Abstract

Resumen

Introduction

Materials and methods

Procedure

Statistics

Results

Discussion

Conclusion

Level of evidence

References

Abstract

Introduction
The correction of thoracic and lumbar spine fractures with a short instrumentation using Schanz screws, is an effective method for stabilization and sagittal balance restoration.

Materials and methods
Bidirectional observational study, included patients undergoing arthrodesis with Schanz screws to manage thoracic and lumbar fractures, the general characteristics, type, and location of the fracture, besides the gain in height of the vertebral body and segmental angle were analyzed before and after surgery. Clinical and imaging control was performed postoperatively and 1 month after this. p-value < .05 was statistically significant.

Results
Of 35 patients undergoing arthrodesis, 13 were excluded due to the absence of images and follow-up. There was a higher proportion of men, the main location of the fracture and AO spine classification was in T12 and type A4/B1 respectively, there was no intraoperative complication, no transfusion was required, and a short hospital stay. A mild complication was presented in the follow-up. The average pre and postoperative change was 12 degrees in the Cobb angle and 5.2 mm vertebral body height in the fractured vertebra, these changes were statistically significant.

Conclusion
Thoracolumbar and lumbar spine fracture correction with short segment fixation using Schanz screws, is an effective, safe and fast, showing significantly vertebral height gain and segmental angle correction, as a consequence, a correction of the balance and alignment of the spine.

Materials and methods

A bidirectional case series study (retrospective and prospective) was performed, of patients who had undergone surgery for arthrodesis with Schanz screws for the management of traumatic thoracic and lumbar fractures. Patients were excluded from the study if data were lacking from their medical records, or there were no control and/or follow-up postoperative images. Sociodemographic information was collected, together with location and type of fracture in accordance with the AO Spine classification,4 pre and postoperative height of the fracture vertebral body and the Cobb angle (also called segmentary angle), and intra and postoperative complications. Regarding clinical and imaging follow-up, this was performed on the first postoperative day and month (Fig. 1). Routine radiography and computerized axial tomography (CAT) was taken for all patients of the thoracic and lumbar spine at the time of the trauma. Given the availability of hospital resources, magnetic resonance of the thoracic and lumbar sacral spine was made of selected patients who were waiting for this, to determine lesion of the posterior ligament complex.

Procedure

The patient was placed in prone position, with upper members extended, with pressure areas protected by rolls. Fluoroscopy marked the mid line and the pedicles of the vertebrae above and below the surgical fracture line. Subperiosteal dissection followed to expose posterior elements of the spine. Biplane fluoroscopy was used to place the Schanz screws bilaterally. The diameter of the screws had been previously measured in imaging. The screws were always to be placed proximal in bloodflow direction for better leverage. Reduction and ligamentotaxis manoeuvres followed with fixation of patellas and rods. Sharp round bur was used for scarification of bone surface and heterologous bone graft placement. Haemostasis was confirmed, layered closure and 1/8 epifascial hemovac drainage was left as required. In some cases, where bone fragments may be found inside the canal, laminectomy and impaction is performed on them (Fig. 2).

1. Background

2. Screening and Diagnosis

3. Management of Osteoporosis and Osteopenia

4. Conclusion

References

Abstract

Osteoporosis and poor bone health effects approximately 200 million people worldwide, with numbers expected to increase as the population ages. Increases in osteoporosis and poor bone health are associated with increased fragility fracture rates, increased morbidity and mortality, and a huge economic burden. Osteoporosis screening and treatment guideline recommendations are currently underutilized resulting in a public health concern. This article describes current osteoporosis screening recommendations, pharmacological interventions, and a collaborative approach to treatment.

Background

Osteoporosis is the most common human bone disease.4 An estimated 10.2 million Americans are living with osteoporosis and 43.4 million more Americans have low bone density, which accounts for 54% of the over-age-50 population. The US prevalence of osteoporosis and osteopenia combined is 35.5 million in women and 18.2 million in men. Osteoporosis and osteoporotic fragility fractures are a growing concern worldwide and are expected to increase with the aging population,1 with an estimated increase of 10.4 million (19%) by 2020 and 17.2 million (32%) by 2030.2 Approximately 50% of Caucasian females and 20% of males will experience an osteoporotic-related fracture of the hip, wrist, or spine in their lifetime.4,5 Although the number of men with osteoporosis is lower than the number of women with the disease, the incidence of fractures in males with osteoporosis is higher than the risk of fracture in women with osteoporosis,6 at least partially owing to gender inequalities in testing and treatment.

Mortality following hip fracture is 2.8 to 4.0 times greater in the first 3 months postfracture than in similarly aged individuals without a hip fracture. Hip fracture survivors often experience a downward spiral in physical and mental health. After a hip fracture, 80% of patients are unable to perform basic tasks, 64% require a stay in a nursing home, and 20% will remain in a nursing home for the remainder of their life. In patients with hip fractures, 40% never regain their prefracture level of function.4,8 Many experience isolation, depression, and fear of falls with subsequent fractures. These mental health issues often elevate to the point of incapacitation.4,8 Hip fractures create a huge economic burden as well. More than $20 billion in health care is spent on osteoporosisrelated hip fractures annually.

1- Introduction

2- Heritability of bone properties

3- Fracture risk: an extremely complex trait

4- Genetic studies of bone mineral density

5- Genetic studies of fracture risk

6- Genetic studies of other bone parameters

7- Variance explained in bone traits by bone-associated variants

8- Biological pathways underlying common bone conditions

9- The fulfilled and unfulfilled promises of genomics

10- Post-GWAS analyses and concluding remarks

References

Abstract

Osteoporosis and fracture risk are common complex diseases, caused by an interaction of numerous disease susceptibility genes and environmental factors. With the advances in genomic technologies, large-scale genomewide association studies (GWAS) have been performed which have broadened our understanding of the genetic architecture and biological mechanisms of complex disease. Currently, more than ~90 loci have been found associated with DXA derived bone mineral density (BMD), over ~500 loci with heel estimated BMD and several others with other less widely available bone parameters such as bone geometry, shape, and microarchitecture. Notably, several of the pathways identified by the GWAS efforts correspond to pathways that are currently targeted for the treatment of osteoporosis. Overall, tremendous progress in the field of the genetics of osteoporosis has been achieved with the discovery of WNT16, EN1, DAAM2, and GPC6 among others. Assessment of the function and biological mechanisms of the remaining genes may further untangle the complex genetic landscape of osteoporosis and fracture risk. With this review we aimed to provide a general overview of the existing GWAS studies on osteoporosis traits and fracture risk.

Introduction

Osteoporosis is a progressive silent disease with devastating clinical and economic consequences. Approximately 1/3 of postmenopausal women suffer osteoporosis worldwide and at least half of these will experience a fragility fracture during their lifetime. Fragility fractures are often associated with increased morbidity and mortality, dramatically decreasing quality of life [1–3]. As population age, the prevalence of osteoporosis and its sequelae will increase substantially, becoming one of the largest global healthcare burdens. Osteoporosis and fracture risk are determined by a complex interplay of genetic and environmental factors. Positive family history of osteoporosis is an important risk factor for fracture, which underscores the pivotal relationship between an individual’s genetic makeup and disease susceptibility. Many monogenic forms of bone fragility have been identified, which are caused by a single mutation in a gene that has a major role in skeletal biology such as observed in X-linked osteoporosis, osteogenesis imperfecta and Paget disease among many others [4]. However, these monogenic mutations explain a very small fraction of the variation in bone mineral density (BMD) and osteoporosis risk in the general population.