L4) and -0.6 ± 0.5 MPa (L4L5). S3 increased to -2.0 ± 1.3 MPa (L3L4) and -1.2 ± 0.6 MPa (L4L5) in full flexion and to -1.1 ± 0.8 MPa (L3L4) and -0.7 ± 0.5 MPa (L4L5) in full extension. S1 and S2 followed similar patterns; shear was small apart from S23. Disc stresses correlated to disc orientation and wedging. The results demonstrate that MR and QF data can be combined in a participant-specific FE model to investigate spinal biomechanics in vivo and that predicted stresses are within ranges reported in the literature.

Predicting Injury Severity and Neurologic Recovery after Acute Cervical Spinal Cord Injury - A Comparison of Cerebrospinal Fluid and Magnetic Resonance Imaging Biomarkers.

Biomarkers of acute human spinal cord injury (SCI) could provide a more objective measure of spinal cord damage and a better predictor of neurologic outcome than the current functional neurologic assessments. There has been growing interest in establishing neurochemical biomarkers using cerebrospinal fluid (CSF) and also imaging biomarkers using measurable features on MRI. In this study, we took the opportunity to compare CSF biomarkers and MRI biomarkers in a cohort of acute cervical SCI patients who had undergone both CSF sampling and pre-operative MRI scanning. From our prospective clinical trial of acute SCI in which lumbar intrathecal catheters were implanted for CSF sampling, we identified 36 cervical SCI patients at our institution who had also undergone pre-operative MRIs. From the CSF samples at 24 hours post-injury, the concentrations of inflammatory cytokines (IL-6, IL-8, MCP-1) and structural proteins (tau, GFAP, S100) were measured. From the pre-operative MRI scans, we measured the vertical length of edema, hematoma length, hematoma extent, CSF effacement, and maximum cord expansion were measured, and maximum cord compression was calculated. Baseline and 6-month post-injury assessments of AIS grade and motor score were conducted. Both MRI measures and CSF biomarker levels were found to correlate with baseline injury grade. For predicting neurologic recovery, the inflammatory biomarker levels predicted AIS grade conversion, while structural biomarker levels predicted motor score improvement. The use of CSF biomarkers alone in a prediction model was found to have 91.2% accuracy. In a direct comparison of MRI biomarkers with CSF biomarkers, the CSF biomarkers discriminate better between different injury severities, and are stronger predictors of neurologic recovery in terms of AIS injury grade and motor score improvement. These findings demonstrate the utility of measuring the acute biologic responses to injury as biomarkers for distinguishing injury severity and predicting neurologic outcome.

Lumbopelvic rhythm during trunk motion in the sagittal plane: A review of the kinematic measurement methods and characterization approaches.

Lumbopelvic rhythm during trunk forward bending and backward return has been widely investigated to have a better understanding of the pattern of trunk motion, as used in research on low back disorders. Considerable differences in the methods used to measure, and approaches used to characterize the lumbopelvic rhythm hinder the integration of findings of those studies for further research in the future. Thus, the purpose of this review was to summarize the methods for kinematic measurement as well as their characterization approaches for the lumbopelvic rhythm. PUBMED and CINAHL databases were searched for relevant studies. Several types of instruments were found to be used in the reviewed studies, mostly using markers or sensors, which were placed on different parts of spine, with different definitions to measure the lumbar and pelvic motion. Also, various characterization approaches were found to be used, of which some related to the magnitude, while the others to the timing aspects of lumbopelvic rhythm. Such a characterization was either qualitative or quantitative. In addition, the specified characterization approaches were applied on a sample of trunk kinematics data from our lab to demonstrate differences in the outcomes of these approaches.

Lumbopelvic rhythm in the sagittal plane: A review of the effects of participants and task characteristics.

Abnormalities of lumbopelvic coordination have been suggested to relate to risk of developing low back pain. The objective of this study is to review and summarize the findings of studies that have implemented and reported on lumbopelvic rhythm during trunk forward bending and backward return.