Academy Library and Information Service Current Awareness Bulletin - Spine May 2021
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Academy Library and Information Service
Current Awareness Bulletin – Spine
May 2021
This Current Awareness Bulletin is produced by Academy Library and Information Service GWH staff with a
range of resources to support practice. It will include recently published systematic reviews, research articles
and details of library resources.
You may be able to access some articles if you have an OpenAthens account. Click on the logo above to register.
For further information or support, please contact the Academy Library on 01793 604596 or email:
gwh.alis@nhs.net.
Resources
BMJ Best Practice uses the latest evidence-based research, guidelines and expert opinion to offer step-by-
step guidance on diagnosis, prognosis, treatment and prevention.
DynaMed study summaries provide brief and clinically oriented descriptions of clinical research studies,
placed in context within the clinical framework. Key elements of a DynaMed study summary include the
study conclusion, level of evidence rating, study type, reference, and study details.
Trip is a clinical search engine designed to allow users to quickly and easily find and use high-quality
research evidence to support their practice and/or care. As well as research evidence we also allow
clinicians to search across other content types including images, videos, patient information leaflets,
educational courses and news.
Original Research
1. A Finite Element Study on the Treatment of Thoracolumbar Fracture with a New Spinal Fixation
System.
Guo Hui BioMed Research International 2021;:1-9.
Objective. In this study, the mechanical properties of the new spinal fixation system (NSFS) in the treatment
of thoracolumbar fractures were evaluated by the finite element analysis method, so as to provide a
mechanical theoretical basis for the later biomechanical experiments and clinical experiments. Methods.
T12-L2 bone model was constructed to simulate L1 vertebral fracture, and three models of internal fixation
systems were established on the basis of universal spinal system (USS): Model A: posterior short-segment
fixation including the fractured vertebra (PSFFV); Model B: short-segment pedicle screw fixation (SSPF);
Model C: new spinal fixation system (NSFS). After assembling the internal fixation system and fracture
model, the finite element analysis was carried out in the ANSYS Workbench 18.0 software, and the stress of
nail rod system, fracture vertebral body stress, vertebral body mobility, and vertebral body displacement
were recorded in the three models. Results. The peak values of internal fixation stress, vertebral body stress,vertebral body maximum displacement, and vertebral body maximum activity in Model C were slightly
smaller than those in Model B. Conclusions. Compared with the traditional internal fixation system, the new
spinal internal fixation system may have the mechanical advantage and can provide sufficient mechanical
stability for thoracolumbar fractures.
Available online at this link
2. A meta-analysis of the secondary fractures for osteoporotic vertebral compression fractures after
percutaneous vertebroplasty.
Zhai Gongwei Medicine 2021;100(16):e25396.
Abstract: To identify the risk factors of the secondary fractures for osteoporotic vertebral compression
fractures (OVCFs) after percutaneous vertebroplasty (PVP).We conducted a search of relevant articles using
Cochrane Library, PubMed, Medline, Science Direct, Embase, the Web of Science and other databases. The
time range we retrieved from establishment of the electronic database to November 2017. Gray studies
were found in the references of included literature reports. STATA version 11.0 (Stata Corporation, College
Station, Texas) was used to analyze the pooled data.Fourteen studies involving 1910 patients, 395 of whom
had fracture secondary to the surgery were included in this meta-analysis. The result of meta-analyses
showed the risk factors of the secondary fractures for OVCFs after PVP was related to bone mineral density
(BMD) [95%CI (-0.650, -0.164), SMD=-0.407, P=.001], cement leakage ((RR=0.596, 95%CI (0.444,0.798),
P = .001)), and kyphosis after primary operation ((SMD=0.741, 95%CI (0.449,1.032), P = .000)), but not to
gender, age, body mass index, cement volume, thoracolumbar spine, and cement injection approaches.Bone
mineral density, cement leakage, and kyphosis after primary operation are the risk factors closely correlative
to the secondary fracture after PVP. There have not been enough evidences to support the association
between the secondary fracture and gender, age, body mass index, cement volume, thoracolumbar spine,
and cement injection approaches. (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health,
Inc.)
Available online at this link
3. A retrospective analysis of the effects of different analgesics on the pain of patients with traumatic
thoracolumbar fractures in the peri-treatment period.
Yuan Hao Journal of Orthopaedic Surgery & Research 2021;16(1):1-10.
Objective: To analyze and compare the effects of peri-treatment analgesics on acute and chronic pain and
postoperative functional recovery of patients with thoracolumbar fractures, so as to guide the clinical drug
use. Methods: Seven hundred nineteen patients with thoracolumbar fractures were collected and divided
into acetaminophen dihydrocodeine, celecoxib, and etoricoxib groups. The main indicators were the degree
of postoperative pain (visual analog scale (VAS)), the incidence of chronic pain and postoperative functional
recovery (Oswestry dysfunction index (ODI) and Japanese Orthopedics Association score (JOA)), which were
continuously tracked through long-term telephone follow-up. The correlation analysis of ODI-pain score,
peri-treatment VAS score, and ODI index was performed, and bivariate regression analysis was conducted to
understand the risk factors for chronic pain. Results: Regression analysis showed that severe spinal cord
injury and peri-treatment use of acetaminophen dihydrocodeine were both one of the risk factors for
postoperative chronic pain. But there were no statistically conspicuous differences in basic characteristics,
preoperative injury, and intraoperative conditions. Compared with the other two groups, patients in the
acetaminophen dihydrocodeine group had longer peri-therapeutic analgesic use, higher pain-related scores
(VAS 1 day preoperatively, VAS 1 month postoperatively, and ODI-pain 1 year postoperatively), higher VAS
variation, higher incidence of chronic pain 1 year after surgery, and higher ODI index. And other ODI items
and JOA assessments showed no statistically significant differences. In addition, the correlation analysis
showed that the peri-treatment pain score was correlated with the severity of postoperative chronic pain.
Conclusion: Although the peri-treatment analgesic effect of acetaminophen dihydrocodeine is good, it is still
necessary to combine analgesics with different mechanisms of action for patients with severe preoperative
pain of thoracolumbar fracture, so as to inhibit the incidence of postoperative chronic pain and improve the
quality of postoperative rehabilitation.
Available online at this link
4. Anterior hybrid construction of multilevel cervical disc disease and spondylotic spinal stenosis:
surgical results and factors affecting adjacent segment problems.
Yilmaz Murat Journal of Orthopaedic Surgery & Research 2021;16(1):1-10.Objective: We aimed to evaluate reliability, radiological outcomes, and the impacts of anterior cervical
hybrid construction on the adjacent segments for the multilevel cervical degenerative disc disease (mCDDD)
and spondylotic spinal stenosis (SSS). Methods: A retrospective analysis was performed using data extracted
from the medical files of 195 patients (105 males, 90 females; mean age: 47.7 years). From 2008 to 2018,
these patients underwent anterior cervical hybrid construction for symptomatic contiguous at least 2-level
cervical degenerative disc diseases and cervical spondylosis. Clinical and radiological data including Neck
Disability Index (NDI), visual analogue scale (VAS), local cervical degenerative disk disease in adjacent
segments on magnetic resonance imaging (MRI) views, and complications were reviewed. Results: The mean
clinical and radiological follow-up was 45.2 months (range 24 to 102). Radiculopathy and/or myelopathy
were the main clinical problems in all patients. The mean VAS scores of HC for arm pain were 7.4 ± 0.8
preoperatively; 2.8 ± 0.6, 1 month after surgery; 2.3 ± 0.6, 6 months after surgery; 1.8 ± 0.6, 12 month after
surgery; and 1.6 ± 0.6, 24 months after surgery. The mean NDI scores (mean ± SD) of HC significantly
improved after surgery (on admission, 57.2 ± 5.5%; 1 month after surgery, 27.35 ± 5.3%; 6 month after
surgery, 21.43 ± 2.8%; 12 months after surgery, 21.9 ± 2.3%; 24 months after surgery, 20.6 ± 2.6%, p =
0.006). Hoarseness and dysphagia were the most common complications and osteophyte formation was the
most frequent radiographic change. Conclusion: Anterior cervical hybrid construction appears to be an
acceptable option in the management of multilevel cervical degenerative disc diseases and spondylotic spinal
stenosis.
Available online at this link
5. Assessment of Quadriceps Corticomotor and Spinal-Reflexive Excitability in Individuals with a
History of Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis.
Rush Justin L. Sports Medicine 2021;51(5):961-990.
Background: Differences in the excitability of motor generating neural pathways are reported following
anterior cruciate ligament reconstruction (ACLR) that is associated with quadriceps dysfunction and
theorized to prevent the full recovery of muscle function. Objective: The aims of this systematic review and
meta-analysis were to compare quadriceps neural excitability between the involved ACLR limb, the
uninvolved limb, and uninjured controls, and to determine at what time intervals these differences are
present after surgery. Methods: We conducted a search of PubMed, SPORTDiscus, Embase, and Web of
Science, and extracted measures assessing difference of quadriceps spinal-reflexive, corticospinal, and
intracortical excitability from studies that compared (1) involved limb to the uninvolved limb, (2) involved
limb to a control limb, or (3) uninvolved limb to a control limb. We stratified time at 24 months, since this
represents a period of heightened risk for reinjury. A modified Downs and Black checklist and Egger's test
were used to determine the methodological quality of individual studies and risk of bias between studies.
Results: Fourteen studies comprising 611 participants (371 individuals with a history of ACLR; median time
from surgery: 31.5 months; range 0.5–221.1 months) were included in the review. Overall, the involved (g =
0.60, 95% CI [0.24, 0.96]) and uninvolved (g = 0.49, 95% CI [0.00, 0.98]) limbs exhibited greater motor
threshold (MT) in comparison to uninjured controls. Motor-evoked potential (MEP) amplitudes were greater
in the uninvolved limb in comparison to uninjured controls (g = 0.31, 95% CI [0.03, 0.59]). Lesser intracortical
inhibition was exhibited in the uninvolved limb compared to uninjured controls (g = 0.54, 95% CI [0.14,
0.93]). When stratified by time from surgery, MEP amplitudes were greater in the uninvolved limb compared
to uninjured controls (g = 0.33, 95% CI [0.03, 0.63]) within the first 24 months after surgery. When evaluated
more than 24 months after surgery, the involved limb exhibited greater Hoffmann reflex (H-reflex) compared
to uninjured controls (g = 0.38, 95% CI [0.00, 0.77]). MT were greater in the involved limb (g = 0.93, 95% CI [−
0.01, 1.88]) and uninvolved limb (g = 0.57, 95% CI [0.13, 1.02]) compared to uninjured controls. MEP
amplitudes in the involved limb were lesser compared to uninjured controls when evaluated more than 24
months after ACLR (g = -1.11, 95% CI [− 2.03, − 0.20]). Conclusions: The available evidence supports that
there are neural excitability differences within the corticospinal tract in individuals with ACLR when
compared to uninjured controls. Future research should focus further on longitudinal assessments of neural
excitability prior to and following ACLR. Identifying interventions aimed to facilitate corticospinal excitability
after ACLR appears to be warranted to improve quadriceps function. Trial Registration: Registered through
PROSPERO CRD42020158714.
Available online at this link
6. Cervical spine injuries in facial fracture patients - injury mechanism and fracture type matter.
Puolakkainen Tero Journal of cranio-maxillo-facial surgery : official publication of the EuropeanAssociation for Cranio-Maxillo-Facial Surgery 2021;49(5):387-393.
Evidence supports the notion that craniofacial fractures are significant predictors of cervical spine injuries
(CSIs), but some debate remains on the injury mechanism of co-existing CSIs in craniofacial fractures and the
relationship between CSI and specific facial fractures. In this retrospective study, we aim to assess the
incidence rates of specific facial fracture types as well as other important variables and their relationship
with CSIs. The primary outcome variable, CSI, and several predictor variables, including facial fracture type,
were evaluated with logistic regression analyses. Of 2919 patients, the total CSI incidence rate was 3.0%.
Rates of CSI in patients with isolated mandibular fractures (OR 0.26 CI 0.10, 0.63; p = 0.006) were lower than
those previously reported, whereas isolated nasal fractures were strongly associated with CSI (OR 2.67 CI
1.36, 5.22; p = 0.004). Patients with concomitant cranial injuries were twice as likely to have CSI (OR 2.00, CI
1.22, 3.27; p = 0.006). Even though there is a strong occurrence rate of CSIs in patients with cranial injuries,
clinicians should be aware that patients presenting with isolated facial fractures are at significant risk for
sustaining CSIs also. (Copyright © 2021 European Association for Cranio-Maxillo-Facial Surgery. Published by
Elsevier Ltd. All rights reserved.)
Available online at this link
7. Comprehensive analysis of lumbar disc degeneration and autophagy-related candidate genes,
pathways, and targeting drugs.
Xu Wei-long Journal of Orthopaedic Surgery & Research 2021;16(1):1-12.
Background: Lumbar disc degeneration (LDD) is an essential pathological mechanism related to low back
pain. Current research on spinal surgery focused on the sophisticated mechanisms involved in LDD, and
autophagy was regarded as an essential factor in the pathogenesis. Objectives: Our research aimed to apply
a bioinformatics approach to select some candidate genes and signaling pathways in relationship with
autophagy and LDD and to figure out potential agents targeting autophagy- and LDD-related genes. Materials
and methods: Text mining was used to find autophagy- and LDD-related genes. The DAVID program was
applied in Gene Ontology and pathway analysis after selecting these genes. Several important gene modules
were obtained by establishing a network of protein-protein interaction and a functional enrichment analysis.
Finally, the selected genes were searched in the drug database to find the agents that target LDD- and
autophagy-related genes. Results: There were 72 genes related to "autophagy" and "LDD." Three significant
gene modules (22 genes) were selected by using gene enrichment analysis, which represented 4 signaling
pathways targeted by 32 kinds of drugs approved by the Food and Drug Administration (FDA). The
interactions between drugs and the genes were also identified. Conclusion: To conclude, a method was
proposed in our research to find candidate genes, pathways, and drugs which were involved in autophagy
and LDD. We discovered 22 genes, 4 pathways, and 32 potential agents, which provided a theoretical basis
and new direction for clinical and basic research on LDD.
Available online at this link
8. Conservative treatment and outcome of upper cervical spine fractures in young children: A
STROBE-compliant case series.
Tomaszewski Ryszard Medicine 2021;100(13):e25334.
Abstract: Cervical spine (C-spine) fractures in young children are very rare, and little information on
treatment modalities and functional, radiographic, and patient-reported outcome exists. In this 2-center,
retrospective case series, we assessed subjective and functional mid-term outcomes in children aged
≤5 years whose C-spine fractures were treated nonoperatively.Between 2000 and 2018, 6 children (median
age at injury: 23.5 months; range: 16-31 months) with C1 or C2 injuries were treated with Minerva cast/brace
or soft collar brace at 1 of the 2 study centers. Two patients suffered C1 fractures, and 4 patients had lysis of
the odontoid synchondrosis. Overall, 3 children had sustained polytrauma. One child died due to the
consequences of massive head injury.For the primary outcome parameter, we recorded subjective
symptoms such as pain and functional restrictions due to the sequelae of C-spine injuries at follow-up.Based
on medical records, we also assessed the causes of injury, diagnostic procedures, treatments and
complications, and time to fracture consolidation.Median follow-up of the 5 surviving children was
51 months (range: 36-160 months). At the latest follow-up, 4 of 5 children did not complain of any pain. One
child who sustained an open head injury in combination with a subluxation of the odontoid and undisplaced
fracture of the massa lateralis reported occasional headache. All patients experienced complete fracture
healing and normal range of motion of the cervical spine.Median duration of cast/brace treatment was
8.5 weeks. Fracture healing was confirmed by computed tomography in all patients.All C-spine injuries weremanaged with either Minerva cast/Halo brace or soft collar brace without complications.In our retrospective
case series, nonoperative treatment of atlas fractures and dislocations or subluxations of the odontoid in
young children using Minerva casts or prefabricated Halo braces resulted in good subjective and functional
outcomes at mid-term. We observed no complications of conservative treatment of C1 and C2 injuries in
young children. (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)
Available online at this link
9. Cost-effectiveness of sequential daily teriparatide/weekly alendronate compared with
alendronate monotherapy for older osteoporotic women with prior vertebral fracture in Japan.
Mori Takahiro Archives of osteoporosis 2021;16(1):72.
Using a Markov microsimulation model among hypothetical cohorts of community-dwelling older
osteoporotic Japanese women with prior vertebral fracture over a lifetime horizon, we found that daily
subcutaneous teriparatide for 2 years followed by weekly oral alendronate for 8 years was not cost-effective
compared with alendronate monotherapy for 10 years.; Purpose: Teriparatide has proven efficacy in
reducing osteoporotic fractures, but with substantial cost. We examined the cost-effectiveness of sequential
teriparatide/alendronate (i.e., daily subcutaneous teriparatide for 2 years followed by weekly oral
alendronate for 8 years) compared with alendronate monotherapy for 10 years among community-dwelling
older osteoporotic women with prior clinical or morphometric vertebral fracture in Japan.; Methods: Using a
previously validated and updated Markov microsimulation model, we obtained incremental cost-
effectiveness ratios (Japanese yen [¥] (or US dollars [$]) per quality-adjusted life year [QALY]) from the
perspective of a single payer responsible for both public healthcare and long-term care. We assumed a
lifetime horizon with a willingness-to-pay of ¥5million (or $47,500) per QALY in the base case. We modeled
the cost of biosimilar teriparatide, which has been available since November 2019 in Japan, assuming the
efficacy was the same as that of the brand version.; Results: In the base case, sequential
teriparatide/alendronate was not cost-effective compared with alendronate monotherapy. In deterministic
sensitivity analyses, sequential teriparatide/alendronate would become cost-effective with 85%, 50%, and
15% price discounts to teriparatide at ages 70, 75, and 80, respectively, compared to the current biosimilar
cost. Otherwise, results were especially sensitive to changes that affected efficacy of teriparatide or
alendronate. In probabilistic sensitivity analyses, the probabilities of sequential teriparatide/alendronate
being cost-effective were 0%, 1%, and 37% at ages 70, 75, and 80, respectively.; Conclusions: Among high-
risk osteoporotic women in Japan, sequential teriparatide/alendronate was not cost-effective compared with
alendronate monotherapy, even with the availability of biosimilar teriparatide.
Available online at this link
10. Effect of compression fracture on trabecular bone score at lumbar spine.
Hsu Y. Osteoporosis international : a journal established as result of cooperation between the
European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA
2021;32(5):961-970.
Bone mineral density (BMD) may be increased due to vertebral compression fractures (VCF). Our study
showed trabecular bone scores (TBS) was less affected than BMD by fractured vertebrae. The TBS of most
compression fractures, including old and recent VCF with mild or moderate deformity and old VCF with
severe deformity, could still be used in predicting fracture risk.; Introduction: Trabecular bone score (TBS), a
noninvasive tool estimating bone microarchitecture, provides complementary information to lumbar spine
bone mineral density (BMD). Lumbar spine BMD might be increased due to both degenerative disease and
vertebral compression fractures (VCF). Lumbar spine TBS has been confirmed not influenced by
osteoarthrosis, but the effects of VCF are still not been well evaluated. This study aimed to investigate
whether lumbar spine TBS was affected by fractured vertebrae.; Methods: We studied postmenopausal
women and men above 50 years old who underwent DXA between January 1, 2017, and May 31, 2019. By
calculating the difference of BMD and TBS between L1 and the mean of L2-3, the study compared the
difference of values between the control group and fracture group to determine the effects of fractured
vertebrae on BMD and TBS.; Results: A total of 377 participants were enrolled with 202 in the control group
(157 females; age: 68.06 ± 6.47 years) and 175 in the fracture group (147 females; age: 71.71 ± 9.44 years).
The mean BMD of the L1 vertebrae in the fracture group was significantly higher than that in the control
group (p < 0.0001). There was no significant difference between the mean differences of TBS between L1 and
the means of L2-3 vertebrae in the control group and the most compression fractures, including old and
recent VCF with mild or moderate deformity and old VCF with severe deformity.; Conclusion: Lumbar spineTBS, unlike BMD, is less affected by fractured vertebrae. The TBS of most compression fractures, including
old and recent VCF with mild or moderate deformity and old VCF with severe deformity, could still be used in
predicting fracture risk.
Available online at this link
11. Effects of endplate healing morphology on intervertebral disc degeneration after pedicle screw
fixation for thoracolumbar fractures.
Su Yunshan Medicine 2021;100(17):e25636.
Abstract: The cartilage endplate plays an important role in the stress distribution and nutrition metabolism
of the intervertebral disc. The healing morphology of the endplate after spinal fracture and its effect on the
intervertebral disc degeneration are still unclear.This was a retrospective study. Patients with traumatic
single-level thoracolumbar fractures treated in our orthopedic trauma service center from June 2011 to May
2019 were included and the relevant data were collected from the medical records. Based on combined
computed tomography and MRI images, the endplate injury status was determined (no endplate injury,
unilateral and bilateral endplate injury). According to the location of the injury, endplate injury was further
divided into endplate central injury and endplate peripheral injury. The degree of posttraumatic disc lesions
and disc degeneration during follow-up were classified based on the Sander classification and the Pfirrmann
classification, respectively. According to the T1 image of MRI at the final follow-up, the healing morphology
of endplates was determined and classified. Univariate analyses and correlation analyses were performed to
evaluate the within- and between-group differences.There were in total 51 patients included in this study.
Cartilage endplate fracture was significantly closely related to the degree of degeneration of the
intervertebral disc (P = .003). Injuries in different parts of the endplate have no significant effect on the
intervertebral disc degeneration (P = .204). The healing morphology after endplate fracture significantly
affected the degree of intervertebral disc degeneration (P = .001). The comparisons of groups showed that
the effects of irregular healing and traumatic Schmorl nodes on disc degeneration were not statistically
significant, but were significantly significant with increased curvature.These results suggest that the irregular
healing and the traumatic Schmorl nodes are closely related to intervertebral disc degeneration. The
presence and severity of the endplate injury can provide valuable information for individualized clinical
decision-making processes. (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)
Available online at this link
12. Effects of once-yearly zoledronic acid on bone density and incident vertebral fractures in
nonmetastatic castration-sensitive prostate cancer patients with osteoporosis.
Watanabe Daisuke BMC cancer 2021;21(1):422.
Background: Androgen deprivation therapy (ADT) is the effective treating prostate cancer but is often
accompanied by cancer treatment-induced bone loss (CTIBL), which impairs the patient's quality of life. In
patients with nonmetastatic castration-sensitive prostate cancer (M0CSPC) who already have osteoporosis
before starting ADT, appropriate bone-modifying agent intervention must be performed in parallel, as the
patient has a high risk of future fracture. However, little is known about therapeutic interventions aimed at
preventing the progression of CTIBL and new fractures. The present study explored the effect of once-yearly
zoledronic acid 5 mg (ZOL 5 mg) on bone mineral density (BMD) and new vertebral fractures (VFs) in M0CSPC
patients with coexisting osteoporosis before starting ADT.; Methods: We conducted a retrospective, multi-
institutional, cohort study involving 42 M0CSPC patients with osteoporosis who had undergone ADT
with/without a single intravenous infusion of ZOL 5 mg at the start of ADT (ZOL 5 mg group, n = 26; control
group, n = 16). The association of the ZOL 5 mg with changes in the BMD from baseline to 12 months and the
incidence of VFs were evaluated.; Results: Prevalent VFs were found in 47.6% of all patients at baseline. ZOL
5 mg significantly increased the lumbar spine BMD (LS-BMD) (mean rate of change: + 4.02%, p < 0.0001) and
significantly decreased the TRACP-5b (mean rate of change: - 52.1%, p < 0.0001) at 12 months after starting
ADT. Incident VFs were identified in 19.0% of all patients at 12 months after starting ADT. After adjusting for
the age, BMI, and changes in the LS-BMD, ZOL 5 mg was not significantly associated with incident VFs (odds
ratio 0.66, 95% confidence interval 0.04-11.3, p = 0.7774).; Conclusion: ZOL 5 mg significantly increased the
LS-BMD 12 months after starting ADT, and our short-term results showed that ZOL 5 mg was not significantly
correlated with the suppression of incident vertebral fractures.
Available online at this link
13. Efficacy and Safety of Balloon Kyphoplasty for Pathological Vertebral Fractures in Patients withHematological Malignancies in Our Institution.
Okada Keigo Internal medicine (Tokyo, Japan) 2021;60(8):1169-1174.
Objective Patients with hematological malignancies, particularly those with multiple myeloma, often suffer
from pathological vertebral compression fractures (VCFs). Consequent and significant spinal pain and
paralysis impair the activities of daily living and quality of life and delay subsequent chemotherapy. Balloon
kyphoplasty (BKP), which is less invasive than conventional therapies, is a type of percutaneous
vertebroplasty in which cement is injected into the broken vertebrae to stabilize the spinal column. The
present study assessed the effect of BKP on hematological tumors. Methods We retrospectively analyzed five
myeloma patients and one lymphoma patient who underwent BKP for pathological VCFs in our institution.
Results The median age was 74 years old. The spinal operation level ranged from T2 to L4. BKP was
performed at the diagnosis in two cases, after first-line chemotherapy in one case, and after subsequent
chemotherapy in three cases. After approximately 1 month, the patients' average Eastern Cooperative
Oncology Group performance status score rapidly improved from 3.2 to 1.3. The numeric rating scale score
decreased from 8.8 to 2.0, and the Karnofsky Performance Status score increased from 35 to 75. No severe
complications were observed. All patients became able to walk unassisted and underwent early subsequent
chemotherapy. Conclusion BKP can be a safe and effective treatment option for pathological VCFs in patients
with hematological malignancies and allows for rapid induction with subsequent chemotherapy.
Available online at this link
14. Efficacy of computed tomography-assisted limited decompression in the surgical management of
thoracolumbar fractures with neurological deficit.
Shi Landa Journal of Orthopaedic Surgery & Research 2021;16(1):1-10.
Objective: To investigate the effect of CT-assisted limited decompression in managing single segment A3
lumbar burst fracture. Method: A retrospective study (January 2015–June, 2019). One hundred six cases with
single-level Magerl type A3 lumbar burst fractures treated with short-segment posterior internal fixation and
limited decompression. Patients were divided into two groups: CT-assisted group and non-CT-assisted group.
Perioperative factors, clinical outcomes, post-operative complications, imaging parameters, and health-
related quality of life (HRQoL) were evaluated. Results: Kyphosis, loss of anterior and posterior vertebral
body heights, operative time, and post-operative complications were not significantly different between the
two groups. The visual analog score (VAS) and spinal canal encroachment in the CT-assisted group were
lower compared with the non-CT-assisted group (p < 0.05). The Japanese Orthopaedic Association (JOA)
score, the simplified HRQoL scale, and the American Spinal Injury Association (ASIA) Spinal Cord Injury Grade
in the CT-assisted group were significantly higher compared with the non-CT-assisted group (p < 0.05).
Conclusion: CT-assisted limited decompression in the treatment of single-segment A3 lumbar burst fracture
can achieve better fracture reduction and surgical results and improve the long-term recovery of the
patients' neurological function and quality of life.
Available online at this link
15. Excretory dysfunction and quality of life after a spinal cord injury: A cross‐sectional study.
Gong De Journal of Clinical Nursing (John Wiley & Sons, Inc.) 2021;30(9/10):1394-1402.
Aims and Objectives: To determine the aspects of excretory dysfunction most influential in determining the
quality of life of survivors of spinal cord injury. Background: Excretory dysfunction is one of the most
common and troublesome sequelae of spinal cord injury. Previous studies have shown that it can restrict
social participation restriction, cause readmission and generally influence quality of life substantially. Design:
A cross‐sectional survey of hospital inpatients following STOBE guidelines. Methods: A convenience sample
of 101 patients with traumatic or non‐traumatic spinal cord injury were asked about their experiences of
excretory dysfunction, and management and their self‐perceived quality of life. Univariate analysis and
multiple linear regression were performed to isolate the most important relationships. Results: Only 2 of the
101 subjects professed to be unaffected by excretion dysfunction. Bladder‐related dysfunction was the most
frequently mentioned type of problem. Quality of life impairment was found to be most often associated
with bladder accidents, bowel accidents and having more than one bladder complications. Conclusions:
Excretory dysfunction substantially impacts quality of life after a spinal cord injury. Bladder accidents, bowel
accidents and more than one bladder complication are factors independently influencing the quality of life of
spinal cord injury survivors. Relevance to Clinical Practice: To improve excretion‐related QOL, patients'
bladder and bowel self‐management training should be strengthened seeking to prevent complications and
reduce the risk of bladder and bowel accidents.Available online at this link
16. Factors Affecting Quality of Life at Discharge among Patients with Osteoporotic Vertebral
Fractures.
Umehara Takuya Southern medical journal 2021;114(4):252-259.
Objectives: This study aimed to identify factors, including physical functions and activities that affect quality
of life (QOL) at discharge among patients with osteoporotic vertebral fractures.; Methods: Patients with
osteoporotic vertebral fractures were included in our prospective cohort study. Multiple regression analysis
was performed to determine the predictors of QOL at discharge using two models: model 1, basic medical
information and physical functions at admission, and model 2, basic medical information, physical function,
and activity after 4 weeks of admission.; Results: Multiple regression analysis (standard partial regression
coefficients) using model 1 identified L2 to L4 bone mineral density (-0.2), Visual Analog Scale for pain during
activity at admission (-0.31), and Revised Hasegawa Dementia Scale (HDS-R) score at admission (0.64) as
factors affecting QOL at discharge. Multiple regression analysis using model 2 identified HDS-R at admission
(0.64), Pain Catastrophizing Scale score at 4 weeks (-0.34), and knee extension muscle strength at 4 weeks
(0.28) as factors affecting QOL at discharge.; Conclusions: Our results suggest that if patients have high bone
mineral density, intense pain, and low cognitive function at admission, then low QOL at discharge will be
predicted; however, improvement of pain catastrophizing and knee extension muscle strength during first
the 4 weeks of admission may be able to improve QOL at discharge. Because patients in this study were
Japanese only, it is important to exercise caution when applying our results to other populations.
Available online at this link
17. Integration of a vertebral fracture identification service into a fracture liaison service: a quality
improvement project.
Ong T. Osteoporosis international : a journal established as result of cooperation between the
European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA
2021;32(5):921-926.
Integration of a vertebral fracture identification service into a Fracture Liaison Service is possible. Almost
one-fifth of computerised tomography scans performed identified an individual with a fracture. This increase
in workload needs to be considered by any FLS that wants to utilise such a service.; Introduction: This service
improvement project aimed to improve detection of incidental vertebral fractures on routine imaging. It
embedded a vertebral fracture identification service (Optasia Medical, OM) on routine computerised
tomography (CT) scans performed in this hospital as part of its Fracture Liaison Service (FLS).; Methods: The
service was integrated into the hospital's CT workstream. Scans of patients aged ≥ 50 years for 3 months
were prospectively retrieved, alongside their clinical history and the CT report. Fractures were identified via
OM's machine learning algorithm and cross-checked by the OM radiologist. Fractures identified were then
added as an addendum to the original CT report and the hospital FLS informed. The FLS made
recommendations based on an agreed algorithm.; Results: In total, 4461 patients with CT scans were
retrieved over the 3-month period of which 850 patients had vertebra fractures identified (19.1%). Only 49%
had the fractures described on hospital radiology report. On average, 61 patients were identified each week
with a median of two fractures. Thirty-six percent were identified by the FLS for further action and
recommendations were made to either primary care or the community osteoporosis team within 3 months
of fracture detection. Of the 64% not identified for further action, almost half was because the CT was part
of cancer assessment or treatment. The remaining were due to a combination of only ≤ 2 mild fractures;
already known to a bone health specialist; in the terminal stages of any chronic illness; significant
dependency for activities of daily living; or a life expectancy of less than 12 months CONCLUSION: It was
feasible to integrate a commercial vertebral fracture identification service into the daily working of a FLS.
There was a significant increase in workload which needs to be considered by any future FLS planning to
incorporate such a service into their clinical practice.
Available online at this link
18. Low-Dose MDCT of Patients With Spinal Instrumentation Using Sparse Sampling: Impact on Metal
Artifacts.
Sollmann Nico AJR. American journal of roentgenology 2021;216(5):1308-1317.
OBJECTIVE. The purpose of our study was to evaluate simulated sparse-sampled MDCT combined with
statistical iterative reconstruction (SIR) for low-dose imaging of patients with spinal instrumentation.MATERIALS AND METHODS. Thirty-eight patients with implanted hardware after spinal instrumentation (24
patients with short- or long-term instrumentation-related complications [i.e., adjacent segment disease,
screw loosening or implant failure, or postoperative hematoma or seroma] and 14 control subjects with no
complications) underwent MDCT. Scans were simulated as if they were performed with 50% (P50), 25%
(P25), 10% (P10), and 5% (P5) of the projections of the original acquisition using an in-house-developed SIR
algorithm for advanced image reconstructions. Two readers performed qualitative image evaluations of
overall image quality and artifacts, image contrast, inspection of the spinal canal, and diagnostic confidence
(1 = high, 2 = medium, and 3 = low confidence). RESULTS. Although overall image quality decreased and
artifacts increased with reductions in the number of projections, all complications were detected by both
readers when 100% of the projections of the original acquisition (P100), P50, and P25 imaging data were
used. For P25 data, diagnostic confidence was still high (mean score ± SD: reader 1, 1.2 ± 0.4; reader 2, 1.3 ±
0.5), and interreader agreement was substantial to almost perfect (weighted Cohen κ = 0.787-0.855). The
mean volumetric CT dose index was 3.2 mGy for P25 data in comparison with 12.6 mGy for the original
acquisition (P100 data). CONCLUSION. The use of sparse sampling and SIR for low-dose MDCT in patients
with spinal instrumentation facilitated considerable reductions in radiation exposure. The use of P25 data
with SIR resulted in no missed complications related to spinal instrumentation and allowed high diagnostic
confidence, so using only 25% of the projections is probably enough for accurate and confident diagnostic
detection of major instrumentation-related complications.
Available online at this link
19. Management of patients admitted to hospital with acute vertebral fragility fractures: a modified
Delphi study.
Ong Terence Age & Ageing 2021;50(3):985-989.
Introduction Acute vertebral fragility fracture requiring hospital admission is common, painful and disabling.
No comprehensive clinical guideline for their care exists. To support the development of such a guideline, we
sought the views of experts in the field. Methods A modified Delphi study was used. A total of 70 statements
were presented, using an online platform, over three consensus-seeking rounds, to participants with
experience in the hospital care of patients with acute vertebral fragility fractures from UK-based specialist
societies. Participants rated the level of their agreement with each statement on a 5-point Likert scale.
Consensus was defined at 70% of respondents choosing either agree/strongly agree or disagree/strong
disagree. Over the first two rounds, statements not reaching consensus were modified in subsequent rounds,
and new statements proposed by participants and agreed by the research team could be added. Results
There were 71 participants in the first round, 37 in the second round and 28 (most of whom were
geriatricians) in the third round. Consensus was reached in 52 statements covering fracture diagnosis,
second-line imaging, organisation of hospital care, pain management and falls and bone health assessment.
Consensus was not achieved for whether vertebral fragility fractures should be managed in a specific clinical
area. Discussion These findings provide the basis for the development of clinical guidelines and quality
improvement initiatives. They also help to justify research into the merits of managing acute vertebral
fragility fracture patients in a specific clinical area.
Available online at this link
20. Opportunistic osteoporosis screening: contrast-enhanced dual-layer spectral CT provides accurate
measurements of vertebral bone mineral density.
Roski Ferdinand European radiology 2021;31(5):3147-3155.
Objectives: Osteoporosis remains under-diagnosed, which may be improved by opportunistic bone mineral
density (BMD) measurements on CT. However, correcting for the influence of intravenous iodine-based
contrast agent is challenging. The purpose of this study was to assess the diagnostic accuracy of iodine-
corrected vertebral BMD measurements derived from non-dedicated contrast-enhanced phantomless dual-
layer spectral CT (DLCT) examinations.; Methods: Vertebral volumetric DLCT-BMD was measured in native,
arterial, and portal-venous scans of 132 patients (63 ± 16 years; 32% women) using virtual monoenergetic
images (50 and 200 keV). For comparison, conventional BMD was determined using an asynchronous QCT
calibration. Additionally, iodine densities were measured in the abdominal aorta (AA), inferior vena cava, and
vena portae (VP) on each CT phase to adjust for iodine-related measurement errors in multivariable linear
regressions and a generalized estimated equation, and conversion equations were calculated.; Results: BMD
values derived from contrast-enhanced phases using conversion equations adjusted for individual vessel
iodine concentrations of VP and/or AA showed a high agreement with those from non-enhanced scans inBland-Altman plots. Mean absolute errors (MAE) of DLCT-BMD were 3.57 mg/ml for the arterial (R 2 = 0.989)
and 3.69 mg/ml for the portal-venous phase (R 2 = 0.987) (conventional BMD: 4.70 [R 2 = 0.983] and
5.15 mg/ml [R 2 = 0.981]). In the phase-independent analysis, MAE was 4.49 mg/ml for DLCT (R 2 = 0.989)
(conventional BMD: 4.82 mg/ml [R 2 = 0.981]).; Conclusions: Converted BMD derived from contrast-
enhanced DLCT examinations and adjusted for individual vessel iodine concentrations showed a high
agreement with non-enhanced DLCT-BMD, suggesting that opportunistic BMD measurements are feasible
even in non-dedicated contrast-enhanced DLCT examinations.; Key Points: • Accurate BMD values can be
converted from contrast-enhanced DLCT scans, independent from the used scan phase. • DLCT-BMD
measurements from contrast-enhanced scans should be adjusted with iodine concentrations of portal vein
and/or abdominal aorta, which significantly improves the goodness-of-fit of conversion models.
Available online at this link
21. Posterior hemivertebra resection and short-segment fusion with lateral mass screws in congenital
scoliosis: a novel strategy for the resource-limited setting.
Zarei Mohammad Journal of Orthopaedic Surgery & Research 2021;16(1):1-7.
Background: Posterior hemivertebra resection and short-segment fusion with pedicle screws are an
established treatment in congenital scoliosis, which require pediatric-specific instrumentation. The purpose
of this study was to report the results of utilizing cervical lateral mass screws instead of pedicle screws in the
treatment of congenital scoliosis in children younger than 5 years old. Methods: In an IRB-approved
retrospective chart review study, patients23. Preoperative X-ray C2C6AR is applicable for prediction of difficult laryngoscopy in patients with
cervical spondylosis.
Zhou Yang BMC Anesthesiology 2021;21(1):1-7.
Background: Airway management is one of the most important techniques in anesthesia practice and
inappropriate airway management is related with airway injury, brain hypoxia, and even death. The patients
with cervical spondylosis are often confronted with difficult laryngoscopy who are more prone to appear
difficult airway, so it is important to figure out valuable predictors of difficult laryngoscopy in these patients.
Methods: We randomly enrolled 270 patients undergoing elective cervical spine surgery and analyzed the
cervical mobility data in predicting difficult laryngoscopy. The preoperative X-ray radiological indicators were
measured by an attending radiologist. Cormack-Lehane scales were assessed during intubation, and patients
with a class III or IV view were assigned to the difficult laryngoscopy group. Results: Univariate analysis
showed that the hyomental distance (HMD, the distance between the hyoid bone and the tip of the chin)
and the hyomental distance ratio (HMDR, the ratio between HMD in the extension position and the one in
the neutral position) might not be suitable indicators in patients with cervical spondylosis. Binary
multivariate logistic regression (backward-Wald) analyses identified two independent correlative factors
from the cervical mobility indicators that correlated best as a predictor of difficult laryngoscopy: modified
Mallampati test (MMT) and C2C6AR (the ratio of the angle between a line passing through the bottom of the
second cervical vertebra and a line passing through the bottom of the sixth cervical vertebra in the extension
position and the one in the neutral position). The odds ratio (OR) and 95 % CI were 2.292(1.093–4.803) and
0.493 (0.306–0.793), respectively. C2C6AR exhibited the largest area under the curve (0.714; 95 % CI 0.633–
0.794). Conclusions: C2C6AR based on preoperative X-ray images may be the most accurate predictor of
cervical mobility indicators for difficult laryngoscopy in patients with cervical spondylosis. Trial registration:
The study was registered at the Chinese Clinical Trial Registry (http://www.chictr.org.cn; identifier: ChiCTR-
ROC-16,008,598) on June 6, 2016.
Available online at this link
24. Prevention and control measures of the coronavirus disease 2019 (COVID-19) in low-risk
departments: The spine surgery department example.
Zheng Yongshun Science progress 2021;104(2):368504211009670.
As the coronavirus disease 2019 (COVID-19) spreads globally, hospital departments will need take steps to
manage their treatment procedures and wards. The preparations of high-risk departments (infection,
respiratory, emergency, and intensive care unit) were relatively well within this pandemic, while low-risk
departments may be unprepared. The spine surgery department in The First Affiliated Hospital of Anhui
Medical University in Hefei, China, was used as an example in this study. The spine surgery department took
measures to manage the patients, medical staff and wards to avoid the cross-infection within hospital.
During the outbreak, no patients or healthcare workers were infected, and no treatment was delayed due to
these measures. The prevention and control measures effectively reduced the risk of nosocomial
transmission between health workers and patients while providing optimum care. It was a feasible
management approach that was applicable to most low-risk and even high-risk departments.
Available online at this link
25. Radiation exposure during the treatment of spinal deformities.
Mehta Jwalant S. The bone & joint journal 2021;103-B(4):1-7.
Aims: To benchmark the radiation dose to patients during the course of treatment for a spinal deformity.;
Methods: Our radiation dose database identified 25,745 exposures of 6,017 children (under 18 years of age)
and adults treated for a spinal deformity between 1 January 2008 and 31 December 2016. Patients were
divided into surgical (974 patients) and non-surgical (5,043 patients) cohorts. We documented the number
and doses of ionizing radiation imaging events (radiographs, CT scans, or intraoperative fluoroscopy) for each
patient. All the doses for plain radiographs, CT scans, and intraoperative fluoroscopy were combined into a
single effective dose by a medical physicist (milliSivert (mSv)).; Results: There were more ionizing radiation-
based imaging events and higher radiation dose exposures in the surgical group than in the non-surgical
group (p < 0.001). The difference in effective dose for children between the surgical and non-surgical groups
was statistically significant, the surgical group being significantly higher (p < 0.001). This led to a higher
estimated risk of cancer induction for the surgical group (1:222 surgical vs 1:1,418 non-surgical). However,
the dose difference for adults was not statistically different between the surgical and non-surgical groups. Inall cases the effective dose received by all cohorts was significantly higher than that from exposure to natural
background radiation.; Conclusion: The treatment of spinal deformity is radiation-heavy. The dose exposure
is several times higher when surgical treatment is undertaken. Clinicians should be aware of this and review
their practices in order to reduce the radiation dose where possible. Cite this article: Bone Joint J 2021;103-
B(4):1-7.
Available online at this link
26. Risk factors associated with surgical site infections after thoracic or lumbar surgery: a 6-year single
centre prospective cohort study.
Spatenkova Vera Journal of Orthopaedic Surgery & Research 2021;16(1):1-8.
Background: Surgical site infection (SSI) is a risk in every operation. Infections negatively impact patient
morbidity and mortality and increase financial demands. The aim of this study was to analyse SSI and its risk
factors in patients after thoracic or lumbar spine surgery. Methods: A six-year single-centre prospective
observational cohort study monitored the incidence of SSI in 274 patients who received planned thoracic or
lumbar spinal surgery for degenerative disease, trauma, or tumour. They were monitored for up to 30 days
postoperatively and again after 1 year. All patients received short antibiotic prophylaxis and stayed in the
eight-bed neurointensive care unit (NICU) during the immediate postoperative period. Risk factors for SSI
were sought using multivariate logistic regression analysis. Results: We recorded 22 incidences of SSI (8.03%;
superficial 5.84%, deep 1.82%, and organ 0.36%). Comparing patients with and without SSI, there were no
differences in age (p=0.374), gender (p=0.545), body mass index (p=0.878), spine diagnosis (p=0.745),
number of vertebrae (p=0.786), spine localization (p=0.808), implant use (p=0.428), American Society of
Anesthesiologists (ASA) Score (p=0.752), urine catheterization (p=0.423), drainage (p=0.498), corticosteroid
use (p=0.409), transfusion (p=0.262), ulcer prophylaxis (p=0.409) and diabetes mellitus (p=0.811). The SSI
group had longer NICU stays (p=0.043) and more non-infectious hospital wound complications (pChan Lung Journal of Orthopaedic Surgery & Research 2021;16(1):1-7.
Background: To evaluate the incidence and risk factors associated with unintended return to the operating
room in adult spinal deformity after spinal deformity corrective surgery. Methods: Retrospect of 141 adult
spinal deformity patients in a single institution between January 2017 and December 2019. Inclusion criteria
enrolled 18 to 80 years old patients who diagnosed with congenital/idiopathic/syndromic/acquired spinal
deformity underwent posterior corrective spinal surgery. The surgical details and complications were
recorded. The rate of unintended return to the operating room (UIROR) during hospitalization was
examined, and the risk factors of unintended return to the operating room were investigated via multivariate
analysis. Results: This is a retrospective study. One hundred and forty-one patients who underwent spinal
deformity surgery with a mean age of 31.8 years (range 18-69 years) were studied. The rate of unintended
return to the operating room was 10.64% (15/141). Two of 15 patients had twice unintended surgery during
hospitalization (13.33%). The most principal complication was neurologic deficit (73.3%); six of 15
postoperative present implants deviation causes severe lower limbs radiating pain (40%). The multivariate
analysis shows higher apical vertebral rotation (AVR>grade II, odds ratio [OR] = 9.362; 95% CI= 1.930-45.420;
P=.006), obesity (OR = 11.448; 95% CI= 1.320-99.263; P=.027), and previous neurological symptom (OR =
7.358; 95% CI= 1.798-30.108; P=.006) were independent predictors of unintended return to the operating
room. Conclusion: Postoperative neurologic deficit and short-term implant malposition are essential causes
of unintended return to the operating room in adult spinal deformity patients. Preoperative factors such as
higher AVR (> grade II), obesity, and previous neurological symptom may significantly increase the risk of
morbidity in UIROR. Spine surgeons should be alert to these risk factors and require adequate preoperative
evaluations to reduce the incidence of unintended return to the operating room.
Available online at this link
29. Systemic mastocytosis revisited with an emphasis on skeletal manifestations.
Leone Antonio La Radiologia medica 2021;126(4):585-598.
Systemic mastocytosis (SM) is a rare form of mastocytosis that can affect various organ systems. Bone
involvement is the most common and prominent imaging feature in patients with SM regardless of the
subtype. Furthermore, bone involvement is a prognostic factor as it may entail an aggressive course of the
disease. Diagnosis is established by bone marrow biopsy complemented by imaging modalities such as
radiography, CT, and magnetic resonance (MR) imaging. The radiographic and CT appearances are that of
sclerotic, lytic, or mixed patterns with focal or diffuse distribution, involving primarily the axial skeleton and
the ends of the long bones. Bone marrow infiltration is best recognized on MR imaging. Osteoporosis is
common in SM; thus, a bone mineral density measurement at lumbar spine and proximal femur by dual-
energy X-ray absorptiometry should be obtained. Imaging plays a huge part in the diagnostic process; when
skeletal imaging findings are carefully interpreted and correlated with clinical features, they can lead to the
suspicion of SM. The primary aims of this review article were to focus on the role of imaging in detection and
characterization of skeletal patterns of SM and to discuss relevant clinical features that could facilitate
prompt and correct diagnosis.
Available online at this link
30. Validation of Scolioscan Air-Portable Radiation-Free Three-Dimensional Ultrasound Imaging
Assessment System for Scoliosis.
Lai Kelly Ka-Lee Sensors (Basel, Switzerland) 2021;21(8):No page numbers.
To diagnose scoliosis, the standing radiograph with Cobb's method is the gold standard for clinical practice.
Recently, three-dimensional (3D) ultrasound imaging, which is radiation-free and inexpensive, has been
demonstrated to be reliable for the assessment of scoliosis and validated by several groups. A portable 3D
ultrasound system for scoliosis assessment is very much demanded, as it can further extend its potential
applications for scoliosis screening, diagnosis, monitoring, treatment outcome measurement, and progress
prediction. The aim of this study was to investigate the reliability of a newly developed portable 3D
ultrasound imaging system, Scolioscan Air, for scoliosis assessment using coronal images it generated. The
system was comprised of a handheld probe and tablet PC linking with a USB cable, and the probe further
included a palm-sized ultrasound module together with a low-profile optical spatial sensor. A plastic
phantom with three different angle structures built-in was used to evaluate the accuracy of measurement by
positioning in 10 different orientations. Then, 19 volunteers with scoliosis (13F and 6M; Age: 13.6 ± 3.2
years) with different severity of scoliosis were assessed. Each subject underwent scanning by a commercially
available 3D ultrasound imaging system, Scolioscan, and the portable 3D ultrasound imaging system, withYou can also read
