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Sample records for adjacent vertebral fractures

  1. Altered disc pressure profile after an osteoporotic vertebral fracture is a risk factor for adjacent vertebral body fracture

    PubMed Central

    Tzermiadianos, Michael N.; Renner, Susan M.; Phillips, Frank M.; Hadjipavlou, Alexander G.; Zindrick, Michael R.; Havey, Robert M.; Voronov, Michael

    2008-01-01

    This study investigated the effect of endplate deformity after an osteoporotic vertebral fracture in increasing the risk for adjacent vertebral fractures. Eight human lower thoracic or thoracolumbar specimens, each consisting of five vertebrae were used. To selectively fracture one of the endplates of the middle VB of each specimen a void was created under the target endplate and the specimen was flexed and compressed until failure. The fractured vertebra was subjected to spinal extension under 150 N preload that restored the anterior wall height and vertebral kyphosis, while the fractured endplate remained significantly depressed. The VB was filled with cement to stabilize the fracture, after complete evacuation of its trabecular content to ensure similar cement distribution under both the endplates. Specimens were tested in flexion-extension under 400 N preload while pressure in the discs and strain at the anterior wall of the adjacent vertebrae were recorded. Disc pressure in the intact specimens increased during flexion by 26 ± 14%. After cementation, disc pressure increased during flexion by 15 ± 11% in the discs with un-fractured endplates, while decreased by 19 ± 26.7% in the discs with the fractured endplates. During flexion, the compressive strain at the anterior wall of the vertebra next to the fractured endplate increased by 94 ± 23% compared to intact status (p < 0.05), while it did not significantly change at the vertebra next to the un-fractured endplate (18.2 ± 7.1%, p > 0.05). Subsequent flexion with compression to failure resulted in adjacent fracture close to the fractured endplate in six specimens and in a non-adjacent fracture in one specimen, while one specimen had no adjacent fractures. Depression of the fractured endplate alters the pressure profile of the damaged disc resulting in increased compressive loading of the anterior wall of adjacent vertebra that predisposes it to wedge fracture. This data suggests that

  2. Risk Factors Associated with Adjacent and Remote- Level Pathologic Vertebral Compression Fracture Following Balloon Kyphoplasty: 2-Year Follow-Up Comparison Versus Conservative Treatment.

    PubMed

    Faloon, Michael J; Ruoff, Mark; Deshpande, Chetan; Hohman, Donald; Dunn, Conor; Beckloff, Nicholas; Patel, Dipak V

    2015-01-01

    Vertebral compression fractures are a significant source of morbidity and mortality among patients of all age groups. These fractures result in both acute and chronic pain. Patients who sustain such fractures are known to suffer from more comorbidities and have a higher mortality rate compared with healthy people in the same age group. In recent years, balloon kyphoplasty has become a popular method for treating vertebral compression fractures. However, as longer-term follow-up becomes available, the effects of cement augmentation on adjacent spinal segments require investigation. Here, we have performed a retrospective chart review of 258 consecutive patients with pathologic vertebral compression fractures secondary to osteoporosis, treated by either conservative measures or balloon kyphoplasty with polymethylmethacrylate cement augmentation. Multivariate analysis of patient comorbidities was performed to assess the risks associated with subsequent adjacent and remote compression fracture at a minimum of 2 years follow-up. A total of 258 patients had 361 vertebral compression fractures. A total of 121 patients were treated nonoperatively and 137 underwent balloon kyphoplasty with polymethylmethacrylate cement augmentation. The mean follow-up for both cohorts was 2.7 years (range, 2-6 years). The kyphoplasty cohort was significantly older than the nonoperative cohort (mean age, 78.5 versus 74.2 years; p = 0.02), had 24 more patients with diabetes mellitus (37 versus 13; p = 0.05), and had 34 more patients with a history of smoking (50 versus 16; p = 0.05). However, the kyphoplasty cohort had less patients with a history of non-steroidal anti-inflammatory drug (NSAID) use (45 versus 71; p = 0.07). There were no demographic differences between groups in patients with secondary fractures. Nonoperative treatment was identified as a statistically significant independent risk factor for subsequent vertebral compression fracture [odds ratio (OR), 2.28]. Univariate

  3. Vertebral Compression Fractures

    MedlinePlus

    ... OI: Information on Vertebral Compression Fractures 804 W. Diamond Ave., Ste. 210 Gaithersburg, MD 20878 (800) 981- ... osteogenesis imperfecta contact : Osteogenesis Imperfecta Foundation 804 W. Diamond Avenue, Suite 210, Gaithersburg, MD 20878 Tel: 800- ...

  4. Cement Leakage into Adjacent Vertebral Body Following Percutaneous Vertebroplasty.

    PubMed

    Park, Jae Hoo; Kim, Hyeun Sung; Kim, Seok Won

    2016-06-01

    Percutaneous vertebroplasty (PV) is a minimally invasive procedure for osteoporotic vertebral compression fractures that fail to respond to conventional conservative treatment. It significantly improves intolerable back pain within hours, and has a low complication rate. Although rare, PV is not free of complications, most of which are directly related to cement leakage. Because of its association with new adjacent fracture, the importance of cement leakage into the adjacent disc space is paramount. Here, we report an interesting case of cement leakage into the adjacent upper vertebral body as well as disc space following PV. To the best of our knowledge, there has been no report of cement leakage into the adjacent vertebral body following PV. This rare case is presented along with a review of the literature.

  5. Opportunistic Identification of Vertebral Fractures.

    PubMed

    Adams, Judith E

    2016-01-01

    Vertebral fractures are powerful predictors of future fracture, so, their identification is important to ensure that patients are commenced on appropriate bone protective or bone-enhancing therapy. Risk factors (e.g., low bone mineral density and increasing age) and symptoms (back pain, loss of height) may herald the presence of vertebral fractures, which are usually confirmed by performing spinal radiographs or, increasingly, using vertebral fracture assessment with dual-energy X-ray absorptiometry scanners. However, a large number (30% or more) of vertebral fractures are asymptomatic and do not come to clinical attention. There is, therefore, scope for opportunistic (fortuitous) identification of vertebral fractures from various imaging modalities (radiographs, computed tomography, magnetic resonance imaging, and radionuclide scans) performed for other clinical indications and which include the spine in the field of view, with midline sagittal reformatted images from computed tomography having the greatest potential for such opportunistic detection. Numerous studies confirm this potential for identification but consistently find underreporting of vertebral fractures. So, a valuable opportunity to improve the management of patients at increased risk of future fracture is being squandered. Educational training programs for all clinicians and constant reiteration, stressing the importance of the accurate and clear reporting of vertebral fractures ("you only see what you look for"), can improve the situation, and automated computer-aided diagnostic tools also show promise to solve the problem of this underreporting of vertebral fractures.

  6. Concomitant and previous osteoporotic vertebral fractures

    PubMed Central

    Lenski, Markus; Büser, Natalie; Scherer, Michael

    2017-01-01

    Background and purpose Patients with osteoporosis who present with an acute onset of back pain often have multiple fractures on plain radiographs. Differentiation of an acute osteoporotic vertebral fracture (AOVF) from previous fractures is difficult. The aim of this study was to investigate the incidence of concomitant AOVFs and previous OVFs in patients with symptomatic AOVFs, and to identify risk factors for concomitant AOVFs. Patients and methods This was a prospective epidemiological study based on the Registry of Pathological Osteoporotic Vertebral Fractures (REPAPORA) with 1,005 patients and 2,874 osteoporotic vertebral fractures, which has been running since February 1, 2006. Concomitant fractures are defined as at least 2 acute short-tau inversion recovery (STIR-) positive vertebral fractures that happen concomitantly. A previous fracture is a STIR-negative fracture at the time of initial diagnostics. Logistic regression was used to examine the influence of various variables on the incidence of concomitant fractures. Results More than 99% of osteoporotic vertebral fractures occurred in the thoracic and lumbar spine. The incidence of concomitant fractures at the time of first patient contact was 26% and that of previous fractures was 60%. The odds ratio (OR) for concomitant fractures decreased with a higher number of previous fractures (OR =0.86; p = 0.03) and higher dual-energy X-ray absorptiometry T-score (OR =0.72; p = 0.003). Interpretation Concomitant and previous osteoporotic vertebral fractures are common. Risk factors for concomitant fractures are a low T-score and a low number of previous vertebral fractures in cases of osteoporotic vertebral fracture. An MRI scan of the the complete thoracic and lumbar spine with STIR sequence reduces the risk of under-diagnosis and under-treatment. PMID:28056595

  7. Vertebral Augmentation for Osteoporotic Compression Fractures.

    PubMed

    Richmond, Bradford J

    2016-01-01

    Vertebral augmentation procedures such as vertebroplasty and kyphoplasty were developed to reduce pain and improve quality of life for patients with osteoporotic vertebral compression fractures. However, the use of vertebral augmentation has been debated and questioned since its inception. This article addresses some of these issues.

  8. Nanotechnology for treating osteoporotic vertebral fractures

    PubMed Central

    Gao, Chunxia; Wei, Donglei; Yang, Huilin; Chen, Tao; Yang, Lei

    2015-01-01

    Osteoporosis is a serious public health problem affecting hundreds of millions of aged people worldwide, with severe consequences including vertebral fractures that are associated with significant morbidity and mortality. To augment or treat osteoporotic vertebral fractures, a number of surgical approaches including minimally invasive vertebroplasty and kyphoplasty have been developed. However, these approaches face problems and difficulties with efficacy and long-term stability. Recent advances and progress in nanotechnology are opening up new opportunities to improve the surgical procedures for treating osteoporotic vertebral fractures. This article reviews the improvements enabled by new nanomaterials and focuses on new injectable biomaterials like bone cements and surgical instruments for treating vertebral fractures. This article also provides an introduction to osteoporotic vertebral fractures and current clinical treatments, along with the rationale and efficacy of utilizing nanomaterials to modify and improve biomaterials or instruments. In addition, perspectives on future trends with injectable bone cements and surgical instruments enhanced by nanotechnology are provided. PMID:26316746

  9. Nanotechnology for treating osteoporotic vertebral fractures.

    PubMed

    Gao, Chunxia; Wei, Donglei; Yang, Huilin; Chen, Tao; Yang, Lei

    2015-01-01

    Osteoporosis is a serious public health problem affecting hundreds of millions of aged people worldwide, with severe consequences including vertebral fractures that are associated with significant morbidity and mortality. To augment or treat osteoporotic vertebral fractures, a number of surgical approaches including minimally invasive vertebroplasty and kyphoplasty have been developed. However, these approaches face problems and difficulties with efficacy and long-term stability. Recent advances and progress in nanotechnology are opening up new opportunities to improve the surgical procedures for treating osteoporotic vertebral fractures. This article reviews the improvements enabled by new nanomaterials and focuses on new injectable biomaterials like bone cements and surgical instruments for treating vertebral fractures. This article also provides an introduction to osteoporotic vertebral fractures and current clinical treatments, along with the rationale and efficacy of utilizing nanomaterials to modify and improve biomaterials or instruments. In addition, perspectives on future trends with injectable bone cements and surgical instruments enhanced by nanotechnology are provided.

  10. Risk of vertebral compression fractures in multiple myeloma patients

    PubMed Central

    Anitha, D.; Thomas, Baum; Jan, Kirschke S.; Subburaj, Karupppasamy

    2017-01-01

    Abstract The purpose of this study was to develop and validate a finite element (FE) model to predict vertebral bone strength in vitro using multidetector computed tomography (MDCT) images in multiple myeloma (MM) patients, to serve as a complementing tool to assess fracture risk. In addition, it also aims to differentiate MM patients with and without vertebral compression fractures (VCFs) by performing FE analysis on vertebra segments (T1–L5) obtained from in vivo routine MDCT imaging scans. MDCT-based FE models were developed from the in vitro vertebrae samples and were then applied to the in vivo vertebrae segments of MM patients (n = 4) after validation. Predicted fracture load using FE models correlated significantly with experimentally measured failure load (r = 0.85, P < 0.001). Interestingly, an erratic behavior was observed in patients with fractures (n = 2) and a more gradual change in FE-predicted strength values in patients without fractures (n = 2). Severe geometric deformations were also observed in models that have already attained fractures. Since BMD is not a reliable parameter for fracture risk prediction in MM subjects, it is necessary to use advanced tools such as FE analysis to predict individual fracture risk. If peaks are observed between adjacent segments in an MM patient, it can be safe to conclude that the spine is experiencing regions of structural instability. Such an FE visualization may have therapeutic consequences to prevent MM associated vertebral fractures. PMID:28079810

  11. Percutaneous Vertebroplasty for Osteoporotic Compression Fracture: Multivariate Study of Predictors of New Vertebral Body Fracture

    SciTech Connect

    Komemushi, Atsushi Tanigawa, Noboru; Kariya, Shuji; Kojima, Hiroyuki; Shomura, Yuzo; Komemushi, Sadao; Sawada, Satoshi

    2006-08-15

    Purpose. To investigate the risk factors and relative risk of new compression fractures following vertebroplasty. Methods. Initially, we enrolled 104 consecutive patients with vertebral compression fractures caused by osteoporosis. A total of 83 of the 104 patients visited our hospital for follow-up examinations for more than 4 weeks after vertebroplasty. Logistic regression analysis of the data obtained from these 83 patients was used to determine relative risks of recurrent compression fractures, using 13 different factors. Results. We identified 59 new fractures in 30 of the 83 patients: 41 new fractures in vertebrae adjacent to treated vertebrae; and 18 new fractures in vertebrae not adjacent to treated vertebrae. New fractures occurred in vertebrae adjacent to treated vertebrae significantly more frequently than in vertebrae not adjacent to treated vertebrae. Only cement leakage into the disk was a significant predictor of new vertebral body fracture after vertebroplasty (odds ratio = 4.633). None of the following covariates were associated with increased risk of new fracture: age, gender, bone mineral density, the number of vertebroplasty procedures, the number of vertebrae treated per procedure, the cumulative number of vertebrae treated, the presence of a single untreated vertebra between treated vertebrae, the presence of multiple untreated vertebrae between treated vertebrae, the amount of bone cement injected per procedure, the cumulative amount of bone cement injected, cement leakage into the soft tissue around the vertebra, and cement leakage into the vein.

  12. Vertebral fracture assessment in patients presenting with a non-hip non-vertebral fragility fracture: experience of a UK Fracture Liaison Service.

    PubMed

    Reniu, Aina Capdevila; Ong, Terence; Ajmal, Syed; Sahota, Opinder

    2017-12-01

    Twenty-five percent of patients with a non-hip non-vertebral fragility fracture have an undiagnosed vertebral fracture detected by vertebral fracture assessment during bone densitometric assessment. The prevalence of an undiagnosed vertebral fracture is higher in older people, and they are more likely to have multiple vertebral fractures.

  13. Percutaneous ethanol embolization and cement augmentation of aggressive vertebral hemangiomas at two adjacent vertebral levels.

    PubMed

    Cianfoni, Alessandro; Massari, Francesco; Dani, Genta; Lena, Jonathan R; Rumboldt, Zoran; Vandergrift, William A; Bonaldi, Giuseppe

    2014-10-01

    This report describes a case of successful percutaneous direct-puncture ethanol embolization, followed by vertebroplasty, of an aggressive vertebral hemangioma (VH) involving two adjacent thoracic vertebral levels. In this case, the 78-year-old male patient presented with a 6-month history of progressive paraparesis due to spinal cord compression by a T8-T9 VH with an extensive epidural component. Follow-up demonstrated epidural component shrinkage with complete regression of symptoms at 3 months. This case suggests that exclusive percutaneous treatment may be considered for symptomatic VH even when two adjacent vertebral levels are affected.

  14. Medical Treatment of Osteoporotic Vertebral Fractures

    PubMed Central

    Langdahl, Bente Lomholt; Harsløf, Torben

    2011-01-01

    A vertebral fracture is a serious symptom of osteoporosis. Vertebral fractures cause moderate-to-severe back pain for a shorter or longer duration, increase the risk of a subsequent vertebral fracture approximately four-fold, reduce quality of life significantly and are associated with increased mortality. In order to choose the optimal treatment for the patient, the severity and type of osteoporosis should be investigated. Prevention of new osteoporotic fractures can be accomplished through treatment with both antiresorptive and anabolic treatments. The antiresorptive treatment modalities comprise calcium, vitamin D, bisphosphonates, hormone therapy, selective oestrogen receptor modulators (SERMs), strontium ranelate, receptor activator of NF-kB ligand (RANKL) antibody and calcitonin. The anabolic treatments comprise teriparatide and parathyroid hormone [(PTH)-(1–84)]. Adherence with treatment of osteoporosis is generally poor and therefore once the choice of treatment has been made and the patient has been instructed properly, long-term adherence to the treatment should be secured through information and regular control visits. PMID:22870463

  15. Limbus lumbar and sacral vertebral fractures.

    PubMed

    Mendez, Jorge S; Huete, Isidro L; Tagle, Patricio M

    2002-03-01

    We evaluated the fractures of the lumbar and sacral vertebral limbus by disc impingement at the peripheral ring apophysis in 23 adults associated with trauma in 16 of them. Lumbalgia, radicular pain and narrow canal symptoms are the presenting forms of this underdiagnosed pathology. CT is the best method of examination, while plain roentgenograms and MR are usually negative. Accurate diagnosis and surgical technique with larger exposure are needed to resect the fractured fragments and protruded disc material for decompressing the roots and the dural sac. Our results were very good on the majority of cases.

  16. Rapid onset mediastinal hematoma due to vertebral fracture and review of relevant literature.

    PubMed

    Koksal, Vaner; Coskun, Selcuk; Coskun, Pinar Koksal

    2015-12-01

    Patients with vertebral fractures are frequently encountered and those with thoracic and lumbar spine fractures are likely to have associated injuries. Detection of a widened mediastinum after trauma is very nonspecific and most of the time it is related to aortic injury or mediastinal hematoma. Vertebral or sternal fractures can also be the cause of mediastinal hematoma with or without aortic injury. This report reviews an unusual case of rapid onset mediastinal hematoma due to vertebral fracture after a fall. In the case, there was a mediastinal hematoma adjacent to a burst fracture of the T8 vertebral body. There was a rapid increase in identified hematoma during the emergency follow up and urgent erythrocyte transfusion was carried out. We would like to raise awareness of this infrequent presentation of mediastinal hematoma, as it is insidious and possibly fatal. In the evaluation of mediastinal hematoma, the detection of osseous injuries is a requirement.

  17. Spinous process fractures in osteoporotic thoracolumbar vertebral fractures

    PubMed Central

    Seo, M R N; Park, S Y; Park, J S; Jin, W; Ryu, K N

    2011-01-01

    Objectives To evaluate the incidence and pattern of spinous process fractures (SPFs) in patients with osteoporotic compression fractures (OCFs) of the thoracolumbar spine. Methods Spinal MRI or CT of 398 female patients (age range 50–89 years, mean age 70 years) who had OCFs in the thoracolumbar spine were retrospectively reviewed. The incidence, location and imaging results for the SPFs were evaluated. Results Of the 398 patients who had thoracolumbar OCFs, 14 (3.5%) had SPF. In six patients with single compression fractures, the SPF occurred at the level just above the vertebral compression fracture. In six out of seven patients with multiple continuous compression fractures, the SPF occurred just one level above the uppermost level of the compression fracture. The remaining one patient who had thoracolumbar spinal fixation at T12–L2 with continuous compression fractures in T12–L5 had a SPF in L2. In one patient who had multiple compression fractures in discontinuous levels (fractures at T10 and L1, respectively), the SPF occurred at T12. The directions of the fractures were vertical or oblique vertical (perpendicular to the long axis of the spinous process) in all cases. Conclusion In the presence of an OCF in the thoracolumbar spine, a SPF was found in 3.5% of cases, and most of the fractures were located just one level above the compression fracture. Therefore, in patients who have OCF, the possibility of a SPF in the level just above the compression fracture should be considered. PMID:21343317

  18. Incidence of Symptomatic Vertebral Fractures in Patients After Percutaneous Vertebroplasty

    SciTech Connect

    Hierholzer, Johannes Fuchs, Heiko; Westphalen, Kerstin; Baumann, Clemens; Slotosch, Christine; Schulz, Rudolf

    2008-11-15

    The aim of this study was to evaluate the incidence of secondary symptomatic vertebral compression fractures (VCFs) in patients previously treated by percutaneous vertebroplasty (VTP). Three hundred sixteen patients with 486 treated VCFs were included in the study according to the inclusion criteria. Patients were kept in regular follow-up using a standardized questionairre before, 1 day, 7 days, 6 months, and 1 year after, and, further on, on a yearly basis after VTP. The incidence of secondary symptomatic VCF was calculated, and anatomical distribution with respect to previous fractures characterized. Mean follow-up was 8 months (6-56 months) after VTP. Fifty-two of 316 (16.4 %) patients (45 female, 7 male) returned for treatment of 69 secondary VCFs adjacent to (35/69; 51%) or distant from (34/69; 49%) previously treated levels. Adjacent secondary VCF occurred significantly more often compared to distant secondary VCF. Of the total 69 secondary VCFs, 35 of 69 occurred below and 27 of 69 above pretreated VCFs. Of the 65 sandwich levels generated, in 7 of 65 (11%) secondary VCFs were observed. Secondary VCF below pretreated VCF occurred significantly earlier in time compared to VCF above and compared to sandwich body fractures. No major complication occurred during initial or follow-up intervention. We conclude that secondary VCFs do occur in individuals after VTP but the rate found in our study remains below the level expected from epidemiologic studies. Adjacent fractures occur more often and follow the cluster distribution of VCF as expected from the natural history of the underlying osteoporosis. No increased rate of secondary VCF after VTP was observed in this retrospective analysis. In accordance with the pertinent literature, short-term and also midterm clinical results are encouraging and provide further support for the usefulness and the low complication rate of this procedure as an adjunct to the spectrum of pain management in patients with severe

  19. Role of Transpedicular Percutaneous Vertebral Biopsy for Diagnosis of Pathology in Vertebral Compression Fractures

    PubMed Central

    Nadkarni, Sunil; Hardikar, Sharad Moreshwar; Hardikar, Madan Sharad

    2016-01-01

    Study Design Retrospective observational study. Purpose To identify the role of percutaneous vertebral biopsy in histopathological diagnosis of vertebral compression fractures and to identify the frequency of unexpected malignancy in vertebral compression fractures. Overview of Literature Vertebral compression fractures are common in the Indian population. Magnetic resonance imaging and nuclear imaging have some limitations in the diagnosis of definitive pathology of vertebral compression fractures. Therefore, histological confirmation is necessary for definitive diagnosis and to plan appropriate management for patient. Methods A retrospective observational study was conducted involving 84 patients who underwent percutaneous vertebral biopsy between 2010 and 2014. We performed C-arm guided percutaneous transpedicular core vertebral biopsy of vertebral compression fractures under combination of local anesthesia and intravenous conscious sedation. Results Sufficient biopsy material was obtained in 79 of the 84 cases. In the other five cases, biopsy material was not sufficient for reporting. Out of the 79 cases, osteoporotic pathology was detected in 69 patients, malignancy was detected in 8 patients and no pathology was found in 2 patients. Two patients with distant metastases to vertebra were identified. Primary spinal malignancy was detected in 6 patients (1 unsuspected plasmacytoma, 5 diagnosed malignancy preoperatively). So, the frequency of unsuspected malignancy of this study was 1.19% (1/84). None of the patients had any complications. Conclusions C-arm guided percutaneous transpedicular vertebral biopsy is useful in obtaining definitive histopathological diagnosis of vertebral compression fractures, especially in differentiating malignant and non-malignant vertebral compression fractures and helping plan appropriate management of patients. The rate of unexpected malignancy in vertebral compression fracture was 1.19%. PMID:27790322

  20. Proximal junctional vertebral fracture-subluxation after adult spine deformity surgery. Does vertebral augmentation avoid this complication? A case report

    PubMed Central

    2012-01-01

    Background To report to the orthopedic community a case of vertebral fracture and adjacent vertebral subluxation through the upper instrumented vertebra after thoracolumbar fusion with augmentation of the cranial level. Methods This report reviewed the patient`s medical record, her imaging studies and related literature. The possible factors contributing to this fracture are hypothesized. Results A 70-year-old woman underwent decompressive surgery and posterolateral fusion for adult lumbar scoliosis. We used pedicular screws from T10 to S1 and iliac screw at the right side, augmented with cement at T10, T11, L1, L5 and S1; and prophylactic vertebroplasty at T9 to avoid the "topping-off syndrome". Thirty days after discharge, without recognizable inciting trauma, the patient complained of pain in the lower thoracic area. The exam revealed overall neurological deficit below the level of fracture. CT scan and MRI demonstrated a T10 vertebral collapse and T9 vertebral subluxation with morphologic features of flexion-distraction fracture through the upper edge of the screw. At this point, the authors performed posterior decompression at T9 to T10 and extended posterolateral arthrodesis from T2 to T10. To our knowledge, this is an unreported fracture. Conclusions Augmentation of the cranial level in a long thoracolumbar fusion has been developed to avoid the junctional kyphosis and compression fractures at that level. We alert the orthopedic community that this augmentation may lead to further and more severe fractures, although this opinion requires investigation for confirmation. PMID:22947422

  1. Outcome of percutaneous balloon kyphoplasty in vertebral compression fractures

    PubMed Central

    Saxena, B Praveen; Shah, B Viral; Joshi, S Prateek

    2015-01-01

    Background: Incidence of vertebral compression fractures (VCFs) is increasing due to increase in human life expectancy and prevalence of osteoporosis. Vertebroplasty had been traditional treatment for pain, but it neither attempts to restore vertebral body height nor eliminates spinal deformity and is associated with a high rate of cement leakage. Balloon kyphoplasty involves introduction of inflatable balloon into the fractured body of vertebra for elevation of the end-plates prior to fixation of the fracture with bone cement. This study evaluates short term functional and radiological outcomes of balloon kyphoplasty. The secondary aim is to explore short-term complications of the procedure. Materials and Methods: A retrospective study of 199 kyphoplasty procedures in 135 patients from March 2009 to March 2012 were evaluated with short form-36 (SF-36) score, visual analogue scale (VAS), detailed neurological and radiological evaluations. The mean followup was 18 months (range 12–20 months). Statistical analysis including paired sample t-test was done with statistical package for social sciences. Results: Statistically significant improvements in SF-36 (from 34.29 to 48.53, an improvement of 14.24, standard deviation (SD) - 20.08 P < 0.0001), VAS (drop of 4.49, from 6.74 to 2.24, SD - 1.44, P < 0.0001), percentage restoration of lost vertebral height (from 30.62% to 16.19%, improvement of 14.43%, SD - 15.37, P < 0.0001) and kyphotic angle correction (from 17.41° to 10.59°, improvement of 6.82, SD - 7.26°, P < 0.0001) were noted postoperatively. Six patients had cement embolism, 65 had cement leak and three had adjacent level fracture which required repeat kyphoplasty later. One patient with history of ischemic heart disease had cardiac arrest during the procedure. No patients had neurological deterioration in the followup period. Conclusions: Kyphoplasty is a safe and effective treatment for VCFs. It improves physical function, reduces pain and corrects

  2. Percutaneous vertebroplasty using hydroxyapatite blocks for the treatment of vertebral body fracture.

    PubMed

    Nishioka, Kazuya; Imae, Shinji; Kitayama, Mari; Miki, Jun-Ichiro; Okawa, Toshika; Itakura, Toru

    2009-11-01

    Vertebroplasty with hydroxyapatite blocks through a modified percutaneous approach was used to treat 30 patients with vertebral body fractures in 32 vertebral bodies between February 2003 and March 2007. The mean follow-up period was 16.6 months. The pain associated with this procedure, effects on adjacent vertebral bodies, and other complications were evaluated. The rate of recollapse after vertebroplasty was examined in 26 patients with 26 vertebral bodies treated and followed up for more than 3 months. Mean time of operation was 57 minutes and mean number of blocks used per vertebral body was 104. The mean visual analogue scale score was 7.0 preoperatively and 1.6 postoperatively. The mean decline in postoperative vertebral body height was 13%. New vertebral body fractures occurred postoperatively in 3 vertebral bodies in 2 patients. Leakage of blocks outside the vertebral body occurred in 2 patients during the operation, and after the operation in one patient, and the hydroxyapatite plug broke postoperatively in one patient. Hydroxyapatite blocks yielded good pain relief comparable to bone cement, with no serious complications such as a pulmonary embolism or leakage into the spinal canal, and are effective for percutaneous vertebroplasty.

  3. Repeated adjacent segment diseases and fractures in osteoporotic patients: a case report

    PubMed Central

    Chen, Hsin-Yao; Chen, Chiu-Liang; Chen, Wei-Liang

    2016-01-01

    Background Pedicle screw instrumentation for treating spinal disorder is becoming increasingly widespread. Many studies have advocated its use to facilitate rigid fixation for spine; however, adjacent segmental disease is a known complication. Instrumented fusion for osteoporotic spines remains a significant challenge for spine surgeons. Prophylactic vertebroplasty for adjacent vertebra has been reported to reduce the complications of junctional compression fractures but has raised a new problem of vertebral subluxation. This case report is a rare and an extreme example with many surgical complications caused by repeated instrumented fusion for osteoporotic spine in a single patient. This patient had various complications including adjacent segmental disease, vertebral subluxation, and junctional fractures on radiographs and magnetic resonance images. Case presentation An 81-year-old Taiwanese woman underwent decompression and instrumented fusion of L4-L5 in Taiwan 10 years ago. Due to degenerative spinal stenosis of L3-L4 and L2-L3, she had decompression with instrumented fusion from L5 to L1 at the previous hospital. However, catastrophic vertebral subluxations with severe neurologic compromise occurred, and she underwent salvage surgeries twice with prolonged instrumented fusion from L5 to T2. The surgeries did not resolve her problems of spinal instability and neurologic complications. Eventually, the patient remained with a Frankel Grade C spinal cord injury. Conclusion Adjacent segmental disease, junctional fracture, and vertebral subluxation are familiar complications following instrumented spinal fusion surgeries for osteoporotic spines. Neurologic injuries following long instrumentation are often serious and difficult to address with surgery alone. Conservative treatments should always be contemplated as an alternative method for patients with poor bone stock. PMID:27555778

  4. Vascular calcifications, vertebral fractures and mortality in haemodialysis patients

    PubMed Central

    Rodríguez-García, Minerva; Gómez-Alonso, Carlos; Naves-Díaz, Manuel; Diaz-Lopez, Jose Bernardino; Diaz-Corte, Carmen; Cannata-Andía, Jorge B.

    2009-01-01

    Background. Vascular calcifications and the bone fractures caused by abnormal bone fragility, also called osteoporotic fractures, are frequent complications associated with chronic kidney diseases (CKD). The aim of this study was to investigate the association between vascular calcifications, osteoporotic bone fractures and survival in haemodialysis (HD) patients. Methods. A total of 193 HD patients were followed up to 2 years. Vascular calcifications and osteoporotic vertebral fractures (quoted just as vertebral fractures in the text) were assessed by thoracic, lumbar spine, pelvic and hand X-rays and graded according to their severity. Clinical, biochemical and therapeutic data gathered during the total time spent on HD were collected. Results. The prevalence of aortic calcifications was higher in HD patients than in a random-based general population (79% versus 37.5%, P < 0.001). Total time on any renal replacement therapy (RRT) and diabetes were positively associated with a higher prevalence of vascular calcifications. In addition to these factors, time on HD was also positively associated with the severity of vascular calcifications, and higher haemoglobin levels were associated with a lower prevalence of severe vascular calcifications in large and medium calibre arteries. The prevalence of vertebral fractures in HD patients was similar to that of the general population (26.5% versus 24.1%). Age and time on HD showed a positive and statistically significant association with the prevalence of vertebral fractures. Vascular calcifications in the medium calibre arteries were associated with a higher rate of prevalent vertebral fractures. In women, severe vascular calcifications and vertebral fractures were positively associated with mortality [RR = 3.2 (1.0–10.0) and RR = 4.8 (1.7–13.4), respectively]. Conclusions. Positive associations between vascular calcifications, vertebral fractures and mortality have been found in patients on HD. PMID:18725376

  5. Vertebral deformities identified by vertebral fracture assessment: associations with clinical characteristics and bone mineral density.

    PubMed

    Jacobs-Kosmin, Dana; Sandorfi, Nora; Murray, Heather; Abruzzo, John L

    2005-01-01

    Whether vertebral fractures identified on radiographs are painful or not, they are associated with increased morbidity and mortality. Vertebral fractures on X-rays correlate with low bone mineral density (BMD) at the spine and hip in addition to several clinical characteristics. Evidence suggests that vertebral deformities detected by X-ray and by vertebral fracture assessment (VFA) show good agreement. We examined the relationship between VFA-detected vertebral deformities and patient characteristics as well as BMD by analyzing the records of 432 patients who had undergone dual-energy X-ray absorptiometry (DXA) scans with VFA. Patients' demographic data and T-scores were obtained from patient questionnaires and DXA scans. We categorized vertebral deformities by type and severity. Patients with vertebral deformities were significantly older and more likely to report a history of fracture after childhood. Significantly more estrogen use was reported in patients without deformity. Those with deformities had significantly lower T-scores at the femoral neck and total hip but not at the spine. Increased severity and number of deformities correlated with lower T-scores at the total hip and femoral neck but not the spine. In conclusion, vertebral deformities detected by VFA, like those on X-ray, correlate with both clinical characteristics and reduced bone mass at the hip. These relationships, in addition to rapid performance, convenience, and minimal radiation exposure, indicate VFA-detected vertebral deformities are a valuable adjunct in identifying patients in need of additional evaluation and treatment.

  6. Surgical treatment of complex axis fractures with adjacent segment instability.

    PubMed

    Wang, Lei; Xia, Tian; Dong, Shuanghai; Zhao, Qinghua; Tian, Jiwei

    2012-03-01

    This study investigates the clinical and radiographic characteristics of complex axis fractures with adjacent segment instability and describes the outcome of surgical treatment. Twenty-one patients (14 male, seven female; mean age=34 years) with complex axis fractures and adjacent segment instability who were treated between August 2003 and June 2009 were retrospectively reviewed. Treatment selection was based on fracture type and stability of the upper cervical segments. All patients were immobilized with a hard collar for three months after surgery. The mean follow-up period was 12 months (range=6-36 months). No intraoperative surgery-related complications were observed and fusion was achieved in all patients. The outcome was excellent for 17 patients, good for two patients, fair for one patient, and poor for one patient. The upper cervical segments that can become unstable due to complex axis fractures include the atlantoaxial and C2-3 joints. Recommended surgical treatments produce good results.

  7. High mortality and poor morbidity after hip fracture in patients with previous vertebral fractures.

    PubMed

    Ha, Yong-Chan; Baek, Ji-Hoon; Ko, Young-Bong; Park, Sang-Min; Song, Sang-Heon

    2015-09-01

    Although vertebral fracture in patients is a predictor of subsequent hip fracture, no study has assessed the mortality and functional outcome in hip fracture patients with previous vertebral fracture. Between September 2009 and December 2012, we evaluated 246 patients over 50-years-of-age diagnosed with femoral neck or intertrochanteric fractures who underwent surgery. The patients were categorized into two groups and two subgroups. Group Ia comprised 150 patients with previous vertebral fracture at the time of hip fracture. Group Ib comprised 96 patients with no vertebral fracture. Group IIa consisted of 76 patients <80-years-of-age with previous vertebral fracture. Group IIb comprised 69 patients <80-years-of-age without previous vertebral fracture. The mortality rate and functional outcome of osteoporotic hip fracture patients with and without vertebral fractures were compared. The cumulative mortality rate at 6 and 12 months post-fracture was 19 and 23 % in Group Ia and 6 and 7 % in Group Ib, respectively. In subgroup analysis, the cumulative mortality rate at 6 and 12 months was 13 and 17 % in Group IIa and 3 and 4 % in Group IIb, respectively. Shut-in patients at the final follow-up included 51 of 103 (49.5 %) patients in Group Ia and 19 of 83 (22.9 %) patients in Group Ib. In subgroup analysis, the shut-in patients included 18 of 58 (31.0 %) patients in Group IIa and 10 of 62 (16.1 %) patients in Group IIb. Previous vertebral fracture was associated with a poor functional outcome and increased mortality in patients with hip fracture.

  8. Gout and the Risk of Non-vertebral Fracture.

    PubMed

    Kim, Seoyoung C; Paik, Julie M; Liu, Jun; Curhan, Gary C; Solomon, Daniel H

    2017-02-01

    Prior studies suggest an association between osteoporosis, systemic inflammation, and pro-inflammatory cytokines such as interleukin (IL)-1 and IL-6. Conflicting findings exist on the association between hyperuricemia and osteoporosis. Furthermore, it remains unknown whether gout, a common inflammatory arthritis, affects fracture risk. Using data from a US commercial health plan (2004-2013), we evaluated the risk of non-vertebral fracture (ie, forearm, wrist, hip, and pelvis) in patients with gout versus those without. Gout patients were identified with ≥2 diagnosis codes and ≥1 dispensing for a gout-related drug. Non-gout patients, identified with ≥2 visits coded for any diagnosis and ≥1 dispensing for any prescription drugs, were free of gout diagnosis and received no gout-related drugs. Hip fracture was the secondary outcome. Fractures were identified with a combination of diagnosis and procedure codes. Cox proportional hazards models compared the risk of non-vertebral fracture in gout patients versus non-gout, adjusting for more than 40 risk factors for osteoporotic fracture. Among gout patients with baseline serum uric acid (sUA) measurements available, we assessed the risk of non-vertebral fracture associated with sUA. We identified 73,202 gout and 219,606 non-gout patients, matched on age, sex, and the date of study entry. The mean age was 60 years and 82% were men. Over the mean 2-year follow-up, the incidence rate of non-vertebral fracture per 1,000 person-years was 2.92 in gout and 2.66 in non-gout. The adjusted hazard ratio (HR) was 0.98 (95% confidence interval [CI] 0.85-1.12) for non-vertebral fracture and 0.83 (95% CI 0.65-1.07) for hip fracture in gout versus non-gout. Subgroup analysis (n = 15,079) showed no association between baseline sUA and non-vertebral fracture (HR = 1.03, 95% CI 0.93-1.15), adjusted for age, sex, comorbidity score, and number of any prescription drugs. Gout was not associated with a risk of non-vertebral

  9. High Serum SHBG Predicts Incident Vertebral Fractures in Elderly Men

    PubMed Central

    Vandenput, Liesbeth; Mellström, Dan; Kindmark, Andreas; Johansson, Helena; Lorentzon, Mattias; Leung, Jason; Redlund‐Johnell, Inga; Rosengren, Björn E; Karlsson, Magnus K; Wang, Yi‐Xiang; Kwok, Timothy

    2016-01-01

    ABSTRACT Previous prospective cohort studies have shown that serum levels of sex steroids and sex hormone‐binding globulin (SHBG) associate with nonvertebral fracture risk in men. The predictive value of sex hormones and SHBG for vertebral fracture risk specifically is, however, less studied. Elderly men (aged ≥65 years) from Sweden and Hong Kong participating in the Osteoporotic Fractures in Men (MrOS) study had baseline estradiol and testosterone analyzed by gas chromatography–mass spectrometry (GC‐MS) and SHBG by immunoradiometric assay (IRMA). Incident clinical vertebral fractures (n = 242 cases) were evaluated in 4324 men during an average follow‐up of 9.1 years. In a subsample of these men (n = 2256), spine X‐rays were obtained at baseline and after an average follow‐up of 4.3 years to identify incident radiographic vertebral fractures (n = 157 cases). The likelihood of incident clinical and radiographic vertebral fractures was estimated by Cox proportional hazards models and logistic regression models, respectively. Neither serum estradiol (hazard ratio [HR] per SD increase = 0.93, 95% confidence interval [CI] 0.80–1.08) nor testosterone (1.05, 0.91–1.21) predicted incident clinical vertebral fractures in age‐adjusted models in the combined data set. High serum SHBG, however, associated with increased clinical vertebral fracture risk (1.24, 1.12–1.37). This association remained significant after further adjustment for FRAX with or without bone mineral density (BMD). SHBG also associated with increased incident radiographic vertebral fracture risk (combined data set; odds ratio [OR] per SD increase = 1.23, 95% CI 1.05–1.44). This association remained significant after adjustment for FRAX with or without BMD. In conclusion, high SHBG predicts incident clinical and radiographic vertebral fractures in elderly men and adds moderate information beyond FRAX with BMD for vertebral fracture risk prediction. © 2015 The

  10. Low Volume Vertebral Augmentation with Cortoss® Cement for Treatment of High Degree Vertebral Compression Fractures and Vertebra Plana

    PubMed Central

    Jacobson, Robert E; Hatgis, Jesse; Berti, Aldo

    2017-01-01

    This is a retrospective analysis of a consecutive series of patients undergoing vertebroplasty and vertebral augmentation in an outpatient setting for high degree osteoporotic vertebral fractures or vertebra plana using consistently low volumes (less than 3 cc) of Cortoss® cement, rather than polymethylmethacrylate (PMMA). The results in these patients demonstrate that it is both technically feasible to do vertebroplasty on these patients and using a low volume hydrophilic silica-based cement is effective in providing diffuse vertebral body fill with minimal complications. There was no increased risk of complications, such as cement leakage, displacement of bone fragments, or progression of the angulation. Specifically, with over a 24-month follow-up, the preoperative collapse or angulation did not worsen and none of the patients developed adjacent level fractures or required further surgery at the involved vertebral level. PMID:28367395

  11. Observer agreement in pediatric semi-quantitative vertebral fracture diagnosis

    PubMed Central

    Siminoski, Kerry; Lentle, Brian; Matzinger, Mary-Ann; Shenouda, Nazih; Ward, Leanne M.

    2013-01-01

    Background The Genant semi-quantitative (GSQ) method has been a standard procedure for diagnosis of vertebral fractures in adults, but has only recently been shown to be of clinical utility in pediatrics. Observer agreement using the GSQ method in this age group has not been described. Objective To evaluate observer agreement on vertebral readability and vertebral fracture diagnosis using the GSQ method in pediatric vertebral morphometry. Materials and methods Spine radiographs of 186 children with acute lymphoblastic leukemia were evaluated independently by three radiologists using the same GSQ methodology as in adults. A subset of 100 radiographs was evaluated on two occasions. Results An average of 4.7% of vertebrae were unreadable for the three radiologists. Intraobserver Cohen’s kappa (κ) on readability ranged from 0.434 to 0.648 at the vertebral level and from 0.416 to 0.611 at the patient level, while interobserver κ for readability had a range of 0.330 to 0.504 at the vertebral level and 0.295 to 0.467 at the patient level. Intraobserver κ for the presence of vertebral fracture had a range of 0.529 to 0.726 at the vertebral level and was 0.528 to 0.767 at the patient level. Interobserver κ for fracture at the vertebral level ranged from 0.455 to 0.548 and from 0.433 to 0.486 at the patient level. Conclusion Most κ values for both intra- and interobserver agreement in applying the GSQ method to pediatric spine radiographs were in the moderate to substantial range, comparable to the performance of the technique in adult studies. The GSQ method should be considered for use in pediatric research and clinical practice. PMID:24323185

  12. Prevalent Morphometric Vertebral Fractures in Professional Male Rugby Players

    PubMed Central

    Hind, Karen; Birrell, Fraser; Beck, Belinda

    2014-01-01

    There is an ongoing concern about the risk of injury to the spine in professional rugby players. The objective of this study was to investigate the prevalence of vertebral fracture using vertebral fracture assessment (VFA) dual energy X-ray absorptiometry (DXA) imaging in professional male rugby players. Ninety five professional rugby league (n = 52) and union (n = 43) players (n = 95; age 25.9 (SD 4.3) years; BMI: 29.5 (SD 2.9) kg.m2) participated in the research. Each participant received one VFA, and one total body and lumbar spine DXA scan (GE Lunar iDXA). One hundred and twenty vertebral fractures were identified in over half of the sample by VFA. Seventy four were graded mild (grade 1), 40 moderate (grade 2) and 6 severe (grade 3). Multiple vertebral fractures (≥2) were found in 37 players (39%). There were no differences in prevalence between codes, or between forwards and backs (both 1.2 v 1.4; p>0.05). The most common sites of fracture were T8 (n = 23), T9 (n = 18) and T10 (n = 21). The mean (SD) lumbar spine bone mineral density Z-score was 2.7 (1.3) indicating high player bone mass in comparison with age- and sex-matched norms. We observed a high number of vertebral fractures using DXA VFA in professional rugby players of both codes. The incidence, aetiology and consequences of vertebral fractures in professional rugby players are unclear, and warrant timely, prospective investigation. PMID:24846310

  13. Underdiagnosis of osteoporotic vertebral fractures in patients with fragility fractures: retrospective analysis of over 300 patients

    PubMed Central

    Bottai, Vanna; Giannotti, Stefano; Raffaetà, Gloria; Mazzantini, Maurizio; Casella, Francesco; De Paola, Gaia; Menconi, Agnese; Falossi, Francesca; Guido, Giulio

    2016-01-01

    Summary Osteoporosis (OP) is a silent disease unless a fracture occurs; it is a major health problem, mainly due to fragility fractures, that occur at vertebral and peripheral sites. Vertebral fractures (VF) are probably the most common fragility fractures, but they go often unrecognized. The main clinical symptoms of VF are acute and chronic back pain, spinal deformity, reduced mobility and impaired quality of life. They are frequently associated with other fragility fractures. We examined 478 patients at our outpatient clinic, who were referred for fragility fracture occurrence. The most common fragility fractures was hip fractures. However, after execution of spine X-rays in patients who had sustained hip fracture, we found that a large proportion of them had VF, which had not been reported in their medical history. PMID:27920807

  14. Vertebral Augmentation Involving Vertebroplasty or Kyphoplasty for Cancer-Related Vertebral Compression Fractures: A Systematic Review

    PubMed Central

    Pron, Gaylene; Holubowich, Corinne; Kaulback, Kellee

    2016-01-01

    Background Cancers that metastasize to the spine and primary cancers such as multiple myeloma can result in vertebral compression fractures or instability. Conservative strategies, including bed rest, bracing, and analgesic use, can be ineffective, resulting in continued pain and progressive functional disability limiting mobility and self-care. Surgery is not usually an option for cancer patients in advanced disease states because of their poor medical health or functional status and limited life expectancy. The objectives of this review were to evaluate the effectiveness and safety of percutaneous image-guided vertebral augmentation techniques, vertebroplasty and kyphoplasty, for palliation of cancer-related vertebral compression fractures. Methods We performed a systematic literature search for studies on vertebral augmentation of cancer-related vertebral compression fractures published from January 1, 2000, to October 2014; abstracts were screened by a single reviewer. For those studies meeting the eligibility criteria, full-text articles were obtained. Owing to the heterogeneity of the clinical reports, we performed a narrative synthesis based on an analytical framework constructed for the type of cancer-related vertebral fractures and the diversity of the vertebral augmentation interventions. Results The evidence review identified 3,391 citations, of which 111 clinical reports (4,235 patients) evaluated the effectiveness of vertebroplasty (78 reports, 2,545 patients) or kyphoplasty (33 reports, 1,690 patients) for patients with mixed primary spinal metastatic cancers, multiple myeloma, or hemangiomas. Overall the mean pain intensity scores often reported within 48 hours of vertebral augmentation (kyphoplasty or vertebroplasty), were significantly reduced. Analgesic use, although variably reported, usually involved parallel decreases, particularly in opioids, and mean pain-related disability scores were also significantly improved. In a randomized controlled

  15. Justification criteria for vertebral fractures: year 2012 revision.

    PubMed

    Mori, Satoshi; Soen, Satoshi; Hagino, Hiroshi; Nakano, Tetsuo; Ito, Masako; Fujiwara, Saeko; Kato, Yoshiharu; Tokuhashi, Yasuaki; Togawa, Daisuke; Endo, Naoto; Sawaguchi, Takeshi

    2013-05-01

    Justification Criteria for Vertebral Fractures 2012 version was made based on new clinical findings. Major differences in this version compared to the 1996 version are inclusion of the semiquantitative method (SQ), statements to improve considerations during radiographic analysis, and the need for more detailed evaluation by MRI.

  16. Quantitative vertebral compression fracture evaluation using a height compass

    NASA Astrophysics Data System (ADS)

    Yao, Jianhua; Burns, Joseph E.; Wiese, Tatjana; Summers, Ronald M.

    2012-03-01

    Vertebral compression fractures can be caused by even minor trauma in patients with pathological conditions such as osteoporosis, varying greatly in vertebral body location and compression geometry. The location and morphology of the compression injury can guide decision making for treatment modality (vertebroplasty versus surgical fixation), and can be important for pre-surgical planning. We propose a height compass to evaluate the axial plane spatial distribution of compression injury (anterior, posterior, lateral, and central), and distinguish it from physiologic height variations of normal vertebrae. The method includes four steps: spine segmentation and partition, endplate detection, height compass computation and compression fracture evaluation. A height compass is computed for each vertebra, where the vertebral body is partitioned in the axial plane into 17 cells oriented about concentric rings. In the compass structure, a crown-like geometry is produced by three concentric rings which are divided into 8 equal length arcs by rays which are subtended by 8 common central angles. The radius of each ring increases multiplicatively, with resultant structure of a central node and two concentric surrounding bands of cells, each divided into octants. The height value for each octant is calculated and plotted against octants in neighboring vertebrae. The height compass shows intuitive display of the height distribution and can be used to easily identify the fracture regions. Our technique was evaluated on 8 thoraco-abdominal CT scans of patients with reported compression fractures and showed statistically significant differences in height value at the sites of the fractures.

  17. Bioceramic vertebral augmentation with a calcium sulphate/hydroxyapatite composite (Cerament SpineSupport): in vertebral compression fractures due to osteoporosis.

    PubMed

    Rauschmann, Michael; Vogl, Thomas; Verheyden, Akhil; Pflugmacher, Robert; Werba, Thomas; Schmidt, Sven; Hierholzer, Johannes

    2010-06-01

    A prospective, non-randomized multicenter study was initiated to study efficacy and safety of a partly resorbable composite of calcium sulphate and hydroxyapatite (Cerament SpineSupport), a novel, injectable bioceramic, in osteoporotic patients with vertebral compression fractures during 18-month follow-up. Fifteen patients with low-energy trauma and 1-2 vertebral compression fractures verified by magnetic resonance imaging were recruited to undergo percutaneous bioceramic vertebral augmentation under fluoroscopy. The patients were treated with a highly flowable bioceramic containing calcium sulphate, hydroxyapatite and the non-ionic radiocontrast agent iohexol, with final setting time within 1 h. After the procedure, the patients were allowed to mobilize after 2 h. Pain (VAS), occurrence of remote and adjacent fractures, and Quality of Life (QoL; SF-36 and EQ-5D) was recorded during 18 months. The injected volume of the composite material ranged from 2.8 to 9 mL (mean 4.2 mL). Pre-operative VAS score was mean 70.3 (CI95% +/-8.7) with an immediate post-operative pain relief, which was maintained at the 4-week visit (mean 26.4 with CI95% +/-16.1) and 8-week visit (mean 18.0 with CI95% +/-13.5 pain relief). Eighty percent of the patients demonstrated a clinical improvement. The pain relief was maintained over 18 months and no adjacent fractures were observed. There was a statistically significant improvement of physical components in the QoL assessment. No extra-vertebral leakage or neurological deficits were reported in this series. This first prospective multicenter study on a partly resorbable bioceramic material indicate that fracture healing can be achieved with sustained pain relief over a follow-up period of 18 months in an osteoporotic patient population with vertebral compression fractures.

  18. Repeated vertebral augmentation for new vertebral compression fractures of postvertebral augmentation patients: a nationwide cohort study

    PubMed Central

    Liang, Cheng-Loong; Wang, Hao-Kwan; Syu, Fei-Kai; Wang, Kuo-Wei; Lu, Kang; Liliang, Po-Chou

    2015-01-01

    Purpose Postvertebral augmentation vertebral compression fractures are common; repeated vertebral augmentation is usually performed for prompt pain relief. This study aimed to evaluate the incidence and risk factors of repeat vertebral augmentation. Methods We performed a retrospective, nationwide, population-based longitudinal observation study, using the National Health Insurance Research Database (NHIRD) of Taiwan. All patients who received vertebral augmentation for vertebral compression fractures were evaluated. The collected data included patient characteristics (demographics, comorbidities, and medication exposure) and repeat vertebral augmentation. Kaplan–Meier and stratified Cox proportional hazard regressions were performed for analyses. Results The overall incidence of repeat vertebral augmentation was 11.3% during the follow-up until 2010. Patients with the following characteristics were at greater risk for repeat vertebral augmentation: female sex (AOR=1.24; 95% confidence interval [CI]: 1.10–2.36), advanced age (AOR=1.60; 95% CI: 1.32–2.08), diabetes mellitus (AOR=4.31; 95% CI: 4.05–5.88), cerebrovascular disease (AOR=4.09; 95% CI: 3.44–5.76), dementia (AOR=1.97; 95% CI: 1.69–2.33), blindness or low vision (AOR=3.72; 95% CI: 2.32–3.95), hypertension (AOR=2.58; 95% CI: 2.35–3.47), and hyperlipidemia (AOR=2.09; 95% CI: 1.67–2.22). Patients taking calcium/vitamin D (AOR=2.98; 95% CI: 1.83–3.93), bisphosphonates (AOR=2.11; 95% CI: 1.26–2.61), or calcitonin (AOR=4.59; 95% CI: 3.40–5.77) were less likely to undergo repeat vertebral augmentation; however, those taking steroids (AOR=7.28; 95% CI: 6.32–8.08), acetaminophen (AOR=3.54; 95% CI: 2.75–4.83), or nonsteroidal anti-inflammatory drugs (NSAIDs) (AOR=6.14; 95% CI: 5.08–7.41) were more likely to undergo repeat vertebral augmentation. Conclusion We conclude that the incidence of repeat vertebral augmentation is rather high. An understanding of risk factors predicting repeat

  19. Prone position in balloon kyphoplasty leads to no secondary vertebral compression fractures in osteoporotic spine – a MRI study

    PubMed Central

    Spalteholz, Matthias; Strasser, Evald; Hantel, Torsten; Gahr, Ralf Herbert

    2014-01-01

    Purpose: Vertebral compression fractures are the most common fractures in the elderly. Long lasting pain and deformity is responsible for consecutive impairment with markedly reduced life quality, increased morbidity and mortality. The beneficial effects of balloon kyphoplasty are verified in many studies. Subsequent fracture risk is not finally clarified, cement related risks and deformity related risks are discussed. There is less knowledge about the risk of bone marrow edema and new fractures during balloon kyphoplasty procedure. The goal of this study is to examine, if prone position during kyphoplasty is an independent risk factor for new fractures in the osteoporotic spine. Methods: Consecutive MRI study of 20 patients with fresh, non-traumatic thoracolumbar vertebral compression fractures and balloon kyphoplasty treatment. MRI Scans of the thoracolumbar spine were obtained after surgery, before patients have been mobilized. Specific MRI changes like new bone marrow edema, signal intensity changes in adjacent and remote segments and new fractures were assessed by specialized neuro-radiologist. Results: 20 MR images were examined within 48 hours after balloon kyphoplasty procedure. 85% did not show bone marrow edema extent changes after kyphoplasty. We found minor increase of bone marrow edema within the augmented vertebral body in 3 cases. We did not find any new bone marrow edema and no new fractures in adjacent and remote segments after balloon kyphoplasty treatment. Conclusion: Prone position leads to no new bone marrow edema and no new fractures in the osteoporotic spine. Accordingly, prone position has no risk for adjacent level fractures in osteoporotic spines. PMID:26504728

  20. Transoral vertebral augmentation with polymethylmethacrylate in the treatment of a patient with a dens fracture nonunion and subarticular vertebral body fracture of C2.

    PubMed

    Beall, Douglas P; Stanfield, Matthew; Martin, Hal D; Stapp, Annette M

    2007-05-01

    The injection of polymethylmethacrylate (PMMA) is a minimally invasive, image-guided procedure used to treat vertebral fractures due to osteoporosis, metastatic lesions, multiple myeloma, and benign but destabilizing bone tumors. The injection of PMMA into the C2 vertebral body using the transoral technique has been reported in three separate patients for treatment of benign tumors (a vertebral hemangioma and an aneurysmal bone cyst) and for multiple myeloma in the third patient. Although the injection of PMMA into the vertebral body is most commonly performed to treat benign vertebral compression fractures, a transoral C2 approach has not been reported in the English literature as a treatment for a benign fracture of C2. We report the treatment of a fracture and nonunion of the base of the dens and a subarticular fracture of the vertebral body of C2 using a bilateral transoral approach.

  1. Complete cage migration/subsidence into the adjacent vertebral body after posterior lumbar interbody fusion.

    PubMed

    Corniola, Marco V; Jägersberg, Max; Stienen, Martin N; Gautschi, Oliver P

    2015-03-01

    A variety of implant-related short and long-term complications after lumbar fusion surgery are recognized. Mid to long-term complications due to cage migration and/or cage subsidence are less frequently reported. Here, we report a patient with a complete cage migration into the superior adjacent vertebral body almost 20 years after the initial posterior lumbar interbody fusion procedure. In this patient, the cage migration/subsidence was clinically silent, but a selective decompression for adjacent segment degenerative lumbar spinal stenosis was performed. We discuss the risk factors for cage migration/subsidence in view of the current literature.

  2. Increased risk of vertebral fracture in patients with rheumatoid arthritis

    PubMed Central

    Chen, Bin; Cheng, Guangqi; Wang, Hantao; Feng, Yu

    2016-01-01

    Abstract The relationship between rheumatoid arthritis and risk of vertebral fracture has been reported by several observational studies. However, there is no higher-level evidence study, such as meta-analysis, that has investigated the relationship, and its mechanisms are not yet fully clear. This meta-analysis aimed to provide a summary of an observational study of the relationship between rheumatoid arthritis and the risk of vertebral fractures. Relevant studies were identified by searching PubMed and EMBASE databases (up to August 1, 2016). We included published observational studies (cohort or case-control design) evaluating the relationship between rheumatoid arthritis and the risk of vertebral fractures. Two reviewers searched and abstracted the data independently. Relative risks (RRs) with 95% confidence intervals (CIs) were used throughout the whole analysis. Seven observational studies (2 cohort studies, 2 nested case-control studies, and 3 case-control studies) were included in this meta-analysis. The results showed that the pooled RR of vertebral fracture for individuals with rheumatoid arthritis was 2.34 (95% CI 2.05–2.63, I2 = 35.4%, P for heterogeneity = 0.16). Further subgroup analysis by sex showed that the pooled RRs for both women and men, and only women were 2.14 (95% CI 1.47–2.8, I2 = 48.5%, P for heterogeneity = 0.12) and 2.39 (95% CI 2.07–2.70, I2 = 34%, P for heterogeneity = 0.22), respectively. Subgroup analysis by study design showed that the pooled RRs for cohort studies, nested case-control studies, and case-control studies were 2.31 (95% CI 1.95–2.67, I2 = 4.8%, P for heterogeneity = 0.31), 1.89 (95% CI 1.01–2.77, I2 = 72.1%, P for heterogeneity = 0.06), and 2.62 (95% CI 2.04–3.91, I2 = 26.1%, P for heterogeneity = 0.26), respectively. Based on our meta-analysis, rheumatoid arthritis should be regarded as an independent risk factor of vertebral fracture. Further studies are

  3. Pregnancy-associated osteoporosis presenting severe vertebral fractures.

    PubMed

    Ozturk, Cihat; Atamaz, Funda Calis; Akkurt, Halil; Akkoc, Yesim

    2014-01-01

    The syndrome of pregnancy-associated osteoporosis (PAO) is a rare disorder which occurs either in late pregnancy or early post-partum period leading to fragility fracture(s), most commonly in the vertebral bodies. We presented two cases with PAO who had compression fractures at multiple levels involving five vertebrae in one case and 10 vertebrae in the other. Their spinal bone mineral density values were below -2.5 standard deviations. Anti-osteoporotic treatments with nasal calcitonin 400 IU/day, vitamin D 300.000 IU single dose, calcium 1000 mg/day, vitamin D 880 IU/day were initiated. In one case, kyphoplasty was performed by a spinal surgeon. In addition to a thoracolumbosacral orthosis, a rehabilitation program including muscle strengthening, range of motion, relaxation and weight-bearing exercises was started for both cases. These cases emphasize that all pregnant women with complaints of back/lumbar pain should be carefully evaluated.

  4. Rate-dependent fracture characteristics of lumbar vertebral bodies.

    PubMed

    Stemper, Brian D; Yoganandan, Narayan; Baisden, Jamie L; Umale, Sagar; Shah, Alok S; Shender, Barry S; Paskoff, Glenn R

    2015-01-01

    Experimental testing incorporating lumbar columns and isolated components is essential to advance the understanding of injury tolerance and for the development of safety enhancements. This study incorporated a whole column axial acceleration model and an isolated vertebral body model to quantify compression rates during realistic loading and compressive tolerance of vertebrae. Eight lumbar columns and 53 vertebral bodies from 23 PMHS were used. Three-factor ANOVA was used to determine significant differences (p<0.05) in physiologic and failure biomechanics based on compression rate, spinal level, and gender. Results demonstrated a significant increase in ultimate force (i.e., fracture) from lower to higher compression rates. Ultimate stress also increased with compression rate. Displacement and strain to failure were consistent at both compression rates. Differences in ultimate mechanics between vertebral bodies obtained from males and females demonstrated non-significant trends, with female vertebral bodies having lower ultimate force that would be associated with decreased injury tolerance. This was likely a result of smaller vertebrae in that population. Combined with existing literature, results presented in this manuscript contribute to the understanding of lumbar spine tolerance during axial loading events that occur in both military and civilian environments with regard to effects of compression rate and gender.

  5. Exercise for improving outcomes after osteoporotic vertebral fracture

    PubMed Central

    Giangregorio, Lora M; MacIntyre, Norma J; Thabane, Lehana; Skidmore, Carly J; Papaioannou, Alexandra

    2016-01-01

    Background Vertebral fractures are associated with increased morbidity (e.g., pain, reduced quality of life), and mortality. Therapeutic exercise is a non-pharmacologic conservative treatment that is often recommended for patients with vertebral fractures to reduce pain and restore functional movement. Objectives Our objectives were to evaluate the benefits and harms of exercise interventions of four weeks or greater (alone or as part of a physical therapy intervention) versus non-exercise/non-active physical therapy intervention, no intervention or place boon the incidence of future fractures and adverse events among adults with a history of osteoporotic vertebral fracture(s). We were also examined the effects of exercise on the following secondary outcomes: falls, pain, posture, physical function, balance, mobility, muscle function, quality of life and bone mineral density of the lumbar spine or hip measured using dual-energy X-ray absorptiometry (DXA). We also reported exercise adherence. Search methods We searched the following databases: The Cochrane Library (Issue 11 of 12, November 2011), MEDLINE (2005 to 2011), EMBASE (1988 to November 23, 2011), CINAHL (Cumulative Index to Nursing and Allied Health Literature, 1982 to November 23, 2011), AMED (1985 to November 2011), and PEDro (Physiotherapy Evidence Database, www.pedro.fhs.usyd.edu.au/index.html, 1929 to November 23, 2011. Ongoing and recently completed trials were identified by searching the World Health Organization International Clinical Trials Registry Platform (to December 2009). Conference proceedings were searched via ISI and SCOPUS, and targeted searches of proceedings of the American Congress of Rehabilitation Medicine and American Society for Bone and Mineral Research. Search terms or MeSH headings included terms such as vertebral fracture AND exercise OR physical therapy. Selection criteria We considered all randomized controlled trials and quasi-randomized trials comparing exercise or active

  6. The impact of endplate fracture on postoperative vertebral height loss and kyphotic deformity during treatment of osteoporotic vertebral compression fractures with balloon kyphoplasty

    PubMed Central

    Li, Qingqing; Xiao, Long; Zhang, Jianwei; Fan, Jin; Zhou, Wei; Yin, Guoyong; Ren, Yongxin

    2016-01-01

    Abstract This retrospective study investigated the impact of endplate fracture on postoperative vertebral height loss and kyphotic deformity in 144 patients with osteoporotic vertebral compression fracture (OVCF), who received balloon kyphoplasty. Patients were divided into four groups: Group 1 had no superior endplate fracture, Group 2 had fractures on the anterior portion of the superior endplate, Group 3 had fractures on the posterior portion of the superior endplate, and Group 4 had complete superior endplate fractures. Anterior and middle vertebral body height, vertebral compression ratio, vertebral height loss rate, and kyphosis Cobb angle of each patient were measured and visual analogue scale (VAS) and Oswestry disability index (ODI) scores were recorded. The anterior vertebral height and kyphosis deformity of all groups significantly improved after the surgery, whereas substantial anterior vertebral height loss and increased Cobb angle were observed in all patients at the last follow-up. Although the vertebral height loss rate and the Cobb angle in Group 2, 3 and 4 were larger compared with Group 1 at the last follow-up, only the vertebral height loss rate in Group 4 and the increase in the Cobb angle in Group 2 and 4 were statistically different from those in Group 1. The VAS and ODI scores in all groups measured after the surgery and at the last follow-up were significantly lower compared with preoperative scores, but there was no significant difference among these groups. Balloon kyphoplasty significantly improved vertebral fracture height and kyphosis. Vertebral height loss and increased kyphotic deformity were observed in OVCF patients with endplate fractures after the surgery. Postoperative aggravation of kyphosis was observed in Group 2. Furthermore, severe vertebral height loss and increased kyphotic deformity were confirmed in Group 4 after the surgery. Our results suggested that postoperative vertebral height loss and aggravation of kyphosis may

  7. Ischemic spinal cord infarction in children without vertebral fracture

    PubMed Central

    Nance, Jessica R.; Golomb, Meredith R.

    2007-01-01

    Spinal cord infarction in children is a rare condition which is becoming more widely recognized. There are few reports in the pediatric literature characterizing etiology, diagnosis, treament and prognosis. The risk factors for pediatric ischemic spinal cord infarction include obstruction of blood flow associated with cardiovascular compromise or malformation, iatrogenic or traumatic vascular inujury, cerebellar herniation, thrombotic or embolic disease, infection, and vasculitis. In many children the cause of spinal cord ischemia in the absence of vertebral fracture is unknown. Imaging diagnosis of spinal cord ischemia is often difficult due to the small transverse area of the cord, cerebrospinal fluid artifact and inadequate resolution of MRI. Physical therapy is the most important treatment option. The prognosis is dependent on the level of spinal cord damage, early identification and reversal of ischemia, and follow-up with intensive physical therapy and medical support. In addition to summarizing the literature regarding spinal cord infarction in children without vertebral fracture, this review article adds two cases to the literature which highlight the difficulties and controversies in the management of this condition. PMID:17437902

  8. Development of computerized method for detection of vertebral fractures on lateral chest radiographs

    NASA Astrophysics Data System (ADS)

    Kasai, Satoshi; Li, Feng; Shiraishi, Junji; Li, Qiang; Nie, Yongkang; Doi, Kunio

    2006-03-01

    Osteoporosis is one of the major public health concerns in the world. Several clinical trials indicated clearly that pharmacologic therapy for osteoporosis is effective for persons with vertebral fractures for preventing subsequent fractures. It is, therefore, important to diagnose vertebral fractures early. Although most vertebral fractures are asymptomatic, they can often be detected on lateral chest radiographs which may be obtained for other purposes. However, investigators have reported that vertebral fractures which were visible on lateral chest radiographs were underdiagnosed or underreported. Therefore, our purpose in this study was to develop a computerized method for detection of vertebral fractures on lateral chest radiographs and to assist radiologists' image interpretation. Our computerized scheme is based on the detection of upper and lower edges of vertebrae on lateral chest images. A curved rectangular area which included a number of visible vertebrae was identified. This area was then straightened such that the upper and lower edges of the vertebrae were oriented horizontally. For detection of vertebral edges, line components were enhanced, and a multiple thresholding technique followed by image feature analysis was applied to the line enhanced image. Finally, vertebral heights determined from the detected vertebral edges were used for characterizing the shape of the vertebrae and for distinguishing fractured from normal vertebrae. Our preliminary results indicated that all of the severely fractured vertebrae in a small database were detected correctly by our computerized method.

  9. Osteoporosis with vertebral fractures associated with pregnancy and lactation.

    PubMed

    Di Gregorio, S; Danilowicz, K; Rubin, Z; Mautalen, C

    2000-01-01

    Three cases of young women who developed severe vertebral osteoporosis after pregnancy and during lactation are described. These patients shared several features: a low-calcium diet during most of their lives, very-low body weight in two patients, and a positive family history of osteoporosis in two patients. Initial studies disclosed vertebral fractures, severely diminished bone mineral density of the spine (Z score = -3.3 to -4.1), and a less severely affected bone mineral density of the hip (Z score = -1.6 to -2.3). During the prolonged follow-up of these patients, treated with oral biphosphonates, vitamin D, and calcium, an improved clinical response with a marked recovery of spine bone mineral density was observed. Poor general nutrition, low calcium intake, and a positive family history of osteoporosis appear to be strong risk factors for pregnancy- and lactation-associated osteoporosis. Although the mechanism of action is uncertain, calcium, vitamin D, and antiresorptive agents may have been beneficial in the treatment of this severe disorder.

  10. Risk factors of vertebral fractures in women with systemic lupus erythematosus.

    PubMed

    Mendoza-Pinto, Claudia; García-Carrasco, Mario; Sandoval-Cruz, Hilda; Muñoz-Guarneros, Margarita; Escárcega, Ricardo O; Jiménez-Hernández, Mario; Munguía-Realpozo, Pamela; Sandoval-Cruz, Manuel; Delezé-Hinojosa, Margarita; López-Colombo, Aurelio; Cervera, Ricard

    2009-05-01

    The aim of the current study was to analyze the role of traditional and systemic lupus erythematosus (SLE)-related risk factors in the development of vertebral fractures. A cross-sectional study was performed in women with SLE attending a single center. A vertebral fracture was defined as a reduction of at least 20% of vertebral body height. Two hundred ten patients were studied, with median age of 43 years and median disease duration of 72 months. Osteopenia was present in 50.3% of patients and osteoporosis in 17.4%. At least one vertebral fracture was detected in 26.1%. Patients with vertebral fractures had a higher mean age (50 +/- 14 vs. 41 +/- 13.2 years, p = 0.001), disease damage (57.1% vs. 34.4%, p = 0.001), lower bone mineral density (BMD) at the total hip (0.902 +/- 0.160 vs. 982 +/- 0.137 g/cm(2), p = 0.002), and postmenopausal status (61.9% vs. 45.3%, p = 0.048). Stepwise logistic regression analysis revealed that only age (p = 0.001) and low BMD at the total hip (p = 0.007) remained as significant factors for the presence of vertebral fracture. The high prevalence of vertebral fractures in the relatively young population implies that more attention must be paid to detect and treat vertebral fractures.

  11. Thoracolumbar kyphosis is associated with compressive vertebral fracture in postmenopausal women.

    PubMed

    Wei, Y; Tian, W; Zhang, G L; Lv, Y W; Cui, G Y

    2017-03-01

    The main aim of this retrospective cross-sectional study was to examine the relationship between vertebral compression fracture and thoracolumbar Cobb angles. Fracture prevalence was found to be significantly higher for patients with moderate [odds ratio (OR) = 4.78 (2.88-7.95)] or severe kyphosis [OR = 10.7 (5.11-22.40)] than for patients with mild kyphosis. The relationship between degree of thoracolumbar kyphosis and vertebral compression fracture was analyzed.

  12. Bone-density-specific fracture risk: A population-based study of the relationship between osteoporosis and vertebral fractures

    SciTech Connect

    Melton, L.J.; Wahner, H.W.; Richelson, L.S.; O'Fallon, W.M.; Dunn, W.L.; Riggs, B.L.

    1985-05-01

    The search for a specific level of bone density that clearly distinguishes patients with osteoporosis from those without has been largely unsuccessful. A different, ''gradient of risk'' model was used to assess the effect of various degrees of osteoporosis on the prevalence of vertebral fractures. The authors measured spinal (L/sub 1/-L/sub 4/) bone mineral (BM) with dual photon absorptiometry in an age-stratified random sample of Rochester, Minnesota women greater than or equal to 35 years old to estimate the distribution of spinal BM in the population of adult woman. The authors also assessed BM among women in the sample who had one or more vertebral fractures to estimate both the total number of women with vertebral fractures in the population and the distribution of spinal BM in such women. These population-based estimates were then used to calculate the prevalence rate of vertebral fracture at various levels of spinal BM. Women with spinal BM greater than or equal to 1.40 g/cm/sup 2/ were free of vertebral fractures. Among women with BM between 1.00 and 1.39 g/cm/sup 2/, the prevalence of vertebral fractures was about 7%. The prevalence rate increased as spinal BM decreased further. Among women with spinal BM<0.60 g/cm/sup 2/, all had at least one vertebral fracture (prevalence=100%). These data indicate that osteoporosis is a necessary cause of age-related vertebral fractures and, at certain low levels, is a sufficient cause of such fractures in conjunction with the activities of daily living.

  13. Interdisciplinary approach to balloon kyphoplasty in the treatment of osteoporotic vertebral compression fractures.

    PubMed

    Franck, Helmut; Boszczyk, Bronek M; Bierschneider, Michael; Jaksche, Hans

    2003-10-01

    Osteoporotic vertebral compression fractures (VCFs) are associated with a series of clinical consequences leading to increased morbidity and even mortality. Early diagnosis and therapeutic intervention is desirable in order to remobilise patients and prevent further bone loss. Not all fractures are, however, sufficiently treatable by conservative measures. Here, vertebroplasty and kyphoplasty may provide immediate pain relief by minimally invasive fracture stabilisation. In cases of acute fractures, kyphoplasty has the potential to reduce kyphosis and restore the normal sagittal alignment of the spine. The complex nature of systemic osteoporosis, coupled with the intricate biomechanics of vertebral fractures, leads to a clinical setting which is ideally treated interdisciplinarily by the rheumatologist and spine surgeon.

  14. Cost-effectiveness of percutaneous vertebroplasty in osteoporotic vertebral fractures

    PubMed Central

    Masala, Salvatore; Ciarrapico, Anna Micaela; Vinicola, Vincenzo; Mammucari, Matteo; Simonetti, Giovanni

    2008-01-01

    A retrospective study was conducted in 179 consecutive patients (48 males, 131 females; mean age: 72.0 ± 8.59 years; range: 51–93) with single symptomatic acute amyelic osteoporotic vertebral fracture presenting between September 2004 and September 2005 to the Santa Lucia Foundation in Rome, Italy. Vertebral fractures usually become manifest due to pain which can be debilitating. Treatment depends on the presence or absence of spinal cord involvement. In the first case, surgical stabilization is mandatory. In the second case, treatment may be performed either by conservative medical therapy (CMT) or percutaneous vertebroplasty (PVT). The aim of this study was to evaluate the effectiveness, costs and cost-effectiveness of percutaneous vertebroplasty. After 2 weeks of analgesic therapy, 153 patients presented refractory pain and were offered treatment by PVT. A total of 58 patients accepted and underwent PVT (PVT group), while 95 refused and underwent conservative medical therapy (CMT group). Follow-up was performed by specialist consults, spine radiography and MRI and a self-assessment questionnaire evaluating pain using a Visual Analogue Scale (VAS) and function using an ambulation and an Activities of Daily Living (ADL) scale. A 12-month follow-up was obtained in 86 of 95 (90.5%) CMT group patients and 54 of 58 (93.1%) PVT group patients. Significant reduction of VAS and improvement of ambulation and ADL was observed in both groups at 1 week and 3 and 12 months (P < 0.05; Wilcoxon signed rank test), however, these results were significantly superior in the PVT group at 1 week and 3 months (P < 0.05; Mann–Whitney U test). Average cost per patient at 1 week and 3 and 12 months were respectively 755.49 ± 661.96, 3791.95 ± 3341.97 and 4299.55 ± 3211.53 € (CMT group) and 3311.35 ± 0.32, 3745.30 ± 3.59 and 4101.05 ± 755.41 € (PVT group). PVT resulted significantly more cost-effective than CMT with regards to the three scales at

  15. Sex hormones, sex hormone binding globulin, and vertebral fractures in older men.

    PubMed

    Cawthon, Peggy M; Schousboe, John T; Harrison, Stephanie L; Ensrud, Kristine E; Black, Dennis; Cauley, Jane A; Cummings, Steven R; LeBlanc, Erin S; Laughlin, Gail A; Nielson, Carrie M; Broughton, Augusta; Kado, Deborah M; Hoffman, Andrew R; Jamal, Sophie A; Barrett-Connor, Elizabeth; Orwoll, Eric S

    2016-03-01

    The association between sex hormones and sex hormone binding globin (SHBG) with vertebral fractures in men is not well studied. In these analyses, we determined whether sex hormones and SHBG were associated with greater likelihood of vertebral fractures in a prospective cohort study of community dwelling older men. We included data from participants in MrOS who had been randomly selected for hormone measurement (N=1463, including 1054 with follow-up data 4.6years later). Major outcomes included prevalent vertebral fracture (semi-quantitative grade≥2, N=140, 9.6%) and new or worsening vertebral fracture (change in SQ grade≥1, N=55, 5.2%). Odds ratios per SD decrease in sex hormones and per SD increase in SHBG were estimated with logistic regression adjusted for potentially confounding factors, including age, bone mineral density, and other sex hormones. Higher SHBG was associated with a greater likelihood of prevalent vertebral fractures (OR: 1.38 per SD increase, 95% CI: 1.11, 1.72). Total estradiol analyzed as a continuous variable was not associated with prevalent vertebral fractures (OR per SD decrease: 0.86, 95% CI: 0.68 to 1.10). Men with total estradiol values ≤17pg/ml had a borderline higher likelihood of prevalent fracture than men with higher values (OR: 1.46, 95% CI: 0.99, 2.16). There was no association between total testosterone and prevalent fracture. In longitudinal analyses, SHBG (OR: 1.42 per SD increase, 95% CI: 1.03, 1.95) was associated with new or worsening vertebral fracture, but there was no association with total estradiol or total testosterone. In conclusion, higher SHBG (but not testosterone or estradiol) is an independent risk factor for vertebral fractures in older men.

  16. Inflammatory Markers and the Risk of Hip and Vertebral Fractures in Men: the Osteoporotic Fractures in Men (MrOS).

    PubMed

    Cauley, Jane A; Barbour, Kamil E; Harrison, Stephanie L; Cloonan, Yona K; Danielson, Michelle E; Ensrud, Kristine E; Fink, Howard A; Orwoll, Eric S; Boudreau, Robert

    2016-12-01

    Cytokines play major roles in regulating bone remodeling, but their relationship to incident fractures in older men is uncertain. We tested the hypothesis that men with higher concentrations of pro-inflammatory markers have a higher risk of fracture. We used a case-cohort design and measured inflammatory markers in a random sample of 961 men and in men with incident fractures including 120 clinical vertebral, 117 hip, and 577 non-spine fractures; average follow-up 6.13 years (7.88 years for vertebral fractures). We measured interleukin (IL)-6, C-reactive protein (CRP), tumor necrosis factor alpha (TNFα), soluble receptors (SR) of IL-6 (IL-6SR) and TNF (TNFαSR1 and TNFαSR2), and IL-10. The risk of non-spine, hip, and clinical vertebral fracture was compared across quartiles (Q) of inflammatory markers using Cox proportional hazard models with tests for linear trend. In multivariable-adjusted models, men with the highest (Q4) TNFa cytokine concentrations and their receptors had a 2.0-4.2-fold higher risk of hip and clinical vertebral fracture than men with the lowest (Q1). Results were similar for all non-spine fractures, but associations were smaller. There was no association between CRP and IL-6SR and fracture. Men in the highest Q of IL-10 had a 49% lower risk of vertebral fracture compared with men in Q1. Among men with ≥3 inflammatory markers in the highest Q, the hazard ratio (HR) for hip fractures was 2.03 (95% confidence interval [CI] 1.11-3.71) and for vertebral fracture 3.06 (1.66-5.63). The HRs for hip fracture were attenuated by 27%, 27%, and 15%, respectively, after adjusting for appendicular lean mass (ALM), disability, and bone density, suggesting mediating roles. ALM also attenuated the HR for vertebral fractures by 10%. There was no association between inflammation and rate of hip BMD loss. We conclude that inflammation may play an important role in the etiology of fractures in older men. © 2016 American Society for Bone and Mineral Research.

  17. A retrospective study evaluating the correlation between the severity of intervertebral disc injury and the anteroposterior type of thoracolumbar vertebral fractures

    PubMed Central

    Su, Yunshan; Ren, Dong; Zou, Yan; Lu, Jian; Wang*, Pengcheng

    2016-01-01

    OBJECTIVE: To evaluate the correlation between the severity of intervertebral disc injury and the anteroposterior type of thoracolumbar vertebral fractures. METHODS: Fifty-six cases of thoracolumbar vertebral fractures treated in our trauma center from October 2012 to October 2013 were included in this study. The fractures were classified by the anteroposterior classification, whereas the severity of intervertebral disc injury was evaluated using magnetic resonance imaging. The Spearman correlation coefficient was used to analyze the correlation between the severity of intervertebral disc injury and the anteroposterior type of thoracolumbar fractures, whereas a χ2 test was adopted to measure the variability between different fracture types and upper and lower adjacent disc injuries. RESULTS: The Spearman correlation coefficients between fracture types and the severity of the upper and lower adjacent disc injuries were 0.739 (PU<0.001) and 0.368 (PL=0.005), respectively. It means that the more complex Arbeitsgemeinschaft für Osteosynthesefragen (AO) classifications are the disc injury is more severe. There was also a significant difference in the severity of injury between the upper and lower adjacent discs near the fractured vertebrae (p<0.001). CONCLUSIONS: In thoracolumbar spinal fractures, the severity of the adjacent intervertebral disc injury is positively correlated with the anteroposterior fracture type. The injury primarily involves intervertebral discs near the fractured end plate, with more frequent and severe injuries observed in the upper than in the lower discs. The presence of intervertebral disc injury, along with its severity, may provide useful information during the clinical decision-making process. PMID:27438561

  18. Incidental PSMA Uptake in an Undisplaced Fracture of a Vertebral Body.

    PubMed

    Vamadevan, Shankar; Le, Ken; Bui, Choung; Mansberg, Robert

    2017-02-24

    A 50-year-old man with recently diagnosed prostate cancer was referred for Ga-prostate-specific membrane antigen (PSMA) PET/CT with elevated prostate-specific antigen. PET/CT demonstrated increased PSMA uptake in an undisplaced transverse fracture of the L1 vertebral body. This case illustrates that PSMA uptake can occur in a transverse vertebral body fracture and is a benign cause of PSMA uptake.

  19. Sacral Insufficiency Fractures: Recognition and Treatment in Patients with Concurrent Lumbar Vertebral Compression Fractures

    PubMed Central

    Granville, Michelle; Jacobson, Robert E; Berti, Aldo

    2017-01-01

    Introduction In reviewing a larger group of osteoporotic vertebral compression fractures (VCFs), we found that the overall incidence of sacral insufficiency fractures (SIFs) is higher than commonly reported values. This is especially seen in patients with previous or concurrent lumbar VCFs and also in a subgroup that had lumbar stenosis or hip arthroplasty. The altered biomechanics due to associated lumbar stenosis or hip arthroplasty lead to increased mechanical stress on already weakened and deficient sacral alae, which are more vulnerable to osteoporotic weakening than other parts of the sacrum. Materials & methods We studied an overall population of patients with VCF seen clinically and separated the patients into the following groups: patients not previously treated, patients treated with vertebroplasty or kyphoplasty at one or more levels, and patients diagnosed with sacral fractures and treated with vertebroplasty or kyphoplasty. We wanted to see if a pattern existed among the patients who had sacral symptoms, were diagnosed with sacral insufficiency fractures, and subsequently underwent sacroplasty. Results In a review of 79 consecutive patients, over a 24-month period, with VCF who underwent surgical treatment, there were 10 patients who also had sacral insufficiency fractures. Four of the patients had sacral insufficiency fractures without VCF. None of the patients with sacral insufficiency fractures were on treatment for osteoporosis at the time of diagnosis. The following symptoms indicated SIF: lower sacral pain (n = 10), buttock pain (n = 7), lateral hip pain (n = 5), and groin pain radiating to the thigh (n = 4). The average time to diagnose SIF was two months after the onset of pain. Conclusions Sacral insufficiency fractures are a frequent cause of both acute and chronic pain; however, they are often missed by the majority of physicians. The frequency of undetected sacral fractures is high. This is due to a number of potential pitfalls

  20. Prevalent Vertebral Fractures among Children Initiating Glucocorticoid Therapy for the Treatment of Rheumatic Disorders

    PubMed Central

    Huber, A.M.; Gaboury, I.; Cabral, D.A.; Lang, B.; Ni, A.; Stephure, D.; Taback, S.; Dent, P.; Ellsworth, J.; LeBlanc, C.; Saint-Cyr, C.; Scuccimarri, R.; Hay, J.; Lentle, B.; Matzinger, M.; Shenouda, N.; Moher, D.; Rauch, F.; Siminoski, K.; Ward, L.M.

    2014-01-01

    Objectives Vertebral fractures are an under-recognized problem in children with inflammatory disorders. We studied spine health among 134 children (87 girls) with rheumatic conditions (median age 10 years) within 30 days of initiating glucocorticoid (GC) therapy. Methods Children were categorized as follows: juvenile dermatomyositis (juvenile DM, N=30), juvenile idiopathic arthritis (JIA; N=28), systemic lupus erythematosus (SLE) and related conditions (N=26), systemic arthritis (N=22), systemic vasculitis (N=16), and other conditions (N=12). Thoracolumbar spine radiograph and dual energy x-ray absorptiometry for lumbar spine areal bone mineral density (LS BMD) were performed within 30 days of GC initiation. Genant semi-quantitative grading was used for vertebral morphometry. Second metacarpal morphometry was carried out on a hand radiograph. Clinical factors including disease and physical activity, calcium and vitamin D intake, cumulative GC dose, underlying diagnosis, LS BMD Z-score and back pain were analyzed for association with vertebral fracture. Results Thirteen vertebral fractures were noted in 9 children (7%). Six patients had a single vertebral fracture and three patients had two to three fractures. Fractures were clustered in the mid-thoracic region (69%). Three vertebral fractures (23%) were moderate (Grade 2); the others were mild (Grade 1). For the entire cohort, mean (±SD) LS BMD Z-score was significantly different from zero (−0.55±1.2, p<0.001) despite a mean height Z-score that was similar to the healthy average (0.02±1.0, p=0.825). Back pain was highly associated with increased odds for fracture (OR 10.6, 95% CI 2.1 to 53.8, p=0.004). Conclusions In pediatric rheumatic conditions, vertebral fractures can be present prior to prolonged GC exposure. PMID:20391507

  1. Relationship Between Vertebral Fracture Burden, Height Loss, and Pulmonary Function in Postmenopausal Women With Osteoporosis.

    PubMed

    Krege, John H; Kendler, David; Krohn, Kelly; Genant, Harry; Alam, Jahangir; Berclaz, Pierre-Yves; Coffey, Barbara; Loghin, Corina

    2015-01-01

    The purpose of this analysis was to assess the association of osteoporosis-related vertebral fracture burden and pulmonary function. This study also examined the relationship between vertebral fracture burden and height loss, estimated by arm span - height. This was a single-site and single-visit study. Patients had a history of at least 1 moderate or severe vertebral fracture. Vertebral fracture burden was quantified using the spinal deformity index (SDI). Pulmonary function during inspiration was determined by spirometry. Forty-one women aged 70-91 completed the study. Vertebral fracture burden negatively correlated with forced inspiratory vital capacity and inspiratory time. For each unit increase in SDI, forced inspiratory vital capacity decreased by 1.62%, and inspiratory time decreased by 2.39%. There was no correlation between SDI and measures of inspiratory flow. For each unit increase in SDI, height decreased by about 0.5 cm. Vertebral fractures were associated with decreased lung volume and height loss.

  2. Effect of Brace to Osteoporotic Vertebral Fracture: a Meta-Analysis

    PubMed Central

    2016-01-01

    Brace is one of the most commonly used interventions to manage osteoporotic vertebral fracture. However, its authentic effectiveness remains unclear. The aim of this study was to investigate the efficacy of brace in patients with osteoporotic vertebral fractures. We conducted a literature review and meta-analysis following the guideline and handbook of the Cochrane collaboration. Ten published articles were included in this study and data from 4 randomized controlled trials were analyzed. Low quality evidence proved using Spinomed brace could bring large and significant beneficial effect to patients with sub-acute osteoporotic vertebral fractures. Very low quality evidence proved no significant difference between Spinomed orthosis, rigid brace and soft brace when they were used in patients with acute fractures. Therefore, it might be applicable to recommend middle term use of Spinomed orthosis to patients with subacute fracture. In addition, this study emphasized the need for high quality randomized controlled trials. PMID:27550495

  3. The prevalence of vitamin D deficiency in patients with vertebral fragility fractures.

    PubMed

    Maier, G S; Seeger, J B; Horas, K; Roth, K E; Kurth, A A; Maus, U

    2015-01-01

    Hypovitaminosis D has been identified as a common risk factor for fragility fractures and poor fracture healing. Epidemiological data on vitamin D deficiency have been gathered in various populations, but the association between vertebral fragility fractures and hypovitaminosis D, especially in males, remains unclear. The purpose of this study was to evaluate serum levels of 25-hydroxyvitamin D (25-OH D) in patients presenting with vertebral fragility fractures and to determine whether patients with a vertebral fracture were at greater risk of hypovitaminosis D than a control population. Furthermore, we studied the seasonal variations in the serum vitamin D levels of tested patients in order to clarify the relationship between other known risk factors for osteoporosis and vitamin D levels. We measured the serum 25-OH D levels of 246 patients admitted with vertebral fractures (105 men, 141 female, mean age 69 years, sd 8.5), and in 392 orthopaedic patients with back pain and no fractures (219 men, 173 female, mean age 63 years, sd 11) to evaluate the prevalence of vitamin D insufficiency. Statistical analysis found a significant difference in vitamin D levels between patients with vertebral fragility fracture and the control group (p = 0.036). In addition, there was a significant main effect of the tested variables: obesity (p < 0.001), nicotine abuse (p = 0.002) and diabetes mellitus (p < 0.001). No statistical difference was found between vitamin D levels and gender (p = 0.34). Vitamin D insufficiency was shown to be a risk factor for vertebral fragility fractures in both men and women.

  4. Computerized detection of vertebral compression fractures on lateral chest radiographs: Preliminary results with a tool for early detection of osteoporosis

    SciTech Connect

    Kasai, Satoshi; Li Feng; Shiraishi, Junji; Li Qiang; Doi, Kunio

    2006-12-15

    Vertebral fracture (or vertebral deformity) is a very common outcome of osteoporosis, which is one of the major public health concerns in the world. Early detection of vertebral fractures is important because timely pharmacologic intervention can reduce the risk of subsequent additional fractures. Chest radiographs are used routinely for detection of lung and heart diseases, and vertebral fractures can be visible on lateral chest radiographs. However, investigators noted that about 50% of vertebral fractures visible on lateral chest radiographs were underdiagnosed or under-reported, even when the fractures were severe. Therefore, our goal was to develop a computerized method for detection of vertebral fractures on lateral chest radiographs in order to assist radiologists' image interpretation and thus allow the early diagnosis of osteoporosis. The cases used in this study were 20 patients with severe vertebral fractures and 118 patients without fractures, as confirmed by the consensus of two radiologists. Radiologists identified the locations of fractured vertebrae, and they provided morphometric data on the vertebral shape for evaluation of the accuracy of detecting vertebral end plates by computer. In our computerized method, a curved search area, which included a number of vertebral end plates, was first extracted automatically, and was straightened so that vertebral end plates became oriented horizontally. Edge candidates were enhanced by use of a horizontal line-enhancement filter in the straightened image, and a multiple thresholding technique, followed by feature analysis, was used for identification of the vertebral end plates. The height of each vertebra was determined from locations of identified vertebral end plates, and fractured vertebrae were detected by comparison of the measured vertebral height with the expected height. The sensitivity of our computerized method for detection of fracture cases was 95% (19/20), with 1.03 (139/135) false

  5. High Incidence of Vertebral Fractures in Children with Acute Lymphoblastic Leukemia 12 Months After the Initiation of Therapy

    PubMed Central

    Alos, Nathalie; Grant, Ronald; Ramsay, Timothy; Halton, Jacqueline; Cummings, Elizabeth A.; Miettunen, Paivi M.; Abish, Sharon; Atkinson, Stephanie; Barr, Ronald; Cabral, David A.; Cairney, Elizabeth; Couch, Robert; Dix, David B.; Fernandez, Conrad V.; Hay, John; Israels, Sara; Laverdière, Caroline; Lentle, Brian; Lewis, Victor; Matzinger, MaryAnn; Rodd, Celia; Shenouda, Nazih; Stein, Robert; Stephure, David; Taback, Shayne; Wilson, Beverly; Williams, Kathryn; Rauch, Frank; Siminoski, Kerry; Ward, Leanne M.

    2014-01-01

    Purpose Vertebral fractures due to osteoporosis are a potential complication of childhood acute lymphoblastic leukemia (ALL). To date, the incidence of vertebral fractures during ALL treatment has not been reported. Patient and Methods We prospectively evaluated 155 children with ALL during the first 12 months of leukemia therapy. Lateral thoracolumbar spine radiographs were obtained at baseline and 12 months. Vertebral bodies were assessed for incident vertebral fractures using the Genant semi-quantitative method, and relevant clinical indices such as spine bone mineral density (BMD), back pain and the presence of vertebral fractures at baseline were analyzed for association with incident vertebral fractures. Results Of the 155 children, 25 (16%, 95% Confidence Interval (CI) 11% to 23%) had a total of 61 incident vertebral fractures, of which 32 (52%) were moderate or severe. Thirteen of the 25 children with incident vertebral fractures (52%) also had fractures at baseline. Vertebral fractures at baseline increased the odds of an incident fracture at 12 months by an odds ratio of 7.3 (95% CI 2.3 to 23.1, p = 0.001). In addition, for every one standard deviation reduction in spine BMD Z-score at baseline, there was 1.8-fold increased odds of incident vertebral fracture at 12 months (95% CI 1.2 to 2.7, p = 0.006). Conclusion Children with ALL have a high incidence of vertebral fractures after 12 months of chemotherapy, and the presence of vertebral fractures and reductions in spine BMD Z-scores at baseline are highly associated clinical features. PMID:22734031

  6. Cerebellar infarction resulting from vertebral artery occlusion associated with a Jefferson fracture.

    PubMed

    Muratsu, Hirotsugu; Doita, Minoru; Yanagi, Toshihide; Sekiguchi, Kenji; Nishida, Kotaro; Tomioka, Masao; Kurosaka, Masahiro

    2005-06-01

    Neurologic deficit secondary to a Jefferson fracture is rare, as the fracture fragments tend to spread outward. To the authors' knowledge, only five cases of vertebral artery injury associated with C1 fracture have been reported. A 75-year-old man with diffuse spinal hyperostosis hit the top of his head and sustained a Jefferson fracture. The patient presented with vertigo and slurred speech. Magnetic resonance (MR) imaging demonstrated cerebellar infarction, and MR angiography (MRA) showed bilateral vertebral artery occlusion associated with a Jefferson fracture. The patient was placed in a halo vest for a total of 11 weeks and treated with anticoagulant therapy. Vertigo gradually improved, and the patient was able to walk with a cane. Previously slurred speech was completely resolved. This case demonstrates that a Jefferson fracture can cause vertebral artery occlusion, resulting in cerebellar infarction. The clinician should be aware of the possibility and implications of vertebral artery injuries, especially if a fracture involving the foramen transversarium with displacement is documented or if there is a neurologic deficit above the level of injury. Advances in noninvasive imaging such as MRA will facilitate accurate evaluation of these potentially life-threatening vascular injuries.

  7. Risk factors for the development of vertebral fractures after percutaneous vertebroplasty.

    PubMed

    Martinez-Ferrer, Angeles; Blasco, Jordi; Carrasco, Josep Li; Macho, Juan M; Román, Luis San; López, Antonio; Monegal, Ana; Guañabens, Nuria; Peris, Pilar

    2013-08-01

    We have recently observed an increased risk for vertebral fractures (VF) in a randomized controlled trial comparing the analgesic effect of vertebroplasty (VP) versus conservative treatment in symptomatic VF. The aim of the present study was to evaluate the risk factors related to the development of VF after VP in these patients. We evaluated risk factors including age, gender, bone mineral density, the number, type, and severity of vertebral deformities at baseline, the number of vertebral bodies treated, the presence and location of disk cement leakage, bone remodeling (determining bone turnover markers) and 25 hydroxyvitamin D [25(OH)D] levels at baseline in all patients. Twenty-nine radiologically new VF were observed in 17 of 57 patients undergoing VP, 72% adjacent to the VP. Patients developing VF after VP showed an increased prevalence of 25(OH)D deficiency (<20 ng/mL) and higher P1NP values. The principal factor related to the development of VF after VP in multivariate analysis was 25(OH)D levels < 20 ng/mL (RR, 15.47; 95% CI, 2.99-79.86, p < 0.0001), whereas age >80 years (RR, 3.20; 95% CI, 1.70-6.03, p = 0.0007) and glucocorticoid therapy (RR, 3.64; 95% CI, 1.61-8.26, p = 0.0055) constituted the principal factors in the overall study population. Increased risk of VF after VP was also associated with cement leakage into the inferior disk (RR, 6.14; 95% CI, 1.65-22.78, p = 0.044) and more than one vertebral body treated during VP (RR, 4.19; 95% CI, 1.03-34.3, p = 0.044). In conclusion, nearly 30% of patients with osteoporotic VF treated with VP had a new VF after the procedure. Age, especially >80 years, the presence of inferior disk cement leakage after the procedure, the number of cemented vertebrae, and low 25(OH)D serum levels were related to the development of new VF in these patients, with the latter indicating the need to correct vitamin D deficiency prior to performing VP.

  8. Vertebral Fracture Assessment in Adolescents and Young Women with Anorexia Nervosa: A Case Series

    PubMed Central

    DiVasta, Amy D.; Feldman, Henry A.; Gordon, Catherine M.

    2013-01-01

    Rates of vertebral fracture (VF) for young women with anorexia nervosa (AN) are not well understood. We sought to determine the rates of asymptomatic VF in patients suffering from AN, hypothesizing that VF rates would be higher in subjects with low BMD Z-scores. We recruited young women with AN (n=80) for participation in a longitudinal trial. Dual-energy X-ray absorptiometry images of the lateral thoracic and lumbar spine were obtained for vertebral fracture assessment at 0, 6, 12, and 18 months. Thirteen subjects (16%) had a low spinal BMD at baseline (BMD Z-score ≤ –2 SD). Using the Genant semiquantitative technique, 2/80 subjects at baseline (2.5%) had evidence of a single, Genant grade 1 deformity. One subject had a Genant Grade 2 deformity. Over the 18-month trial, 10 incident vertebral fractures occurred in 9 subjects (12.5%). Using quantitative techniques, only two subjects had a >15% loss in vertebral height. Neither anthropometric data nor markers of disease severity were associated with fracture. In conclusion, ill young women with AN were at low risk for asymptomatic VF in our cohort. Vertebral fractures were not predicted by duration of illness, severity of malnutrition, or traditional measures of aBMD at the lumbar spine. PMID:23562364

  9. Multiple seizure-induced thoracic vertebral compression fractures: a case report

    PubMed Central

    Stilwell, Peter; Harman, Katherine; Hsu, William; Seaman, Brian

    2016-01-01

    Background: Musculoskeletal injuries stemming from forceful muscular contractions during seizures have been documented in the literature. Reports of multiple seizure-induced spinal fractures, in the absence of external trauma and without risk factors for fracture, are rare. Case Presentation: A 28-year-old male, newly diagnosed with epilepsy, presented to a chiropractic clinic with the complaint of mid-thoracic pain beginning after a tonic-clonic seizure with no associated external trauma. Radiographs revealed the impression of five new vertebral compression fractures from T4 to T8. Discussion: This report highlights the importance of a complete history and examination of patients with a history of tonic-clonic seizures and back pain, especially when considering spinal adjustments. Summary: This case report presents an argument that a tonic-clonic seizure, in the absence of external trauma or significant risk factors for fracture, resulted in multiple vertebral compression fractures. PMID:27713581

  10. Incidence of Symptomatic Vertebral Fractures Among Newly Diagnosed Autoimmune Diseases Initiating Glucocorticoid Therapy

    PubMed Central

    Migita, Kiyoshi; Iwanaga, Nozomi; Imadachi, Shunsuke; Jiuchi, Yuka; Izumi, Yasumori; Tsuji, Yoshika; Kawahara, Chieko; Kawakami, Atsushi; Furukawa, Hiroshi; Tohma, Shigeto

    2015-01-01

    Abstract Few data are available regarding vertebral fracture risk in patients treated with corticosteroids including patients with interstitial lung disease (ILD). The aim of the present study was to identify risk factors for symptomatic vertebral fracture analyzed in patients with newly diagnosed autoimmune diseases. This was an observational cohort study conducted in the National Hospital Organization-EBM study group from 2006 to 2008. The study subjects were autoimmune disease patients who were newly treated with glucocorticoids (GCs). The primary endpoint was the first occurrence of vertebral fracture diagnosed by x-rays. Cox proportional-hazards regression was used to determine independent risk factors for vertebral fracture with covariates including sex, age, comorbidity, laboratory data, use of immunosuppressants, and dose of GCs. Survival was analyzed according to the Kaplan–Meier method and assessed by the log-rank test. Among 604 patients of mean age 59.5 years and mean GC dose 50.4 mg/d (first 1 months), 19 patient (3.1%) had at least 1 symptomatic vertebral fracture during 1.9 years of follow-up period. Cox regression model demonstrated that the relative risk for symptomatic vertebral fracture was independently higher in patient with ILD (hazard ratio [HR] = 2.86, 95% confidence interval [CI] = 1.10–7.42, P = 0.031) and in every 10-year increment of the age of disease onset (HR = 1.57, 95% CI = 1.09–2.26, P = 0.015). Kaplan–Meier analyses demonstrated that the incidence of vertebral fractures in patients with ILD was significantly higher in comparison with those without ILD. Our results indicate a higher risk of vertebral facture in patients with ILD and elderly patients during the initial GC treatment against autoimmune diseases. There is a need for further, even longer-term, prospective studies subjected patients with autoimmune disease, including ILD, under GC treatment. PMID:26166127

  11. Factors associated with an increased risk of vertebral fracture in monoclonal gammopathies of undetermined significance

    PubMed Central

    Piot, J M; Royer, M; Schmidt-Tanguy, A; Hoppé, E; Gardembas, M; Bourrée, T; Hunault, M; François, S; Boyer, F; Ifrah, N; Renier, G; Chevailler, A; Audran, M; Chappard, D; Libouban, H; Mabilleau, G; Legrand, E; Bouvard, B

    2015-01-01

    Monoclonal gammopathies of undetermined significance (MGUS) have been shown to be associated with an increased risk of fractures. This study describes prospectively the bone status of MGUS patients and determines the factors associated with vertebral fracture. We included prospectively 201 patients with MGUS, incidentally discovered, and with no known history of osteoporosis: mean age 66.6±12.5 years, 48.3% women, 51.7% immunoglobulin G (IgG), 33.3% IgM and 10.4% IgA. Light chain was kappa in 64.2% patients. All patients had spinal radiographs and bone mineral density measurement in addition to gammopathy assessment. At least one prevalent non-traumatic vertebral fracture was discovered in 18.4% patients and equally distributed between men and women. Fractured patients were older, had a lower bone density and had also more frequently a lambda light chain isotype. Compared with patients with κ light chain, the odds ratio of being fractured for patients with λ light chain was 4.32 (95% confidence interval 1.80–11.16; P=0.002). These results suggest a high prevalence of non-traumatic vertebral fractures in MGUS associated with lambda light chain isotype and not only explained by low bone density. PMID:26314987

  12. Location of Vertebral Fractures is Associated with Bone Mineral Density and History of Traumatic Injury.

    PubMed

    Watt, Jennifer; Crilly, Richard

    2017-04-01

    The upper and lower thoracolumbar spine have been associated with different biomechanical outcomes. This concept, as it applies to osteoporotic fracture risk, has not been well documented. This was a case-control study of 120 patients seen in an osteoporosis clinic. Vertebral fractures were identified from lateral radiographs using Genant's semi-quantitative assessment method. An association between bone mineral density (BMD) T-scores and vertebral fracture location was assessed. In an additional analysis, the association between a history of any traumatic injury and possible predictor variables was also explored. The median age of patients was 75 (IQR 67-80), and 84.2% of patients were female. A history of trauma was reported by 46.7% of patients. A vertebral fracture in the lower thoracolumbar spine (T11-L4) was associated with significantly higher femoral neck (p < 0.001), lumbar (p = 0.005), trochanteric (p = 0.002), intertrochanteric (p < 0.001), and total hip (p = 0.0006) BMD T-scores. The odds of having a femoral neck (OR 0.24, 95% CI 0.07-0.75, p = 0.01) or total hip (OR 0.19, 95% CI 0.06-0.65, p = 0.008) T-score less than -2.5 was also lower among patients with vertebral fractures in the lower thoracolumbar spine. A fracture in the upper thoracolumbar spine (T4-T10) decreased the odds of having a history of traumatic injury (OR 0.32, 95% CI 0.14-0.76, p = 0.01), while a non-vertebral fracture increased the odds of such an injury (OR 2.41, 95% CI 1.10-5.32, p = 0.03). Vertebral fractures in the lower thoracolumbar spine are associated with higher BMD T-scores. This should be studied further to understand possible correlations with patients' future fracture risk.

  13. Risedronate decreases bone resorption and improves low back pain in postmenopausal osteoporosis patients without vertebral fractures.

    PubMed

    Ohtori, Seiji; Akazawa, Tsutomu; Murata, Yasuaki; Kinoshita, Tomoaki; Yamashita, Masaomi; Nakagawa, Koichi; Inoue, Gen; Nakamura, Junichi; Orita, Sumihisa; Ochiai, Nobuyasu; Kishida, Shunji; Takaso, Masashi; Eguchi, Yawara; Yamauchi, Kazuyo; Suzuki, Munetaka; Aoki, Yasuchika; Takahashi, Kazuhisa

    2010-02-01

    Elderly postmenopausal women who have osteoporosis sometimes experience low back pain, however, the relationship between low back pain and osteoporosis in the absence of vertebral fractures remains unclear. We examined the relationship between bone mineral density (BMD), bone resorption and low back pain in elderly female patients who did not have osteoporotic vertebral fractures. The average BMD was 0.675 g/cm(2) when assessed by dual-energy X-ray absorptiometry (DEXA). Patients were excluded from the study if they had vertebral fractures revealed by radiography, CT scans or MRI. Bisphosphonate (risedronate) was administered for 4 months. The visual analogue scale (VAS) pain score, Roland Morris Disability Questionnaire (RDQ), Short Form-36 (SF-36) questionnaire, BMD and N-terminal telopeptide of type I collagen (NTx; a marker for bone resorption) were examined before and after treatment. DEXA did not increase significantly, but serum and urinary NTx were decreased (-51.4% and -62.0%, respectively) after 4 months of risedronate treatment (p<0.01). The assessment was repeated using the VAS score, RDQ and SF-36, which revealed an improvement after risedronate treatment (p<0.01). A decrease in serum and urinary NTx was associated with improvement of low back pain, suggesting that despite the absence of vertebral fractures, bone resorption due to osteoporosis may cause low back pain.

  14. Prediction of Incident Major Osteoporotic and Hip Fractures by Trabecular Bone Score (TBS) and Prevalent Radiographic Vertebral Fracture in Older Men.

    PubMed

    Schousboe, John T; Vo, Tien; Taylor, Brent C; Cawthon, Peggy M; Schwartz, Ann V; Bauer, Douglas C; Orwoll, Eric S; Lane, Nancy E; Barrett-Connor, Elizabeth; Ensrud, Kristine E

    2016-03-01

    Trabecular bone score (TBS) has been shown to predict major osteoporotic (clinical vertebral, hip, humerus, and wrist) and hip fractures in postmenopausal women and older men, but the association of TBS with these incident fractures in men independent of prevalent radiographic vertebral fracture is unknown. TBS was estimated on anteroposterior (AP) spine dual-energy X-ray absorptiometry (DXA) scans obtained at the baseline visit for 5979 men aged ≥65 years enrolled in the Osteoporotic Fractures in Men (MrOS) Study and its association with incident major osteoporotic and hip fractures estimated with proportional hazards models. Model discrimination was tested with Harrell's C-statistic and with a categorical net reclassification improvement index, using 10-year risk cutpoints of 20% for major osteoporotic and 3% for hip fractures. For each standard deviation decrease in TBS, there were hazard ratios of 1.27 (95% confidence interval [CI] 1.17 to 1.39) for major osteoporotic fracture, and 1.20 (95% CI 1.05 to 1.39) for hip fracture, adjusted for FRAX with bone mineral density (BMD) 10-year fracture risks and prevalent radiographic vertebral fracture. In the same model, those with prevalent radiographic vertebral fracture compared with those without prevalent radiographic vertebral fracture had hazard ratios of 1.92 (95% CI 1.49 to 2.48) for major osteoporotic fracture and 1.86 (95% CI 1.26 to 2.74) for hip fracture. There were improvements of 3.3%, 5.2%, and 6.2%, respectively, of classification of major osteoporotic fracture cases when TBS, prevalent radiographic vertebral fracture status, or both were added to FRAX with BMD and age, with minimal loss of correct classification of non-cases. Neither TBS nor prevalent radiographic vertebral fracture improved discrimination of hip fracture cases or non-cases. In conclusion, TBS and prevalent radiographic vertebral fracture are associated with incident major osteoporotic fractures in older men independent of each other

  15. Common normal variants of pediatric vertebral development that mimic fractures: a pictorial review from a national longitudinal bone health study

    PubMed Central

    Jaremko, Jacob Lester; Siminoski, Kerry; Firth, Gregory; Matzinger, Mary Ann; Shenouda, Nazih; Konji, Victor N.; Roth, Johannes; Sbrocchi, Anne Marie; Reed, Martin; O’Brien, Kathleen; Nadel, Helen; McKillop, Scott; Kloiber, Reinhard; Dubois, Josée; Coblentz, Craig; Charron, Martin; Ward, Leanne M.

    2015-01-01

    Children with glucocorticoid-treated illnesses are at risk for osteoporotic vertebral fractures and growing awareness has led to increased monitoring for these fractures. However scant literature describes developmental changes in vertebral morphology that can mimic fractures. The goal of this paper is to aid in distinguishing between normal variants and fractures. We illustrate differences using lateral spine radiographs obtained annually from children recruited to the Canada-wide STeroid-Associated Osteoporosis in the Pediatric Population (STOPP) observational study, in which 400 children with glucocorticoid-treated leukemia, rheumatic disorders, and nephrotic syndrome were enrolled near glucocorticoid initiation and followed prospectively for 6 years. Normal variants mimicking fractures exist in all regions of the spine and fall into two groups. The first group comprises variants mimicking pathological vertebral height loss, including not-yet-ossified vertebral apophyses superiorly and inferiorly which can lead to a vertebral shape easily over-interpreted as anterior wedge fracture, physiologic beaking, and spondylolisthesis associated with shortened posterior vertebral height. The second group includes variants mimicking other radiologic signs of fractures: anterior vertebral artery groove resembling an anterior buckle fracture, Cupid’s bow balloon disk morphology, Schmorl nodes mimicking concave endplate fractures, and parallax artifact resembling endplate interruption or biconcavity. If an unexpected vertebral body contour is detected, careful attention to its location, detailed morphology, and (if available) serial changes over time may clarify whether it is a fracture requiring change in management or simply a normal variant. Awareness of the variants described in this paper can improve accuracy in the diagnosis of pediatric vertebral fractures. PMID:25828359

  16. Staged Correction of Severe Thoracic Kyphosis in Patients with Multilevel Osteoporotic Vertebral Compression Fractures

    PubMed Central

    Behrbalk, Eyal; Uri, Ofir; Folman, Yoram; Rickert, Marcus; Kaiser, Radek; Boszczyk, Bronek Maximilian

    2015-01-01

    Study Design Technical report. Objective Multilevel osteoporotic vertebral compression fractures may lead to considerable thoracic deformity and sagittal imbalance, which may necessitate surgical intervention. Correction of advanced thoracic kyphosis in patients with severe osteoporosis remains challenging, with a high rate of failure. This study describes a surgical technique of staged vertebral augmentation with osteotomies for the treatment of advanced thoracic kyphosis in patients with osteoporotic multilevel vertebral compression fractures. Methods Five patients (average age 62 ± 6 years) with multilevel osteoporotic vertebral compression fractures and severe symptomatic thoracic kyphosis underwent staged vertebral augmentation and surgical correction of their sagittal deformity. Clinical and radiographic outcomes were assessed retrospectively at a mean postoperative follow-up of 34 months. Results Patients' self-reported back pain decreased from 7.2 ± 0.8 to 3.0 ± 0.7 (0 to 10 numerical scale; p < 0.001). Patients' back-related disability decreased from 60 ± 10% to 29 ± 10% (0 to 100% Oswestry Disability Index; p < 0.001). Thoracic kyphosis was corrected from 89 ± 5 degrees to 40 ± 4 degrees (p < 0.001), and the sagittal vertical axis was corrected from 112 ± 83 mm to 38 ± 23 mm (p = 0.058). One patient had cement leakage without subsequent neurologic deficit. Decreased blood pressure was observed in another patient during the cement injection. No correction loss, hardware failure, or neurologic deficiency was seen in the other patients. Conclusion The surgical technique described here, despite its complexity, may offer a safe and effective method for the treatment of advanced thoracic kyphosis in patients with osteoporotic multilevel vertebral compression fractures. PMID:27781192

  17. Vertebral fractures in motor vehicle accidents - a medical and technical analysis of 33,015 injured front-seat occupants.

    PubMed

    Müller, Christian W; Otte, Dietmar; Decker, Sebastian; Stübig, Timo; Panzica, Martin; Krettek, Christian; Brand, Stephan

    2014-05-01

    Spinal injuries pose a considerable risk to life and quality of life. In spite of improvements in active and passive safety of motor vehicles, car accidents are regarded as a major cause for vertebral fractures. The purpose of this study was to evaluate the current incidence of vertebral fractures among front-seat occupants in motor vehicle accidents, and to identify specific risk factors for sustaining vertebral fractures in motor vehicle accidents. Data from an accident research unit were accessed to collect collision details, preclinical data, and clinical data. We included all data on front-seat occupants. Hospital records were retrieved, and radiological images were evaluated. We analysed 33,015 front-seat occupants involved in motor vehicle accidents over a 24-year period. We identified 126 subjects (0.38%) with cervical spine fractures, 78 (0.24%) with thoracic fractures, and 99 (0.30%) with lumbar fractures. The mean relative collision speeds were 48, 39, and 40 kph in subjects with cervical, thoracic, and lumbar spine fractures, respectively, while it was 17.3 kph in the whole cohort. Contrary to the overall cohort, these patients typically sustained multiple hits rather than simple front collisions. Occupants with vertebral fractures frequently showed numerous concomitant injuries; for example, additional vertebral fractures. The incidence of vertebral fractures corresponded with collision speed. Safety belts were highly effective in the prevention of vertebral fractures. Apart from high speed, complex injury mechanisms as multiple collisions or rollovers were associated with vertebral fractures. Additional preventive measures should focus on these collision mechanisms.

  18. Severe muscle trauma triggers heightened and prolonged local musculoskeletal inflammation and impairs adjacent tibia fracture healing

    PubMed Central

    Hurtgen, B.J.; Ward, C.L.; Garg, K.; Pollot, B.E.; Goldman, S.M.; McKinley, T.O.; Wenke, J.C.; Corona, B.T.

    2016-01-01

    Objectives: Complicated fracture healing is often associated with the severity of surrounding muscle tissue trauma. Since inflammation is a primary determinant of musculoskeletal health and regeneration, it is plausible that delayed healing and non-unions are partly caused by compounding local inflammation in response to concomitant muscle trauma. Methods and results: To investigate this possibility, a Lewis rat open fracture model [tibia osteotomy with adjacent tibialis anterior (TA) muscle volumetric muscle loss (VML) injury] was interrogated. We observed that VML injury impaired tibia healing, as indicated by diminished mechanical strength and decreased mineralized bone within the fracture callus, as well as continued presence of cartilage instead of woven bone 28 days post-injury. The VML injured muscle presented innate and adaptive immune responses that were atypical of canonical muscle injury healing. Additionally, the VML injury resulted in a perturbation of the inflammatory phase of fracture healing, as indicated by elevations of CD3+ lymphocytes and CD68+ macrophages in the fracture callus at 3 and 14d post-injury, respectively. Conclusions: These data indicate that heightened and sustained innate and adaptive immune responses to traumatized muscle are associated with impaired fracture healing and may be targeted for the prevention of delayed and non-union following musculoskeletal trauma. PMID:27282456

  19. Fractal properties of cancellous bone of the iliac crest in vertebral crush fracture.

    PubMed

    Fazzalari, N L; Parkinson, I H

    1998-07-01

    Fractal analysis is a method for describing complex shapes, including the cancellous structure of bone. It describes the surface texture and form of individual trabecular profiles and the overall cancellous structure. Sixty-four postmenopausal women with symptoms of back pain were referred for investigation for osteoporosis. The patients were divided into two groups for comparison: vertebral crush fracture (n = 31, mean age 68.58 +/- 6.47 years), and no vertebral crush fracture (n = 33, mean age 63.36 +/- 7.21 years). Cores of cancellous bone, 3 mm in diameter, were taken from the iliac crest and sectioned. A box-counting method implemented on an image analyzer was used to measure the fractal dimension. Three fractal dimensions describing trabecular surface texture (fractal 1), trabecular shape (fractal 2), and trabecular arrangement (fractal 3) were measured, indicating that cancellous bone has sectional self-similarity. Conventional histomorphometry was also performed on the samples. The results show that fractal 2 is significantly lower in the vertebral crush fracture group than in the nonfracture group (1.15 +/- 0.10 < 1.23 +/- 0.090, p < 0.0013). The histomorphometric analysis shows that bone surface total volume (p < 0.0002), trabecular number (p < 0.0001), and osteoid surface bone surface (p < 0.028) are significantly lower in the fracture group than the nonfracture group. Eroded surface/bone surface (p < 0.056) follows this trend, whereas trabecular separation (p < 0.001) is significantly higher in the fracture group than in the nonfracture group. Fractal 1 and fractal 3 were not significantly different between study groups. The fractal dimension detects changes in the cancellous architecture and gives information about iliac bone transformation in postmenopausal women with vertebral fracture.

  20. Risk of Vertebral Fracture in Patients Diagnosed with a Depressive Disorder: A Nationwide Population-Based Cohort Study

    PubMed Central

    Lee, Shyh-Chyang; Hu, Li-Yu; Huang, Min-Wei; Shen, Cheng-Che; Huang, Wei-Lun; Lu, Ti; Hsu, Chiao-Lin; Pan, Chih-Chuan

    2017-01-01

    OBJECTIVE: Previous studies have reported that depression may play a crucial role in the occurrence of vertebral fractures. However, a clear correlation between depressive disorders and osteoporotic fractures has not been established. We explored the association between depressive disorders and subsequent new-onset vertebral fractures. Additionally, we aimed to identify the potential risk factors for vertebral fracture in patients with a depressive disorder. METHODS: We studied patients listed in the Taiwan National Health Insurance Research Database who were diagnosed with a depressive disorder by a psychiatrist. The comparison cohort consisted of age- and sex-matched patients without a depressive disorder. The incidence rate and hazard ratios of subsequent vertebral fracture were evaluated. We used Cox regression analysis to evaluate the risk of vertebral fracture among patients with a depressive disorder. RESULTS: The total number of patients with and without a depressive disorder was 44,812. The incidence risk ratio (IRR) between these 2 cohorts indicated that depressive disorder patients had a higher risk of developing a subsequent vertebral fracture (IRR=1.41, 95% confidence interval [CI]=1.26–1.57, p<0.001). In the multivariate analysis, the depressive disorder cohort showed a higher risk of vertebral fracture than the comparison cohort (adjusted hazard ratio=1.24, 95% CI=1.11–1.38, p<0.001). Being older than 50 years, having a lower monthly income, and having hypertension, diabetes mellitus, cerebrovascular disease, chronic obstructive pulmonary disease, autoimmune disease, or osteoporosis were considered predictive factors for vertebral fracture in patients with depressive disorders. CONCLUSIONS: Depressive disorders may increase the risk of a subsequent new-onset vertebral fracture. PMID:28226032

  1. Vertebral artery injury in a patient with fractured C4 vertebra.

    PubMed

    Banić, Tihomir; Banić, Morana; Cvjetko, Ivan; Somun, Nenad; Bilić, Vide; Vidjak, Vinko; Pavić, Vladimir; Coc, Ivan; Kokić, Tomislav; Kejlal, Zvonko

    2014-09-01

    Vertebral artery injuries due to cervical spine trauma, although rarely described in the literature, are relatively common. While most of them will remain asymptomatic, a small percentage of patients may suffer life threatening complications. We report a case of the right vertebral artery injury in a patient with fracture of C4 vertebra, successfully treated with endovascular approach. A 78-year-old male patient was hospitalized for cervical spine injury caused by falling off the tractor. Radiological assessment revealed fracture of C4 vertebra with proximal two-thirds of C4 body dislocated five millimeters dorsally. Significant swelling of soft prevertebral tissues distally of C2 segment was also present. During emergency surgery using standard anterior approach for cervical spine, excessive bleeding started from the injured right vertebral artery. Bleeding was stopped by tamponade with oxidized regenerated cellulose sheet and C4-C5 anterior fixation; then partial reduction of displacement was done. Fifteen days later, after angiography, endovascular repair of the right vertebral artery was performed using percutaneous stent graft. Follow up computed tomography scan angiography showed valid stent patency without contrast extravasation. In cases of cervical spine trauma, surgeon should always be prepared to manage injury of vertebral artery. Bleeding can primarily be stopped by hemostatic packing, and definitive repair can be successfully achieved by endovascular approach using percutaneous stent graft.

  2. Prediction of New Clinical Vertebral Fractures in Elderly Men using Finite Element Analysis of CT Scans

    PubMed Central

    Wang, Xiang; Sanyal, Arnav; Cawthon, Peggy M.; Palermo, Lisa; Jekir, Michael; Christensen, John; Ensrud, Kristine E.; Cummings, Steven R.; Orwoll, Eric; Black, Dennis M.; Keaveny, Tony M.

    2012-01-01

    Vertebral strength, as estimated by finite element analysis of computed tomography (CT) scans, has not yet been compared against areal bone mineral density (BMD) by dual energy x-ray absorptiometry (DXA) for prospectively assessing the risk of new clinical vertebral fractures. To do so, we conducted a case-cohort analysis of 306 men aged 65 yrs and older, which included 63 men who developed new clinically-identified vertebral fractures and 243 men who did not, all observed over an average of 6.5 years. Non-linear finite element analysis was performed on the baseline CT scans, blinded to fracture status, to estimate L1 vertebral compressive strength and a load-to-strength ratio. Volumetric BMD by quantitative CT and areal BMD by DXA were also evaluated. We found that, for the risk of new clinical vertebral fracture, the age-adjusted hazard ratio per standard deviation change for areal BMD (3.2; 95% CI: 2.0–5.2) was significantly lower (p<0.005) than for strength (7.2; 3.6–14.1), numerically lower than for volumetric BMD (5.7; 3.1–10.3), and similar for the load-to-strength ratio (3.0; 2.1–4.3). After also adjusting for race, BMI, clinical center, and areal BMD, all these hazard ratios remained highly statistically significant, particularly those for strength (8.5; 3.6–20.1) and volumetric BMD (9.4; 4.1–21.6). The area-under-the-curve for areal BMD (AUC=0.76) was significantly lower than for strength (AUC=0.83, p=0.02), volumetric BMD (AUC=0.82, p=0.05), and the load-to-strength ratio (AUC=0.82, p=0.05). We conclude that, compared to areal BMD by DXA, vertebral compressive strength and volumetric BMD consistently improved vertebral fracture risk assessment in this cohort of elderly men. PMID:22190331

  3. Postpartum osteoporosis and vertebral fractures in two patients treated with enoxaparin during pregnancy.

    PubMed

    Ozdemir, D; Tam, A A; Dirikoc, A; Ersoy, R; Cakir, B

    2015-01-01

    Postpartum osteoporosis (PPO) is a rare disease associated with pregnancy and lactation period. Here, we report severe PPO and multiple vertebral compression fractures in two patients treated with enoxaparin--low-molecular-weight heparin (LMWH)--throughout their pregnancy. A 34-year-old woman who has delivered her second baby 3 months ago presented with severe low-back pain. She was treated with enoxaparin 40 mg/day for 8 months during her pregnancy. Dual-energy X-ray absorptiometry (DEXA) showed low T- and Z-scores in lumbar (L) vertebras. In magnetic resonance imaging (MRI), severe height losses in thoracic (T) 12, L1, and L2 vertebras were detected. She was diagnosed to have severe PPO and multiple vertebral compression fractures and was prescribed risedronate 35 mg/week, calcium, and vitamin D. The other patient was a 36-year-old woman diagnosed with PPO and vertebral fractures at the third week postpartum. She was also treated with enoxaparin 60 mg/day during her pregnancy. Severe osteoporosis in L vertebras and height losses indicative for compression fractures in T5-8, T11-12, and L2-5 vertebras were detected by DEXA and MRI, respectively. She was treated with calcitonin 200 U/day, calcium, and vitamin D. These findings suggest that vertebral compression fractures and PPO may be one of the causes of severe back pain in postpartum patients. Treatment with LMWH during pregnancy might be considered as a new risk factor for this rare condition.

  4. Initial clinical experience with a novel vertebral augmentation system for treatment of symptomatic vertebral compression fractures: A case series of 26 consecutive patients

    PubMed Central

    2011-01-01

    Background Minimally invasive vertebral augmentation procedures are widely used to treat vertebral compression fractures although procedural polymethylmethacrylate cement leakage remains common. We report herein our initial experience with a novel vertebral augmentation technique designed to treat symptomatic vertebral osteoporotic fractures and osteolytic metastases with minimal cement extravasation. Methods Forty-two vertebral fractures were identified in 26 consecutive patients (mean age 74 ± 9 years). All patients were treated with a novel percutaneous vertebral augmentation device (Kiva® VCF Treatment System, Benvenue Medical, Santa Clara, CA, USA). Indications for surgery included recent (≤ 3 months) symptomatic osteoporotic vertebral fracture (n = 34) and pathologic vertebral fractures (e.g. metabolic bone disease, myeloma, metastasis) (n = 8) located between T10 and S1. Patient outcomes were evaluated pre-treatment and at 2- and 6-month follow-up visits. Postoperative cement extravasation was assessed with computed tomography. Patient-reported back pain was quantified using an 11-point numeric scale. Back-specific functional disability was self-reported with the Oswestry Disability Index on a 0 to 100% scale. Results No cases of intraoperative hypotension, respiratory disturbance, neurological deterioration, infection, or death were observed. There were 2 (4.8%) levels where anterior cement leakage was visible radiographically in patients with osteolyses. No intracanal leakage was observed. Back pain scores improved 71% (p < 0.001) from pre-treatment to the 6-month follow-up. Back function improved 56% from baseline to 6 months (p < 0.001). Conclusions The initial clinical experience with the Kiva® System demonstrated significant improvements in back pain and function with minimal and clinically insignificant procedural cement leakage. PMID:21939548

  5. Effects of cement augmentation on the mechanical stability of multilevel spine after vertebral compression fracture

    PubMed Central

    Wang, Tian; Pelletier, Matthew H.; Walsh, William R.

    2016-01-01

    Background Studies on the effects of cement augmentation or vertebroplasty on multi-level spine after vertebral compression fractures are lacking. This paper seeks to establish a 3-vertebrae ovine model to determine the impact of compression fracture on spine biomechanics, and to discover if cement augmentation can restore mechanical stability to fractured spine. Methods Five lumbar spine segments (L1-L3) were obtained from 5-year-old female Merino sheep. Standardized wedge-compression fractures were generated in each L2 vertebra, and then augmented with polymethyl methacrylate (PMMA) cement mixed with 30% barium sulphate powder. Biomechanical pure moment testing in axial rotation (AR), flexion/extension (FE) and lateral bending (LB) was carried out in the intact, fractured and repaired states. Range of motion (ROM) and neutral zone (NZ) parameters were compared, and plain radiographs taken at every stage. Results Except for a significant increase in ROM between the intact and fractured states in AR between L1 and L2 (P<0.05), there were no other significant differences in ROM or NZ between the other groups. There was a trend towards an increase in ROM and NZ in all directions after fracture, but this did not reach significance. Normal biomechanics was only minimally restored after augmentation. Conclusions Results suggest that cement augmentation could not restore mechanical stability of fractured spine. Model-specific factors may have had a role in these findings. Caution should be exercised when applying these results to humans. PMID:27683707

  6. Analysis of the spinal nerve roots in relation to the adjacent vertebral bodies with respect to a posterolateral vertebral body replacement procedure

    PubMed Central

    Awwad, Waleed; Bourget-Murray, Jonathan; Zeiadin, Nadil; Mejia, Juan P; Steffen, Thomas; Algarni, Abdulrahman D; Alsaleh, Khalid; Ouellet, Jean; Weber, Michael; Jarzem, Peter F

    2017-01-01

    Objective: This study aims to improve the understanding of the anatomic variations along the thoracic and lumbar spine encountered during an all-posterior vertebrectomy, and reconstruction procedure. This information will help improve our understanding of human spine anatomy and will allow better planning for a vertebral body replacement (VBR) through either a transpedicular or costotransversectomy approach. Summary of Background Data: The major challenge to a total posterior approach vertebrectomy and VBR in the thoracolumbar spine lies in the preservation of important neural structures. Methods: This was a retrospective analysis. Hundred normal magnetic resonance imaging (MRI) spinal studies (T1–L5) on sagittal T2-weighted MRI images were studied to quantify: (1) mid-sagittal vertebral body (VB) dimensions (anterior, midline, and posterior VB height), (2) midline VB and associated intervertebral discs height, (3) mean distance between adjacent spinal nerve roots (DNN) and mean distance between the inferior endplate of the superior vertebrae to its respective spinal nerve root (DNE), and (4) posterior approach expansion ratio (PAER). Results: (1) The mean anterior VB height gradually increased craniocaudally from T1 to L5. The mean midline and posterior VB height showed a similar pattern up to L2. Mean posterior VB height was larger than the mean anterior VB height from T1 to L2, consistent with anterior wedging, and then measured less than the mean anterior VB height, indicating posterior wedging. (2) Midline VB and intervertebral disc height gradually increased from T1 to L4. (3) DNN and DNE were similar, whereby they gradually increased from T1 to L3. (5) Mean PAER varied between 1.69 (T12) and 2.27 (L5) depending on anatomic level. Conclusions: The dimensions of the thoracic and lumbar vertebrae and discs vary greatly. Thus, any attempt at carrying out a VBR from a posterior approach should take into account the specifications at each spinal level. PMID

  7. Multiple vertebral fractures in young man as first manifestation of systemic mastocytosis.

    PubMed

    Carrasco Cubero, Carmen; Chamizo Carmona, Eugenio

    Systemic mastocytosis (SM) is a clonal disease of mast cell progenitors from the bone marrow. The clinical picture varies from asymptomatic forms (indolent) to a highly aggressive form with a very short (mast cell leukemia) survival. Between 28-34% of patients with SM are related to bone condition at the time of diagnosis and 16% have symptomatic fractures. The presentation of SM as clinical vertebral fractures in young men is rare. Here, we describe a case of established osteoporosis as the only manifestation of SM.

  8. Once-weekly teriparatide reduces the risk of vertebral fracture in patients with various fracture risks: subgroup analysis of the Teriparatide Once-Weekly Efficacy Research (TOWER) trial.

    PubMed

    Nakano, Tetsuo; Shiraki, Masataka; Sugimoto, Toshitsugu; Kishimoto, Hideaki; Ito, Masako; Fukunaga, Masao; Hagino, Hiroshi; Sone, Teruki; Kuroda, Tatsuhiko; Nakamura, Toshitaka

    2014-07-01

    Once-weekly teriparatide (human parathyroid hormone [1-34]) (56.5 μg for 72 weeks) injections provided a vertebral fracture risk reduction in Japanese osteoporotic patients evaluated in the Teriparatide Once-Weekly Efficacy Research (TOWER) trial. Using data from the TOWER trial, a subgroup analysis was performed to study the efficacy of once-weekly teriparatide for a variety of baseline clinical risk factors in placebo (n = 281) and teriparatide (n = 261) groups. Significant fracture risk reductions were observed in the subgroups of individuals aged <75 years [relative risk (RR) 0.06, p = 0.007] and ≥75 years (RR 0.32, p = 0.015). A significant risk reduction was observed among patients with prevalent vertebral fracture in the subgroup with 1 (RR 0.08, p = 0.015) or ≥2 (RR 0.29, p = 0.009) prevalent vertebral fractures, and in those with grade 3 deformity (RR 0.26, p = 0.003). Significant risk reduction was observed in the subgroup with lumbar bone mineral density (BMD) < -2.5 SD (RR 0.25, p = 0.035). In the teriparatide group, no incident fracture was observed in the subgroups with a prevalent vertebral fracture number of 0, with grade 0-2 vertebral deformity, or with lumbar BMD ≥2.5 SD. Significant risk reduction was observed in all of the bone turnover marker and estimated glomerular filtration rate subgroups. In conclusion, once-weekly 56.5 μg teriparatide injection reduced the vertebral fracture risk in patients with varying degrees of fracture risk, age, vertebral fracture number and grade, bone turnover level, and renal function.

  9. Conservative Management of Osteoporotic Vertebral Fractures: A Prospective Study of Thirty Patients

    PubMed Central

    Goregaonkar, Arvind B

    2016-01-01

    Introduction Osteoporotic vertebral fractures relate to poorer quality of life and higher long-term mortality. In a resource-poor setup, conservative management assumes great importance as primary means of treatment. We assess the clinico-pathological epidemiology of osteoporotic vertebral fractures and prospectively evaluate the effectiveness of conservative management in their treatment. Materials & Methods    Thirty consecutive patients, diagnosed with osteoporotic vertebral fracture, underwent the predetermined protocol of conservative treatment (bed rest, titrated analgesia, antiosteoporosis pharmacotherapy, bracing, and supervised physical therapy) after assessment of basic demographic data and clinical examination. They were evaluated every three months for nine months, using visual analog scale (VAS) for backpain, Oswestry Disability Index (ODI), and radiological and hematological parameters. Results  The mean age of the patients was 66.9 +/-7.6 years and the female: male ratio was 14:1. All (100%) women were postmenopausal and the mean time since menopause was 16.75 +/- 8.12 years. The presenting complaints were backpain (100%) and deformity (53.33%). Neurodeficit was noted in one (3.33%) patient. Higher age was correlated to greater vertebral collapse (p=0.001) and higher kyphotic angle (p=0.002). At nine months after treatment, there was a significant decrease in the VAS score (p<0.0001) and the ODI score (p<0.0001), with the final VAS score improving by 49.25% and the ODI score improving by 47.23% from the baseline. There was progressive increase in vertebral collapse (p=0.0474) with no change in kyphotic or scoliotic angles. With treatment there was a consistent increase in serum calcium (p<0.0001), phosphorous (p<0.0001), and vitamin D3 (p<0.0001) levels, and decrease in parathyroid hormone levels (p<0.0001). Conclusions  A multidisciplinary conservative treatment is effective as the primary treatment for patients with osteoporotic

  10. Induced seismicity caused by hydraulic fracturing in deep geothermal wells in Germany and adjacent areas

    NASA Astrophysics Data System (ADS)

    Plenefisch, Thomas; Brückner, Lisa; Ceranna, Lars; Gestermann, Nicolai; Houben, Georg; Tischner, Torsten; Wegler, Ulrich; Wellbrink, Matthias; Bönnemann, Christian; Bertram, Andreas; Kirschbaum, Bernd

    2016-04-01

    Recently, the BGR has worked out a study on the potential environmental impact caused by hydraulic fracturing or chemical stimulations in deep geothermal reservoirs in Germany and adjacent areas. The investigations and analyses are based on existing studies and information provided by operators. The two environmental impacts being essentially considered in the report are induced seismicity and possible contamination of the groundwater reservoirs which serve for drinking water supply. Altogether, in this study, information on 30 hydraulic frac operations and 26 chemical stimulations including information from neighboring countries were compiled and analyzed. Out of the hydraulic stimulations two thirds were carried out as waterfracs and one third as fracturing with proppants. Parameters used in the study to characterize the induced seismicity are maximum magnitude, number of seismic events, size of the seismically active volume, and the relation of this volume to fault zones and the cap rock, as well as, finally, the impacts at the Earth's surface. The response of the subsurface to hydraulic fracturing is variable: There are some activities, which cause perceptible seismic events, others, where no perceptible but instrumentally detected events occurred, and moreover activities without even any instrumentally detected events. A classification of seismic hazard with respect to tectonic region, geology, or depth of the layer is still difficult, since the number of hydraulic fracturing measures in deep geothermal wells is small making a statistically sound analysis impossible. However, there are some indications, that hydraulic fracturing in granite in tectonically active regions like the Upper Rhine Graben results in comparatively stronger, perceptible seismicity compared to hydraulic fracturing in the sedimentary rocks of the North German basin. The maximum magnitudes of induced earthquakes caused by hydraulic fracturing of deep geothermal wells in Germany are

  11. Spinal Epidural Hematoma after Thoracolumbar Posterior Fusion Surgery without Decompression for Thoracic Vertebral Fracture

    PubMed Central

    Minato, Tsuyoki; Miyagi, Masayuki; Saito, Wataru; Shoji, Shintaro; Nakazawa, Toshiyuki; Inoue, Gen; Imura, Takayuki; Minehara, Hiroaki; Matsuura, Terumasa; Kawamura, Tadashi; Namba, Takanori; Takahira, Naonobu; Takaso, Masashi

    2016-01-01

    We present a rare case of spinal epidural hematoma (SEH) after thoracolumbar posterior fusion without decompression surgery for a thoracic vertebral fracture. A 42-year-old man was hospitalized for a thoracic vertebral fracture caused by being sandwiched against his back on broken concrete block. Computed tomography revealed a T12 dislocation fracture of AO type B2, multiple bilateral rib fractures, and a right hemopneumothorax. Four days after the injury, in order to promote early orthostasis and to improve respiratory status, we performed thoracolumbar posterior fusion surgery without decompression; the patient had back pain but no neurological deficits. Three hours after surgery, he complained of acute pain and severe weakness of his bilateral lower extremities; with allodynia below the level of his umbilicus, postoperative SEH was diagnosed. We performed immediate revision surgery. After removal of the hematoma, his symptoms improved gradually, and he was discharged ambulatory one month after revision surgery. Through experience of this case, we should strongly consider the possibility of preexisting SEH before surgery, even in patients with no neurological deficits. We should also consider perioperative coagulopathy in patients with multiple trauma, as in this case. PMID:26989542

  12. Vertebral Compression Fracture (VCF) After Spine Stereotactic Body Radiation Therapy (SBRT): Analysis of Predictive Factors

    SciTech Connect

    Cunha, Marcelo V.R.; Al-Omair, Ameen; Atenafu, Eshetu G.; Masucci, Giuseppina Laura; Letourneau, Daniel; Korol, Renee; Yu, Eugene; Howard, Peter; Lochray, Fiona; Costa, Leodante B. da; Fehlings, Michael G.; Sahgal, Arjun

    2012-11-01

    Purpose: Vertebral compression fractures (VCFs) are increasingly observed after spine stereotactic body radiation therapy (SBRT). The aim of this study was to determine the risk of VCF after spine SBRT and identify clinical and dosimetric factors predictive for VCF. The analysis incorporated the recently described Spinal Instability Neoplastic Score (SINS) criteria. Methods and Materials: The primary endpoint of this study was the development of a de novo VCF (ie, new endplate fracture or collapse deformity) or fracture progression based on an existing fracture at the site of treatment after SBRT. We retrospectively scored 167 spinal segments in 90 patients treated with spine SBRT according to each of the 6 SINS criteria. We also evaluated the presence of paraspinal extension, prior radiation, various dosimetric parameters including dose per fraction ({>=}20 Gy vs <20 Gy), age, and histology. Results: The median follow-up was 7.4 months. We identified 19 fractures (11%): 12 de novo fractures (63%) and 7 cases of fracture progression (37%). The mean time to fracture after SBRT was 3.3 months (range, 0.5-21.6 months). The 1-year fracture-free probability was 87.3%. Multivariate analysis confirmed that alignment (P=.0003), lytic lesions (P=.007), lung (P=.03) and hepatocellular (P<.0001) primary histologies, and dose per fraction of 20 Gy or greater (P=.004) were significant predictors of VCF. Conclusions: The presence of kyphotic/scoliotic deformity and the presence of lytic tumor were the only predictive factors of VCF based on the original 6 SINS criteria. We also report that patients with lung and hepatocellular tumors and treatment with SBRT of 20 Gy or greater in a single fraction are at a higher risk of VCF.

  13. Effect of inhaled glucocorticoids and beta(2) agonists on vertebral fracture risk in COPD patients: the EOLO study.

    PubMed

    Gonnelli, S; Caffarelli, C; Maggi, S; Guglielmi, G; Siviero, P; Rossi, S; Crepaldi, G; Nuti, R

    2010-08-01

    Although inhaled glucocorticoids (GCs) and beta(2) agonists are being more frequently prescribed in the management of chronic obstructive pulmonary disease (COPD), their role in the impairment of bone status and in fracture risk remains controversial. This study aimed to evaluate whether the dose of inhaled GCs and beta(2) agonists may independently influence bone status and vertebral fracture risk in COPD patients aged 50 years or over. COPD severity, presence of vertebral fractures on lateral chest X-ray, and bone status by quantitative ultrasound (QUS) at the calcaneus were evaluated. The risk of vertebral fractures was significantly increased in patients taking the highest daily dose (>1,500 microg) of inhaled GCs (OR = 1.4, CI 1.04-1.89). The highest dose of inhaled GCs was significantly associated with low values of stiffness index (OR = 1.74, CI 1.03-2.94). Inhaled beta(2) agonists were not associated either with increased risk of vertebral fracture or with reduced values of stiffness. Moreover, the risk of fractures was markedly increased in patients with very severe or severe COPD (OR = 2.05, CI 1.28-3.28, and OR = 1.40, CI 1.06-1.82, respectively). In conclusion, in COPD patients high doses of inhaled GCs, but not beta(2) agonists, are associated with an increased risk of vertebral fractures and a reduction of QUS at the calcaneus.

  14. Comparison of Kyphoplasty and Lordoplasty in the Treatment of Osteoporotic Vertebral Compression Fracture

    PubMed Central

    Jeon, Taek-Soo; Lee, Woo-Suk; Roh, Jae-Young; Kim, Jae-Young; Park, Won-Ki

    2010-01-01

    Study Design A retrospective study. Purpose To compare the level of restoration of the vertebral height, improvement in the wedge and kyphotic angles, and the incidence of complications in osteoporotic compression fracture in patients treated with either kyphoplasty or lordoplasty. Overview of Literature Kyphoplasty involves recompression of the vertebral bodies. Recently, a more effective method known as lordoplasty was introduced. Methods Between 2004 and 2009, patients with osteoporotic thoracolumbar vertebral compression fractures were treated by either kyphoplasty (n = 24) or lordoplasty (n = 12) using polymethylmethacrylate (PMMA) cement, and the results of the two interventions were compared. A visual analogue scale was used to measure the pain status. Preoperative and postoperative radiographs were analyzed to quantify the anterior vertebral height restoration and the wedge and kyphotic alignment correction. Results All patients in both groups reported a significant decrease in pain. The anterior heights increased 24.2% and 17.5% after the lordoplasty and kyphoplasty procedures, respectively (p < 0.05). Three months after the procedures, there was a larger decrease in the loss of anterior vertebral height in the kyphoplasty group (12.8%) than in the lordoplasty group (6.3%, p < 0.05). The wedge angles decreased after both procedures. The wedge angle in the lordoplasty group maintained its value after 3 months (p < 0.05). The kyphotic angular correction was 11.4 and 7.0° in the lordoplasty and kyphoplasty groups, respectively (p < 0.05). Both kyphotic deformities worsened to a similar degree of 5° after 3 months. Conclusions Lordoplasty is more useful than kyphoplasty in terms of the improved anatomic restoration and postoperative maintenance. PMID:21165313

  15. Effectiveness of elcatonin for alleviating pain and inhibiting bone resorption in patients with osteoporotic vertebral fractures.

    PubMed

    Tanaka, Shinya; Yoshida, Akira; Kono, Shinjiro; Oguma, Tadanori; Hasegawa, Kyoichi; Ito, Manabu

    2016-11-09

    Elderly patients with osteoporotic vertebral fractures often experience severe pain that reduces their quality of life (QOL). Calcitonin, a bone resorption inhibitor, has been reported to alleviate pain in such patients; however, few clinical studies have demonstrated this effect. The objective of this study was to compare changes in pain scores, activities of daily living (ADL), QOL, bone resorption, bone mineral density (BMD), and fracture healing among patients with new vertebral fractures who received different treatment modalities. We conducted an open-label, multicenter, randomized, parallel control group study comprising 107 female patients ≥55 years old with acute back pain from vertebral fracture. All subjects received either intramuscular injections of elcatonin, a derivative of calcitonin, or an oral nonsteroidal antiinflammatory drug (NSAID) combined with an active vitamin D3 (VD3) analogue for 6 months. The pain was assessed using a visual analogue scale, and ADL and QOL were assessed using questionnaires. BMD was measured using dual-energy X-ray absorptiometry. A two-tailed significance level of 5% was used. The elcatonin IM group had significantly higher QOL score at 2 weeks and later, and significantly lower VAS and ADL scores than those in the NSAID + VD3 group at 1 month and later. The elcatonin IM group had significantly reduced TRACP-5b levels compared with those in the NSAID + VD3 group at 3 months and later and significantly higher percent changes in BMD than the NSAID + VD3 group. These results suggest that elcatonin significantly alleviated pain, inhibited bone resorption, and improved ADL, QOL, and BMD compared with NSAID + VD3.

  16. Vertebral Compression Fracture with Intravertebral Vacuum Cleft Sign: Pathogenesis, Image, and Surgical Intervention

    PubMed Central

    Wu, Ai-Min; Ni, Wen-Fei

    2013-01-01

    The intravertebral vacuum cleft (IVC) sign in vertebral compression fracture patients has obtained much attention. The pathogenesis, image character and efficacy of surgical intervention were disputed. Many pathogenesis theories were proposed, and its image characters are distinct from malignancy and infection. Percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) have been the main therapeutic methods for these patients in recent years. Avascular necrosis theory is the most supported; PVP could relieve back pain, restore vertebral body height and correct the kyphotic angulation (KA), and is recommended for these patients. PKP seems to be more effective for the correction of KA and lower cement leakage. The Kümmell's disease with IVC sign reported by modern authors was incomplete consistent with syndrome reported by Dr. Hermann Kümmell. PMID:23741556

  17. A predictive mechanical model for evaluating vertebral fracture probability in lumbar spine under different osteoporotic drug therapies.

    PubMed

    López, E; Ibarz, E; Herrera, A; Puértolas, S; Gabarre, S; Más, Y; Mateo, J; Gil-Albarova, J; Gracia, L

    2016-07-01

    Osteoporotic vertebral fractures represent a major cause of disability, loss of quality of life and even mortality among the elderly population. Decisions on drug therapy are based on the assessment of risk factors for fracture from bone mineral density (BMD) measurements. A previously developed model, based on the Damage and Fracture Mechanics, was applied for the evaluation of the mechanical magnitudes involved in the fracture process from clinical BMD measurements. BMD evolution in untreated patients and in patients with seven different treatments was analyzed from clinical studies in order to compare the variation in the risk of fracture. The predictive model was applied in a finite element simulation of the whole lumbar spine, obtaining detailed maps of damage and fracture probability, identifying high-risk local zones at vertebral body. For every vertebra, strontium ranelate exhibits the highest decrease, whereas minimum decrease is achieved with oral ibandronate. All the treatments manifest similar trends for every vertebra. Conversely, for the natural BMD evolution, as bone stiffness decreases, the mechanical damage and fracture probability show a significant increase (as it occurs in the natural history of BMD). Vertebral walls and external areas of vertebral end plates are the zones at greatest risk, in coincidence with the typical locations of osteoporotic fractures, characterized by a vertebral crushing due to the collapse of vertebral walls. This methodology could be applied for an individual patient, in order to obtain the trends corresponding to different treatments, in identifying at-risk individuals in early stages of osteoporosis and might be helpful for treatment decisions.

  18. Incident vertebral fractures and risk factors in the first three years following glucocorticoid initiation among pediatric patients with rheumatic disorders

    PubMed Central

    LeBlanc, Claire MA; Ma, Jinhui; Taljaard, Monica; Roth, Johannes; Scuccimarri, Rosie; Miettunen, Paivi; Lang, Bianca; Huber, Adam M; Houghton, Kristin; Jaremko, Jacob L; Ho, Josephine; Shenouda, Nazih; Matzinger, Mary Ann; Lentle, Brian; Stein, Robert; Sbrocchi, Anne Marie; Oen, Kiem; Rodd, Celia; Jurencak, Roman; Cummings, Elizabeth; Couch, Robert; Cabral, David A; Atkinson, Stephanie; Alos, Nathalie; Rauch, Frank; Siminoski, Kerry; Ward, Leanne M

    2015-01-01

    Vertebral fractures are an important yet under-recognized manifestation of osteoporosis in children with chronic, glucocorticoid-treated illnesses. Our goal was to determine the incidence and clinical predictors of vertebral fractures in the three years following glucocorticoid initiation among pediatric patients with rheumatic disorders. Incident vertebral fractures were evaluated according to the Genant semi-quantitative method on lateral radiographs at baseline and then annually in the 3 years following glucocorticoid initiation. Extended Cox models were used to assess the association between vertebral fractures and clinical risk predictors. A total of 134 children with rheumatic disorders were enrolled in the study (mean ± standard deviation (SD) age 9.9±4.4 years, 65% girls). The unadjusted vertebral fracture incidence rate was 4.4 per 100 person-years, with a three-year incidence proportion of 12.4%. The highest annual incidence occurred in the first year (6.0%, 95% confidence interval (CI) 2.9–11.7). Almost one-half of the patients with fractures were asymptomatic. Every 0.5 mg/kg increase in average daily glucocorticoid (prednisone equivalents) dose was associated with a 2.0-fold increased fracture risk (hazard ratio (HR) 2.0, 95% CI 1.1–3.5). Other predictors of increased vertebral fracture risk included: (1) Increases in disease severity scores between baseline and 12 months, (2) Increases in body mass index Z-scores in the first 6 of each 12-month period preceding the annual fracture assessment, and (3) Decreases in lumbar spine bone mineral density Z-scores in the first 6 months of glucocorticoid therapy. As such, we observed that a clinically significant number of children with rheumatic disorders developed incident vertebral fractures in the three years following glucocorticoid initiation. Almost half of the children were asymptomatic and thereby would have been undiagnosed in the absence of radiographic monitoring. In addition, discrete

  19. Incident Vertebral Fractures and Risk Factors in the First Three Years Following Glucocorticoid Initiation Among Pediatric Patients With Rheumatic Disorders.

    PubMed

    LeBlanc, Claire M A; Ma, Jinhui; Taljaard, Monica; Roth, Johannes; Scuccimarri, Rosie; Miettunen, Paivi; Lang, Bianca; Huber, Adam M; Houghton, Kristin; Jaremko, Jacob L; Ho, Josephine; Shenouda, Nazih; Matzinger, Mary Ann; Lentle, Brian; Stein, Robert; Sbrocchi, Anne Marie; Oen, Kiem; Rodd, Celia; Jurencak, Roman; Cummings, Elizabeth A; Couch, Robert; Cabral, David A; Atkinson, Stephanie; Alos, Nathalie; Rauch, Frank; Siminoski, Kerry; Ward, Leanne M

    2015-09-01

    Vertebral fractures are an important yet underrecognized manifestation of osteoporosis in children with chronic, glucocorticoid-treated illnesses. Our goal was to determine the incidence and clinical predictors of vertebral fractures in the 3 years following glucocorticoid initiation among pediatric patients with rheumatic disorders. Incident vertebral fractures were evaluated according to the Genant semiquantitative method on lateral radiographs at baseline and then annually in the 3 years following glucocorticoid initiation. Extended Cox models were used to assess the association between vertebral fractures and clinical risk predictors. A total of 134 children with rheumatic disorders were enrolled in the study (mean ± standard deviation (SD) age 9.9 ± 4.4 years; 65% girls). The unadjusted vertebral fracture incidence rate was 4.4 per 100 person-years, with a 3-year incidence proportion of 12.4%. The highest annual incidence occurred in the first year (6.0%; 95% confidence interval (CI) 2.9% to 11.7%). Almost one-half of the patients with fractures were asymptomatic. Every 0.5 mg/kg increase in average daily glucocorticoid (prednisone equivalents) dose was associated with a twofold increased fracture risk (hazard ratio (HR) 2.0; 95% CI 1.1 to 3.5). Other predictors of increased vertebral fracture risk included: (1) increases in disease severity scores between baseline and 12 months; (2) increases in body mass index Z-scores in the first 6 months of each 12-month period preceding the annual fracture assessment; and (3) decreases in lumbar spine bone mineral density Z-scores in the first 6 months of glucocorticoid therapy. As such, we observed that a clinically significant number of children with rheumatic disorders developed incident vertebral fractures in the 3 years following glucocorticoid initiation. Almost one-half of the children were asymptomatic and thereby would have been undiagnosed in the absence of radiographic monitoring. In addition, discrete

  20. Detection of Aortic Calcification during Vertebral Fracture Assessment (VFA) Compared to Digital Radiography

    PubMed Central

    Schousboe, John T.; Wilson, Kevin E.; Hangartner, Thomas N.

    2007-01-01

    Background Cardiovascular disease is the most common cause of mortality among post-menopausal women. Our objective was to determine whether or not lateral spine images obtained on a bone densitometer to detect prevalent vertebral fracture can also accurately detect radiographic abdominal aortic calcification (AAC), an important risk factor for cardiovascular disease independent of clinical risk factors. Methodology/Principal Findings One hundred seventy four postmenopausal women had bone densitometry, lateral spine densitometry imaging (called vertebral fracture assessment, or VFA), and lateral spine digital radiographs. Radiographs and VFA images were scored for AAC using a previously validated 24 point scale and a simplified, new 8 point scale (AAC-8). One hundred fifty six (90%) of the VFA images were evaluable for AAC. The non-parametric intraclass correlation coefficient between VFA and radiographic 24 point and AAC-8 readings, respectively, were 0.80 (95% C.I. 0.68–0.87) and 0.76 (95% C.I. 0.65–0.84). Areas under receiver operating characteristics (ROC) curves for VFA to detect those with a radiographic 24-point AAC score ≥5 were 0.86 (95% C.I. 0.77–0.94) using the 24 point scale and 0.84 (95% C.I. 0.76–0.92) using the AAC-8 scale. Conclusion/Significance VFA imaging intended to detect prevalent vertebral fracture can also detect radiographic AAC, an important cardiovascular disease risk factor. Since bone densitometry is recommended for all women age 65 and older, VFA imaging at the time of bone densitometry offers an opportunity to assess this risk factor in the post-menopausal female population at very little incremental time and expense. PMID:17684561

  1. Capacitively Coupled Electric Field for Pain Relief in Patients with Vertebral Fractures and Chronic Pain

    PubMed Central

    Viapiana, Ombretta; Gatti, Davide; de Terlizzi, Francesca; Adami, Silvano

    2009-01-01

    Fragility vertebral fractures often are associated with chronic back pain controlled by analgesic compounds. Capacitive coupling electrical stimulation is a type of electrical stimulation technology approved by the US FDA to noninvasively enhance fracture repair and spinal fusion. These uses suggest it would be a possible treatment for patients with back pain attributable to vertebral fractures. We therefore randomized 51 postmenopausal women with multiple fractures and chronic pain to the use of one of two indistinguishable devices delivering either the standard capacitive coupling electrical stimulation by Osteospine™ (active group) or low intensity pulse (control group). Twenty patients of the active group and 21 of the control group (80%) completed the study for a total duration of 3 months. The mean visual analog scale values for pain and the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO) scores improved in both groups. We observed a relationship between hours of treatments and reductions in pain intensity only in the active group. Capacitive coupling electrical stimulation was not more effective than control treatment when comparing mean visual analog scale pain and QALEFFO scores in the two groups and when adjusting for the hours of treatment. However, the proportion of patients able to discontinue NSAIDs owing to elimination or reduction of pain was greater in the active group than in the control group. We interpret these findings as suggesting capacitive coupling electrical stimulation controls pain in some patients and reduces the use of NSAIDs. Level of Evidence: Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. PMID:19756902

  2. Relationship between treatments with insulin and oral hypoglycemic agents versus the presence of vertebral fractures in type 2 diabetes mellitus.

    PubMed

    Kanazawa, Ippei; Yamaguchi, Toru; Yamamoto, Masahiro; Sugimoto, Toshitsugu

    2010-09-01

    Although previous studies indicated that hypoglycemic agents could affect bone metabolism, little is known about whether these agents are associated with the risks of osteoporotic fracture in Japanese patents with type 2 diabetes. We examined whether treatments of diabetes, such as insulin administration, sulfonylurea, thiazolidinedione, and metformin, were associated with the presence of vertebral fractures in 494 men and 344 postmenopausal women with type 2 diabetes. We analyzed the relationships between each treatment versus bone turnover markers, bone mineral density (BMD), and the presence of prevalent vertebral fractures. Multiple logistic regression analysis adjusted for age, duration of diabetes, body mass index, serum creatinine, serum C-peptide, and HbA(1c) showed that, in postmenopausal women, treatments with insulin administration or thiazolidinedione were significantly and positively associated with the presence of vertebral fractures [odds ratio (OR) = 2.27, P = 0.012 and OR = 3.38, P = 0.038, respectively], whereas treatment with sulfonylurea was significantly and inversely associated with vertebral fractures (OR = 0.48, P = 0.018). These relationships were still significant after additional adjustment for lumbar BMD. In contrast, no significant relationships between treatments with any agent and the presence of vertebral fractures were found in men. These findings suggest that postmenopausal women treated with insulin or thiazolidinedione have a high risk of vertebral fractures independent of age, body stature, blood glucose level, insulin secretion, or BMD whereas treatment with sulfonylurea is associated with a decreased risk.

  3. Impaired bone health and asymptomatic vertebral compressions in fracture-prone children: a case-control study.

    PubMed

    Mäyränpää, Mervi K; Viljakainen, Heli T; Toiviainen-Salo, Sanna; Kallio, Pentti E; Mäkitie, Outi

    2012-06-01

    Frequent fractures in children may be a sign of impaired bone health, but it remains unestablished when and how fracture-prone children should be assessed. This prospective study elucidated skeletal characteristics and predisposing factors in children with recurrent fractures. Findings were used to establish guidelines for screening. During a 12-month period we recorded fracture history for all children (n = 1412) treated for an acute fracture at a large university hospital. All apparently healthy children over 4 years of age, who had sustained: (1) at least one vertebral fracture; (2) two long-bone fractures before age 10 years; or (3) three long-bone fractures before age 16 years, were recruited. They underwent dual-energy X-ray absorptiometry (DXA), laboratory tests, and spinal radiography. Information regarding family history and lifestyle factors were collected. Findings were compared with healthy controls. Sixty-six fracture-prone children (44 males, mean age 10.7 years; 5% of all children with fractures) were identified. Altogether, they had sustained 183 long-bone fractures (median 3, range 0–7); 11 children had sustained vertebral fracture(s). Patients had significantly lower bone mineral density (BMD) at lumbar spine (p < 0.001), hip (p = 0.007), and whole body (p < 0.001) than the controls; only 5 children (8%) had a BMD Z-score < −2.0. Asymptomatic vertebral compressions were prevalent, especially in those under 10 years of age. Hypercalciuria (11%) and hyperphosphaturia (22%) were significantly more prevalent than in controls. Serum concentration of 25-hydroxyvitamin D (S-25OHD) was below 50 nmol/L in 55%; low levels were associated with low BMD and vertebral compressions. The fracture-prone children had lower calcium intake, less physical activity, and more often had siblings with fractures than the controls. The findings suggest that a thorough pediatric evaluation, including DXA and spinal radiography, is often indicated

  4. Multi-functionality of computer-aided quantitative vertebral fracture morphometry analyses

    PubMed Central

    Oei, Ling; Ly, Felisia; El Saddy, Salih; Makurthou, Ater A.; Hofman, Albert; van Rooij, Frank J. A.; Uitterlinden, André G.; Zillikens, M. Carola; Rivadeneira, Fernando

    2013-01-01

    Osteoporotic vertebral fractures are an increasingly active area of research. Oftentimes assessments are performed by software-assisted quantitative morphometry. Here, we will discuss multi-functionality of these data for research purposes. A team of trained research assistants processed lateral spine radiographs from the population-based Rotterdam Study with SpineAnalyzer® software (Optasia Medical Ltd, Cheadle, UK). Next, the raw coordinate data of the two upper corners of Th5 and the two lower corners of Th12 were extracted to calculate the Cobb’s kyphosis angle. In addition, two readers performed independent manual measurements of the Cobb’s kyphosis angle between Th5 and Th12 for a sample (n=99). The mean kyphosis angle and its standard deviation were 53° and 10° for the SpineAnalyzer® software measurements and 54° and 12° by manual measurements, respectively. The Pearson’s correlation coefficient was 0.65 [95% confidence interval (CI): 0.53-0.75; P=2×10–13]. There was a substantial intraclass correlation with a coefficient of 0.64 (95% CI: 0.51-0.74). The mean difference between methods was 1° (95% CI: –2°-4°), with 95% limits of agreement of –20°-17° and there were no systematic biases. In conclusion, vertebral fracture morphometry data can be used to derive the Cobb’s kyphosis angle. Even more quantitative measures could be derived from the raw data, such as vertebral wedging, intervertebral disc space, spondylolisthesis and the lordosis angle. These measures may be of interest for research into musculoskeletal disorders such as osteoporosis, degenerative disease or Scheuermann’s disease. Large-scale studies may benefit from efficient capture of multiple quantitative measures in the spine. PMID:24273742

  5. Clinical application of a pedicle nail system with polymethylmethacrylate for osteoporotic vertebral fracture

    PubMed Central

    Tanaka, Masato; Sugimoto, Yoshihisa; Takigawa, Tomoyuki; Ozaki, Toshifumi; Konishi, Hitoshi

    2010-01-01

    The instrumentation of the osteoporotic spine may sometimes result in failure due to the loosening or pullout of the conventional pedicle screw. Moreover, augmentation of screws with polymethylmethacrylate (PMMA) has risks of complications. We developed a new and original pedicle nail system with PMMA for osteoporotic vertebral fractures. A clinical evaluation of this novel pedicle nail system utilized in patients with an osteoporotic vertebral collapse was performed to determine the effectiveness and safety of this technique. Thirty-four elderly patients who suffered from osteoporotic compression fractures were treated by posterolateral fusion using the pedicle nail system. The mean follow-up period was 37 months. Of the 25 patients with neurological symptoms, two patients improved two stages at the Frankel level. Fifteen patients improved one stage at the Frankel level, and eight other patients improved, however, their improvement did not exceed a Frankel level. Nine cases with neuralgia symptoms improved from 4.4 to 2.2 points on average on the Denis pain scale (p < 0.01). The fusion rate was 94% as determined by X-rays of flexion and extension, and the correction of the compression fracture site was maintained well. A pedicle nail system stabilizes the spinal column with osteoporosis and reduces the instrumentation failure. The technique for the insertion of the pedicle nail reduces complication from cement augmentation. The authors speculate that the strategy using the pedicle nail system for osteoporotic spine may be effective and safe when the surgery is performed through a posterior approach. PMID:20414689

  6. Vertebral augmentation treatment of painful osteoporotic compression fractures with the Kiva VCF Treatment System

    PubMed Central

    Olivarez, Luis M. Rosales; Dipp, Juan M.; Escamilla, Ricardo Flores; Bajares, Guillermo; Perez, Alejandro; Stubbs, Harrison A.; Block, Jon E.

    2011-01-01

    Background Vertebral compression fractures (VCFs) can cause significant pain and functional impairment, and their cumulative effect can lead to progressive morbidity. This single-arm, prospective feasibility trial, conducted at 4 clinical sites, was undertaken to evaluate the clinical outcomes associated with the use of an innovative vertebral augmentation device, the Kiva VCF Treatment System (Benvenue Medical, Santa Clara, California), in the management of symptomatic VCFs associated with osteoporosis. Methods Vertebral augmentation treatment was performed for persistent back pain symptoms in 57 patients (mean age, 71.9 ± 10.4 years), including 46 women, with radiologically confirmed VCFs; 36 of these patients (63%) had reached 12 months of follow-up at this data analysis. There were 51 one-level cases, 5 two-level cases, and 1 three-level case, representing 64 treated levels. Back pain severity and condition-specific functional impairment were evaluated with a standard 100-mm visual analog scale and the Oswestry Disability Index (ODI), respectively, before device implantation as well as at 6 weeks, 3 months, and 12 months. Results Marked clinical improvements were realized in back pain severity and functional impairment through 12 months of follow-up. The mean back pain score on the visual analog scale improved from 79.3 ± 17.2 before treatment to 21.9 ± 21.3, 21.9 ± 24.6, and 23.2 ± 23.3 at 6 weeks, 3 months, and 12 months, respectively. The mean decrease at 12 months was 49.9 ± 30.3 mm, or approximately 66% (P < .0001). Similarly, the mean ODI score improved from 68.1% ± 16.9% before treatment to 27.4% ± 17.2%, 23.8% ± 18.7%, and 23.3% ± 15.5% at 6 weeks, 3 months, and 12 months, respectively, representing a mean change of 39.2 ± 19.6 percentage points, or approximately 63%, at 12 months. Overall clinical success rates based on a 30% improvement in pain severity or greater and maintenance or improvement in the ODI were 91%, 88%, and 89% at 6 weeks

  7. Kyphoplasty in the treatment of osteoporotic Vertebral Compression Fractures (VCF) : procedure description and analysis of the outcomes in 128 patients.

    PubMed

    Molina, Guillermo Saul Fernandez; Campero, A; Feito, R; Pombo, S

    2011-01-01

    In recent years, the advent of percutaneous techniques in the management of osteoporotic vertebral compression fractures has proven to be a great step forward in the evolution of patients suffering from this pathology.Vertebroplasty, which was developed in 1984 by Galibert and Deramond, presents the disadvantage of leakage of the cementation material and the impossibility to restore spinal deformity. Kyphoplasty has shown to be almost a definite solution to these problems. The description of the technique, its indications, and the outcomes resulting from our series of 200 vertebral fractures in 128 patients are presented in this paper.

  8. Analgesic effect of salmon calcitonin in osteoporotic vertebral fractures: a double-blind placebo-controlled clinical study.

    PubMed

    Lyritis, G P; Tsakalakos, N; Magiasis, B; Karachalios, T; Yiatzides, A; Tsekoura, M

    1991-12-01

    Back pain due to vertebral collapse is the main symptom of postmenopausal osteoporosis. The clinical picture in these crush fractures varies, depending on the type and the location of fracture, but in general, a new vertebral crush fracture gives rise to severe pain that immobilizes the patient and necessitates bedrest. In this double-blind controlled clinical trial, 56 patients who had recently (within the last 3 days) suffered an osteoporotic vertebral fracture were hospitalized for a period of 14 days. Salmon calcitonin (100 IU) or placebo injections were given daily. Pain was rated daily on a 10-point scale by the same observers. Blood and urinary parameters were also evaluated. The results showed a significant (P less than 0.001) difference in pain intensity between the calcitonin group and the placebo group. This beneficial effect was generally apparent from the second day of treatment onward, and over the following 2 weeks, the patients were able to sit and stand, and gradually started to walk again. A significant decrease in urinary hydroxyproline and urinary calcium was also noted in the calcitonin group. It is concluded that calcitonin exerts a beneficial effect on back pain following a vertebral crush fracture.

  9. Factors influencing quality of life in Moroccan postmenopausal women with osteoporotic vertebral fracture assessed by ECOS 16 questionnaire

    PubMed Central

    Abourazzak, Fatima E; Allali, Fadoua; Rostom, Samira; Hmamouchi, Ihsane; Ichchou, Linda; El Mansouri, Laila; Bennani, Loubna; Khazzani, Hamza; Abouqal, Redouane; Hajjaj-Hassouni, Najia

    2009-01-01

    Objective The aim of the study was to evaluate factors influencing quality of life (QOL) in Moroccan postmenopausal women with osteoporotic vertebral fracture assessed by the Arabic version of ECOS 16 questionnaire. Methods 357 postmenopausal women were included in this study. The participants underwent bone mineral density (BMD) measurements by DXA of the lumbar spine and the total hip as well as X-ray examination of the thoraco-lumbar spine to identify subclinical vertebral fractures. Patients were asked to complete a questionnaire on clinical and sociodemographic parameters, and osteoporosis risk factors. The Arabic version of the ECOS16 (Assessment of health related quality of life in osteoporosis questionnaire) was used to assess quality of life. Results The mean age was 58 ± 7.8 years, and the mean BMI was 28.3 ± 4.8 kg/m2. One hundred and eight women (30.1%) were osteoporotic and 46.7% had vertebral fractures. Most were categorized as Grade1 (75%). Three independent factors were associated with a poor quality of life: low educational level (p = 0,01), vertebral fracture (p = 0,03), and history of peripheral fracture (p = 0,006). Worse QOL was observed in the group with vertebral fracture in all domains except "pain": Physical functioning (p = 0,002); Fear of illness (p = 0,001); and Psychosocial functioning (p = 0,007). The number of fractures was a determinant of a low QOL, as indicated by an increased score in physical functioning (p = 0,01), fear of illness (p = 0,007), and total score (p = 0,01) after adjusting on age and educational level. Patients with higher Genant score had low QOL in these two domains too (p = 0,002; p = 0,001 respectively), and in the total score (p = 0,01) after adjusting on age and educational level. Conclusion Our current data showed that the quality of life assessed by the Arabic version of the ECOS 16 questionnaire is decreased in post menopausal women with prevalent vertebral fractures, with the increasing number and the

  10. Percutaneous Dorsal Instrumentation of Vertebral Burst Fractures: Value of Additional Percutaneous Intravertebral Reposition—Cadaver Study

    PubMed Central

    Krüger, Antonio; Schmuck, Maya; Noriega, David C.; Ruchholtz, Steffen; Baroud, Gamal; Oberkircher, Ludwig

    2015-01-01

    Purpose. The treatment of vertebral burst fractures is still controversial. The aim of the study is to evaluate the purpose of additional percutaneous intravertebral reduction when combined with dorsal instrumentation. Methods. In this biomechanical cadaver study twenty-eight spine segments (T11-L3) were used (male donors, mean age 64.9 ± 6.5 years). Burst fractures of L1 were generated using a standardised protocol. After fracture all spines were allocated to four similar groups and randomised according to surgical techniques (posterior instrumentation; posterior instrumentation + intravertebral reduction device + cement augmentation; posterior instrumentation + intravertebral reduction device without cement; and intravertebral reduction device + cement augmentation). After treatment, 100000 cycles (100–600 N, 3 Hz) were applied using a servohydraulic loading frame. Results. Overall anatomical restoration was better in all groups where the intravertebral reduction device was used (p < 0.05). In particular, it was possible to restore central endplates (p > 0.05). All techniques decreased narrowing of the spinal canal. After loading, clearance could be maintained in all groups fitted with the intravertebral reduction device. Narrowing increased in the group treated with dorsal instrumentation. Conclusions. For height and anatomical restoration, the combination of an intravertebral reduction device with dorsal instrumentation showed significantly better results than sole dorsal instrumentation. PMID:26137481

  11. Ruptured urinary bladder attributable to urethral compression by a haematoma after vertebral fracture in a bull

    PubMed Central

    2014-01-01

    Background In male cattle, rupture of the urinary bladder is usually associated with urethral obstruction by uroliths. Less common causes include urethral compression or stricture. This case report describes the findings in a young Limousion breeding bull with rupture of the urinary bladder because of urethral compression by a haematoma after coccygeal fracture. Case presentation The bull had been introduced into a 40-head Red-Holstein herd one week before being injured. One week after introduction to the herd, the bull had an acute onset of anorexia and he was referred to the clinic. There was marked abdominal distension, reduced skin turgor and enophthalmus. The serum concentration of urea and creatinine was increased. Ultrasonographic examination revealed severe ascites and abdominocentesis yielded clear yellow fluid with high urea and creatinine concentrations, which supported a diagnosis of uroperitoneum. The bull was euthanatized because of a poor prognosis. Postmortem examination revealed a comminuted fracture of the first two coccygeal vertebrae associated with a massive haematoma that obstructed entire pelvic cavity. The haematoma compressed the urethra thereby preventing outflow of urine, which resulted in a 5-cm tear ventrally at the neck of the bladder. It was assumed that the newly-introduced bull had sustained the vertebral fractures when he was mounted by a cow. Conclusions The present case study serves to expand the differential diagnosis of urinary bladder rupture. Therefore, in addition to obstructive urolithiasis, compression and stricture of the urethra might be considered in male cattle with uroperitoneum. PMID:24666697

  12. Radioecology of Vertebrate Animals in the Area Adjacent to the Chernobyl Nuclear Power Plant Site in 1986-2008

    NASA Astrophysics Data System (ADS)

    Farfan, E. B.; Gashchak, S. P.; Makliuk, Y. A.; Maksymenko, A. M.; Bondarkov, M. D.; Jannik, G. T.; Marra, J. C.

    2009-12-01

    A widespread environmental contamination of the areas adjacent to the Chernobyl Nuclear Power Plant (ChNPP) site attracted a great deal of publicity to the biological consequences of the ChNPP catastrophe. However, only a few studies focused on a detailed analysis of radioactive contamination of the local wild fauna and most of them were published in Eastern European languages, making them poorly accessible for Western scientists. In addition, evaluation of this information appears difficult due to significant differences in raw data acquisition and analysis methodologies and final data presentation formats. Using an integrated approach to assessment of all available information, the International Radioecology Laboratory scientists showed that the ChNPP accident had increased the average values of the animals 137Cs and 90Sr contamination by a factor of thousands, followed by its decrease by a factor of tens, primarily resulting from a decrease in the biological accessibility of the radionuclides. However, this trend depended on many factors. Plant and bottom feeding fish species were the first to reach the maximum contamination levels. No data are available on other vertebrates, but it can be assumed that the same trend was true for all plant feeding animals and animals searching for food on the soil surface. The most significant decrease of the average values occurred during the first 3-5 years after the accident and it was the most pronounced for elks and plant and plankton feeding fish. Their diet included elements “alienated” from the major radionuclide inventory; for example, upper soil layers and bottom deposits where the fallout that had originally precipitated on plants, water and soils gradually migrated. Further radionuclide penetration into deeper layers of soils and its bonding with their mineral components intensified decontamination of the fauna. It took a while for the contamination of predatory fish and mammals (wolves) to reach the maximum

  13. High-resolution-cone beam tomography analysis of bone microarchitecture in patients with acromegaly and radiological vertebral fractures.

    PubMed

    Maffezzoni, Filippo; Maddalo, Michele; Frara, Stefano; Mezzone, Monica; Zorza, Ivan; Baruffaldi, Fabio; Doglietto, Francesco; Mazziotti, Gherardo; Maroldi, Roberto; Giustina, Andrea

    2016-11-01

    Vertebral fractures are an emerging complication of acromegaly but their prediction is still difficult occurring even in patients with normal bone mineral density. In this study we evaluated the ability of high-resolution cone-beam computed tomography to provide information on skeletal abnormalities associated with vertebral fractures in acromegaly. 40 patients (24 females, 16 males; median age 57 years, range 25-72) and 21 healthy volunteers (10 females, 11 males; median age 60 years, range: 25-68) were evaluated for trabecular (bone volume/trabecular volume ratio, mean trabecular separation, and mean trabecular thickness) and cortical (thickness and porosity) parameters at distal radius using a high-resolution cone-beam computed tomography system. All acromegaly patients were evaluated for morphometric vertebral fractures and for mineral bone density by dual-energy X-ray absorptiometry at lumbar spine, total hip, femoral neck, and distal radius. Acromegaly patients with vertebral fractures (15 cases) had significantly (p < 0.05) lower bone volume/trabecular volume ratio, greater mean trabecular separation, and higher cortical porosity vs. nonfractured patients, without statistically significant differences in mean trabecular thickness and cortical thickness. Fractured and nonfractured acromegaly patients did not have significant differences in bone density at either skeletal site. Patients with acromegaly showed lower bone volume/trabecular volume ratio (p = 0.003) and mean trabecular thickness (p < 0.001) and greater mean trabecular separation (p = 0.02) as compared to control subjects, without significant differences in cortical thickness and porosity. This study shows for the first time that abnormalities of bone microstructure are associated with radiological vertebral fractures in acromegaly. High-resolution cone-beam computed tomography at the distal radius may be useful to evaluate and predict the effects of acromegaly on bone

  14. Anatomical distribution of vertebral fractures: comparison of pediatric and adult spines

    PubMed Central

    Lee, K-C.; Jen, H.; Warshawski, R.; Matzinger, M-A.; Shenouda, N.; Charron, M.; Coblentz, C.; Dubois, J.; Kloiber, R.; Nadel, H.; O’Brien, K.; Reed, M.; Sparrow, K.; Webber, C.; Lentle, B.; Ward, L. M.

    2014-01-01

    Introduction We hypothesized that the anatomical distribution of vertebral fractures (VF) would be different in children compared with adults. Methods We compared the distribution of VF defined using the Genant semi-quantitative method (GSQ method) in adults (N=221; 545 fractures) and in children early in the course of glucocorticoid therapy (N = 44; 94 fractures). Results The average age in the adult cohort was 62.9 years (SD, 13.4 yrs), 26% were male, the mean lumbar spine Z-score was −1.0 (SD, 1.5), and the corresponding T-score was −2.4 (SD, 1.4). The pediatric cohort median age was 7.7 years (range, 2.1–16.6 years), the mean lumbar spine Z-score was −1.7 (SD, 1.5), 52% were male, and disease categories were acute lymphoblastic leukemia (66%), rheumatological conditions (21%), and nephrotic syndrome (14%). The VF distribution was biphasic in both populations, but the peaks differed in location. In adults, the peaks were at T7/T8 and at T12/L1. In children, the focus was higher in the thoracic spine, at T6/T7, and lower in the lumbar spine, at L1/L2. When children were assessed in two age-defined sub-groups, a biphasic VF distribution was seen in both, but the upward shift of the thoracic focus to T6 was observed only in the older group, with the highest rates of fracture present between ages 7 and 10 years. Conclusions These results suggest that the anatomical distribution of VF differs between children and adults, perhaps relating to the different shape of the immature spine, notably the changing ratio of kyphosis to lordosis. PMID:22109742

  15. Circulating levels of vitamin K1, menaquinone-4, and menaquinone-7 in healthy elderly Japanese women and patients with vertebral fractures and patients with hip fractures.

    PubMed

    Kawana, K; Takahashi, M; Hoshino, H; Kushida, K

    2001-08-01

    Recently, vitamin K has become increasingly of interest in the bone metabolism field because of its role as a cofactor in the carboxylation of osteocalcin. Although the role of osteocalcin is not clear, noncarboxylated osteocalcin is one risk factor in hip fractures. It has been reported that the circulating levels of vitamin K1 in osteoporotic patients were significantly lower than those of age-matched control subjects. In this study, we measured circulating levels of vitamin K1, menaquinone-4 (MK-4) and menaquinone-7 (MK-7) in 23 normal healthy women aged 52-93 years (mean +/- SD: 80.1 +/- 3.5), 13 female patients with vertebral fractures aged 66-93 years (80.3 +/- 7.8) and 38 female patients with hip fractures aged 76-87 years (79.8 +/- 9.2), (all Japanese), in order to make sure whether these vitamin K levels were different in these three groups. Serum circulating levels of MK-4 was undetectable in most subjects (only one out of 74). Appreciable numbers from these three groups had undetectable levels of MK-7 (52% of the control group, 23% of the vertebral fracture group and 24% of the hip fracture group). Eight subjects from the normal control group (35%) and five patients from the vertebral group (38%) had undetectable levels of vitamin K1. We did not find a significant difference in the measurable levels of vitamin K1, MK-4 and MK-7 in patients with vertebral fractures or patients with hip fractures compared to age-matched normal controls. Undetectable levels of measured vitamin K1, MK-4 and MK-7 in most of subjects may significantly affect the results.

  16. The implantation of a Nickel-Titanium shape memory alloy ameliorates vertebral body compression fractures: a cadaveric study

    PubMed Central

    Chen, Bo; Zheng, Yue-Huang; Zheng, Tao; Sun, Chang-Hui; Lu, Jiong; Cao, Peng; Zhou, Jian-Hua

    2015-01-01

    Objective: To evaluate the effect of a Nickel-Titanium (Ni-Ti) shape memory alloy in the treatment of vertebral body compression fractures. Methods: The experimental thoracic-lumbar fracture units were made with adult human fresh-frozen vertebral specimens. A total of 30 fresh-frozen vertebral units were randomly assigned to 3 experimental groups: control group, percutaneous kyphoplasty group (PKP group), and percutaneous Ni-Ti shape memory alloys implant group (Ni-Ti implant group). Vertebral height and ultimate compression load of the vertebral body before and after procedures were measured to determine the restoration of vertebral heights and compressive strength, respectively. Results: The Ni-Ti implant group achieved a vertebrae endplate reduction effect comparable to the PKP group. The vertebral height of the PKP group was restored from 2.01±0.21 cm to 2.27±0.18 cm after procedure, whereas that of the Ni-Ti implant group was restored from 2.00±0.18 cm to 2.31±0.17 cm. The ultimate loads of the vertebrae body of the PKP and the Ni-Ti implant groups were 2880.75±126.17 N and 2888.00±144.69 N, respectively, both of which were statistically significantly higher than that of the control group (2017.17±163.71 N). There was no significant difference in ultimate compression load of vertebrae body between the Ni-Ti implant and PKP groups. Conclusions: The implantation of Ni-Ti shape memory alloys of vertebral body induced effective endplate reduction, restored vertebral height, and provided immediate biomechanical spinal stability. PMID:26629241

  17. Usefulness of bone densitometry in postmenopausal women with clinically diagnosed vertebral fractures

    PubMed Central

    Nolla, J; Gomez-Vaquero, C; Fiter, J; Vilaseca, D; Mateo, L; Rozadilla, A; Romera, M; Valverde, J; Escofet, D

    2002-01-01

    Methods: Women with vertebral fracture diagnosed over a 10 year period were recruited from our database. The following were excluded: (a) patients with high energy trauma; (b) patients with malignancies; (c) patients with a metabolic bone disease other than osteoporosis. All postmenopausal women were included in whom BMD had been evaluated at both the lumbar spine and femoral neck by dual energy x ray absorptiometry during the six months after the diagnosis. Patients with a potential cause of osteoporosis other than age and menopause were not considered. A total of 215 patients were identified. Results: The mean (SD) age of the patients was 65.9 (6.9) years. BMD at the lumbar spine was 0.725 (0.128) g/cm2 and the T score was -2.94 (1.22); BMD at the femoral neck was 0.598 (0.095) g/cm2 and the T score was -2.22 (0.89). The BMD of the patients was significantly lower than that of the general population at both the lumbar spine and femoral neck. When the lowest value of the two analysed zones was considered, six patients (3%) showed a normal BMD, 51 (23.5%) osteopenia, and 158 (73.5%) osteoporosis. The prevalence of osteoporosis at the femoral neck increased with age; it was 25% in patients under 60, 35% in patients aged 60–70, and 60% in patients over 70. Conclusion: These results indicate that bone densitometry is not required in postmenopausal women with clinically diagnosed vertebral fractures if it is performed only to confirm the existence of a low BMD. PMID:11779765

  18. Non-traumatic Thoracic Vertebral Compression Fractures Occurred in a Young Epileptic Patient: A Case Report

    PubMed Central

    Mimata, Yoshikuni; Sato, Kotaro; Oikawa, Ryunosuke; Doita, Minoru

    2016-01-01

    Introduction: The occurrence of non-traumatic vertebral compression fractures (VCFs) in a healthy young male is very rare. We present a rare case of non-traumatic thoracic VCFs in a young epileptic patient. Case Report: A 19-year-old healthy male experienced severe back pain. There had been no significant traumatic event. A radiograph of the spine showed collapsed vertebra at Th6 and Th7 and magnetic resonance image of the spine showed intensity changes at Th6, Th7 and Th8. Bone mineral density (BMD) at the radius was low and urine N-terminal telopeptide (NTx) was very high. The patient was diagnosed with VCFs caused by low BMD. The patient had a medical history of epilepsy and had taken valproate for thirteen years. We instructed the patient to stop taking valproate and to begin taking bisphosphonate. As a result, urine NTx became normal. Conclusion: It was previously reported that valproate reduced BMD in epileptic children and reduction in BMD increased with the duration of valproate therapy. We propose that regular BMD screening and measurement of bone metabolic markers should be conducted for all patients taking long-term antiepileptic drugs to prevent BMD loss and associated fractures. PMID:28116280

  19. Vertebral Compression Fracture Related to Pancreatic Cancer With Osteoblastic Metastasis: A Case Report and Literature Review.

    PubMed

    Chih, Yu-Pin; Wu, Wei-Ting; Lin, Chien-Lin; Jou, Herng-Jeng; Huang, Yu-Hsuan; Chen, Liang-Chi; Chou, Li-Wei

    2016-02-01

    Compression fracture of the vertebral body is common in the older patients. The possible etiology like osteoporosis or cancer metastasis should be included as a possibility in the differential diagnosis for severe back pain, to prevent delays in diagnosis and treatment. More severe fractures can cause significant pain, leading to inability to perform activities of daily living, and life-threatening in the older patient.We report a rare case of a 61-year-old man suffering from severe lower back pain and intermittent abdominal fullness. He came to our clinic, where muscle power was normal, but could not stand up or change posture because of severe back pain. Plain film and magnetic resonance imaging of lumbar spine both revealed osteoblastic lesion at L2 spine. Abdomen computed tomography showed a mass at the pancreatic body. The pancreatic cancer with osteoblastic metastasis was diagnosed. After receiving multimodality therapy such as percutaneous vertebroplasty and pain controlling, we provided effective palliation of symptoms, aggressive rehabilitation program, and better quality of life.Our case highlights the benefits of multidisciplinary cancer treatment for such patient, preventing the complications such as immobilization accompanied with adverse effects like musculoskeletal, respiratory, and cardiovascular systems. All clinicians should be informed of the clinical findings to provide patients with suitable therapies and surveys.

  20. Assessing vertebral fracture risk on volumetric quantitative computed tomography by geometric characterization of trabecular bone structure

    NASA Astrophysics Data System (ADS)

    Checefsky, Walter A.; Abidin, Anas Z.; Nagarajan, Mahesh B.; Bauer, Jan S.; Baum, Thomas; Wismüller, Axel

    2016-03-01

    The current clinical standard for measuring Bone Mineral Density (BMD) is dual X-ray absorptiometry, however more recently BMD derived from volumetric quantitative computed tomography has been shown to demonstrate a high association with spinal fracture susceptibility. In this study, we propose a method of fracture risk assessment using structural properties of trabecular bone in spinal vertebrae. Experimental data was acquired via axial multi-detector CT (MDCT) from 12 spinal vertebrae specimens using a whole-body 256-row CT scanner with a dedicated calibration phantom. Common image processing methods were used to annotate the trabecular compartment in the vertebral slices creating a circular region of interest (ROI) that excluded cortical bone for each slice. The pixels inside the ROI were converted to values indicative of BMD. High dimensional geometrical features were derived using the scaling index method (SIM) at different radii and scaling factors (SF). The mean BMD values within the ROI were then extracted and used in conjunction with a support vector machine to predict the failure load of the specimens. Prediction performance was measured using the root-mean-square error (RMSE) metric and determined that SIM combined with mean BMD features (RMSE = 0.82 +/- 0.37) outperformed MDCT-measured mean BMD (RMSE = 1.11 +/- 0.33) (p < 10-4). These results demonstrate that biomechanical strength prediction in vertebrae can be significantly improved through the use of SIM-derived texture features from trabecular bone.

  1. A fatal iatrogenic right vertebral injury after transoral odontoidectomy and posterior cervical stabilization for a type II odontoid fracture.

    PubMed

    Scalici, Edoardo; Indorato, Francesca; Portelli, Francesca; Savì, Tommaso; Maresi, Emiliano; Busardò, Francesco P

    2014-02-01

    The authors present a singular case of an iatrogenic right vertebral artery injury, involving a 67 year-old man, who reported a type II odontoid fracture (Anderson and D'Alonzo Classification) and posterior atlantoaxial dislocation following a road traffic accident. A small injury involving the right vertebral artery occurred as a consequence of transoral odontoidectomy and posterior cervical stabilization. It was caused by bone spicules of spinal origin and their presence was confirmed by the histological section of the right vertebral artery at the level of C1-C2. The case confirms how iatrogenic vertebral artery injuries during cervical spine surgery may be potentially lethal, especially where complications arise some days after surgery.

  2. High-sensitivity CRP is an independent risk factor for all fractures and vertebral fractures in elderly men: the MrOS Sweden study.

    PubMed

    Eriksson, Anna L; Movérare-Skrtic, Sofia; Ljunggren, Östen; Karlsson, Magnus; Mellström, Dan; Ohlsson, Claes

    2014-02-01

    Epidemiological studies have shown low-grade inflammation measured by high-sensitivity C-reactive protein (hs-CRP) to be associated with fracture risk in women. However, it is still unclear whether hs-CRP is also associated with fracture risk in men. We therefore measured serum levels of hs-CRP in 2910 men, mean age 75 years, included in the prospective population-based MrOS Sweden cohort. Study participants were divided into tertile groups based on hs-CRP level. Fractures occurring after the baseline visit were validated (average follow-up 5.4 years). The incidence for having at least one fracture after baseline was 23.9 per 1000 person-years. In Cox proportional hazard regression analyses adjusted for age, hs-CRP was related to fracture risk. The hazard ratio (HR) of fracture for the highest tertile of hs-CRP, compared with the lowest and the medium tertiles combined, was 1.48 (95% CI, 1.20-1.82). Multivariate adjustment for other risk factors for fractures had no major effect on the associations between hs-CRP and fracture. Results were essentially unchanged after exclusion of subjects with hs-CRP levels greater than 7.5 mg/L, as well as after exclusion of subjects with a first fracture within 3 years of follow-up, supporting that the associations between hs-CRP and fracture risk were not merely a reflection of a poor health status at the time of serum sampling. Femoral neck bone mineral density (BMD) was not associated with hs-CRP, and the predictive role of hs-CRP for fracture risk was essentially unchanged when femoral neck BMD was added to the model (HR, 1.37; 95% CI, 1.09-1.72). Exploratory subanalyses of fracture type demonstrated that hs-CRP was clearly associated with clinical vertebral fractures (HR, 1.61; 95% CI, 1.12-2.29). We demonstrate, using a large prospective population-based study, that elderly men with high hs-CRP have increased risk of fractures, and that these fractures are mainly vertebral. The association between hs-CRP and fractures was

  3. Characterizing trabecular bone structure for assessing vertebral fracture risk on volumetric quantitative computed tomography

    NASA Astrophysics Data System (ADS)

    Nagarajan, Mahesh B.; Checefsky, Walter A.; Abidin, Anas Z.; Tsai, Halley; Wang, Xixi; Hobbs, Susan K.; Bauer, Jan S.; Baum, Thomas; Wismüller, Axel

    2015-03-01

    While the proximal femur is preferred for measuring bone mineral density (BMD) in fracture risk estimation, the introduction of volumetric quantitative computed tomography has revealed stronger associations between BMD and spinal fracture status. In this study, we propose to capture properties of trabecular bone structure in spinal vertebrae with advanced second-order statistical features for purposes of fracture risk assessment. For this purpose, axial multi-detector CT (MDCT) images were acquired from 28 spinal vertebrae specimens using a whole-body 256-row CT scanner with a dedicated calibration phantom. A semi-automated method was used to annotate the trabecular compartment in the central vertebral slice with a circular region of interest (ROI) to exclude cortical bone; pixels within were converted to values indicative of BMD. Six second-order statistical features derived from gray-level co-occurrence matrices (GLCM) and the mean BMD within the ROI were then extracted and used in conjunction with a generalized radial basis functions (GRBF) neural network to predict the failure load of the specimens; true failure load was measured through biomechanical testing. Prediction performance was evaluated with a root-mean-square error (RMSE) metric. The best prediction performance was observed with GLCM feature `correlation' (RMSE = 1.02 ± 0.18), which significantly outperformed all other GLCM features (p < 0.01). GLCM feature correlation also significantly outperformed MDCTmeasured mean BMD (RMSE = 1.11 ± 0.17) (p< 10-4). These results suggest that biomechanical strength prediction in spinal vertebrae can be significantly improved through characterization of trabecular bone structure with GLCM-derived texture features.

  4. Bone cement distribution in the vertebral body affects chances of recompression after percutaneous vertebroplasty treatment in elderly patients with osteoporotic vertebral compression fractures

    PubMed Central

    Zhang, Liang; Wang, Qiang; Wang, Lin; Shen, Jian; Zhang, Qiwei; Sun, Changtai

    2017-01-01

    Objective Percutaneous vertebroplasty (PVP) is a surgical procedure that has been widely used to treat patients suffering from osteoporotic vertebral compression fractures (OVCFs). The procedure involves injection of bone cement into a fractured vertebra. In this study, we investigated whether the distribution of the cement in the vertebral body is related to the occurrence of recompression after surgery. Patients and methods A total of 172 patients diagnosed with OVCF, from January 2008 to June 2013, were retrospectively reviewed. Fifty of these patients experienced recompression after surgery during the follow-up period (recompression group), and 122 patients had no recompression observed during the follow-up period (control group). Statistical analysis was performed to compare clinical and operative parameters between these two groups. Results Differences were found in bone cement distribution between the recompression group and control group (P=0.001). Patients with bone cement distributed around both upper and lower endplates had a significantly less incidence of recompression (4/50 patients), when compared to other patterns of cement distribution (eg, below upper endplate, above lower endplate, and in the middle of vertebral body). The logistic multiple regression analysis also indicated that patients with bone cement distributed around both the upper and lower endplates had a lower risk of recompression when compared to patients with bone cement distributed in the middle of vertebral body (odds ratio =0.223, P=0.003). Conclusion We herein suggest that the control of bone cement distribution during surgery provides beneficial effects on reducing the risks of recompression after PVP treatment in patients with OVCF. PMID:28260871

  5. Contribution of vertebral deformities to chronic back pain and disability. The Study of Osteoporotic Fractures Research Group

    NASA Technical Reports Server (NTRS)

    Ettinger, B.; Black, D. M.; Nevitt, M. C.; Rundle, A. C.; Cauley, J. A.; Cummings, S. R.; Genant, H. K.

    1992-01-01

    Among 2992 white women aged 65-70 years recruited from population-based listings, we measured radiographic vertebral dimensions of T5-L4 and calculated ratios of heights: anterior/posterior, mid/posterior, and posterior/posterior of either adjacent vertebra. The degree of deformity for each vertebra was analyzed in terms of the number of standard deviations (SD) that ratio differed from the mean ratio calculated for the same vertebral level in this population. We correlated the severity of each woman's worst vertebral deformity with back pain, back disability in six activities of daily living, and height loss since age 25. Only 39.4% of the cohort had no vertebral deformity; 10.2% had a deformity greater than or equal to 4 SD. Vertebral deformities less than 4 SD below the mean were not associated with increased back pain, disability, or loss of height. In contrast, women whose deformity was greater than or equal to 4 SD had a 1.9 (95% CI, 1.5-2.4) times higher risk of moderate to severe back pain and a 2.6 (95% CI, 1.7-3.9) times higher risk of disability involving the back; they were also 2.5 (95% CI, 2.0-3.2) times more likely to have lost greater than or equal to 4 cm in height. All three types of vertebral deformity (wedge, end plate, and crush) were equally associated with these outcomes. Multiple deformities less than 4 SD did not increase the likelihood of these three outcomes, but multiple deformities greater than or equal to 4 SD tended to be associated with increased back pain, disability, and height loss. This large cross-sectional study suggests that vertebral deformities cause substantial pain, disability, or loss of height only if vertebral height ratios fall 4 SD below the normal mean. Much back pain could not be attributed to vertebral deformities, suggesting other causes.

  6. Relationship between spinal osteoarthritis and vertebral fractures in men older than 50 years: data from the Camargo Cohort Study.

    PubMed

    Pariente, Emilio; Olmos, José M; Landeras, Rosa; Nan, Daniel; González-Macías, Jesús; Hernández, José Luis

    2017-01-01

    Spinal osteoarthritis has been suggested as a risk factor for vertebral fractures. However, results are conflicting: most of the data are focused on the lumbar region, and referred to postmenopausal women, whereas data for men are scarce. The aim of this study is to assess the relationship between spinal osteoarthritis and vertebral fractures in men over 50 years of age. We conducted a cross-sectional study, nested in a prospective population-based cohort, including 507 community-dwelling men, 93 of them with at least one vertebral fracture. Vertebral fractures, osteophytosis, and disc space narrowing (DSN) were assessed by lateral thoracic and lumbar radiographs. Anthropometric, clinical, and densitometric variables were also analyzed. A multiple logistic regression model was performed. Eighty-five percent of vertebral fractures were located at the thoracic spine. Osteophytosis and DSN showed a bimodal distribution, with major frequency peaks at mid- and distal lumbar spine. The three distributions overlapped around the T9 vertebra. We did not find any relationship between lumbar osteoarthritis and vertebral fractures. Nevertheless, thoracic osteophytosis (OR, 1.84; 95 % CI, 1.05-3.17; p = 0.03) and DSN (OR, 2.52; 95 % CI, 1.43-4.46; p = 0.001) were found to be independently associated with prevalent vertebral fractures, after adjusting for confounders. Our results suggest a positive relationship between radiologic osteoarthritic changes at the thoracic spine and prevalent vertebral fractures in men more than 50 years of age. Osteoarthritis may act as a local risk factor, in addition to other mechanical factors, resulting in a greater propensity to fracture, especially at the mid-thoracic region.

  7. Association of QCT Bone Mineral Density and Bone Structure With Vertebral Fractures in Patients With Multiple Myeloma.

    PubMed

    Borggrefe, Jan; Giravent, Sarah; Thomsen, Felix; Peña, Jaime; Campbell, Graeme; Wulff, Asmus; Günther, Andreas; Heller, Martin; Glüer, Claus C

    2015-07-01

    Computed tomography (CT) is used for staging osteolytic lesions and detecting fractures in patients with multiple myeloma (MM). In the OsteoLysis of Metastases and Plasmacell-infiltration Computed Tomography 2 study (OLyMP-CT) study we investigated whether patients with and without vertebral fractures show differences in bone mineral density (BMD) or microstructure that could be used to identify patients at risk for fracture. We evaluated whole-body CT scans in a group of 104 MM patients without visible osteolytic lesions using an underlying lightweight calibration phantom (Image Analysis Inc., Columbia, KY, USA). QCT software (StructuralInsight) was used for the assessment of BMD and bone structure of the T11 or T12 vertebral body. Age-adjusted standardized odds ratios (sORs) per SD change were derived from logistic regression analyses, and areas under the receiver operating characteristics (ROC) curve (AUCs) analyses were calculated. Forty-six of the 104 patients had prevalent vertebral fractures (24/60 men, 22/44 women). Patients with fractures were not significantly older than patients without fractures (mean ± SD, 64 ± 9.2 versus 62 ± 12.3 years; p = 0.4). Trabecular BMD in patients with fractures versus without fractures was 169 ± 41 versus 192 ± 51 mg/cc (AUC = 0.62 ± 0.06, sOR = 1.6 [1.1 to 2.5], p = 0.02). Microstructural variables achieved optimal discriminatory power at bone thresholds of 150 mg/cc. Best fracture discrimination for single microstructural variables was observed for trabecular separation (Tb.Sp) (AUC = 0.72 ± 0.05, sOR = 2.4 (1.5 to 3.9), p < 0.0001). In multivariate models AUCs improved to 0.77 ± 0.05 for BMD and Tb.Sp, and 0.79 ± 0.05 for Tb.Sp and trabecular thickness (Tb.Th). Compared to BMD values, these improvements of AUC values were statistically significant (p < 0.0001). In MM patients, QCT-based analyses of bone structure derived from routine CT

  8. Impact of Instrumented Spinal Fusion on the Development of Vertebral Compression Fracture

    PubMed Central

    Chiu, Yen-Chun; Tsai, Tsung-Ting; Yang, Shih-Chieh; Chen, Hung-Shu; Kao, Yu-Hsien; Tu, Yuan-Kun

    2016-01-01

    Abstract Instrumented spinal fusion has become one of the most common surgeries for patients with various spinal disorders. Only few studies have reported subsequent vertebral compression fractures (VCFs) after instrumented spinal fusion. The purpose of this study was to evaluate the risk of new VCFs in patients undergoing instrumented spinal fusion. We obtained claims data from the National Health Insurance Research Database of Taiwan and retrospectively reviewed 6949 patients with instrumented spinal fusion as the spinal fusion cohort. Control subjects were individually matched at a ratio of 10:1 with those of the spinal fusion cohort according to age, sex, and the index day. Comorbidities were classified as those existing before the index day, and these included diabetes mellitus, hypertension, osteoporosis, and cerebrovascular accident. The end of the follow-up period for the analyses was marked on the day new VCFs developed, enrolment in the National Health Insurance was terminated, on the day of death, or until the end of 2012. We used the Cox proportion hazards model to analyze the hazard ratio (HR) for developing new VCFs. Patients with instrumented spinal fusion were significantly more likely to develop new VCFs (1.87% vs .25%, HR: 8.56; P < 0.001). Female, elderly, and osteoporotic patients had a high incidence of new VCFs after spinal fusion. The HR for developing new VCFs after instrumented spinal fusion was higher in patients younger than 65 years than in those 65 years or older (HR: 10.61 vs 8.09). Male patients with instrumented spinal fusion also had a higher HR of developing new VCFs than female patients (men, HR: 26.42; women, HR: 7.53). In our retrospective cohort study, patients who had undergone instrumented spinal fusion surgery exhibited an increased risk of developing new VCFs. Particularly, the HR increased in young (age <65 years) and male patients. PMID:27124040

  9. Incident Vertebral Fractures in Children with Leukemia During the Four Years Following Diagnosis

    PubMed Central

    Cummings, Elizabeth A; Ma, Jinhui; Fernandez, Conrad V; Halton, Jacqueline; Alos, Nathalie; Miettunen, Paivi M; Jaremko, Jacob L; Ho, Josephine; Shenouda, Nazih; Matzinger, Mary Ann; Lentle, Brian; Stephure, David; Stein, Robert; Sbrocchi, Ann Marie; Rodd, Celia; Lang, Bianca; Israels, Sara; Grant, Ronald M; Couch, Robert; Barr, Ronald; Hay, John; Rauch, Frank; Siminoski, Kerry; Ward, Leanne M

    2016-01-01

    Objectives The purpose of this article was to determine the incidence and predictors of vertebral fractures (VF) during the four years following diagnosis in pediatric acute lymphoblastic leukemia (ALL). Patients and Methods Children were enrolled within 30 days of chemotherapy initiation, with incident VF assessed annually on lateral spine radiographs according to the Genant method. Extended Cox’s models were used to assess the association between incident VF and clinical predictors. Results 186 children with ALL completed the baseline evaluation (median age 5.3 years, interquartile range 3.4 to 9.7, 58% boys). The VF incidence rate was 8.7 per 100 person-years, with a four-year cumulative incidence of 26.4%. The highest annual incidence occurred at 12 months (16.1%; 95% confidence interval (CI) 11.2 – 22.7), falling to 2.9% at four years (95% CI, 1.1 – 7.3). Half of the children with incident VF had moderate or severe VF and 39% of those with incident VF were asymptomatic. Every 10 mg/m2 increase in average daily glucocorticoid dose (prednisone equivalents) was associated with a 5.9-fold increased VF risk (95% CI, 3.0–11.8; p < 0.01). Other predictors of increased VF risk included: VF at diagnosis, younger age, and lower spine bone mineral density Z-scores at baseline and each annual assessment. Conclusions One quarter of children with ALL developed incident VF in the four years following diagnosis; most of the VF burden was in the first year. Over one third of children with incident VF were asymptomatic. Discrete clinical predictors of VF were evident early in the patient’s clinical course, including VF at diagnosis. PMID:26171800

  10. [Difference of anti-fracture mechanical characteristics between lateral-root branches and adjacent upper straight roots of four plant species in vigorous growth period].

    PubMed

    Liu, Peng-fei; Liu, Jing; Zhu, Hong-hui; Zhang, Xin; Zhang, Ge; Li, You-fang; Su, Yu; Wang, Chen-jia

    2016-01-01

    Taking four plant species, Caragana korshinskii, Salix psammophila, Hippophae rhamnides and Artemisia sphaerocephala, which were 3-4 years old and in vigorous growth period, as test materials, the anti-fracture forces of lateral-root branches and adjacent upper straight roots were measured with the self-made fixture and the instrument of TY 8000. The lateral-root branches were vital and the diameters were 1-4 mm. The results showed that the anti-fracture force and anti-fracture strength of lateral-root branches were lesser than those of the adjacent upper straight roots even though the average diameter of lateral-root branches was greater. The ratios of anti-fracture strength of lateral-root branches to the adjacent upper straight roots were 71.5% for C. korshinskii, 62.9% for S. psammophila, 45.4% for H. rhamnides and 35.4% for A. sphaerocephala. For the four plants, the anti-fracture force positively correlated with the diameter in a power function, while the anti-fracture strength negatively correlated with diameter in a power function. The anti-fracture strengths of lateral-root branches and adjacent upper straight roots for the four species followed the sequence of C. korshinskii (33.66 and 47.06 MPa) > S. psammophila (17.31 and 27.54 MPa) > H. rhamnides (3.97 and 8.75 MPa) > A. sphaerphala (2.18 and 6.15 MPa).

  11. Screening for osteoporosis following non-vertebral fractures in patients aged 50 and older independently of gender or level of trauma energy-a Swiss trauma center approach.

    PubMed

    Hemmeler, Christoph; Morell, Sabrina; Amsler, Felix; Gross, Thomas

    2017-12-01

    Screening in a standardized manner for osteoporosis in non-vertebral fracture patients aged 50 and older independently of both gender and level of trauma energy yielded the indication for osteoporotic therapy for every fourth male high-energy fracture patient.

  12. Advanced vertebral fracture among newly diagnosed children with acute lymphoblastic leukemia: results of the Canadian Steroid-Associated Osteoporosis in the Pediatric Population (STOPP) research program.

    PubMed

    Halton, Jacqueline; Gaboury, Isabelle; Grant, Ronald; Alos, Nathalie; Cummings, Elizabeth A; Matzinger, Maryann; Shenouda, Nazih; Lentle, Brian; Abish, Sharon; Atkinson, Stephanie; Cairney, Elizabeth; Dix, David; Israels, Sara; Stephure, David; Wilson, Beverly; Hay, John; Moher, David; Rauch, Frank; Siminoski, Kerry; Ward, Leanne M

    2009-07-01

    Vertebral compression is a serious complication of childhood acute lymphoblastic leukemia (ALL). The prevalence and pattern of vertebral fractures, as well as their relationship to BMD and other clinical indices, have not been systematically studied. We evaluated spine health in 186 newly diagnosed children (median age, 5.3 yr; 108 boys) with ALL (precursor B cell: N = 167; T cell: N = 19) who were enrolled in a national bone health research program. Patients were assessed within 30 days of diagnosis by lateral thoraco-lumbar spine radiograph, bone age (also used for metacarpal morphometry), and BMD. Vertebral morphometry was carried out by the Genant semiquantitative method. Twenty-nine patients (16%) had a total of 75 grade 1 or higher prevalent vertebral compression fractures (53 thoracic, 71%; 22 lumbar). Grade 1 fractures as the worst grade were present in 14 children (48%), 9 patients (31%) had grade 2 fractures, and 6 children (21%) had grade 3 fractures. The distribution of spine fracture was bimodal, with most occurring in the midthoracic and thoraco-lumbar regions. Children with grade 1 or higher vertebral compression had reduced lumbar spine (LS) areal BMD Z-scores compared with those without (mean +/- SD, -2.1 +/- 1.5 versus -1.1 +/- 1.2; p < 0.001). LS BMD Z-score, second metacarpal percent cortical area Z-score, and back pain were associated with increased odds for fracture. For every 1 SD reduction in LS BMD Z-score, the odds for fracture increased by 80% (95% CI: 10-193%); the presence of back pain had an OR of 4.7 (95% CI: 1.5-14.5). These results show that vertebral compression is an under-recognized complication of newly diagnosed ALL. Whether the fractures will resolve through bone growth during or after leukemia chemotherapy remains to be determined.

  13. Association of chronic obstructive pulmonary disease and smoking status with bone density and vertebral fractures in male lung cancer screening participants.

    PubMed

    de Jong, Werner U; de Jong, Pim A; Vliegenthart, Rozemarijn; Isgum, Ivana; Lammers, Jan-Willem J; Oudkerk, Matthijs; van der Aalst, Carlijn; de Koning, Harry J; Mohamed Hoesein, Firdaus A

    2014-10-01

    We studied the vertebral fracture prevalence on low-dose chest computed tomography (CT) in male lung cancer screening participants and the association of fractures and bone density with chronic obstructive pulmonary disease (COPD) and smoking. 1140 male current and former smokers with ≥ 16.5 packyears from the NELSON lung cancer screening trial were included. Age, body mass index, and smoking status were registered. CT scans and pulmonary function tests were obtained on the same day. On CT, vertebral fractures and bone density were measured. The cohort had a mean age of 62.5 years (standard deviation 5.2) old; 531 (46.6%) had quit smoking; and 437 (38.3%) had COPD. Of the group, 100 (8.8%) participants had a vertebral fracture. Fracture prevalence was higher in current compared to former smokers (11.3% versus 5.8%, p = 0.001), but similar in participants with COPD compared to those without (9.6% versus 8.3%, p = 0.430). The multivariable adjusted odds ratio for fracture presence was 1.79 (95% CI: 1.13-2.84) in current smokers and 1.08 (95% CI: 0.69-1.67) in COPD participants. Bone density was lower in current compared to former smokers (103.2 HU versus 108.7 HU, p = 0.006) and in participants with COPD compared to those without [100.7 Hounsfield Units (HU) versus 108.9 HU, p < 0.001]. In multivariate analysis, smoking status and COPD status were independently associated with bone density, corrected for age and body mass index. In conclusion, our study shows that lung cancer screening participants have a substantial vertebral fracture burden. Fractures are more common in current smokers, who also have lower bone density. We could not confirm that COPD is independently associated with vertebral fractures.

  14. Associations of self-reported height loss and kyphosis with vertebral fractures in Japanese women 60 years and older: a cross-sectional survey

    PubMed Central

    Kamimura, Mikio; Nakamura, Yukio; Sugino, Noriyuki; Uchiyama, Shigeharu; Komatsu, Masatoshi; Ikegami, Shota; Kato, Hiroyuki; Taguchi, Akira

    2016-01-01

    Some vertebral fractures come to clinical attention but most do not. This cross-sectional survey aimed to clarify the associations of self-reported height loss and kyphosis with vertebral fractures. We enrolled 407 women aged 60–92 years who visited our orthopaedic clinic between June and August 2014 in our study. Inclusion criteria were lateral radiography followed by completion of a structured questionnaire in this study. The primary outcome was vertebral fracture diagnosed on lateral radiography and graded using a semiquantitative grading method, from SQ0 (normal) to SQ3 (severe). Self-reported kyphosis was defined as none, mild to moderate, severe. Self-reported height loss was defined as <4 cm or ≥4 cm. Number of SQ1 fracture was associated only with kyphosis. Self-reported severe kyphosis was significantly associated with increased numbers of ≥SQ2 vertebral fractures (p = 0.007). Height loss ≥4 cm was significantly associated with increased ≥SQ2 grade fractures (p < 0.001). Odds ratios (ORs) for fractures associated with mild-to-moderate and severe kyphosis were 2.1 [95% confidence interval 1.4 to 3.3) and 4.2 (1.8 to 9.5), respectively. OR for fractures associated with height loss ≥4 cm was 2.3 (1.4 to 3.7). Self-reported kyphosis may be useful for identifying Japanese women aged ≥60 years who have undetected vertebral fractures. PMID:27381354

  15. Decreased Serum Insulin-like Growth Factor-I is a Risk Factor for Non-vertebral Fractures in Diabetic Postmenopausal Women.

    PubMed

    Miyake, Hitomi; Kanazawa, Ippei; Sugimoto, Toshitsugu

    2017-01-01

    Objective Previous studies have shown that serum insulin-like growth factor-I (IGF-I) is involved in diabetes-related bone fragility. Although lower serum levels of IGF-I are reported to be associated with a higher risk of vertebral fractures in patients with type 2 diabetes, it is unknown whether or not the serum level of IGF-I is associated with the incidence of non-vertebral fractures. Methods We investigated the relationships between the serum levels of IGF-I and the incidence of non-vertebral osteoporotic fractures in 188 men and 168 postmenopausal women with type 2 diabetes. Results A multiple logistic regression analysis adjusted for age, duration of diabetes, observation period, body mass index, HbA1c, serum creatinine, and the bone mineral density at the lumbar spine showed that the serum IGF-I level was significantly and inversely associated with the incidence of non-vertebral osteoporotic fractures in postmenopausal women (odds ratio =0.48, 95% confidential interval [CI] 0.23-0.99 per SD increase; p=0.047), but not in men. Moreover, the inverse association between the serum IGF-I level and the incidence of non-vertebral fractures remained significant after additional adjustment for insulin use, and the serum calcium and phosphate levels (odds ratio =0.48, 95% CI 0.23-0.99 per SD increase; p=0.046). Conclusion This is the first study to show that decreased serum IGF-I levels are associated with a higher risk of non-vertebral osteoporotic fractures in postmenopausal women with type 2 diabetes. Serum IGF-I could be a useful marker for assessing the incidence of osteoporotic fractures.

  16. Effect of vertebroplasty on pain relief, quality of life, and the incidence of new vertebral fractures: a 12-month randomized follow-up, controlled trial.

    PubMed

    Blasco, Jordi; Martinez-Ferrer, Angeles; Macho, Juan; San Roman, Luis; Pomés, Jaume; Carrasco, Josep; Monegal, Ana; Guañabens, Nuria; Peris, Pilar

    2012-05-01

    Uncertainty regarding the benefits of vertebroplasty (VP) for the treatment of acute osteoporotic vertebral fractures has recently arisen. A prospective, controlled, randomized single-center trial (ClinicalTrials.gov registration number NCT00994032) was designed to compare the effects of VP versus conservative treatment on the quality of life and pain in patients with painful osteoporotic vertebral fractures, new fractures and secondary adverse effects were also analyzed during a 12-month follow-up period. A total of 125 patients were randomly assigned to receive conservative treatment or VP. The primary end point was to compare the evolution of the quality of life (Quality of Life Questionnaire of the European Foundation for Osteoporosis [Qualeffo-41] and pain (Visual Analogue Scale [VAS]) during a 12 month follow-up. Secondary outcomes included comparison of analgesic consumption, clinical complications, and radiological vertebral fractures at the same time points. Both arms showed significant improvement in VAS scores at all time points, with greater improvement (p = 0.035) in the VP group at the 2-month follow-up. Significant improvement in Qualeffo total score was seen in the VP group throughout the study, whereas this was not seen in the conservative treatment arm until the 6-month follow-up. VP treatment was associated with a significantly increased incidence of vertebral fractures (odds ratio [OR], 2 · 78; 95% confidence interval [CI], 1.02-7.62, p = 0.0462). VP and conservative treatment are both associated with significant improvement in pain and quality of life in patients with painful osteoporotic vertebral fractures over a 1-year follow-up period. VP achieved faster pain relief with significant improvement in the pain score at the 2-month follow-up but was associated with a higher incidence in vertebral fractures.

  17. Decreased Serum Insulin-like Growth Factor-I is a Risk Factor for Non-vertebral Fractures in Diabetic Postmenopausal Women

    PubMed Central

    Miyake, Hitomi; Kanazawa, Ippei; Sugimoto, Toshitsugu

    2017-01-01

    Objective Previous studies have shown that serum insulin-like growth factor-I (IGF-I) is involved in diabetes-related bone fragility. Although lower serum levels of IGF-I are reported to be associated with a higher risk of vertebral fractures in patients with type 2 diabetes, it is unknown whether or not the serum level of IGF-I is associated with the incidence of non-vertebral fractures. Methods We investigated the relationships between the serum levels of IGF-I and the incidence of non-vertebral osteoporotic fractures in 188 men and 168 postmenopausal women with type 2 diabetes. Results A multiple logistic regression analysis adjusted for age, duration of diabetes, observation period, body mass index, HbA1c, serum creatinine, and the bone mineral density at the lumbar spine showed that the serum IGF-I level was significantly and inversely associated with the incidence of non-vertebral osteoporotic fractures in postmenopausal women (odds ratio =0.48, 95% confidential interval [CI] 0.23-0.99 per SD increase; p=0.047), but not in men. Moreover, the inverse association between the serum IGF-I level and the incidence of non-vertebral fractures remained significant after additional adjustment for insulin use, and the serum calcium and phosphate levels (odds ratio =0.48, 95% CI 0.23-0.99 per SD increase; p=0.046). Conclusion This is the first study to show that decreased serum IGF-I levels are associated with a higher risk of non-vertebral osteoporotic fractures in postmenopausal women with type 2 diabetes. Serum IGF-I could be a useful marker for assessing the incidence of osteoporotic fractures. PMID:28154269

  18. Transient groundwater observations and modelling at a rockslide in fractured rocks adjacent to a hydropower reservoir (Kaunertal valley, Austria)

    NASA Astrophysics Data System (ADS)

    Strauhal, Thomas; Zangerl, Christian; Loew, Simon; Holzmann, Michael; Perzlmaier, Sebastian

    2015-04-01

    Positive pore water pressure within the fractured network of a rock slope reduces the effective stresses. This makes the knowledge of transient pore pressure magnitudes essential to evaluate time-dependent hydro-mechanically coupled rock slope processes. Slowly moving, deep-seated rockslides are a common type of gravitational mass movements in fractured metamorphic rocks. The hydrogeological conditions in rockslides adjacent to hydropower reservoirs are of major interest given that several case studies document the hydro-mechanical coupling between seasonal variations in the rockslide deformation behaviour and the filling and drawing down of the reservoir and/or seasonal variations of pore water pressure due to rainfall-events and snowmelt. Groundwater flow and pore pressure distributions in deep-seated rockslides, composed of fractured rocks, are usually only described by simplified conceptual models because of a lack of field measurements and difficulties in transient numerical modelling. The heterogeneous degree of disintegration of the sliding mass, soil-like deformation zones and the anisotropic fractured bedrock complicate the hydrogeological measurement, interpretation and analysis. In this study, detailed hydrogeological analyses of the Klasgarten rockslide at the Gepatsch reservoir (Kaunertal valley, Austria) are presented. A focus is set on the impact of reservoir level fluctuations, groundwater recharge along the slope and drainage by an exploring adit. The effect of various hydrogeological properties of the sliding mass, the deformation zone and the fractured bedrock on the groundwater fluctuations is discussed. Information on the groundwater flow regime, hydraulic relevant material properties and pore water pressure data are gained from borehole based investigations, a subhorizontal exploring adit and laboratory tests. Field observations are interpreted and validated on the basis of two dimensional finite element groundwater modelling. The transient

  19. Turbines and terrestrial vertebrates: variation in tortoise survivorship between a wind energy facility and an adjacent undisturbed wildland area in the desert southwest (USA)

    USGS Publications Warehouse

    Agha, Mickey; Lovich, Jeffrey E.; Ennen, Joshua R.; Augustine, Benjamin J.; Arundel, Terry; Murphy, Mason O.; Meyer-Wilkins, Kathie; Bjurlin, Curtis; Delaney, David F.; Briggs, Jessica; Austin, Meaghan; Madrak, Sheila V.; Price, Steven J.

    2015-01-01

    With the recent increase in utility-scale wind energy development, researchers have become increasingly concerned how this activity will affect wildlife and their habitat. To understand the potential impacts of wind energy facilities (WEF) post-construction (i.e., operation and maintenance) on wildlife, we compared differences in activity centers and survivorship of Agassiz's desert tortoises (Gopherus agassizii) inside or near a WEF to neighboring tortoises living near a wilderness area (NWA) and farther from the WEF. We found that the size of tortoise activity centers varied, but not significantly so, between the WEF (6.25 ± 2.13 ha) and adjacent NWA (4.13 ± 1.23 ha). However, apparent survival did differ significantly between the habitat types: over the 18 year study period apparent annual survival estimates were 0.96 ± 0.01 for WEF tortoises and 0.92 ± 0.02 for tortoises in the NWA. High annual survival suggests that operation and maintenance of the WEF has not caused considerable declines in the adult population over the past two decades. Low traffic volume, enhanced resource availability and decreased predator populations may influence annual survivorship at this WEF. Further research on these proximate mechanisms and population recruitment would be useful for mitigating and managing post-development impacts of utility scale wind energy on long-lived terrestrial vertebrates.

  20. Turbines and Terrestrial Vertebrates: Variation in Tortoise Survivorship Between a Wind Energy Facility and an Adjacent Undisturbed Wildland Area in the Desert Southwest (USA)

    NASA Astrophysics Data System (ADS)

    Agha, Mickey; Lovich, Jeffrey E.; Ennen, Joshua R.; Augustine, Benjamin; Arundel, Terence R.; Murphy, Mason O.; Meyer-Wilkins, Kathie; Bjurlin, Curtis; Delaney, David; Briggs, Jessica; Austin, Meaghan; Madrak, Sheila V.; Price, Steven J.

    2015-08-01

    With the recent increase in utility-scale wind energy development, researchers have become increasingly concerned how this activity will affect wildlife and their habitat. To understand the potential impacts of wind energy facilities (WEF) post-construction (i.e., operation and maintenance) on wildlife, we compared differences in activity centers and survivorship of Agassiz's desert tortoises ( Gopherus agassizii) inside or near a WEF to neighboring tortoises living near a wilderness area (NWA) and farther from the WEF. We found that the size of tortoise activity centers varied, but not significantly so, between the WEF (6.25 ± 2.13 ha) and adjacent NWA (4.13 ± 1.23 ha). However, apparent survival did differ significantly between the habitat types: over the 18-year study period apparent annual survival estimates were 0.96 ± 0.01 for WEF tortoises and 0.92 ± 0.02 for tortoises in the NWA. High annual survival suggests that operation and maintenance of the WEF has not caused considerable declines in the adult population over the past two decades. Low traffic volume, enhanced resource availability, and decreased predator populations may influence annual survivorship at this WEF. Further research on these proximate mechanisms and population recruitment would be useful for mitigating and managing post-development impacts of utility-scale wind energy on long-lived terrestrial vertebrates.

  1. Turbines and Terrestrial Vertebrates: Variation in Tortoise Survivorship Between a Wind Energy Facility and an Adjacent Undisturbed Wildland Area in the Desert Southwest (USA).

    PubMed

    Agha, Mickey; Lovich, Jeffrey E; Ennen, Joshua R; Augustine, Benjamin; Arundel, Terence R; Murphy, Mason O; Meyer-Wilkins, Kathie; Bjurlin, Curtis; Delaney, David; Briggs, Jessica; Austin, Meaghan; Madrak, Sheila V; Price, Steven J

    2015-08-01

    With the recent increase in utility-scale wind energy development, researchers have become increasingly concerned how this activity will affect wildlife and their habitat. To understand the potential impacts of wind energy facilities (WEF) post-construction (i.e., operation and maintenance) on wildlife, we compared differences in activity centers and survivorship of Agassiz's desert tortoises (Gopherus agassizii) inside or near a WEF to neighboring tortoises living near a wilderness area (NWA) and farther from the WEF. We found that the size of tortoise activity centers varied, but not significantly so, between the WEF (6.25 ± 2.13 ha) and adjacent NWA (4.13 ± 1.23 ha). However, apparent survival did differ significantly between the habitat types: over the 18-year study period apparent annual survival estimates were 0.96 ± 0.01 for WEF tortoises and 0.92 ± 0.02 for tortoises in the NWA. High annual survival suggests that operation and maintenance of the WEF has not caused considerable declines in the adult population over the past two decades. Low traffic volume, enhanced resource availability, and decreased predator populations may influence annual survivorship at this WEF. Further research on these proximate mechanisms and population recruitment would be useful for mitigating and managing post-development impacts of utility-scale wind energy on long-lived terrestrial vertebrates.

  2. [Quantitative morphology of vertebral body cortical bone. Building block for noninvasive calculation of fracture threshold in osteoporosis].

    PubMed

    Ritzel, H; Amling, M; Hahn, M; Maas, R; Delling, G

    1998-04-01

    The vertebral bodies consist of two main structures, trabecular and cortical bone. The histological changes within the spine, especially in cortical bone, leading to osteoporotic fractures remain, however, poorly understood. Therefore, the complete front column of the spine was removed in 26 autopsy cases without skeletal diseases and in 11 cases with proven osteoporosis. A sagittal segment prepared through the center of all vertebral bodies was undecalcified embedded in plastic, ground to a 1-mm-thick block and stained using a modification of the von Kossa method. The analysis included measurement of the mean cortical thickness of both ventral and dorsal shell (from C3 to L5). The qualitative investigation of the structure of the cortical ring completed the analysis. The skeletally intact specimens had high cortical thickness values in the cervical spine (285 +/- 22 microns), a decrease in the thoracic spine (244 +/- 14 microns) and an increase in the lumbar spine (290 +/- 15 microns). The mean thickness of the ventral shell is in general higher than the thickness of the dorsal shell. The cortical thickness of the spine showed no gender-specific differences (P = n.s.). There was a slight decrease in the cortical thickness with age; however, this decrease and the correlation of cortical thickness to age was only significant below vertebral body T8 (r = 0.225 to 0.574; Pr < 0.05 to Pr < 0.005). Most interestingly, osteoporosis is characterized by a significant decrease in cortical thickness throughout the whole spine. This decrease in cortical thickness was more marked in the dorsal shell (P < 0.05) than in the ventral shell (ventral from C3 to T6 (P < 0.05) below T6 (P = n.s.). We therefore conclude that in osteoporosis, biomechanical competence is affected by both trabecular bone loss and decrease of cortical thickness. This suggests that, in addition to trabecular bone measurements, the cortical thickness is of special interest for diagnostic radiological

  3. Advanced Vertebral Fracture among Newly Diagnosed Children with Acute Lymphoblastic Leukemia: Results of the Canadian STeroid-associated Osteoporosis in the Pediatric Population (STOPP) Research Program

    PubMed Central

    Halton, J.; Gaboury, I.; Grant, R.; Alos, N.; Cummings, E. A.; Matzinger, M.; Shenouda, N.; Lentle, B.; Abish, S.; Atkinson, S.; Cairney, E.; Dix, D.; Israels, S.; Stephure, D.; Wilson, B.; Hay, J.; Moher, D.; Rauch, F.; Siminoski, K.; Ward, L.M.

    2013-01-01

    Vertebral compression is a serious complication of childhood acute lymphoblastic leukemia (ALL). The prevalence and pattern of vertebral fractures, as well as their relationship to bone mineral density (BMD) and other clinical indices, have not been systematically studied. We evaluated spine health in 186 newly diagnosed children (median age 5.3 years, 108 boys) with ALL (precursor B cell: N=167; T-cell: N=19), who were enrolled in a national bone health research program. Patients were assessed within 30 days of diagnosis by lateral thoraco-lumbar spine radiograph, bone age (also used for metacarpal morphometry) and BMD. Vertebral morphometry was carried out by the Genant semi-quantitative method. Twenty-nine patients (16%) had a total of 75 grade 1 or higher prevalent vertebral compression fractures (53 thoracic, 71%; 22 lumbar). Grade 1 fractures as the worst grade were present in 14 children (48%), 9 patients (31%) had grade 2 fractures, and 6 children (21%) had grade 3 fractures. The distribution of spine fracture was bi-modal, with most occurring in the mid-thoracic and thoraco-lumbar regions. Children with grade 1 or higher vertebral compression had reduced lumbar spine (LS) areal BMD Z-scores compared to those without (mean±SD, −2.1±1.5 vs. −1.1±1.2; P < 0.001). LS BMD Z-score, second metacarpal percent cortical area Z-score, and back pain were associated with increased odds for fracture. For every 1 SD reduction in LS BMD Z-score, the odds for fracture increased by 80% (95% CI 10% to 193%); the presence of back pain had an odds ratio of 4.7 (95% CI, 1.5 to 14.5). These results show that vertebral compression is an under-recognized complication of newly diagnosed ALL. Whether the fractures will resolve through bone growth during or after leukemia chemotherapy remains to be determined. PMID:19210218

  4. Risk factors for recollapse of the augmented vertebrae after percutaneous vertebroplasty for osteoporotic vertebral fractures with intravertebral vacuum cleft

    PubMed Central

    Yu, Weibo; Liang, De; Yao, Zhensong; Qiu, Ting; Ye, Linqiang; Huang, Xuecheng; Jiang, Xiaobing

    2017-01-01

    Abstract To determine risk factors related to recollapse of the augmented vertebrae after percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCFs) with intravertebral vacuum cleft (IVC). Fifty-two patients treated with PVP for single OVCFs with the IVC were retrospectively reviewed. The follow-up period was at least 2 years. Vertebral height loss ≥15% or kyphotic angle ≥10° at the final follow-up in relation to the immediately postoperative values were adopted as a definition of recollapse of the augmented vertebrae. Correlation analysis and multiple logistic regression analyses were performed to elucidate the related clinical or radiological factors for recollapse of the augmented vertebrae including age, gender, bone mineral density, preoperative fracture severity, locations of IVC sign, distribution patterns of polymethylmethacrylate (PMMA), reduction rate, and reduction angle. Assuming the increase of height loss more than 15% as a criterion of recollapse, only cleft filling pattern of PMMA in the IVC area was a significant risk factor for recollapse of the augmented vertebrae (P < 0.01). Assuming ≥10° progression of kyphotic angle as a criterion, cleft filling pattern of PMMA and higher values of reduction angle was as 2 significant risk factors for recollapse of the augmented vertebrae (P < 0.01). No significant difference was found in other clinical and radiological factors (P > 0.05). Cleft filling pattern of PMMA and higher values of reduction angle may play an important role in inducing recollapse of the augmented vertebrae after PVP for OVCFs with the IVC. Careful observation of patients with these conditions is necessary to prevent deterioration of their clinical course. PMID:28079799

  5. Risk factors for recollapse of the augmented vertebrae after percutaneous vertebroplasty for osteoporotic vertebral fractures with intravertebral vacuum cleft.

    PubMed

    Yu, Weibo; Liang, De; Yao, Zhensong; Qiu, Ting; Ye, Linqiang; Huang, Xuecheng; Jiang, Xiaobing

    2017-01-01

    To determine risk factors related to recollapse of the augmented vertebrae after percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCFs) with intravertebral vacuum cleft (IVC).Fifty-two patients treated with PVP for single OVCFs with the IVC were retrospectively reviewed. The follow-up period was at least 2 years. Vertebral height loss ≥15% or kyphotic angle ≥10° at the final follow-up in relation to the immediately postoperative values were adopted as a definition of recollapse of the augmented vertebrae. Correlation analysis and multiple logistic regression analyses were performed to elucidate the related clinical or radiological factors for recollapse of the augmented vertebrae including age, gender, bone mineral density, preoperative fracture severity, locations of IVC sign, distribution patterns of polymethylmethacrylate (PMMA), reduction rate, and reduction angle.Assuming the increase of height loss more than 15% as a criterion of recollapse, only cleft filling pattern of PMMA in the IVC area was a significant risk factor for recollapse of the augmented vertebrae (P < 0.01). Assuming ≥10° progression of kyphotic angle as a criterion, cleft filling pattern of PMMA and higher values of reduction angle was as 2 significant risk factors for recollapse of the augmented vertebrae (P < 0.01). No significant difference was found in other clinical and radiological factors (P > 0.05).Cleft filling pattern of PMMA and higher values of reduction angle may play an important role in inducing recollapse of the augmented vertebrae after PVP for OVCFs with the IVC. Careful observation of patients with these conditions is necessary to prevent deterioration of their clinical course.

  6. Association of Plasminogen Activator Inhibitor-1 (PAI-1) Gene Polymorphisms with Osteoporotic Vertebral Compression Fractures (OVCFs) in Postmenopausal Women

    PubMed Central

    Kim, Jung Oh; Han, Soo Hong; Lee, Yeon Ho; Ahn, Tae Keun; Lim, Jae Joon; Chung, Young Sun; Shin, Dong Eun; Lee, Woo Sik; Han, In Bo; Kim, Nam Keun

    2016-01-01

    Osteoporosis and osteoporotic fractures are strongly associated with mortality and morbidity, both in developing and developed countries. Menopause accelerates bone loss due to estrogen deficiency and age-related linear bone loss. We investigated plasminogen activator inhibitor-1 (PAI-1) gene polymorphisms in postmenopausal women with osteoporotic vertebral compression fractures (OVCFs). In this case-control study, 355 postmenopausal women were genotyped for the presence of PAI-1 gene polymorphisms −844A > G, −675 4G > 5G, 43G > A, 9785A > G, and 11053T > G. Genetic polymorphisms of PAI-1 were analyzed by the polymerization chain reaction restriction fragment length polymorphism assay, and their association with disease status and folate and homocysteine levels was determined in 158 OVCF patients and 197 control subjects. The PAI-1 −675 5G5G (adjusted odds ratio (AOR), 3.302; p = 0.017) and 43GA + AA (AOR, 2.087; p = 0.042) genotype frequencies showed significant association with the increased prevalence of OVCFs in postmenopausal women. In addition, we performed gene–environment interaction studies and demonstrated an association between PAI-1 gene polymorphisms and OVCF prevalence. Our novel finding is the identification of several PAI-1 genetic variants that increase susceptibility to OVCF. Our findings suggest that polymorphisms in PAI-1 may contribute to OVCF, and that they can be developed as biomarkers for evaluating OVCF risk. PMID:27941685

  7. Cooperative effect of serum 25-hydroxyvitamin D concentration and a polymorphism of transforming growth factor-beta1 gene on the prevalence of vertebral fractures in postmenopausal osteoporosis.

    PubMed

    Mori, Seijiro; Fuku, Noriyuki; Chiba, Yuko; Tokimura, Fumiaki; Hosoi, Takayuki; Kimbara, Yoshiyuki; Tamura, Yoshiaki; Araki, Atsushi; Tanaka, Masashi; Ito, Hideki

    2010-07-01

    A T869-->C polymorphism of the transforming growth factor-beta1 (TGF-beta1) gene is reported to be associated with genetic susceptibility to both osteoporosis and vertebral fractures. A low serum 25-hydroxyvitamin D [25(OH)D] level is known to be associated with a higher risk for hip fracture. This study aimed to assess a possible cooperative effect of the gene polymorphism and vitamin D status on vertebral fracture risk. The prevalence of vertebral fracture in 168 postmenopausal female patients with osteoporosis was analyzed, and its association with the TGF-beta1 gene polymorphism and serum 25(OH)D concentration was assessed cross-sectionally. The fracture prevalence increased according to the rank order of the TGF-beta1 genotypes CC < CT < TT, as expected. A significant difference was found not only between the CC and TT genotypes (P = 0.005) but also between the CC and CT genotypes (P < 0.05) when the patients with serum 25(OH)D of more than the median value [22 ng/ml (55 nmol/l)] were analyzed. On the other hand, when those with serum 25(OH)D of less than the median value were analyzed, the protective effect of the C allele against the fracture was blunted; statistical significance in the difference of the fracture prevalence was lost between the CC genotype and the other genotypes. These data suggest that vitamin D fulfillment is prerequisite for the TGF-beta1 genotype in exerting its full effect on the fracture prevalence.

  8. Safety and efficacy of vertebroplasty in the treatment of osteoporotic vertebral compression fractures: a prospective multicenter international randomized controlled study

    PubMed Central

    Leali, Paolo Tranquilli; Solla, Federico; Maestretti, Gianluca; Balsano, Massimo; Doria, Carlo

    2016-01-01

    Summary Background Vertebral compression fractures (VCFs) treated non-operatively can diminish function and quality of life, and lead to chronic health effects. The short-term safety and effectiveness of vertebroplasty for symptomatic VCFs are well-documented, but long-term follow-up is needed. Purpose The aim of this paper was to analyse a multicenter international experience of 200 compression fractures treated with percutaneous vertebroplasty (VP) and compare the results of this procedure with the result of 200 patients treated conservatively. To estimate cost-effectiveness of VP compared to conservative care in terms of: pain reduction, quality of life, complications, secondary fractures and mortality. Materials and methods 400 patients have been enrolled in a prospective randomized controlled study with painful VCFs with bone edema on MR imaging, local back pain for 6 weeks or less, osteoporosis and aged 55 years or older; after obtaining informed consent patients are included and randomized for VP or conservative care. Before treatment and at follow-up with regular intervals during 1-year period were administered to patients standard questionnaires addressing: clinical symptoms, pain medication, Visual Analogue Scale (VAS) score for pain, Oswestry Disability Index (ODI) score to evaluate functional activity. Results 200 patients treated with PV compared with 200 patients treated conservatively had significantly better VAS and used less analgesics 1 day after treatment. Twenty-four hours after VP, there was a reduction in pain scores and an improvement in physical functions, whereas remain unchanged in the patients treated conservatively. Conclusions Pain relief and improvement of mobility and function after PV is immediate and significantly better in the short term compared with non-surgical care treatment. PMID:28228788

  9. In-Vivo Assessment of Femoral Bone Strength Using Finite Element Analysis (FEA) Based on Routine MDCT Imaging: A Preliminary Study on Patients with Vertebral Fractures

    PubMed Central

    Liebl, Hans; Garcia, Eduardo Grande; Holzner, Fabian; Noel, Peter B.; Burgkart, Rainer; Rummeny, Ernst J.; Baum, Thomas; Bauer, Jan S.

    2015-01-01

    Purpose To experimentally validate a non-linear finite element analysis (FEA) modeling approach assessing in-vitro fracture risk at the proximal femur and to transfer the method to standard in-vivo multi-detector computed tomography (MDCT) data of the hip aiming to predict additional hip fracture risk in subjects with and without osteoporosis associated vertebral fractures using bone mineral density (BMD) measurements as gold standard. Methods One fresh-frozen human femur specimen was mechanically tested and fractured simulating stance and clinically relevant fall loading configurations to the hip. After experimental in-vitro validation, the FEA simulation protocol was transferred to standard contrast-enhanced in-vivo MDCT images to calculate individual hip fracture risk each for 4 subjects with and without a history of osteoporotic vertebral fractures matched by age and gender. In addition, FEA based risk factor calculations were compared to manual femoral BMD measurements of all subjects. Results In-vitro simulations showed good correlation with the experimentally measured strains both in stance (R2 = 0.963) and fall configuration (R2 = 0.976). The simulated maximum stress overestimated the experimental failure load (4743 N) by 14.7% (5440 N) while the simulated maximum strain overestimated by 4.7% (4968 N). The simulated failed elements coincided precisely with the experimentally determined fracture locations. BMD measurements in subjects with a history of osteoporotic vertebral fractures did not differ significantly from subjects without fragility fractures (femoral head: p = 0.989; femoral neck: p = 0.366), but showed higher FEA based risk factors for additional incident hip fractures (p = 0.028). Conclusion FEA simulations were successfully validated by elastic and destructive in-vitro experiments. In the subsequent in-vivo analyses, MDCT based FEA based risk factor differences for additional hip fractures were not mirrored by according BMD measurements. Our

  10. Fuzzy logic structure analysis of trabecular bone of the calcaneus to estimate proximal femur fracture load and discriminate subjects with and without vertebral fractures using high-resolution magnetic resonance imaging at 1.5 T and 3 T.

    PubMed

    Patel, Priyesh V; Eckstein, Felix; Carballido-Gamio, Julio; Phan, Catherine; Matsuura, Maiko; Lochmüller, Eva-Maria; Majumdar, Sharmila; Link, Thomas M

    2007-10-01

    Newly developed fuzzy logic-derived structural parameters were used to characterize trabecular bone architecture in high-resolution magnetic resonance imaging (HR-MRI) of human cadaver calcaneus specimens. These parameters were compared to standard histomorphological structural measures and analyzed concerning performance in discriminating vertebral fracture status and estimating proximal femur fracture load. Sets of 60 sagittal 1.5 T and 3.0 T HR-MRI images of the calcaneus were obtained in 39 cadavers using a fast gradient recalled echo sequence. Structural parameters equivalent to bone histomorphometry and fuzzy logic-derived parameters were calculated using two chosen regions of interest. Calcaneal, spine, and hip bone mineral density (BMD) measurements were also obtained. Fracture status of the thoracic and lumbar spine was assessed on lateral radiographs. Finally, mechanical strength testing of the proximal femur was performed. Diagnostic performance in discriminating vertebral fracture status and estimating femoral fracture load was calculated using regression analyses, two-tailed t-tests of significance, and receiver operating characteristic (ROC) analyses. Significant correlations were obtained at both field strengths between all structural and fuzzy logic parameters (r up to 0.92). Correlations between histomorphological or fuzzy logic parameters and calcaneal BMD were mostly significant (r up to 0.78). ROC analyses demonstrated that standard structural parameters were able to differentiate persons with and without vertebral fractures (area under the curve [A(Z)] up to 0.73). However, none of the parameters obtained in the 1.5-T images and none of the fuzzy logic parameters discriminated persons with and without vertebral fractures. Significant correlations were found between fuzzy or structural parameters and femoral fracture load. Using multiple regression analysis, none of the structural or fuzzy parameters were found to add discriminative value to BMD

  11. The development of a clinical decision making algorithm for detection of osteoporotic vertebral compression fracture or wedge deformity.

    PubMed

    Roman, Matthew; Brown, Christopher; Richardson, William; Isaacs, Robert; Howes, Cameron; Cook, Chad

    2010-03-01

    The clinical diagnosis of an osteoporotic vertebral compression fracture (OVCF) is challenging and requires detailed assessment using comprehensive imaging methods. Further complicating matter is that the clinical sequelae associated with OVCF typically involves asymptomatic findings and variable pain patterns. The purpose of this study was to identify clinical characteristics and assessment findings that were associated with a diagnosis of OVCF. The study evaluated routine clinical findings in over 1400 subjects seen at an adult spine surgery clinic for thoracolumbar spine-related conditions within the years 2005-2009. All patients underwent a standardized clinical examination that included a self-report, observational, physical examination and imaging assessment. The diagnosis of OVCF was made after assessment of radiographic findings in sagittal alignment, vertebral body compression, and spinal canal dimensions. Data from the patient history and observational findings were then statistically analyzed and compared between those patients with a diagnosis of OVCF and those with an alternative diagnosis. Based on the results, a diagnostic support tool was created to predict the likelihood of OVCF. The most diagnostic combination included a cluster of: (1) age > 52 years; (2) no presence of leg pain; (3) body mass index ⩽ 22; (4) does not exercise regularly; and (5) female gender. A finding of two of five positive tests or less demonstrated high sensitivity of 0.95 (95% CI  =  0.83-0.99) and low negative likelihood ratio of 0.16 (95% CI  =  0.04-0.51), providing moderate value to rule out OVCF. Four of five yielded a positive likelihood ratio (LR+) of 9.6 (95% CI  =  3.7-14.9) providing moderate value in ruling in the diagnosis of OVCF. Further validation is necessary prospectively to determine the value of these findings on a disparate sample of patients in other unique environments.

  12. [Case of painful muscle spasm induced by thoracic vertebral fracture: successful treatment with lumbar sympathetic ganglia block].

    PubMed

    Shimizu, Fumitaka; Kawai, Motoharu; Koga, Michiaki; Ogasawara, Jun-ichi; Negoro, Kiyoshi; Kanda, Takashi

    2008-10-01

    We report a 70-year-old man, who developed painful involuntary muscle contraction of the left leg after the lumbar discectomy, which exacerbated after a vertebral fracture of Th12. This involuntary movement was accompanied with the abnormal position of left leg simulating triple flexion response, and was induced by active or passive movement of his left knee and foot joints. Several drugs including benzodiazepines and dantrolene were ineffective, although treatment with baclofen or carbamazepine was effective. These findings suggest that hyperexcitability of the anterior horn cells following the disturbance of spinal inhibitory interneurons was involved. Electophysiological studies suggested the disturbance of left lumber nerve roots. The spinal root blocks from L3 to S1 were performed, after which the painful involuntary muscle spasm was resolved. The lumbar sympathetic ganglia block was also effective; suggesting that abnormal afferent neuronal input to spinal cord was caused by the nerve root trauma which triggered the formation of secondary abnormal network in the spine. Lumbar sympathetic ganglia block should be recommended to a therapeutic option for the refractory painful muscle spasm of the leg.

  13. Acute vertebral fracture after spinal fusion: a case report illustrating the added value of single-source dual-energy computed tomography to magnetic resonance imaging in a patient with spinal Instrumentation.

    PubMed

    Fuchs, M; Putzier, M; Pumberger, M; Hermann, K G; Diekhoff, T

    2016-09-01

    Magnetic resonance imaging (MRI) is degraded by metal-implant-induced artifacts when used for the diagnostic assessment of vertebral compression fractures in patients with instrumented spinal fusion. Dual-energy computed tomography (DECT) offers a promising supplementary imaging tool in these patients. This case report describes an 85-year-old woman who presented with a suspected acute vertebral fracture after long posterior lumbar interbody fusion. This is the first report of a vertebral fracture that showed bone marrow edema on DECT; however, edema was missed by an MRI STIR sequence owing to metal artifacts. Bone marrow assessment using DECT is less susceptible to metal artifacts than MRI, resulting in improved visualization of vertebral edema in the vicinity of fused vertebral bodies.

  14. Critique of the analysis of UpToDate.com on the treatment of painful vertebral compression fractures: time to update UpToDate.

    PubMed

    Beall, D P; McRoberts, W P; Berven, S H; Ledlie, J T; Tutton, S M; Parsons, B P

    2015-04-01

    The treatment of painful vertebral compression fractures has changed substantially since the introduction of vertebroplasty in the mid-1980s and balloon kyphoplasty in the late 1990s. Both procedures were widely accepted with the vertebral fractures treated reaching 150,000 per annum in 2009 prior to the publication of 2 randomized controlled trials comparing vertebroplasty with a sham treatment published in the New England Journal of Medicine in August 2009. Since then, there has been a flood of information on vertebral augmentation and balloon kyphoplasty. It is worth evaluating this information especially because it relates to current recommendations that are often followed blindly by medical and administrative groups unfamiliar with either the procedure or the high level of evidence surrounding vertebral augmentation. To streamline the evaluation of some current recommendations, we limited the analysis to the recommendations found on UpToDate.com. This Web site is an evidence-based, peer-reviewed source of information available for patients, doctors, health insurance companies, and population-based medical decision-making.

  15. The Reverse Thomas Position for Thoracolumbar Fracture Height Restoration: Relative Contribution of Patient Positioning in Percutaneous Balloon Kyphoplasty for Acute Vertebral Compressions

    PubMed Central

    Cawley, Derek T.; Beecher, Suzanne M.; Baker, Joseph F.; McCabe, John P.

    2016-01-01

    Background Standard positioning for percutaneous balloon kyphoplasty requires placing a patient prone with supports under the iliac crests and upper thorax. The authors believe that hip hyperextension maximises pelvic anteversion creating anterior longitudinal ligamentotaxis, thus facilitating restoration of vertebral height. Methods Radiographic imaging including pre-operative, post-positioning, post balloon tamp inflation and post-operative lateral radiographs were analysed for anterior and posterior column height, wedge angle of the affected vertebra and 3-level Cobb angle in patients with recent fractures of T11-L1. Fracture dimensions of the index vertebra were expressed as percentage of the analogous dimension of the referent vertebra. Results From a total of 149 patients, a full imaging sequence was available on 21 cases of vertebral compression fractures. The described positioning technique created a mean anterior column height increase from 68.3% to 75.3% with positioning (p = 0.15), increasing to 82.3% post balloon inflation. Average Cobb and wedge angle improvement of 4.7° (p = 0.004)and 3.6° (p = 0.002) from positioning along were also recorded. Conclusion The Reverse Thomas Position is a safe and effective technique for augmenting thoracolumbar fracture height restoration in percutaneous balloon kyphoplasty. PMID:27441179

  16. Vertebral bone marrow fat, bone mineral density and diabetes: The Osteoporotic Fractures in Men (MrOS) study.

    PubMed

    Sheu, Yahtyng; Amati, Francesca; Schwartz, Ann V; Danielson, Michelle E; Li, Xiaojuan; Boudreau, Robert; Cauley, Jane A

    2017-04-01

    Elevated vertebral bone marrow fat (BMF) among individuals with osteoporosis has been established in histomorphometric studies. Several studies have found a negative correlation between BMF and bone mineral density (BMD) at the spine in men and women across different age groups. Animal studies have also observed bone loss with increased BMF in mice with induced diabetes. Our study objective was to test the hypothesis that the association between BMF and BMD varies by diabetic status. We performed a cross-sectional study of 156 men aged 74-96years from the Osteoporotic Fractures in Men study at the Pittsburgh clinical site. All men had spine BMF scans using proton magnetic resonance spectroscopy and spine and hip BMD scans by dual-energy X-ray absorptiometry. BMF was expressed as lipid to "lipid+water" ratio (%). Men were considered diabetic if they self-reported a physician diagnosis of diabetes, diabetes medication or had a fasting glucose ≥126mg/dl. Men with diabetes (n=38) had a significantly higher spine BMF (58.9 vs. 54.6%, p=0.0035), spine BMD (1.20 vs. 1.10g/cm(2), P=0.007) and total hip BMD (1.00 vs. 0.94g/cm(2), p=0.04) than those without, while no differences were observed for body weight, body mass index or waist circumference. Pearson correlation tests showed no significant correlation of spine BMF with age or BMD in non-diabetics. Significant inverse correlations were observed between BMF and BMD (-0.30 for femoral neck and -0.39 for total hip) among diabetic men. In conclusion, men with diabetes had a higher BMF compared to non-diabetic men. The correlation between BMF and BMD differed by diabetes status. Further investigation of the association of diabetes with BMF and BMD may provide a better understanding of the high fracture rates among individuals with diabetes despite their higher BMD.

  17. Performance of five phalangeal QUS parameters in the evaluation of gonadal-status, age and vertebral fracture risk compared with DXA.

    PubMed

    Albanese, Carlina V; Cepollaro, Chiara; de Terlizzi, Francesca; Brandi, Maria Luisa; Passariello, Roberto

    2009-04-01

    The aim of this cross-sectional study was to study the value of five different quantified ultrasound (QUS) parameters-amplitude-dependent speed of sound (AD-SoS), Ultrasound Bone Profile Index (UBPI), fast-wave amplitude (FWA), bone transmission time (BTT) and signal dynamic (SDY)-measured at the phalanges of the hand in discriminating women with vertebral fracture and their relationship with some determinants of bone mass, in particular age and gonadal status compared with lumbar spine and hip dual-energy x-ray absorptiometry (DXA). We included 791 women aged 35-84 y, divided into pre-menopause, early menopause and late postmenopause groups on the basis of gonadal status and years since menopause (YSM). The presence of vertebral fracture was evaluated radiographically. All QUS parameters were very sensitive to changes in early postmenopause, with a doubled decrease in early postmenopausal with respect to late postmenopause. In particular AD-SoS and BTT decreases were markedly high in the early postmenopause group. In the late menopause group, similar decreases were observed for AD-SoS, UBPI and hip bone mineral density (BMD). In the multiple logistic model, DXA and QUS significantly discriminate women with and without fractures (p < 0.0001); odds ratio (OR) was higher at lumbar spine BMD (OR 4.01), FWA (OR 3.88), AD-SoS (OR 3.81) and total hip BMD (OR 3.77). Even adjusting the logistic model for age, height, weight, lumbar spine and total hip BMD, all QUS parameters remained significantly predictive of vertebral fracture. AD-SoS showed the best performances both in terms of OR and ROC analysis. QUS parameters show a different behavior in evaluating the effect on bone mass of the time since menopause; AD-SoS and BTT showed a high sensitivity to first changes in bone tissue after menopause. After correction for potential confounders, AD-SoS showed the same ability of lumbar spine BMD in discriminating women with or without vertebral fractures and in the prediction

  18. Incident Vertebral Fractures among Children with Rheumatic Disorders 12 Months Post-Glucocorticoid Initiation: a National Observational Study

    PubMed Central

    Rodd, Celia; Lang, Bianca; Ramsay, Timothy; Alos, Nathalie; Huber, Adam M.; Cabral, David A.; Scuccimarri, Rosie; Miettunen, Paivi M.; Roth, Johannes; Atkinson, Stephanie A.; Couch, Robert; Cummings, Elizabeth A.; Dent, Peter B.; Ellsworth, Janet; Hay, John; Houghton, Kristin; Jurencak, Roman; Larché, Maggie; LeBlanc, Claire; Oen, Kiem; Saint-Cyr, Claire; Stein, Robert; Stephure, David; Taback, Shayne; Lentle, Brian; Matzinger, MaryAnn; Shenouda, Nazih; Moher, David; Rauch, Frank; Siminoski, Kerry; Ward, Leanne M.

    2014-01-01

    Objectives To determine the frequency of incident vertebral fractures (IVF) 12 months after glucocorticoid (GC) initiation in children with rheumatic diseases and to identify children at higher risk. Methods Children with rheumatic diseases initiating GC were enrolled in a prospective observational study. Annual spine radiographs were evaluated using the Genant semi-quantitative method. Spine areal bone mineral density (aBMD) was measured every 6 months. Clinical features, including cumulative GC dose, back pain, disease and physical activity, calcium and vitamin D intake, and spine aBMD Z-scores were analyzed for association with IVF. Results Seven (6%) of 118 children (95% Confidence Interval 2.9 to 11.7) had IVF. Their diagnoses were: juvenile dermatomyositis (n = 2), systemic lupus erythematosus (n = 3), systemic vasculitis (n = 1) and mixed connective tissue disease (n = 1). One child was omitted from the analyses after 4 months because of osteoporosis treatment for symptomatic IVF. Children with IVF received on average 50% more GC than those without (p=0.030), had a greater increase in body mass index (BMI) at 6 months (p=0.010), and had greater decrements in spine aBMD Z-scores in the first 6 months (p=0.048). Four (67%) of 6 children with IVF and data to 12 months had spine aBMD Z-scores less than −2.0 at 12 months compared to 16% of children without IVF (p=0.011). Conclusions The incidence of VF 12 months following GC initiation was 6%; most children were asymptomatic. Children with IVF received more GC, had greater increases in BMI and greater declines in spine aBMD Z-scores in the first 6 months. PMID:22213727

  19. Percutaneous vertebroplasty and interventional tumor removal for malignant vertebral compression fractures and/or spinal metastatic tumor with epidural involvement: a prospective pilot study

    PubMed Central

    Gu, Yi-Feng; Tian, Qing-Hua; Li, Yong-Dong; Wu, Chun-Gen; Su, Yan; Song, Hong-Mei; He, Cheng-Jian; Chen, Dong

    2017-01-01

    Objective The aim of this study was to compare the efficacy of percutaneous vertebroplasty (PVP) and interventional tumor removal (ITR), with PVP alone for malignant vertebral compression fractures and/or spinal metastatic tumor with epidural involvement. Patients and methods A total of 124 patients were selected for PVP and ITR (n = 71, group A) and PVP alone (n = 53, group B). A 14 G needle and guide wire were inserted into the vertebral body, followed by sequential dilatation of the tract until the last cannula reached the anterior portion of the pedicle. Tumors were then ablated with a radiofrequency probe. ITR was performed with marrow nucleus rongeurs, and then cement was injected into the extirpated vertebra. Outcomes were collected preoperatively and at 1, 3 and 6 months and every subsequent 6 months. Results The rates of pain relief and increased mobility at the last follow-up were higher in group A than those in group B (P < 0.05). There were significant differences in visual analog scale (VAS) score and Oswestry disability index (ODI) score at 1, 3 and 6 months, 1 year and >1 year in group A than in group B (P < 0.05). The rates of paraplegia recovery and vertebral stability in group A were higher than those in group B (P < 0.05). Conclusion PVP and ITR proved to be an effective approach for patients with malignant vertebral compression fractures and/or spinal metastatic tumor and provided distinct advantages in pain relief, function recovery and vertebral stability that are comparable to that obtained with PVP alone. PMID:28176970

  20. A comparative study of high-viscosity cement percutaneous vertebroplasty vs. low-viscosity cement percutaneous kyphoplasty for treatment of osteoporotic vertebral compression fractures.

    PubMed

    Sun, Kai; Liu, Yang; Peng, Hao; Tan, Jun-Feng; Zhang, Mi; Zheng, Xian-Nian; Chen, Fang-Zhou; Li, Ming-Hui

    2016-06-01

    The clinical effects of two different methods-high-viscosity cement percutaneous vertebroplasty (PVP) and low-viscosity cement percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fractures (OVCFs) were investigated. From June 2010 to August 2013, 98 cases of OVCFs were included in our study. Forty-six patients underwent high-viscosity PVP and 52 patients underwent low-viscosity PKP. The occurrence of cement leakage was observed. Pain relief and functional activity were evaluated using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI), respectively. Restoration of the vertebral body height and angle of kyphosis were assessed by comparing preoperative and postoperative measurements of the anterior heights, middle heights and the kyphotic angle of the fractured vertebra. Nine out of the 54 vertebra bodies and 11 out of the 60 vertebra bodies were observed to have cement leakage in the high-viscosity PVP and low-viscosity PKP groups, respectively. The rate of cement leakage, correction of anterior vertebral height and kyphotic angles showed no significant differences between the two groups (P>0.05). Low-viscosity PKP had significant advantage in terms of the restoration of middle vertebral height as compared with the high-viscosity PVP (P<0.05). Both groups showed significant improvements in pain relief and functional capacity status after surgery (P<0.05). It was concluded that high-viscosity PVP and low-viscosity PKP have similar clinical effects in terms of the rate of cement leakage, restoration of the anterior vertebral body height, changes of kyphotic angles, functional activity, and pain relief. Low-viscosity PKP is better than high-viscosity PVP in restoring the height of the middle vertebra.

  1. Evaluation and Interventional Management of Pain After Vertebral Augmentation Procedures

    PubMed Central

    Granville, Michelle; Jacobson, Robert E

    2017-01-01

    Introduction A small subset of patients who underwent successful vertebral compression fracture (VCF) augmentation procedures may develop subsequent pain requiring spinal injections. In a retrospective analysis, we determined whether the pain was related to the original fracture site or to another area within the lumbar or thoracic spine. The pain occurred either at the same/adjacent level and/or non-adjacent level as the VCF. Interventional treatments primarily targeted the facet joints, specifically in the form of facet joint blocks and/or radiofrequency ablation to the medial branches. The pattern of facet injections relative to the original fracture level was studied. Additionally, the elapsed time between the vertebral augmentation and the subsequent interventional blocks was also evaluated. Methods A total of 56 patients sustained VCFs. 12 of these patients underwent interventional procedures after vertebral augmentation procedures. The level(s) of same/adjacent level and non-adjacent level pain were determined via physical examination and/or imaging studies. These levels were subsequently treated with interventional procedures primarily focused on the facet joints. The time period of the injections varied from two weeks status post-vertebral augmentation to as late as 304 weeks (5.8 years) status post-vertebral augmentation. Results We performed 25 vertebral augmentation procedures on these 12 patients. 15 lumbar, eight lower thoracic, and two mid-thoracic VCFs were augmented. 9/14 cases of blocks included those performed at non-adjacent levels, whereas 5/14 cases of blocks were performed only at the same and/or adjacent levels as the VCF. For the events in which thoracic VCFs were augmented, 6/7 (or 86%) had developed non-adjacent level pain in areas of the lumbar spine.  The time from vertebral augmentation procedure to subsequent pain procedure ranged from two weeks to five plus years. The average time elapsed was 83 weeks. Only one case

  2. Value of bone scintigraphy for detection and ageing of vertebral fractures in patients with severe osteoporosis and correlation between bone scintigraphy and mineral bone density.

    PubMed

    Kucukalic-Selimovic, Elma; Begic, Amela

    2004-01-01

    Osteoporosis is the most common of the metabolic bone diseases, and is an important cause of morbidity in the elderly. Bone scintigraphy is used to detect skeletal lesions at the earliest possible time, to monitor the course of the skeletal discase and to evaluate the metabolic activity of skeletal lesions. The aim of this study was to determine, by using the bone scan age of vertebral fractures in patients with severe osteoporosis, and make correlation between bone scintigraphy and mineral bone density. Material and methods 30 female patients were studied with bone scintigraphy after BMD.BMD was measurred with DEXA Hologic QDR 4500 Elite System. Correlation between T-score and uptake of radiofarmaceutical (Tc-99mMDP) was 0.849, and it was high. Intensity of uptake of Tc-99m MDP scintigraphy is an accurate method for the detection and ageing of fractures in osteoporotic patients.

  3. Build Better Bones With Exercise: Protocol for a Feasibility Study of a Multicenter Randomized Controlled Trial of 12 Months of Home Exercise in Women With a Vertebral Fracture

    PubMed Central

    Thabane, Lehana; Adachi, Jonathan D.; Ashe, Maureen C.; Bleakney, Robert R.; Braun, E. Anne; Cheung, Angela M.; Fraser, Lisa-Ann; Gibbs, Jenna C.; Hill, Keith D.; Hodsman, Anthony B.; Kendler, David L.; Mittmann, Nicole; Prasad, Sadhana; Scherer, Samuel C.; Wark, John D.; Papaioannou, Alexandra

    2014-01-01

    Background Our goal is to conduct a multicenter randomized controlled trial (RCT) to investigate whether exercise can reduce incident fractures compared with no intervention among women aged ≥65 years with a vertebral fracture. Objectives This pilot study will determine the feasibility of recruitment, retention, and adherence for the proposed trial. Design The proposed RCT will be a pilot feasibility study with 1:1 randomization to exercise or attentional control groups. Setting Five Canadian sites (1 community hospital partnered with an academic center and 4 academic hospitals or centers affiliated with an academic center) and 2 Australian centers (1 academic hospital and 1 center for community primary care, geriatric, and rehabilitation services). Participants One hundred sixty women aged ≥65 years with vertebral fracture at 5 Canadian and 2 Australian centers will be recruited. Intervention The Build Better Bones With Exercise (B3E) intervention includes exercise and behavioral counseling, delivered by a physical therapist in 6 home visits over 8 months, and monthly calls; participants are to exercise ≥3 times weekly. Controls will receive equal attention. Measurements Primary outcomes will include recruitment, retention, and adherence. Adherence to exercise will be assessed via calendar diary. Secondary outcomes will include physical function (lower extremity strength, mobility, and balance), posture, and falls. Additional secondary outcomes will include quality of life, pain, fall self-efficacy, behavior change variables, intervention cost, fractures, and adverse events. Analyses of feasibility objectives will be descriptive or based on estimates with 95% confidence intervals, where feasibility will be assessed relative to a priori criteria. Differences in secondary outcomes will be evaluated in intention-to-treat analyses via independent Student t tests, chi-square tests, or logistic regression. The Bonferroni method will be used to adjust the level of

  4. Which is best for osteoporotic vertebral compression fractures: balloon kyphoplasty, percutaneous vertebroplasty or non-surgical treatment? A study protocol for a Bayesian network meta-analysis

    PubMed Central

    Kan, Shun-Li; Yuan, Zhi-Fang; Chen, Ling-Xiao; Sun, Jing-Cheng; Ning, Guang-Zhi; Feng, Shi-Qing

    2017-01-01

    Introduction Osteoporotic vertebral compression fractures (OVCFs) commonly cause both acute and chronic back pain, substantial spinal deformity, functional disability and decreased quality of life and increase the risk of future vertebral fractures and mortality. Percutaneous vertebroplasty (PVP), balloon kyphoplasty (BK) and non-surgical treatment (NST) are mostly used for the treatment of OVCFs. However, which treatment is preferred is unknown. The purpose of this study is to comprehensively review the literature and ascertain the relative efficacy and safety of BK, PVP and NST for patients with OVCFs using a Bayesian network meta-analysis. Methods and analysis We will comprehensively search PubMed, EMBASE and the Cochrane Central Register of Controlled Trials, to include randomided controlled trials that compare BK, PVP or NST for treating OVCFs. The risk of bias for individual studies will be assessed according to the Cochrane Handbook. Bayesian network meta-analysis will be performed to compare the efficacy and safety of BK, PVP and NST. The quality of evidence will be evaluated by GRADE. Ethics and dissemination Ethical approval and patient consent are not required since this study is a meta-analysis based on published studies. The results of this network meta-analysis will be submitted to a peer-reviewed journal for publication. PROSPERO registration number CRD42016039452; Pre-results. PMID:28093431

  5. Does metaphyseal cement augmentation in fracture management influence the adjacent subchondral bone and joint cartilage?: an in vivo study in sheep stifle joints.

    PubMed

    Goetzen, Michael; Hofmann-Fliri, Ladina; Arens, Daniel; Zeiter, Stephan; Stadelmann, Vincent; Nehrbass, Dirk; Richards, R Geoff; Blauth, Michael

    2015-01-01

    Augmentation of implants with polymethylmethacrylate (PMMA) bone cement in osteoporotic fractures is a promising approach to increase implant purchase. Side effects of PMMA for the metaphyseal bone, particularly for the adjacent subchondral bone plate and joint cartilage, have not yet been studied. The following experimental study investigates whether subchondral PMMA injection compromises the homeostasis of the subchondral bone and/or the joint cartilage.Ten mature sheep were used to simulate subchondral PMMA injection. Follow-ups of 2 (4 animals) and 4 (6 animals) months were chosen to investigate possible cartilage damage and subchondral plate alterations in the knee. Evaluation was completed by means of high-resolution peripheral quantitative computed tomography (HRpQCT) imaging, histopathological osteoarthritis scoring, and determination of glycosaminoglycan content in the joint cartilage. Results were compared with the untreated contralateral knee and statistically analyzed using nonparametric tests.Evaluation of the histological osteoarthritis score revealed no obvious cartilage damage for the treated knee; median histological score after 2 months 0 (range 4), after 4 months 1 (range 5). There was no significant difference when compared with the untreated control site after 2 and 4 months (P = 0.23 and 0.76, respectively). HRpQCT imaging showed no damage to the metaphyseal trabeculae. Glycosaminoglycan measurements of the treated joint cartilage after 4 months revealed no significant difference compared with the untreated cartilage (P = 0.24).The findings of this study support initial clinical observation that PMMA implant augmentation of metaphyseal fractures appears to be a safe procedure for fixation without harming the subchondral bone plate and adjacent joint cartilage.

  6. Total and Visceral Adiposity Are Associated With Prevalent Vertebral Fracture in Women but Not Men at Age 62 Years: The Newcastle Thousand Families Study.

    PubMed

    Hind, Karen; Pearce, Mark; Birrell, Fraser

    2017-03-06

    Low body weight is an established risk factor for osteoporosis and fracture, but the skeletal risks of higher adiposity are unclear and appear sex-specific and site-dependent. The aim of this study was to investigate associations of total fat mass (TFM), visceral adipose tissue (VAT), and C-reactive protein (CRP) with bone mineral density (BMD) and prevalent vertebral fracture (VF) in men and women aged 62 years. A total of 352 men and women aged 62.5 ± 0.5 years from the Newcastle Thousand Families Study cohort received dual-energy X-ray absorptiometry (DXA) evaluations of femoral neck and lumbar spine BMD, of the lateral spine for vertebral fracture assessment, and of the whole body for TFM and VAT (GE Lunar CoreScan, Madison, WI, USA). Plasma CRP, FRAX scores, falls in the last 12 months, and occupation at age 50 years were also included in the analysis. Vertebral fractures were less prevalent in women than in men (odds ratio [OR] = 0.33, p < 0.001) and BMD or FRAX scores did not differ between participants with and without VF. Women with VF were heavier and had higher TFM, VAT, and CRP than women without (p < 0.001). In women, greater (+1 SD) TFM and VAT increased the odds of any grade VF (TFM: OR = 1.06, p = 0.001; VAT: OR = 2.50, p = 0.002), and greater VAT mass increased the odds of prevalent mild VF (OR = 2.60, p = 0.002). In contrast, there were no associations in men. In both sexes, after controlling for body weight, neither VAT nor CRP were associated with BMD. In conclusion, irrespective of BMD, total and visceral adiposity were associated with prevalent VF in women but not in men. High fat mass, particularly if visceral, should be considered when assessing VF risk in women. Risk factors for VF in men require further investigation, particularly given their high prevalence. © 2017 American Society for Bone and Mineral Research.

  7. Fracture risk assessment: improved evaluation of vertebral integrity among metastatic cancer patients to aid in surgical decision-making

    NASA Astrophysics Data System (ADS)

    Augustine, Kurt E.; Camp, Jon J.; Holmes, David R.; Huddleston, Paul M.; Lu, Lichun; Yaszemski, Michael J.; Robb, Richard A.

    2012-03-01

    Failure of the spine's structural integrity from metastatic disease can lead to both pain and neurologic deficit. Fractures that require treatment occur in over 30% of bony metastases. Our objective is to use computed tomography (CT) in conjunction with analytic techniques that have been previously developed to predict fracture risk in cancer patients with metastatic disease to the spine. Current clinical practice for cancer patients with spine metastasis often requires an empirical decision regarding spinal reconstructive surgery. Early image-based software systems used for CT analysis are time consuming and poorly suited for clinical application. The Biomedical Image Resource (BIR) at Mayo Clinic, Rochester has developed an image analysis computer program that calculates from CT scans, the residual load-bearing capacity in a vertebra with metastatic cancer. The Spine Cancer Assessment (SCA) program is built on a platform designed for clinical practice, with a workflow format that allows for rapid selection of patient CT exams, followed by guided image analysis tasks, resulting in a fracture risk report. The analysis features allow the surgeon to quickly isolate a single vertebra and obtain an immediate pre-surgical multiple parallel section composite beam fracture risk analysis based on algorithms developed at Mayo Clinic. The analysis software is undergoing clinical validation studies. We expect this approach will facilitate patient management and utilization of reliable guidelines for selecting among various treatment option based on fracture risk.

  8. Detective value of historical height loss and current height/knee height ratio for prevalent vertebral fracture in Japanese postmenopausal women.

    PubMed

    Yoh, Kousei; Kuwabara, Akiko; Tanaka, Kiyoshi

    2014-09-01

    Vertebral fracture (VFx) is associated with various co-morbidities and increased mortality. In this paper, we have studied the detective value of height loss for VFx using two indices; historical height loss (HHL) which is the difference between the maximal height, and the current height (CH), and CH/knee height (KH) ratio. One-hundred and fifty-one postmenopausal women visiting the outpatient clinic of orthopaedics were studied for their CH, self-reported maximal height, KH, and radiographically diagnosed VFx number(s). VFx was present in 41.1 % of the subjects. Multiple regression analyses revealed that the number of prevalent fractures was a significant predictor of HHL and CH/KH ratio. Receiver operator characteristic curve analysis has shown that for HHL, the area under the curve (AUC) with their 95 %CI in the parentheses was 0.84 (0.77, 0.90), 0.88 (0.83, 0.94), and 0.91 (0.86, 0.96) for ≥ 1, ≥ 2, and ≥ 3 fractures, respectively. For the presence of ≥ 1 VFx, the cut-off value was 4.0 cm (specificity 79 %; sensitivity 79 %). Regarding the CH/KH ratio, AUC was 0.73 (0.65, 0.82), 0.85 (0.78, 0.93), and 0.91 (0.86, 0.96) for ≥ 1, ≥ 2, and ≥ 3 fractures, respectively. For the presence of ≥ 1 VFx, the cut-off value was 3.3 (specificity 47 %; sensitivity 91 %). Both cut-off values for HHL and CH/KH ratio had high negative predictivity across the wide range of theoretical VFx prevalence. Thus, HHL and CH/KH were both good detectors of VFx. Our data would be the basis to determine the cut-off value for the screening or case finding of subjects with VFx.

  9. Fast trabecular bone strength predictions of HR-pQCT and individual trabeculae segmentation-based plate and rod finite element model discriminate postmenopausal vertebral fractures.

    PubMed

    Liu, X Sherry; Wang, Ji; Zhou, Bin; Stein, Emily; Shi, Xiutao; Adams, Mark; Shane, Elizabeth; Guo, X Edward

    2013-07-01

    Although high-resolution peripheral quantitative computed tomography (HR-pQCT) has advanced clinical assessment of trabecular bone microstructure, nonlinear microstructural finite element (µFE) prediction of yield strength using a HR-pQCT voxel model is impractical for clinical use due to its prohibitively high computational costs. The goal of this study was to develop an efficient HR-pQCT-based plate and rod (PR) modeling technique to fill the unmet clinical need for fast bone strength estimation. By using an individual trabecula segmentation (ITS) technique to segment the trabecular structure into individual plates and rods, a patient-specific PR model was implemented by modeling each trabecular plate with multiple shell elements and each rod with a beam element. To validate this modeling technique, predictions by HR-pQCT PR model were compared with those of the registered high-resolution micro-computed tomography (HR-µCT) voxel model of 19 trabecular subvolumes from human cadaveric tibia samples. Both the Young's modulus and yield strength of HR-pQCT PR models strongly correlated with those of µCT voxel models (r²  = 0.91 and 0.86). Notably, the HR-pQCT PR models achieved major reductions in element number (>40-fold) and computer central processing unit (CPU) time (>1200-fold). Then, we applied PR model µFE analysis to HR-pQCT images of 60 postmenopausal women with (n = 30) and without (n = 30) a history of vertebral fracture. HR-pQCT PR model revealed significantly lower Young's modulus and yield strength at the radius and tibia in fracture subjects compared to controls. Moreover, these mechanical measurements remained significantly lower in fracture subjects at both sites after adjustment for areal bone mineral density (aBMD) T-score at the ultradistal radius or total hip. In conclusion, we validated a novel HR-pQCT PR model of human trabecular bone against µCT voxel models and demonstrated its ability to discriminate vertebral fracture

  10. Assessment of Regional Bone Density in Fractured Vertebrae Using Quantitative Computed Tomography

    PubMed Central

    Soliman, Hany A.G.; Mac-Thiong, Jean-Marc; Levasseur, Annie; Parent, Stefan

    2017-01-01

    Study Design Cohort study. Purpose The aim of this study is to propose and evaluate a new technique to assess bone mineral density of fractured vertebrae using quantitative computed tomography (QCT). Overview of Literature There is no available technique to estimate bone mineral density (BMD) at the fractured vertebra because of the alterations in bony structures at the fracture site. Methods Forty patients with isolated fracture from T10 to L2 were analyzed from the vertebrae above and below the fracture level. Apparent density (AD) was measured based on the relationship between QCT images attenuation coefficients and the density of calibration objects. AD of 8 independent regions of interest (ROI) within the vertebral body and 2 ROI within the pedicles of vertebrae above and below the fractured vertebra were measured. At the level of the fractured vertebra, AD was measured at the pedicles, which are typically intact. AD of the fractured vertebral body was linearly interpolated, based on the assumption that AD at the fractured vertebra is equivalent to the average AD measured in vertebrae adjacent to the fracture. Estimated and measured AD of the pedicles at the fractured level were compared to verify our assumption of linear interpolation from adjacent vertebrae. Results The difference between the measured and the interpolated density of the pedicles at the fractured vertebra was 0.006 and 0.003 g/cm3 for right and left pedicle respectively. The highest mean AD located at the pedicles and the lowest mean AD was found at the anterior ROI of the vertebral body. Significant negative correlation exist between age and AD of ROI in the vertebral body. Conclusions This study suggests that the proposed technique is adequate to estimate the AD of a fractured vertebra from the density of adjacent vertebrae. PMID:28243370

  11. What Effects Does Necrotic Area of Contrast-Enhanced MRI in Osteoporotic Vertebral Fracture Have on Further Compression and Clinical Outcome?

    PubMed Central

    Lee, Ja Myoung; Lee, Young Seok; Kim, Young Baeg; Park, Seung Won; Kang, Dong Ho; Lee, Shin Heon

    2017-01-01

    Objective The objective of this study was to analyze the correlation between further compression and necrotic area in osteoporotic vertebral fracture (OVF) patients with contrast-enhanced magnetic resonance imaging (CEMRI). In addition, we investigated the radiological and clinical outcome according to the range of the necrotic area. Methods Between 2012 and 2014, the study subjects were 82 OVF patients who did not undergo vertebroplasty or surgical treatment. The fracture areas examined on CEMRI at admission were defined as edematous if enhancement was seen and as necrotic if no enhancement was seen. The correlation between further compression and the necrotic and edematous areas of CEMRI, age, and bone mineral density was examined. Also, necrotic areas were classified into those with less than 25% (non-necrosis group) and those with more than 25% (necrosis group) according to the percentages of the entire vertebral body. For both groups, further compression and the changes in wedge and kyphotic angles were examined at admission and at 1 week, 3 months, and 6 months after admission, while the clinical outcomes were compared using the visual analog scale (VAS) and Eastern Cooperative Oncology Group (ECOG) performance status grade. Results Further compression was 14.78±11.11% at 1 month and 21.75±14.43% at 6 months. There was a very strong correlation between the necrotic lesion of CEMRI and further compression (r=0.690, p<0.001). The compression of the necrosis group was 33.52±12.96%, which was higher than that of the non-necrosis group, 14.96±10.34% (p<0.005). Also, there was a statistically significantly higher number of intervertebral cleft development and surgical treatments being performed in the necrosis group than in the non-necrosis group (p<0.005). Moreover, there was a statistical difference in the decrease in the height of the vertebral body, and an increase was observed in the kyphotic change of wedge angle progression. There was also a difference

  12. Radiological Follow-up of New Compression Fractures Following Percutaneous Vertebroplasty

    SciTech Connect

    Tanigawa, Noboru Komemushi, Atsushi; Kariya, Shuji; Kojima, Hiroyuki; Shomura, Yuzo; Sawada, Satoshi

    2006-02-15

    The purpose of the present study was to ascertain chronological changes in the analgesic effects of percutaneous vertebroplasty (PVP) on osteoporotic vertebral compression factures and to radiologically follow new compression fractures after PVP. Seventy-six patients (206 vertebral bodies) were followed radiologically for a mean of 11.5 months. A visual analog scale (VAS; 0-10) was used to assess pain severity, and frontal and lateral plain radiographs of the thoracic and lumbar vertebrae were taken 1-3 days and 1, 4, 10, and 22 months after PVP.The average VAS score was 7.2 {+-} 2.0 (mean pain score {+-} standard deviation) before PVP, 2.5 {+-} 2.3 at 1-3 days after PVP, 2.2 {+-} 2.3 at 1 month, 1.9 {+-} 2.2 at 4 months, 1.8 {+-} 2.4 at 10 months, and 1.0 {+-} 0.2 at 22 months. A new compression fracture was confirmed in 56 vertebral bodies in 28 patients (36.8%), affecting 38 adjacent vertebral bodies (67.8%), 17 nonadjacent vertebral bodies (30.4%), and 1 treated vertebral body (1.8%). A new compression fracture occurred within 1 week of PVP in 2 vertebral bodies (3.6%), between 1 week and 1 month after PVP in 22 (39.3%), between 1 and 3 months in 12 (21.4%), between 3 and 6 months in 12 (21.4%), and after more than 6 months in 8 (14.3%). PVP was highly effective in relieving the pain associated with osteoporosis-induced vertebral compression fractures, and this analgesia was long lasting. Radiological follow-up observation revealed new compression fractures in about one-third of patients. More than half of these new compression fractures occurred in adjacent vertebral bodies within 3 months of PVP.

  13. Breaking into the Plate: Seismic and Hydroacoustic Analysis of a 7.6 Mw Oceanic Fracture Zone Earthquake Adjacent to the Central Indian Ridge Plate Boundary

    NASA Astrophysics Data System (ADS)

    Bohnenstiehl, D. R.; Tolstoy, M.; Chapp, E.

    2003-12-01

    aftershock zone and the centroid location lies within its eastern portion, the rupture appears to have propagated from the plate boundary, breaking into the Indian plate along the fracture zone. The moment tensor solution for the mainshock event indicates dominantly right-lateral slip with a near vertical nodal plane striking parallel to the trend of the aftershocks. The right-lateral sense of slip opposes the left-lateral slip along the adjacent active transform and is consistent with reactivation due to north-south extension in association with a diffuse plate boundary that separates the Indian and Australian Plates. Coulomb failure modeling indicates that the right-lateral mainshock should promote left-lateral slip on the active portions of neighboring transforms. Consistent with this prediction, the largest aftershock, a 5.6 Mw left-lateral earthquake, is located on the active portion of a transform approximately 150 km northwest of the mainshock rupture. These models also show that left-lateral slip on the adjacent active transform, extending southwest from mainshock rupture, should be inhibited. No aftershock activity is observed along this active transform. Static stress changes will tend to reduce ridge-normal compressive stresses along the portion of the CIR axis to the north of the mainshock, with an increase in ridge-normal compression to the south. This will promote and impede axis-parallel diking events within these respective regions.

  14. Comparative Prospective Study of Load Distribution Projection Among Patients with Vertebral Fractures Treated with Percutaneous Vertebroplasty and a Control Group of Healthy Volunteers

    SciTech Connect

    Kelekis, Alexios Filippiadis, Dimitrios K. Vergadis, Chrysovalantis Tsitskari, Maria Nasis, Nikolaos Malagari, Aikaterini Kelekis, Nikolaos

    2013-04-12

    PurposeThrough a prospective comparison of patients with vertebral fractures and normal population, we illustrate effect of percutaneous vertebroplasty (PV) upon projection of load distribution changes.MethodsVertebroplasty group (36 symptomatic patients with osteoporotic vertebral fractures) was evaluated on an electronic baropodometer registering projection of weight bearing areas on feet. Load distribution between right and left foot (including rear-front of the same foot) during standing and walking was recorded and compared before (group V1) and the day after (group V2) PV. Control group (30 healthy asymptomatic volunteers-no surgery record) were evaluated on the same baropodometer.ResultsMean value of load distribution difference between rear-front of the same foot was 9.45 ± 6.79 % (54.72–45.28 %) upon standing and 14.76 ± 7.09 % (57.38–42.62 %) upon walking in the control group. Respective load distribution values before PV were 16.52 ± 11.23 and 30.91 ± 19.26 % and after PV were 10.08 ± 6.26 and 14.25 ± 7.68 % upon standing and walking respectively. Mean value of load distribution variation between the two feet was 6.36 and 14.6 % before and 4.62 and 10.4 % after PV upon standing and walking respectively. Comparison of load distribution variation (group V1–V2, group V1-control group) is statistically significant. Comparison of load distribution variation (group V2-control group) is not statistically significant. Comparison of load distribution variation among the two feet is statistically significant during walking but not statistically significant during standing.ConclusionsThere is a statistically significant difference when comparing load distribution variation prior vertebroplasty and that of normal population. After vertebroplasty, this difference normalizes in a statistically significant way. PV is efficient on equilibrium-load distribution improvement as well.

  15. Evaluation of equivalent and effective dose by KAP for patient and orthopedic surgeon in vertebral compression fracture surgery

    NASA Astrophysics Data System (ADS)

    Santos, Felipe A.; Galeano, Diego C.; Santos, William S.; Silva, Ademir X.; Souza, Susana O.; Carvalho Júnior, Albérico B.

    2017-03-01

    Clinical scenarios were virtually modeled to estimate both the equivalent and effective doses normalized by KAP (Kerma Area Product) to vertebra compression fracture surgery in patient and surgeon. This surgery is known as kyphoplasty and involves the use of X-ray equipment, the C-arm, which provides real-time images to assist the surgeon in conducting instruments inserted into the patient and in the delivery of surgical cement into the fractured vertebra. The radiation transport code used was MCNPX (Monte Carlo N-Particle eXtended) and a pair of UFHADM (University of Florida Hybrid ADult Male) virtual phantoms. The developed scenarios allowed us to calculate a set of equivalent dose (HT) and effective dose (E) for patients and surgeons. In additional, the same scenario was calculated KAP in the tube output and was used for calculating conversion coefficients (E/KAP and HT/KAP). From the knowledge of the experimental values of KAP and the results presented in this study, it is possible to estimate absolute values of effective doses for different exposure conditions. In this work, we developed scenarios with and without the surgical table with the purpose of comparison with the existing data in the literature. The absence of the bed in the scenario promoted a percentage absolute difference of 56% in the patient effective doses in relation to scenarios calculated with a bed. Regarding the surgeon, the use of the personal protective equipment (PPE) reduces between 75% and 79% the effective dose and the use of the under table shield (UTS) reduces the effective dose of between 3% and 7%. All these variations emphasize the importance of the elaboration of virtual scenarios that approach the actual clinical conditions generating E/KAP and HT/KAP closer to the actual values.

  16. What's new in vertebral cementoplasty?

    PubMed Central

    Guarnieri, Gianluigi; Giurazza, Francesco; Manfrè, Luigi

    2016-01-01

    Vertebral cementoplasty is a well-known mini-invasive treatment to obtain pain relief in patients affected by vertebral porotic fractures, primary or secondary spine lesions and spine trauma through intrametameric cement injection. Two major categories of treatment are included within the term vertebral cementoplasty: the first is vertebroplasty in which a simple cement injection in the vertebral body is performed; the second is assisted technique in which a device is positioned inside the metamer before the cement injection to restore vertebral height and allow a better cement distribution, reducing the kyphotic deformity of the spine, trying to obtain an almost normal spine biomechanics. We will describe the most advanced techniques and indications of vertebral cementoplasty, having recently expanded the field of applications to not only patients with porotic fractures but also spine tumours and trauma. PMID:26728798

  17. Higher plasma platelet-activating factor levels are associated with increased risk of vertebral fracture and lower bone mineral density in postmenopausal women.

    PubMed

    Kim, Hyeonmok; Kim, Beom-Jun; Ahn, Seong Hee; Lee, Seung Hun; Koh, Jung-Min

    2015-11-01

    Despite experimental and animal evidence showing the detrimental effects of platelet-activating factor (PAF) on bone metabolism, there are no clinical studies relating PAF to osteoporosis-related phenotypes. This case-control study investigates the association between plasma PAF, osteoporotic vertebral fracture (VF), and bone mineral density (BMD) in postmenopausal Korean women. Among 474 eligible women not taking any drug or having any disease that could affect bone metabolism, we identified 73 cases defined as subjects with radiological VF. The controls were randomly selected from the remaining 401 subjects and matched 1:1 to cases in terms of both age and body mass index (BMI). Lateral thoracolumbar radiographs, BMD, and plasma PAF levels were determined for all subjects. Postmenopausal women with VF demonstrated 34.6 % higher plasma PAF levels than subjects without VF after adjusting for age, BMI, smoking habits, alcohol intake, regular exercise, and parental history of osteoporotic fractures (P = 0.021). Multiple logistic regression analyses revealed that the odds ratio for VF linearly increased across increasing PAF quartiles (P for trend = 0.040) and the odds for VF were 2.88-fold higher in subjects in the highest quartile in comparison with those in the lowest quartile (95 % CI 1.04-8.01). Plasma PAF levels were inversely correlated with BMD at various sites (γ = -0.253 to -0.176, P = 0.003-0.041). These findings suggest that plasma PAF may be a potential biomarker for predicting poor bone health in postmenopausal women.

  18. The Choice of Normative Pediatric Reference Database Changes Spine Bone Mineral Density Z-scores But Not The Relationship Between Bone Mineral Density and Prevalent Vertebral Fractures

    PubMed Central

    Ma, Jinhui; Siminoski, Kerry; Alos, Nathalie; Halton, Jacqueline; Ho, Josephine; Lentle, Brian; Matzinger, MaryAnn; Shenouda, Nazih; Atkinson, Stephanie; Barr, Ronald; Cabral, David A.; Couch, Robert; Cummings, Elizabeth A.; Fernandez, Conrad V.; Grant, Ronald M.; Rodd, Celia; Sbrocchi, Anne Marie; Scharke, Maya; Rauch, Frank; Ward, Leanne M.

    2015-01-01

    Objectives Our objectives were to assess the magnitude of the disparity in lumbar spine bone mineral density (LSBMD) Z-scores generated by different reference databases and to evaluate whether the relationship between LSBMD Z-scores and vertebral fractures (VF) varies by choice of database. Patients and Design Children with leukemia underwent LSBMD by cross-calibrated dual energy x-ray absorptiometry, with Z-scores generated according to Hologic and Lunar databases. VF were assessed by the Genant method on spine radiographs. Logistic regression was used to assess the association between fractures and LSBMD Z-scores. Net reclassification improvement (NRI) and area under the receiver operating characteristic curve (AUC) were calculated to assess the predictive accuracy of LSBMD Z-scores for VF. Results For the 186 children from 0–18 years of age, 6 different age ranges were studied. The Z-scores generated for the 0 to 18 group were highly correlated (r ≥ 0.90), but the proportion of children with LSBMD Z-scores ≤ −2.0 among those with VF varied substantially (from 38 to 66%). Odds ratios (OR) for the association between LSBMD Z-score and VF were similar regardless of database (OR = 1.92, 95% confidence interval (CI): 1.44, 2.56 to OR = 2.70, 95% CI: 1.70, 4.28). AUC and NRI ranged from 0.71 to 0.75 and −0.15 to 0.07 respectively. Conclusions Although the use of a LSBMD Z-score threshold as part of the definition of osteoporosis in a child with VF does not appear valid, the study of relationships between BMD and VF is valid regardless of the BMD database that is used. PMID:25494661

  19. Fractures

    MedlinePlus

    A fracture is a break, usually in a bone. If the broken bone punctures the skin, it is called an open ... falls, or sports injuries. Other causes are low bone density and osteoporosis, which cause weakening of the ...

  20. Clinical outcome after the use of a new craniocaudal expandable implant for vertebral compression fracture treatment: one year results from a prospective multicentric study.

    PubMed

    Noriega, David; Krüger, Antonio; Ardura, Francisco; Hansen-Algenstaedt, Nils; Hassel, Frank; Barreau, Xavier; Beyerlein, Jörg

    2015-01-01

    The purpose of this prospective multicentric observational study was to confirm the safety and clinical performance of a craniocaudal expandable implant used in combination with high viscosity PMMA bone cement for the treatment of vertebral compression fractures. Thirty-nine VCFs in 32 patients were treated using the SpineJack minimally invasive surgery protocol. Outcome was determined by using the Visual Analogue Scale for measuring pain, the Oswestry Disability Index for scoring functional capacity, and the self-reporting European Quality of Life scores for the quality of life. Safety was evaluated by reporting all adverse events. The occurrence of cement leakages was assessed by either radiographs or CT scan or both. Statistically significant improvements were found regarding pain, function, and quality of life. The global pain score reduction at 1 year was 80.9% compared to the preoperative situation and the result of the Oswestry Disability Index showed a decrease from 65.0% at baseline to 10.5% at 12 months postoperatively. The cement leakage rate was 30.8%. No device- or surgery-related complications were found. This observational study demonstrates promising and persistent results consisting of immediate and sustained pain relief and durable clinical improvement after the procedure and throughout the 1-year follow-up period.

  1. Compression fractures of the back

    MedlinePlus

    Vertebral compression fractures ... the most common cause of this type of fracture. Osteoporosis is a disease in which bones become ... the spine, such as multiple myeloma Having many fractures of the vertebrae can lead to kyphosis . This ...

  2. Percutaneous Vertebroplasty and Bone Cement Leakage: Clinical Experience with a New High-Viscosity Bone Cement and Delivery System for Vertebral Augmentation in Benign and Malignant Compression Fractures

    SciTech Connect

    Anselmetti, Giovanni Carlo; Zoarski, Gregg; Manca, Antonio; Masala, Salvatore; Eminefendic, Haris; Russo, Filippo; Regge, Daniele

    2008-09-15

    The aim of this study was to assess the feasibility of and venous leakage reduction in percutaneous vertebroplasty (PV) using a new high-viscosity bone cement (PMMA). PV has been used effectively for pain relief in osteoporotic and malignant vertebral fractures. Cement extrusion is a common problem and can lead to complications. Sixty patients (52 female; mean age, 72.2 {+-} 7.2) suffering from osteoporosis (46), malignancy (12), and angiomas (2), divided into two groups (A and B), underwent PV on 190 vertebrae (86 dorsal, 104 lumbar). In Group A, PV with high-viscosity PMMA (Confidence, Disc-O-Tech, Israel) was used. This PMMA was injected by a proprietary delivery system, a hydraulic saline-filled screw injector. In Group B, a standard low-viscosity PMMA was used. Postprocedural CT was carried out to detect PMMA leakages and complications. Fisher's exact test and Wilcoxon rank test were used to assess significant differences (p < 0.05) in leakages and to evaluate the clinical outcome. PV was feasible, achieving good clinical outcome (p < 0.0001) without major complications. In Group A, postprocedural CT showed an asymptomatic leak in the venous structures of 8 of 98 (8.2%) treated vertebrae; a discoidal leak occurred in 6 of 98 (6.1%). In Group B, a venous leak was seen in 38 of 92 (41.3%) and a discoidal leak in 12 of 92 (13.0%). Reduction of venous leak obtained by high-viscosity PMMA was highly significant (p < 0.0001), whereas this result was not significant (p = 0.14) related to the disc. The high-viscosity PMMA system is safe and effective for clinical use, allowing a significant reduction of extravasation rate and, thus, leakage-related complications.

  3. Validation of the Portuguese version of the quality of life questionnaire of the European foundation for osteoporosis (QUALEFFO-41) in Brazilian women with postmenopausal osteoporosis with vertebral fracture.

    PubMed

    de Oliveira Ferreira, Néville; Arthuso, Michael; da Silva, Raimunda Beserra; Pinto-Neto, Aarão Mendes; Costa-Paiva, Lúcia

    2013-11-01

    To validate the Portuguese version of the quality of life questionnaire of the European foundation for osteoporosis (QUALEFFO-41) in Brazilian women with osteoporotic vertebral fractures (VF). A questionnaire validation study of 86 postmenopausal women was conducted. Women were divided into two groups: 43 in a group with VF and 43 in a group without osteoporosis, age-matched (±3 years). The QUALEFFO-41 questionnaire was administered twice in 4 weeks and compared to a generic questionnaire SF-36. For analysis of the QUALEFFO-41, internal consistency, repeatability, and discriminant capacity between VF patients and control patients were assessed. The significance level adopted was 5 %. The mean age of the women was 66.1 ± 7.2 years for the group with VF and 64.9 ± 6.3 years for the control group (p = 0.4259). The QUALEFFO showed adequate internal consistency in all domains (Cronbach's α of 0.74 to 0.84) and good repeatability (ICC of domains = 0.67-0.90). Of the total questions, 92.6 % demonstrated satisfactory convergent validity, and 95 % of the questions showed good discriminant validity. The mean scores of both questionnaires were significantly higher in the group with VF. There was a good correlation among the QUALEFFO-41 domains and their corresponding SF-36 domains, except for social function. All QUALEFFO-41 domains were significantly predictive of VF on assessment of the ROC curve. The Portuguese version of the QUALEFFO-41 may be used in Brazilian women with osteoporotic VF because it shows good reliability, repeatability, and validity. It was also shown to impair quality of life (QOL) in women with VF and had good ability to discriminate QOL in women with osteoporotic VF.

  4. Balloon Kyphoplasty Compared to Vertebroplasty and Non-Surgical Management in Patients Hospitalised with Acute Osteoporotic Vertebral Compression Fracture – A UK Cost-Effectiveness Analysis

    PubMed Central

    Alvares, L; Cooper, C; Marsh, D; Ström, O

    2013-01-01

    Objective To estimate the cost-effectiveness of Balloon Kyphoplasty (BKP) for the treatment of patients hospitalised with acute Osteoporotic Vertebral Compression Fracture (OVCF) compared to Percutaneous Vertebroplasty (PVP) and Non-Surgical Management (NSM) in the UK. Methods A Markov simulation model was developed to evaluate treatment with BKP, NSM and PVP in patients with symptomatic OVCF. Data on health related quality of life (HRQoL) with acute OVCF were derived from the FREE and VERTOS II Randomised Clinical Trials (RCTs) and normalized to the NSM arm in the FREE trial. Estimated differences in mortality among the treatments and costs for NSM were obtained from the literature whereas procedure costs for BKP and PVP were obtained from three NHS hospitals. It was assumed that BKP and PVP reduced hospital length of stay by six days compared to NSM. Results The incremental cost-effectiveness ratio (ICER) was estimated at GBP 2,706 per QALY and GBP 15,982 per QALY compared to NSM and PVP respectively. Sensitivity analysis showed that the cost-effectiveness of BKP vs. NSM was robust when mortality and HRQoL benefits with BKP were varied. The cost-effectiveness of BKP compared to PVP was particularly sensitive to changes in the mortality benefit. Conclusion BKP may be a cost-effective strategy for the treatment of patients hospitalised with acute OVCF in the UK compared to NSM and PVP. Additional RCT data on the benefits of BKP and PVP compared to simulated sham-surgery and further data on the mortality benefits with BKP compared to NSM and PVP would reduce uncertainty. PMID:22890362

  5. [Atlas fractures].

    PubMed

    Schären, S; Jeanneret, B

    1999-05-01

    Fractures of the atlas account for 1-2% of all vertebral fractures. We divide atlas fractures into 5 groups: isolated fractures of the anterior arch of the atlas, isolated fractures of the posterior arch, combined fractures of the anterior and posterior arch (so-called Jefferson fractures), isolated fractures of the lateral mass and fractures of the transverse process. Isolated fractures of the anterior or posterior arch are benign and are treated conservatively with a soft collar until the neck pain has disappeared. Jefferson fractures are divided into stable and unstable fracture depending on the integrity of the transverse ligament. Stable Jefferson fractures are treated conservatively with good outcome while unstable Jefferson fractures are probably best treated operatively with a posterior atlanto-axial or occipito-axial stabilization and fusion. The authors preferred treatment modality is the immediate open reduction of the dislocated lateral masses combined with a stabilization in the reduced position using a transarticular screw fixation C1/C2 according to Magerl. This has the advantage of saving the atlanto-occipital joints and offering an immediate stability which makes immobilization in an halo or Minerva cast superfluous. In late instabilities C1/2 with incongruency of the lateral masses occurring after primary conservative treatment, an occipito-cervical fusion is indicated. Isolated fractures of the lateral masses are very rare and may, if the lateral mass is totally destroyed, be a reason for an occipito-cervical fusion. Fractures of the transverse processes may be the cause for a thrombosis of the vertebral artery. No treatment is necessary for the fracture itself.

  6. Traumatic lateral expulsion of the L-4 vertebral body from the spinal column.

    PubMed

    Wilkinson, Jeffrey S; Riesberry, Martha A; Mann, Sumeer A; Fourney, Daryl R

    2011-04-01

    Traumatic lateral spondyloptosis is mostly a lateral shearing injury that must be tremendous enough to completely disrupt the strong musculoligamentous and bony structures. This injury has only been described at single levels in the lumbar spine. Lateral expulsion of a vertebral body from the spinal column due to 2-level adjacent spondyloptosis has not been previously reported. This 16-year-old girl was referred to our center for the management of an extremely unusual L2-5 fracture-dislocation. Motor deficits were incomplete and sacral sensation was spared. Three-dimensional reconstructed CT scans revealed a fracture involving the superior L-4 vertebral body and endplate. There was also complete disruption of the L4-5 disc space. The majority of the L-4 vertebral body was expelled to the right of the spinal column, with the collapse of L-3 and a small remnant of the L-4 superior endplate onto L-5. Surgical management involved decompression, reduction, reconstruction of L-4 with a cage, and L1-ilium stabilization and fusion. Only a few attachments of the psoas muscles had to be divided to roll the L-4 vertebral body out posterolaterally, similar to the method of complete en bloc spondylectomy used in oncology. Neurological recovery has thus far included the resumption of normal bladder and bowel function, as well as ambulation with the use of a right leg brace. Perhaps this type of fracture has not been previously described because many patients would be expected to succumb to vascular or visceral injury. The authors believe this is the first case report of double lateral spondyloptosis at adjacent levels, resulting in expulsion of the vertebral body from the spinal column.

  7. Delayed Traumatic Diaphragm Hernia after Thoracolumbar Fracture in a Patient with Ankylosing Spondylitis

    PubMed Central

    Lee, Hyoun-Ho; Kim, Sang Woo; Jung, Young Jin

    2015-01-01

    Traumatic diaphragm hernia can occur in rare cases and generally accompanies thoracic or abdominal injuries. When suffering from ankylosing spondylitis, a small force can develop into vertebral fracture and an adjacent structural injury, and lead to diaphragm hernia without accompanying concomitant thoracoabdominal injury. A high level of suspicion may be a most reliable diagnostic tool in the detection of a diaphragm injury, and we need to keep in mind a possibility in a patient with ankylosing spondylitis and a thoracolumbar fracture, even in the case of minor trauma. PMID:25733996

  8. Update of vertebral cementoplasty in porotic patients

    PubMed Central

    Masala, Salvatore; Muto, Mario

    2015-01-01

    Vertebroplasty (VP) is a percutaneous mini-invasive technique developed in the late 1980s as antalgic and stabilizing treatment in patients affected by symptomatic vertebral fracture due to porotic disease, traumatic injury and primary or secondary vertebral spine tumors. The technique consists of a simple metameric injection of an inert cement (poly-methyl-methacrylate, PMMA), through a needle by trans-peduncular, parapeduncular or trans-somatic approach obtaining a vertebral augmentation and stabilization effect associated with pain relief. The technique is simple and fast, and should be performed under fluoroscopy or CT guidance in order to obtain a good result with low complication rate. The aim of this paper is to illustrate the utility of VP, the indications-contraindications criteria, how to technically perform the technique using imaging guidance, and the results and complications of this treatment in patients affected by symptomatic vertebral compression fracture. PMID:26015527

  9. Percutaneous Vertebral Body Augmentation: An Updated Review

    PubMed Central

    Omidi-Kashani, Farzad

    2014-01-01

    There are many medical conditions like osteoporosis, tumor, or osteonecrosis that weaken the structural strength of the vertebral body and prone it to fracture. Percutaneous vertebral augmentation that is usually applied by polymethylmethacrylate is a relatively safe, effective, and long lasting procedure commonly performed in these situations. In this paper, we updated a review of biomechanics, indications, contraindications, surgical techniques, complications, and overall prognosis of these minimally invasive spinal procedures. PMID:25379561

  10. Efficacy of antiresorptive agents for preventing fractures in Japanese patients with an increased fracture risk: review of the literature.

    PubMed

    Iwamoto, Jun; Sato, Yoshihiro; Takeda, Tsuyoshi; Matsumoto, Hideo

    2012-03-01

    The aim of the present review was to clarify the efficacy of currently available potent antiresorptive agents for preventing fractures in Japanese patients with an increased fracture risk. PubMed was used to search the literature for randomized controlled trials (RCTs), with the following search terms: fracture, etidronate, alendronate, risedronate, minodronate, raloxifene, bazedoxifene and Japan. The inclusion criteria were papers written in English, ≥50 subjects per group and a study period of ≥1 year. Fourteen RCTs met these criteria. The efficacy of antiresorptive agents for preventing vertebral, nonvertebral and hip fractures was investigated. There was evidence that raloxifene reduced the incidence of clinical vertebral fractures, while etidronate, alendronate and minodronate (but not bazedoxifene) reduced the incidence of morphometric vertebral fractures in patients with postmenopausal or involutional osteoporosis. Head-to-head trials showed that alendronate and raloxifene had similar efficacy for preventing vertebral fractures in patients with postmenopausal osteoporosis, while risedronate was not inferior to etidronate for reducing the incidence of morphometric vertebral fractures in patients with involutional osteoporosis. Alendronate reduced the incidence of hip fractures in patients with Parkinson's disease, and risedronate reduced the incidence of nonvertebral fractures and hip fractures in patients with Alzheimer's disease or stroke. In conclusion, the present review confirmed the efficacy of etidronate, minodronate and raloxifene for the prevention of vertebral fractures, the efficacy of alendronate for vertebral and hip fractures, and the efficacy of risedronate for vertebral, nonvertebral and hip fractures in Japanese patients with an increased fracture risk.

  11. Does the fracture fragment at the anterior column in thoracolumbar burst fractures get enough attention?

    PubMed Central

    Deqing, Luo; Kejian, Lian; Teng, Li; Weitao, Zou; Dasheng, Lin

    2017-01-01

    Abstract Prospective cohort study. To evaluate whether failure of the fracture fragment at the anterior column reduction in thoracolumbar fracture has an influence on the final radiologic and clinical outcomes. Cervical teardrop fracture has caused wide concern in spinal surgery field. Although similar fracture fragment at the anterior column was also observed in thoracolumbar burst fractures, the conception of teardrop fracture in thoracolumbar fractures was rarely mentioned in the literature, let alone a study. Fifty patients who suffered from thoracolumbar burst fractures with a fracture fragment at the anterior column were prospectively analyzed. Twenty-seven patients in whom the fragments were reduced by posterior surgery, verified by postoperative X-ray or CT, were included in the reduced group, and 23 patients were included in the nonreduced group. Radiologic and clinical outcomes of both groups were compared after over 2 years follow-up. There was no significant difference regarding to Cobb angle, Oswestry Disability Index (ODI) score, and disc grade between the 2 groups preoperatively. At final follow-up, the mean angle of kyphosis was 13.91° ± 3.47° in the nonreduced group and 8.42° ± 2.07° in the reduced groups (P < 0.01). All fractures consolidated in the reduced group, but the nonreduced group revealed 3 cases with nonunion. Besides, the average Pfirrmann grade of degenerative disc adjacent to the fractured vertebral was 2.87 ± 1.18 in the nonreduced group, higher than 1.81 ± 0.62 in the reduced group (P < 0.01). The ODI score in the nonreduced group was 0.54 ± 0.13 and 0.36 ± 0.12 in the reduced group (P < 0.01). In the present study, failure reduction of the fracture fragment at the anterior column could result in poor radiologic and clinical outcomes of the thoracolumbar burst fractures treated with posterior surgery. Therefore, we recommend the surgeon should pay more attention to reducing the fracture

  12. Symptomatic vertebral hemangiomas during pregnancy.

    PubMed

    Moles, Alexis; Hamel, Olivier; Perret, Christophe; Bord, Eric; Robert, Roger; Buffenoir, Kevin

    2014-05-01

    Symptomatic vertebral hemangiomas during pregnancy are rare, as only 27 cases have been reported in the literature since 1948. However, symptomatic vertebral hemangiomas can be responsible for spinal cord compression, in which case they constitute a medical emergency, which raises management difficulties in the context of pregnancy. Pregnancy is a known factor responsible for deterioration of these vascular tumors. In this paper, the authors report 2 clinical cases of symptomatic vertebral hemangiomas during pregnancy, including 1 case of spontaneous fracture that has never been previously reported in the literature. The authors then present a brief review of the literature to discuss emergency management of this condition. The first case was a 28-year-old woman at 35 weeks of gestation, who presented with paraparesis. Spinal cord MRI demonstrated a vertebral hemangioma invading the body and posterior arch of T-3 with posterior epidural extension. Laminectomy and vertebroplasty were performed after cesarean section, allowing neurological recovery. The second case involved a 35-year-old woman who presented with spontaneous fracture of T-7 at 36 weeks of gestation, revealing a vertebral hemangioma with no neurological deficit, but it was responsible for pain and local instability. Treatment consisted of postpartum posterior interbody fusion. With a clinical and radiological follow-up of 2 years, no complications and no modification of the hemangiomas were observed. A review of the literature reveals discordant management of these rare cases, which is why the treatment course must be decided by a multidisciplinary team as a function of fetal gestational age and maternal neurological features.

  13. The Vitamin D Assessment (ViDA) Study: design of a randomized controlled trial of vitamin D supplementation for the prevention of cardiovascular disease, acute respiratory infection, falls and non-vertebral fractures.

    PubMed

    Scragg, Robert; Waayer, Debbie; Stewart, Alistair W; Lawes, Carlene M M; Toop, Les; Murphy, Judy; Khaw, Kay-Tee; Camargo, Carlos A

    2016-11-01

    Observational studies have shown that low vitamin D status is associated with an increased risk of cardiovascular disease, acute respiratory infection, falls and non-vertebral fractures. We recruited 5110 Auckland adults, aged 50-84 years, into a randomized, double-blind, placebo-controlled trial to test whether vitamin D supplementation protects against these four major outcomes. The intervention is a monthly cholecalciferol dose of 100,000IU (2.5mg) for an estimated median 3.3 years (range 2.5-4.2) during 2011-2015. Participants were recruited primarily from family practices, plus community groups with a high proportion of Maori, Pacific, or South Asian individuals. The baseline evaluation included medical history, lifestyle, physical measurements (e.g. blood pressure, arterial waveform, lung function, muscle function), and a blood sample (stored at -80°C for later testing). Capsules are being mailed to home addresses with a questionnaire to collect data on non-hospitalized outcomes and to monitor adherence and potential adverse effects. Other data sources include New Zealand Ministry of Health data on mortality, hospitalization, cancer registrations and dispensed pharmaceuticals. A random sample of 438 participants returned for annual collection of blood samples to monitor adherence and safety (hypercalcemia), including repeat physical measurements at 12 months follow-up. The trial will allow testing of a priori hypotheses on several other endpoints including: weight, blood pressure, arterial waveform parameters, heart rate variability, lung function, muscle strength, gait and balance, mood, psoriasis, bone density, and chronic pain.

  14. Lumbar facet stress fracture in a ballet dancer.

    PubMed

    Fehlandt, A F; Micheli, L J

    1993-12-01

    A frequent cause of back pain in athletes and dancers is stress injury to the posterior vertebral elements. Stress fractures affect the pars interarticularis and, rarely, other vertebral regions. The authors present their experience with the diagnosis and treatment of a fourth lumbar inferior articular facet stress fracture in a ballerina in this brief report and discuss the literature concerning posterior element stress fractures.

  15. Early steps in vertebrate cardiogenesis.

    PubMed

    Mohun, T; Sparrow, D

    1997-10-01

    Heart formation provides an excellent model for studying the molecular basis of cell determination in vertebrate embryos. By combining molecular assays with the experimental approaches of classic embryology, a model for the cell signalling events that initiate cardiogenesis is emerging. Studies of chick, amphibian, and fish embryos demonstrate the inductive role of dorso-anterior endoderm in specifying the cardiac fate of adjacent mesoderm. A consequence of this signalling is the onset of cardiomyogenesis and several transcription factors--Nkx2-5-related, HAND, GATA and MEF-2 families--contribute to these events.

  16. Nose fracture

    MedlinePlus

    Fracture of the nose; Broken nose; Nasal fracture; Nasal bone fracture; Nasal septal fracture ... A fractured nose is the most common fracture of the face. It ... with other fractures of the face. Sometimes a blunt injury can ...

  17. Cervical Fracture/Subluxation in a Patient with a Prior C2-Sacrum Fusion: Case Report and Review of Literature.

    PubMed

    Chen, Yi-Ren; Chan, Alvin Y; Kumar, Kevin K; Veeravagu, Anand

    2016-11-22

    Traumatic injury to an adjacent segment of a previously fused spine is a rare complication of scoliosis surgery. The adjacent spinal segments may be more vulnerable to traumatic fracture or dislocation due to increased strain. We present a patient with prior C2 to sacrum fusion who suffered a C2 fracture/dislocation after falling. A 52-year-old female with a previous C2 to the sacrum fusion for idiopathic scoliosis presented with severe and progressively worsening neck pain after multiple falls. Imaging showed anterior displacement of the C2 vertebral body, fracture of C2, and anterior subluxation of the C1-2 complex on C3. The patient underwent posterior occiput to cervical fusion and reduction of the C1-C2 complex. Our case describes a potential complication of long-segment fusion. Adjacent segments may be more prone to fracture-dislocation because of increased intradiscal pressure and strain. Clinicians should have a high suspicion of fractures in patients with prior spinal fusions in the setting of trauma.

  18. Cervical Fracture/Subluxation in a Patient with a Prior C2-Sacrum Fusion: Case Report and Review of Literature

    PubMed Central

    Chen, Yi-Ren; Kumar, Kevin K; Veeravagu, Anand

    2016-01-01

    Traumatic injury to an adjacent segment of a previously fused spine is a rare complication of scoliosis surgery. The adjacent spinal segments may be more vulnerable to traumatic fracture or dislocation due to increased strain. We present a patient with prior C2 to sacrum fusion who suffered a C2 fracture/dislocation after falling. A 52-year-old female with a previous C2 to the sacrum fusion for idiopathic scoliosis presented with severe and progressively worsening neck pain after multiple falls. Imaging showed anterior displacement of the C2 vertebral body, fracture of C2, and anterior subluxation of the C1-2 complex on C3. The patient underwent posterior occiput to cervical fusion and reduction of the C1-C2 complex. Our case describes a potential complication of long-segment fusion. Adjacent segments may be more prone to fracture-dislocation because of increased intradiscal pressure and strain. Clinicians should have a high suspicion of fractures in patients with prior spinal fusions in the setting of trauma. PMID:28018758

  19. Mathematical model for predicting human vertebral fracture

    NASA Technical Reports Server (NTRS)

    Benedict, J. V.

    1973-01-01

    Mathematical model has been constructed to predict dynamic response of tapered, curved beam columns in as much as human spine closely resembles this form. Model takes into consideration effects of impact force, mass distribution, and material properties. Solutions were verified by dynamic tests on curved, tapered, elastic polyethylene beam.

  20. Classifying thoracolumbar fractures: role of quantitative imaging

    PubMed Central

    Tomás Muñoz, Pablo; Moya Sánchez, Elena; Revelles Paniza, Marta; Martínez Martínez, Alberto; Pérez Abela, Antonio Luis

    2016-01-01

    This article describes different types of vertebral fractures that affect the thoracolumbar spine and the most relevant contributions of the different classification systems to vertebral fracture management. The vertebral fractures types are based on the three columns model of Denis that includes compression, burst, flexion-distraction and fracture-dislocation types. The most recent classifications systems of these types of fractures are reviewed, including the Thoracolumbar Injury Classification and Severity score (TLICS) and the Arbeitsgemeinschaft für Osteosynthesefragen Spine Thoracolumbar Injury Classification and Severity score (AOSpine-TLICS). Correct classification requires a quantitative imaging approach in which several measurements determine TLICS or AOSpine-TLICS grade. If the TLICS score is greater than 4, or the AOSpine-TLICS is greater than 5, surgical management is indicated. In this review, the most important imaging findings and measurements on radiography, multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) are described. These include degree of vertebral wedging and percentage of vertebral height loss in compression fractures, degree of interpedicular distance widening and spinal canal stenosis in burst fractures, and the degree of vertebral translation or interspinous widening in more severe fractures types, such as flexion-distraction and fracture-dislocation. These findings and measurements are illustrated with schemes and cases of our archives in a didactic way. PMID:28090452

  1. Extracranial vertebral artery intervention.

    PubMed

    Mukherjee, Debabrata; Pineda, Guillermo

    2007-12-01

    Atherosclerosis is the commonest cause of vertebral artery stenosis and has a predilection for the origin and proximal section of the extracranial portion of the vessel and also the intracranial portion of the vessel. Although it has generally been thought that extracranial vertebral artery (ECVA) disease has a more benign outcome compared to intracranial vertebral artery disease, significant occlusive disease of the proximal vertebral artery is the primary cause of vertebral artery ischemia in a significant proportion of patients. We focus on the interventional management of patients with proximal ECVA disease in this article.

  2. The epidemiology of osteoporosis and fractures in ankylosing spondylitis.

    PubMed

    Sambrook, Philip N; Geusens, Piet

    2012-08-01

    Bone is a target in many inflammatory rheumatic diseases. Inflammation leads to a wide range of changes in bone, and especially bone remodeling. In ankylosing spondylitis (AS) bone loss has been documented, but measuring bone density in the spine is hampered by new bone formation in syndesmophytes, periost and within the vertebrae. The risk of vertebral fractures is increased in AS. The diagnosis of vertebral fractures requires imaging and adequate evaluation of vertebral heights. In addition, in the ankysosed spine segments, additional imaging is often needed to diagnose spinal fractures at unusual locations (cervical spine) or in the posterior arch structures. Risk factors for vertebral fractures are helpful for case finding. Fracture prevention is indicated in high risk patients with AS, especially when they have already a vertebral fracture or in the presence of osteoporosis.

  3. Percutaneous vertebral augmentation for painful osteolytic vertebral metastasis: a case report

    PubMed Central

    Anselmetti, Giovanni C; Tutton, Sean M; Facchini, Francis R; Miller, Larry E; Block, Jon E

    2012-01-01

    Introduction Vertebral metastases are associated with significant pain, disability, and morbidity. Open surgery for fracture stabilization is often inappropriate in this population due to a poor risk-benefit profile, particularly if life expectancy is short. Percutaneous vertebroplasty and kyphoplasty are appealing adjunctive procedures in patients with malignancy for alleviation of intractable pain. However, these patients have higher risk of serious complications, notably cement extravasation. Described in this report is a case of a painful osteolytic vertebral metastasis that was successfully treated by a novel percutaneous vertebral augmentation system. Case presentation A 42-year-old Caucasian female presented with a history of metastatic lung cancer unresponsive to radiation and chemotherapy with symptoms inadequately controlled by opiates over the previous 6 months. Magnetic resonance imaging and spiral computed tomography with two-dimensional reconstruction showed an osteolytic vertebral metastasis with complete involvement of the T10 vertebral body, extending to the cortical vertebral wall anteriorly and posteriorly. The patient was treated with percutaneous vertebral augmentation (Kiva® VCF Treatment System, Benvenue Medical, Inc, Santa Clara, CA) utilizing a novel coil-shaped polyetheretherketone implant designed to minimize the risk of cement extravasation. After the minimally invasive procedure, bone cement distribution within the vertebral body was ideal, with no observed cement extravasation. No complications were reported, pain completely resolved within 24 hours, and use of intravenous narcotics was progressively diminished within 1 week. Complete pain relief was maintained throughout 4 months of follow-up. Conclusion The Kiva System represents a novel and effective minimally invasive treatment option for patients suffering from severe pain due to osteolytic vertebral metastasis. PMID:23754917

  4. Testing Skills in Vertebrates

    ERIC Educational Resources Information Center

    Funk, Mildred Sears; Tosto, Pat

    2007-01-01

    In this article, the authors present a project that gives students examples of basic skills that many vertebrate species develop as they grow and function in their ecosystem. These activities involve information gathering about surroundings, learning how to use objects, and tracking and searching skills. Different vertebrate species may acquire…

  5. The time to and determinants of first fractures in boys with Duchenne muscular dystrophy.

    PubMed

    Ma, J; McMillan, H J; Karagüzel, G; Goodin, C; Wasson, J; Matzinger, M A; DesClouds, P; Cram, D; Page, M; Konji, V N; Lentle, B; Ward, L M

    2017-02-01

    Boys with vertebral fractures (VF) identified through routine spine radiographs had milder, less symptomatic, and fewer VF compared to those diagnosed with VF following consultation for back pain. Spontaneous (i.e., medication-unassisted) reshaping of fractured vertebral bodies was absent. Long bone fractures were present even before Duchenne muscular dystrophy (DMD) diagnosis in some boys.

  6. Comprehensive management of symptomatic and aggressive vertebral hemangiomas.

    PubMed

    Acosta, Frank L; Sanai, Nader; Chi, John H; Dowd, Christopher F; Chin, Cynthia; Tihan, Tarik; Chou, Dean; Weinstein, Philip R; Ames, Christopher P

    2008-01-01

    Conservative surgical strategies are appropriate for most symptomatic hemangiomas causing cord compression without instability or deformity. Even so, complete intralesional spondylectomy following embolization of aggressive vertebral hemangiomas with circumferential vertebral involvement can be safely accomplished. Such a spondylectomy can also prevent recurrence of hemangiomas. Transarterial embolization without decompression is an effective treatment for painful intraosseous hemangiomas. Vertebroplasty is useful for improving pain symptoms, especially when vertebral body compression fracture has occurred in patients without neurological deficit, but is less effective in providing long-term pain relief.

  7. Fatal Vertebral Artery Injury in Penetrating Cervical Spine Trauma.

    PubMed

    Tannoury, Chadi; Degiacomo, Anthony

    2015-01-01

    Study Design. This case illustrates complications to a vertebral artery injury (VAI) resulting from penetrating cervical spine trauma. Objectives. To discuss the management of both VAI and cervical spine trauma after penetrating gunshot wound to the neck. Summary of Background Data. Vertebral artery injury following cervical spine trauma is infrequent, and a unilateral VAI often occurs without neurologic sequela. Nevertheless, devastating complications of stroke and death do occur. Methods. A gunshot wound to the neck resulted in a C6 vertebral body fracture and C5-C7 transverse foramina fractures. Neck CT angiogram identified a left vertebral artery occlusion. A cerebral angiography confirmed occlusion of the left extracranial vertebral artery and patency of the remaining cerebrovascular system. Following anterior cervical corpectomy and stabilization, brainstem infarction occurred and resulted in death. Results. A fatal outcome resulted from vertebral artery thrombus propagation with occlusion of the basilar artery triggering basilar ischemia and subsequent brainstem and cerebellar infarction. Conclusions. Vertebral artery injury secondary to cervical spine trauma can lead to potentially devastating neurologic sequela. Early surgical stabilization, along with anticoagulation therapy, contributes towards managing the combination of injuries. Unfortunately, despite efforts, a poor outcome is sometimes inevitable when cervical spine trauma is coupled with a VAI.

  8. Fatal Vertebral Artery Injury in Penetrating Cervical Spine Trauma

    PubMed Central

    Tannoury, Chadi; Degiacomo, Anthony

    2015-01-01

    Study Design. This case illustrates complications to a vertebral artery injury (VAI) resulting from penetrating cervical spine trauma. Objectives. To discuss the management of both VAI and cervical spine trauma after penetrating gunshot wound to the neck. Summary of Background Data. Vertebral artery injury following cervical spine trauma is infrequent, and a unilateral VAI often occurs without neurologic sequela. Nevertheless, devastating complications of stroke and death do occur. Methods. A gunshot wound to the neck resulted in a C6 vertebral body fracture and C5–C7 transverse foramina fractures. Neck CT angiogram identified a left vertebral artery occlusion. A cerebral angiography confirmed occlusion of the left extracranial vertebral artery and patency of the remaining cerebrovascular system. Following anterior cervical corpectomy and stabilization, brainstem infarction occurred and resulted in death. Results. A fatal outcome resulted from vertebral artery thrombus propagation with occlusion of the basilar artery triggering basilar ischemia and subsequent brainstem and cerebellar infarction. Conclusions. Vertebral artery injury secondary to cervical spine trauma can lead to potentially devastating neurologic sequela. Early surgical stabilization, along with anticoagulation therapy, contributes towards managing the combination of injuries. Unfortunately, despite efforts, a poor outcome is sometimes inevitable when cervical spine trauma is coupled with a VAI. PMID:26640731

  9. Gene expression throughout a vertebrate's embryogenesis

    PubMed Central

    2011-01-01

    Background Describing the patterns of gene expression during embryonic development has broadened our understanding of the processes and patterns that define morphogenesis. Yet gene expression patterns have not been described throughout vertebrate embryogenesis. This study presents statistical analyses of gene expression during all 40 developmental stages in the teleost Fundulus heteroclitus using four biological replicates per stage. Results Patterns of gene expression for 7,000 genes appear to be important as they recapitulate developmental timing. Among the 45% of genes with significant expression differences between pairs of temporally adjacent stages, significant differences in gene expression vary from as few as five to more than 660. Five adjacent stages have disproportionately more significant changes in gene expression (> 200 genes) relative to other stages: four to eight and eight to sixteen cell stages, onset of circulation, pre and post-hatch, and during complete yolk absorption. The fewest differences among adjacent stages occur during gastrulation. Yet, at stage 16, (pre-mid-gastrulation) the largest number of genes has peak expression. This stage has an over representation of genes in oxidative respiration and protein expression (ribosomes, translational genes and proteases). Unexpectedly, among all ribosomal genes, both strong positive and negative correlations occur. Similar correlated patterns of expression occur among all significant genes. Conclusions These data provide statistical support for the temporal dynamics of developmental gene expression during all stages of vertebrate development. PMID:21356103

  10. Pleistocene vertebrates of the Yukon Territory

    NASA Astrophysics Data System (ADS)

    Harington, C. R.

    2011-08-01

    Unglaciated parts of the Yukon constitute one of the most important areas in North America for yielding Pleistocene vertebrate fossils. Nearly 30 vertebrate faunal localities are reviewed spanning a period of about 1.6 Ma (million years ago) to the close of the Pleistocene some 10 000 BP (radiocarbon years before present, taken as 1950). The vertebrate fossils represent at least 8 species of fishes, 1 amphibian, 41 species of birds and 83 species of mammals. Dominant among the large mammals are: steppe bison ( Bison priscus), horse ( Equus sp.), woolly mammoth ( Mammuthus primigenius), and caribou ( Rangifer tarandus) - signature species of the Mammoth Steppe fauna ( Fig. 1), which was widespread from the British Isles, through northern Europe, and Siberia to Alaska, Yukon and adjacent Northwest Territories. The Yukon faunas extend from Herschel Island in the north to Revenue Creek in the south and from the Alaskan border in the west to Ketza River in the east. The Yukon holds evidence of the earliest-known people in North America. Artifacts made from bison, mammoth and caribou bones from Bluefish Caves, Old Crow Basin and Dawson City areas show that people had a substantial knowledge of making and using bone tools at least by 25 000 BP, and possibly as early as 40 000 BP. A suggested chronological sequence of Yukon Pleistocene vertebrates ( Table 1) facilitates comparison of selected faunas and indicates the known duration of various taxa.

  11. Dynamic epithelia of the developing vertebrate face.

    PubMed

    Choe, Chong Pyo; Crump, J Gage

    2015-06-01

    A segmental series of endoderm-derived pouch and ectoderm-derived cleft epithelia act as signaling centers in the developing face. Their precise morphogenesis is therefore essential for proper patterning of the vertebrate head. Intercellular adhesion and polarity are highly dynamic within developing facial epithelial cells, with signaling from the adjacent mesenchyme controlling both epithelial character and directional migration. Endodermal and ectodermal epithelia fuse to form the primary mouth and gill slits, which involves basement membrane dissolution, cell intercalations, and apoptosis, as well as undergo further morphogenesis to generate the middle ear cavity and glands of the neck. Recent studies of facial epithelia are revealing both core programs of epithelial morphogenesis and insights into the coordinated assembly of the vertebrate head.

  12. Experiment K307: Vertebral body strength of rat spinal columns

    NASA Technical Reports Server (NTRS)

    Kazarian, L. E.

    1981-01-01

    The effects of space flight on vertebral body bone strength excised were investigated. Comparative biomechanical investigations of vertebral body strength for flight, synchronous, and vivarium rats following spacecraft recovery (R+0), at R+6 and R+29 days post flight recovery are presented. Statistical analyses are presented for the mechanical properties of stiffness, ultimate load, displacement to ultimate load, and energy to ultimate load. At R+0 all of the above properties show that the vertebral body exhibits an increasing susceptibility to fracture. The reduction of bone strength is inhomogeneous and dependent on vertebral level. The R+6 recovery data was inconclusive since it varied above and below the R+0 data. At R+29 ultimate load values showed a statistically significant increase in bone strength approaching that of the vivarium or control group.

  13. Incidental vertebral lesions.

    PubMed

    Coumans, Jean-Valery C E; Walcott, Brian P

    2011-12-01

    Incidental vertebral lesions on imaging of the spine are commonly encountered in clinical practice. Contributing factors include the aging population, the increasing prevalence of back pain, and increased usage of MR imaging. Additionally, refinements in CT and MR imaging have increased the number of demonstrable lesions. The management of incidental findings varies among practitioners and commonly depends more on practice style than on data or guidelines. In this article we review incidental findings within the vertebral column and review management of these lesions, based on available Class III data.

  14. Vertebral-Basilar Insufficiency

    PubMed Central

    Cape, Ronald D. T.; Hogan, David B.

    1983-01-01

    Vertebral-basilar ischemia can result in giddiness, transient ischemic attacks, and drop attacks. Management involves controlling blood pressure, getting the patient to stop smoking, controlling diabetes and/or hyperlipidemia, and instituting antiplatelet therapy. Several facets of this problem remain unexplained. PMID:21283322

  15. Shoulder Fractures

    MedlinePlus

    ... Journal of Hand Surgery (JHS) Home Anatomy Shoulder Fractures Email to a friend * required fields From * To * ... create difficulty with its function. Types of Shoulder Fractures The type of fracture varies by age. Most ...

  16. Stress Fractures

    MedlinePlus

    Stress fractures Overview By Mayo Clinic Staff Stress fractures are tiny cracks in a bone. They're caused by ... up and down or running long distances. Stress fractures can also arise from normal use of a ...

  17. Greenstick Fractures

    MedlinePlus

    Greenstick fractures Overview By Mayo Clinic Staff A greenstick fracture occurs when a bone bends and cracks, instead of breaking completely into separate pieces. The fracture looks similar to what happens when you try ...

  18. NFFLOW: A reservoir simulator incorporating explicit fractures (SPE 153890)

    SciTech Connect

    Boyle, E.J.; Sams, W.N.

    2012-01-01

    NFFLOW is a research code that quickly and inexpensively simulates flow in moderately fractured reservoirs. It explicitly recognizes fractures separately from rock matrix. In NFFLOW fracture flow is proportional to the pressure gradient along the fracture, and flow in the rock matrix is determined by Darcy’s Law. The two flow mechanisms are coupled through the pressure gradient between a fracture and its adjacent rock matrix. Presented is a promising change to NFFLOW that allows for flow across a rock matrix block.

  19. Can initial clinical assessment exclude thoracolumbar vertebral injury?

    PubMed Central

    Gill, Dinendra Singh; Mitra, Biswadev; Reeves, Fairleigh; Cameron, Peter A; Fitzgerald, Mark; Liew, Susan; Varma, Dinesh

    2013-01-01

    Introduction The aim of this study was to test the hypothesis that all blunt trauma patients, presenting with a Glasgow coma scale (GCS) score of 15, without intoxication or neurological deficit, and no pain or tenderness on log-roll can have any thoracolumbar fracture excluded without imaging. Materials and Methods All patients diagnosed with a thoracolumbar fracture presenting to the emergency department of a major trauma centre and having an initial GCS score of 15 were included in the study. Variables collected included type of fracture, mechanism of injury, the presence of pain or tenderness on log-roll, ethanol levels and prehospital opioid analgesia. Results There were 536 patients with thoracolumbar fractures, of which 508 (94.8%) patients had either pain, tenderness or had received prehospital opioid analgesia. A small subgroup of 28 (5.2%) patients who received no prehospital opioid analgesia, did not complain of pain and had no tenderness to the thoracolumbar spine elicited on log-roll. This subgroup was significantly older (p=0.033) and a high proportion of patients (64.3%) had a concurrent fracture of the cervical spine. Within this subgroup, a clinically significant unstable thoracic fracture was present in three patients, with all three patients exhibiting symptoms and signs of neurological injury or having a concurrent cervical vertebral fracture. Conclusions In this population of blunt trauma patients with a GCS score of 15, not under the influence of alcohol or prehospital morphine administration, the absence of pain or tenderness on log-roll can exclude a clinically significant lumbar vertebral fracture, but does not exclude a thoracic fracture. PMID:22915226

  20. Adjacent-level arthroplasty following cervical fusion.

    PubMed

    Rajakumar, Deshpande V; Hari, Akshay; Krishna, Murali; Konar, Subhas; Sharma, Ankit

    2017-02-01

    OBJECTIVE Adjacent-level disc degeneration following cervical fusion has been well reported. This condition poses a major treatment dilemma when it becomes symptomatic. The potential application of cervical arthroplasty to preserve motion in the affected segment is not well documented, with few studies in the literature. The authors present their initial experience of analyzing clinical and radiological results in such patients who were treated with arthroplasty for new or persistent arm and/or neck symptoms related to neural compression due to adjacent-segment disease after anterior cervical discectomy and fusion (ACDF). METHODS During a 5-year period, 11 patients who had undergone ACDF anterior cervical discectomy and fusion (ACDF) and subsequently developed recurrent neck or arm pain related to adjacent-level cervical disc disease were treated with cervical arthroplasty at the authors' institution. A total of 15 devices were implanted (range of treated levels per patient: 1-3). Clinical evaluation was performed both before and after surgery, using a visual analog scale (VAS) for pain and the Neck Disability Index (NDI). Radiological outcomes were analyzed using pre- and postoperative flexion/extension lateral radiographs measuring Cobb angle (overall C2-7 sagittal alignment), functional spinal unit (FSU) angle, and range of motion (ROM). RESULTS There were no major perioperative complications or device-related failures. Statistically significant results, obtained in all cases, were reflected by an improvement in VAS scores for neck/arm pain and NDI scores for neck pain. Radiologically, statistically significant increases in the overall lordosis (as measured by Cobb angle) and ROM at the treated disc level were observed. Three patients were lost to follow-up within the first year after arthroplasty. In the remaining 8 cases, the duration of follow-up ranged from 1 to 3 years. None of these 8 patients required surgery for the same vertebral level during the follow

  1. Progression of Infection after Surgical CT Navigation-Assisted Aspiration Biopsy of a Vertebral Abscess

    PubMed Central

    Spyropoulou, Vasiliki; Valaikaite, Raimunda; Dhouib, Amira; Dayer, Romain; Ceroni, Dimitri

    2016-01-01

    Background Context. Computed tomography- (CT-) guided fine-needle aspiration biopsy of the vertebral body is an important tool in the diagnostic evaluation of vertebral osteomyelitis. The procedure is considered simple to perform and it is considered a safe procedure with few complications. Purpose. The purpose of this study was to describe an unusual complication due to a CT-guided fine-needle aspiration biopsy of the vertebral body of L3, to better understand the relationship between surgical procedure and complication, and to reflect on how to avoid it. Study Design/Setting. Case report and literature review. Methods. The medical records, laboratory findings, and radiographic imaging studies of an 11-year-old boy, with an unusual complication due to a CT-guided fine-needle aspiration biopsy of the vertebral body of L3, were reviewed. Results. We report a case of vertebral osteomyelitis of L3 caused by methicillin-sensitive Staphylococcus aureus (MSSA). Following a computed tomography-guided aspiration biopsy of the vertebral body of L3, vertebral osteomyelitis rapidly progressed into the vertebral body of L4 as well as the L3-L4 disk. Conclusions. Based on the present case, one should consider that a CT-guided fine-needle aspiration biopsy of the vertebral body may be complicated by a progression of a vertebral osteomyelitis into both the intervertebral disk and also the adjacent vertebral body. PMID:26949558

  2. Head segmentation in vertebrates

    PubMed Central

    Kuratani, Shigeru; Schilling, Thomas

    2008-01-01

    Classic theories of vertebrate head segmentation clearly exemplify the idealistic nature of comparative embryology prior to the 20th century. Comparative embryology aimed at recognizing the basic, primary structure that is shared by all vertebrates, either as an archetype or an ancestral developmental pattern. Modern evolutionary developmental (Evo-Devo) studies are also based on comparison, and therefore have a tendency to reduce complex embryonic anatomy into overly simplified patterns. Here again, a basic segmental plan for the head has been sought among chordates. We convened a symposium that brought together leading researchers dealing with this problem, in a number of different evolutionary and developmental contexts. Here we give an overview of the outcome and the status of the field in this modern era of Evo-Devo. We emphasize the fact that the head segmentation problem is not fully resolved, and we discuss new directions in the search for hints for a way out of this maze. PMID:20607135

  3. Viruses of lower vertebrates.

    PubMed

    Essbauer, S; Ahne, W

    2001-08-01

    Viruses of lower vertebrates recently became a field of interest to the public due to increasing epizootics and economic losses of poikilothermic animals. These were reported worldwide from both wildlife and collections of aquatic poikilothermic animals. Several RNA and DNA viruses infecting fish, amphibians and reptiles have been studied intensively during the last 20 years. Many of these viruses induce diseases resulting in important economic losses of lower vertebrates, especially in fish aquaculture. In addition, some of the DNA viruses seem to be emerging pathogens involved in the worldwide decline in wildlife. Irido-, herpes- and polyomavirus infections may be involved in the reduction in the numbers of endangered amphibian and reptile species. In this context the knowledge of several important RNA viruses such as orthomyxo-, paramyxo-, rhabdo-, retro-, corona-, calici-, toga-, picorna-, noda-, reo- and birnaviruses, and DNA viruses such as parvo-, irido-, herpes-, adeno-, polyoma- and poxviruses, is described in this review.

  4. Building the Vertebrate Spine

    NASA Astrophysics Data System (ADS)

    Pourquié, Olivier

    2008-03-01

    The vertebrate body can be subdivided along the antero-posterior (AP) axis into repeated structures called segments. This periodic pattern is established during embryogenesis by the somitogenesis process. Somites are generated in a rhythmic fashion from the paraxial mesoderm and subsequently differentiate to give rise to the vertebrae and skeletal muscles of the body. Somite formation involves an oscillator-the segmentation clock-whose periodic signal is converted into the periodic array of somite boundaries. This clock drives the dynamic expression of cyclic genes in the presomitic mesoderm and requires Notch and Wnt signaling. Microarray studies of the mouse presomitic mesoderm transcriptome reveal that the segmentation clock drives the periodic expression of a large network of cyclic genes involved in cell signaling. Mutually exclusive activation of the Notch/FGF and Wnt pathways during each cycle suggests that coordinated regulation of these three pathways underlies the clock oscillator. In humans, mutations in the genes associated to the function of this oscillator such as Dll3 or Lunatic Fringe result in abnormal segmentation of the vertebral column such as those seen in congenital scoliosis. Whereas the segmentation clock is thought to set the pace of vertebrate segmentation, the translation of this pulsation into the reiterated arrangement of segment boundaries along the AP axis involves dynamic gradients of FGF and Wnt signaling. The FGF signaling gradient is established based on an unusual mechanism involving mRNA decay which provides an efficient means to couple the spatio-temporal activation of segmentation to the posterior elongation of the embryo. Another striking aspect of somite production is the strict bilateral symmetry of the process. Retinoic acid was shown to control aspects of this coordination by buffering destabilizing effects from the embryonic left-right machinery. Defects in this embryonic program controlling vertebral symmetry might lead

  5. A central role for the notochord in vertebral patterning.

    PubMed

    Fleming, Angeleen; Keynes, Roger; Tannahill, David

    2004-02-01

    The vertebrates are defined by their segmented vertebral column, and vertebral periodicity is thought to originate from embryonic segments, the somites. According to the widely accepted 'resegmentation' model, a single vertebra forms from the recombination of the anterior and posterior halves of two adjacent sclerotomes on both sides of the embryo. Although there is supporting evidence for this model in amniotes, it remains uncertain whether it applies to all vertebrates. To explore this, we have investigated vertebral patterning in the zebrafish. Surprisingly, we find that vertebral bodies (centra) arise by secretion of bone matrix from the notochord rather than somites; centra do not form via a cartilage intermediate stage, nor do they contain osteoblasts. Moreover, isolated, cultured notochords secrete bone matrix in vitro, and ablation of notochord cells at segmentally reiterated positions in vivo prevents the formation of centra. Analysis of fss mutant embryos, in which sclerotome segmentation is disrupted, shows that whereas neural arch segmentation is also disrupted, centrum development proceeds normally. These findings suggest that the notochord plays a key, perhaps ancient, role in the segmental patterning of vertebrae.

  6. Biomechanical compression tests with a new implant for thoracolumbar vertebral body replacement.

    PubMed

    Knop, C; Lange, U; Bastian, L; Oeser, M; Blauth, M

    2001-02-01

    The authors present an investigation into the biomechanical functioning of a new titanium implant for vertebral body replacement (Synex). Possible indications are fractures and/or dislocations with damage of the anterior column, posttraumatic kyphosis and tumors of the thoracolumbar spine. The construction must be supplemented by a stabilizing posterior or anterior implant. For best fit and contact with adjacent end-plates, Synex is distractable in situ. We performed comparative compression tests with Synex and MOSS ("Harms mesh cage") on human cadaveric specimens of intact vertebrae (L1). The aim of the study was to measure the compressive strength of the vertebral body end-plate in uniaxial loading via both implants to exclude collapse of Synex in vivo. Twelve human cadaveric specimens of intact vertebrae (L1) were divided into two identical groups (matched pairs) according to bone mineral density (BMD), determined using dual-energy quantitative computed tomography (DE-QCT). The specimens were loaded with an axial compression force at a constant speed of 5 mm/min to failure, and the displacement was recorded with a continuous load-displacement curve. The mean ultimate compression force (Fmax) showed a tendency towards a higher reading for Synex: 3396 N versus 2719 N (non-significant). The displacement until Fmax was 2.9 mm in the Synex group, which was half as far as in the MOSS group (5.8 mm). The difference was significant (P < 0.001). The compression force was twice as high, and significantly (P < 0.05) higher with Synex at displacements of 1 mm, 1.5 mm and 2 mm. A significant (P < 0.001) correlation (R = 0.89) between Fmax and BMD was found. Synex was found to be at least comparable to MOSS concerning the compressive performance at the vertebral end-plate. A possible consequence of the significantly higher mean compression forces between 1 and 2 mm displacement might be decreased collapse of the implant into the vertebral body in vivo.

  7. Continuous broad protection against osteoporotic fractures with strontium ranelate.

    PubMed

    Ferrari, Serge

    2009-10-01

    Among the available agents for osteoporosis, anti-resorptive drugs do not increase bone formation, whereas anabolic agents do not reduce bone resorption. Strontium ranelate (SR) uniquely does both, rebalancing bone turnover in favour of bone formation. In the Spinal Osteoporosis Therapeutic Intervention (SOTI) study, a 4-year trial, SR treatment reduced vertebral fracture risk by 33% (P < 0.001), and symptomatic vertebral fracture risk by 36% (P < 0.001). SR also significantly improved quality of life as assessed by the Quality-of-Life Questionnaire in Osteoporosis (QUALIOST) instrument. In the Treatment of Peripheral Osteoporosis Study (TROPOS) study, a 5-year trial, SR significantly reduced total fracture risk by 20% (29.1 vs 33.9%; P < 0.001), total non-vertebral fracture risk by 15% (18.6 vs 20.9%; P = 0.032) and hip fracture risk by 43% (7.2 vs 10.2%; P = 0.036) in the subgroup that is at high risk for hip fracture. Analysis of pooled data from these two studies found that SR is also safe and effective in patients aged >or=80 years, reducing the risk of vertebral fracture over 5 years by 31% (P = 0.010) and non-vertebral fracture by 26% (P = 0.019). Adherence to treatment in the trials exceeded 80%, and the adverse event profile of SR was similar to that of placebo. Taken together, these long-term findings clearly demonstrate that SR is safe and effective in reducing both vertebral and non-vertebral (particularly hip) fracture risks for at least 5 years of pre-planned follow-up.

  8. Diabetic foot complicated by vertebral osteomyelitis and epidural abscess

    PubMed Central

    Trombetta, Maddalena; Imbriaco, Chiara; Rigolon, Riccardo; Mingolla, Lucia; Zamboni, Federica; Dal Molin, Francesca; Cioccoloni, Dario; Sanga, Viola; Bruti, Massimiliano; Brocco, Enrico; Conti, Michela; Ravenna, Giorgio; Perrone, Fabrizia; Stoico, Vincenzo; Bonora, Enzo

    2016-01-01

    Summary Vertebral osteomyelitis (or spondylodiscitis) is steadily increasing in Western countries and often results from hematogenous seeding, direct inoculation during spinal surgery, or contiguous spread from an infection in the adjacent soft tissue. We present the case of a 67-year-old white patient with type 2 diabetes who went to Hospital for high fever, back pain, and worsening of known infected ulcers in the left foot. Despite intravenous antibiotic treatment and surgical debridement of the foot infection, high fever and lower back pain continued. Bone biopsy and two consecutive blood cultures were positive for Staphylococcus aureus. A spinal magnetic resonance imaging (MRI) was performed, revealing serious osteomyelitis in L4 and L5 complicated by an epidural abscess. Contiguous or other distant focuses of infection were not identified. In this case, diabetic foot could be considered as a primary distant focus for vertebral osteomyelitis. Clinicians should consider vertebral osteomyelitis as a ‘possible’ diagnosis in patients with type 2 diabetes complicated by foot infection that is associated with fever and lower back pain. Learning points Vertebral osteomyelitis is increasing in Western countries, especially in patients with type 2 diabetes. The primary focus of infection is the genitourinary tract followed by skin, soft tissue, endocarditis, bursitis, septic arthritis, and intravascular access. Diabetic foot could be a rare primary focus of infection for vertebral osteomyelitis, and, however, vertebral osteomyelitis could be a serious, albeit rare, complication of diabetic foot. Clinicians should keep in mind the many potential complications of diabetic foot ulcerations and consider vertebral osteomyelitis as a “possible” diagnosis in patients with type 2 diabetes and foot ulcers associated with nonspecific symptoms such as lower back pain. Early diagnosis and correct management of vertebral osteomyelitis are crucial to improve clinical outcomes

  9. Performance of vertebral cancellous bone augmented with compliant PMMA under dynamic loads.

    PubMed

    Boger, Andreas; Bohner, Marc; Heini, Paul; Schwieger, Karsten; Schneider, Erich

    2008-11-01

    Increased fracture risk has been reported for the adjacent vertebral bodies after vertebroplasty. This increase has been partly attributed to the high Young's modulus of commonly used polymethylmethacrylate (PMMA). Therefore, a compliant bone cement of PMMA with a bulk modulus closer to the apparent modulus of cancellous bone has been produced. This compliant bone cement was achieved by introducing pores in the cement. Due to the reduced failure strength of that porous PMMA cement, cancellous bone augmented with such cement could deteriorate under dynamic loading. The aim of the present study was to assess the potential of acute failure, particle generation and mechanical properties of cancellous bone augmented with this compliant cement in comparison to regular cement. For this purpose, vertebral biopsies were augmented with porous- and regular PMMA bone cement, submitted to dynamic tests and compression to failure. Changes in Young's modulus and height due to dynamic loading were determined. Afterwards, yield strength and Young's modulus were determined by compressive tests to failure and compared to the individual composite materials. No failure occurred and no particle generation could be observed during dynamical testing for both groups. Height loss was significantly higher for the porous cement composite (0.53+/-0.21%) in comparison to the biopsies augmented with regular cement (0.16+/-0.1%). Young's modulus of biopsies augmented with porous PMMA was comparable to cancellous bone or porous cement alone (200-700 MPa). The yield strength of those biopsies (21.1+/-4.1 MPa) was around two times higher than for porous cement alone (11.6+/-3.3 MPa).

  10. Spermatogenesis in nonmammalian vertebrates.

    PubMed

    Pudney, J

    1995-12-15

    Spermatogenesis appears to be a fairly conserved process throughout the vertebrate series. Thus, spermatogonia develop into spermatocytes that undergo meiosis to produce spermatids which enter spermiogenesis where they undergo a morphological transformation into spermatozoa. There is, however, variation amongst the vertebrates in how germ cell development and maturation is accomplished. This difference can be broadly divided into two distinct patterns, one present in anamniotes (fish, amphibia) and the other in amniotes (reptiles, birds, mammals). For anamniotes, spermatogenesis occurs in spermatocysts (cysts) which for most species develop within seminiferous lobules. Cysts are produced when a Sertoli cell becomes associated with a primary spermatogonium. Mitotic divisions of the primary spermatogonium produce a cohort of secondary spermatogonia that are enclosed by the Sertoli cell which forms the wall of the cyst. With spermatogenic progression a clone of isogeneic spermatozoa is produced which are released, by rupture of the cyst, into the lumen of the seminiferous lobule. Following spermiation, the Sertoli cell degenerates. For anamniotes, therefore, there is no permanent germinal epithelium since spermatocysts have to be replaced during successive breeding seasons. By contrast, spermatogenesis in amniotes does not occur in cysts but in seminiferous tubules that possess a permanent population of Sertoli cells and spermatogonia which act as a germ cell reservoir for succeeding bouts of spermatogenic activity. There is, in general, a greater variation in the organization of the testis and pattern of spermatogenesis in the anamniotes compared to amniotes. This is primarily due to the fact there is more reproductive diversity in anamniotes ranging from a relatively unspecialized condition where gametes are simply released into the aqueous environment to highly specialized strategies involving internal fertilization. These differences are obviously reflected in the

  11. Inhomogeneity of human vertebral cancellous bone: systematic density and structure patterns inside the vertebral body.

    PubMed

    Banse, X; Devogelaer, J P; Munting, E; Delloye, C; Cornu, O; Grynpas, M

    2001-05-01

    In the spine, cancellous bone quality is usually assessed for the whole vertebral body in a transverse central slice. Correct identification and assessment of the weakest parts of the cancellous bone may lead to better prediction of fracture risk. The density and structural parameters were systematically investigated inside the thoracic (T-9), thoracolumbar (T12-L1), and lumbar (L-4) vertebral bodies of nine subjects. On both sides of the median sagittal plane, anterior and posterior 8.2 mm vertical cores were harvested in the thoracic vertebra. In the thoracolumbar and lumbar vertebrae, external samples were also cored. Peripheral quantitative computed tomographic (pQCT) density analysis of the 136 cores was performed at four different levels, from the lower to the upper endplate. The relatively thin slice thickness (300 microm) and small pixel size (70 microm x 70 microm) was considered sufficient to investigate the structural parameters on the four transverse slices and in the sagittal and coronal planes (total of 816 images). Using a constant threshold a binary image was generated and the morphometric data were extracted. The binary image was further skeletonized and classical strut analysis was performed. Cancellous bone density was 20% higher in the posterior cores than in the anterior and external cores. Moreover, clear vertical inhomogeneity was noted because the lowest half of the vertebral body presented lower density than the upper half (differences ranging from 25% to 15%). All structural parameters were strongly dependent on the location of the measurement. Structural differences between anterior, posterior, and external areas were mild and followed the density patterns. On the other hand, vertical inhomogeneity of the structural parameters was important. For example, in the thoracolumbar and lumbar vertebrae, the numbers of nodes or node-to-node struts were almost twofold higher in the inferior half than in the superior half (p < 0.01), whereas

  12. Ischial apophyseal fracture in an abused infant.

    PubMed

    Bixby, Sarah D; Wilson, Celeste R; Barber, Ignasi; Kleinman, Paul K

    2014-09-01

    We report a previously healthy 4-month-old who presented to the hospital with leg pain and swelling and no history of trauma. Radiographs demonstrated a comminuted left femur fracture. Given the concern for child abuse, skeletal survey was performed and revealed four vertebral compression deformities. Although abuse was suspected, the possibility of a lytic lesion associated with the femur fracture and multiple spinal abnormalities raised the possibility of an underlying process such as Langerhans cell histiocytosis. Subsequently 18F-NaF positron emission tomographic (PET) scintigraphy revealed increased tracer activity in the ischium, and MRI confirmed an ischial apophyseal fracture. Pelvic fractures, particularly ischial fractures, are extremely rare in the setting of child abuse. This case report describes the multimodality imaging findings of an ischial fracture in an abused infant.

  13. Skull fracture

    MedlinePlus

    ... compress the underlying brain tissue (subdural or epidural hematoma). A simple fracture is a break in the bone without damage ... Causes of skull fracture can include: Head trauma Falls, automobile accidents, physical assault, and sports

  14. Rib Fractures

    MedlinePlus

    ... From Brain Injury Additional Content Medical News Rib Fractures By Thomas G. Weiser, MD, MPH, Department of ... Hemothorax Injury to the Aorta Pulmonary Contusion Rib Fractures Tension Pneumothorax Traumatic Pneumothorax (See also Introduction to ...

  15. Hand Fractures

    MedlinePlus

    ... Thumb Arthritis Thumb Sprains Trigger Finger Tumors Wrist Fracture Hand Safety Fireworks Safety Lawnmower Safety Snowblower safety ... Tunnel Ganglion Cysts Thumb Arthritis Trigger Finger Wrist Fracture Hand Safety Fireworks Safety Lawnmower Safety Snowblower safety ...

  16. Polymethylmethacrylate and radioisotopes in vertebral augmentation: an explanation of underlying principles.

    PubMed

    Hirsch, Ariel E; Rosenstein, Barry S; Medich, David C; Martel, Christopher B; Hirsch, Joshua A

    2009-01-01

    We recently reported a novel concept for combining radioactive isotope technology with polymethylmethacrylate (PMMA) cement used for vertebral augmentation and have advocated that pain physicians become aware of this new concept when treating malignant compression fractures. The use of vertebral augmentation for malignant compression fractures is steadily increasing, and the goal of this novel approach would be to stabilize the fractured vertebral body while also controlling proliferation of the tumor cells in the vertebral body that caused the vertebral fracture. This approach would therefore provide mechanical stabilization of the fractured vertebral body at the same time as direct targeting of the cancer cells causing the fracture. For our analysis, we investigated six specific radioisotopes with regard to physical and biologic properties as they would interact with PMMA and local bone metastatic disease, taking into consideration anatomical, biological and physical characteristics. The radioisotopes investigated include beta emitting (plus and minus) sources, as well as low energy and mid-energy photon sources and are: P-32, Ho-166, Y-90, I-125, F-18, and Tc-99m. We review the advantages and disadvantages of each radioisotope. In addition, this paper serves to provide pain physicians with a basic background of the biologic principles (Biologically Effective Dose) and statistical modeling (Monte Carlo method) used in that analysis. We also review the potential complications when using radioactive sources in a clinical setting. Understanding the methodologies employed in determining isotope selection empowers the practitioner by fostering understanding of this presently theoretical treatment option. We believe that embedding radioisotopes in PMMA is merely a first step in the road of local treatment for symptomatic local lesions in the setting of systemic disease.

  17. Chemical ecology of vertebrate carrion

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Vertebrate carrion is a nutrient-rich, ephemeral resource that is utilized by many different organisms ranging from vertebrate and invertebrate scavengers to microbes. The organisms that consume carrion play an important ecological role, as decomposition is vital to ecosystem function. Without the...

  18. Facial fractures.

    PubMed Central

    Carr, M. M.; Freiberg, A.; Martin, R. D.

    1994-01-01

    Emergency room physicians frequently see facial fractures that can have serious consequences for patients if mismanaged. This article reviews the signs, symptoms, imaging techniques, and general modes of treatment of common facial fractures. It focuses on fractures of the mandible, zygomaticomaxillary region, orbital floor, and nose. Images p520-a p522-a PMID:8199509

  19. Successful Angioplasty of Left Vertebral Artery and Right Subclavian Artery Via Retrograde Approach

    PubMed Central

    Namazi, Mohammad Hasan; Momenizadeh, Amir; Dousti, Amir; Naderian, Mohammadreza

    2017-01-01

    We describe a 77-year-old male who had right upper limb ischemic symptoms and history of unsuccessful right subclavian artery angioplasty. According to ultrasound findings, upper limb angiography was performed which confirmed stenosis of the left vertebral and right subclavian arteries. Percutaneous angioplasty and stenting of left vertebral and right subclavian arteries were performed in two separate sessions. Retrograde approach was scheduled for right subclavian artery angioplasty which is challenging due to potential risks to adjacent vertebral artery. This case reports underscores that percutaneous approaches may be preferential given their confirmed long-term efficacy and lower morbidity.

  20. Trabecular mineral content of the spine in women with hip fracture: CT measurement

    SciTech Connect

    Firooznia, H.; Rafii, M.; Golimbu, C.; Schwartz, M.S.; Ort, P.

    1986-06-01

    The trabecular bone mineral content (BMC) of the spine was measured by computed tomography in 185 women aged 47-84 years with vertebral fracture (n = 74), hip fracture (n = 83), and both vertebral and hip fracture (n = 28). Eighty-seven percent of vertebral-fracture patients, 38% of hip-fracture patients, and 82% of vertebral- and hip-fracture patients had spinal BMC values below the fifth percentile for healthy premenopausal women and values 64%, 9%, and 68% below the fifth percentile for age-matched control subjects. No significant loss of spinal trabecular bone was seen in patients with hip fracture. If it is assumed that the rate of trabecular bone loss is the same in the spine and femoral neck, then hip fracture (unlike osteoporotic vertebral fracture) is not associated with disproportionate loss of trabecular bone. Hip fracture occurs secondary to weakening of bone and increased incidence of falls. Bone weakening may be due to disproportionate loss of trabecular or cortical bone, proportionate loss of both, or other as yet undetermined qualitative changes in bone.

  1. Comparative anatomy: all vertebrates do have vertebrae.

    PubMed

    Janvier, Philippe

    2011-09-13

    In contrast to lampreys and jawed vertebrates, hagfishes were thought to lack vertebrae. Now, long overlooked vertebral rudiments have been analysed in hagfish, suggesting that vertebrae existed in the last common ancestor of all vertebrates.

  2. Prevalence of exclusively and concomitant pelvic fractures at magnetic resonance imaging of suspect and occult hip fractures.

    PubMed

    Collin, David; Geijer, Mats; Göthlin, Jan H

    2016-02-01

    Pelvic fractures may occur together with hip fractures as a result of low energy trauma. It is unclear whether they do require special attention. There are conflicting results in the literature about the prevalence of both concomitant hip and pelvic fractures as well as exclusive pelvic fractures. It has been reported that hip fractures and obturator ring fractures are mutually exclusive. To retrospectively analyze the prevalence of exclusively pelvic as well as concomitant hip and pelvic fractures in patients examined with MRI after low-energy trauma in elderly. During 9 years, 316 elderly patients had been examined with MRI for suspected or occult hip fracture after a fall. A fracture was diagnosed when MRI showed focal signal abnormalities in the subcortical bone marrow, with or without disruption of adjacent cortices. One observer reviewed all studies. A second observer verified all studies with hip fractures. Follow-up was available for all but two patients that died prior to hip surgery. The prevalence of concomitant pelvic and femoral neck or trochanteric fractures was statistically compared using chi-squared test for categorical variables. Hip fractures were found in 161 (51 %) patients of which 29 (9 %) had concomitant pelvic fractures. There were exclusively pelvic fractures in 82 (26 %) patients of which 65 (79 %) were on the traumatized side only. In 73 patients, there were no fractures. Occult or suspected hip fractures are not infrequently associated with pelvic fractures. Exclusively pelvic fractures are not uncommon.

  3. Detailed description of anatomy of the fracture line in hangman's injury: a retrospective observational study on motor vehicle accident victims

    PubMed Central

    Menon, K Venugopal

    2016-01-01

    Objective: To study the precise location of fracture line in hangman's fracture to determine the fracture patterns, symmetry and involvement of different vertebral elements. Methods: 32 cases of hangman's fractures were retrospectively evaluated. All patients presented with motor vehicle accidents. CT scans were studied to accurately localize the fracture lines. Symmetry of fracture lines on both sides was assessed, and involvement of the vertebral bodies, lamina, facet joints and foramen transversarium was also determined. Results: 20 patients showed asymmetric fracture locations, 13 of them had a unilateral pedicle fracture and a contralateral pars fracture which comprised the most common injury pattern (40% of cases). Less frequent combinations for the two sides of asymmetric C2 ring disruption include pars–vertebral body (3 patients), pedicle–vertebral body (2 patients) and pedicle–lamina (2 patients). 12 patients showed symmetrical fractures (5 through the pars and 7 through the pedicles). Vertebral body and facet joint involvement were demonstrated in 15 (47%) and 16 (50%) cases, respectively. 18 cases had fractures extending into the foramen transversarium (56%). In total, 26 fracture lines primarily affected the pars (40%) and 31 affected the pedicles (49%). Conclusion: Asymmetric hangman's fracture is more common with the usual pattern being fracture pedicle on one side and pars on the other followed by the symmetric bilateral pedicle and bilateral pars fractures. Fracture lines running into the transverse foramen and facet joints are very frequent as well as those involving the vertebral bodies. Advances in knowledge: There is controversy in literature regarding the fracture locations in hangman's injury owing to lack of studies that address this subject. This article is the first to describe precisely the anatomical locations and patterns of this injury. PMID:26607649

  4. [Zoledronic acid reduces risk of any new clinical fracture and risk of death after surgical repair of a low-trauma hip fracture].

    PubMed

    Leszczyński, Piotr

    2010-01-01

    The most common treatment option for postmenopausal osteoporosis are the bisphosphonates which inhibit osteoclast function. Bisphosphonates interfere with cellular metabolism and in large clinical trials reduce risk of vertebral and non-vertebral fractures. Zoledronic acid is a potent bisphosphonate also approved for the treatment of postmenopausal osteoporosis. In addition zoledronic acid reduce relative risk of any new clinical fracture after surgical repair of low-trauma hip fracture. Also the reduction in the relative risk of death was observed after repeated once-yearly intravenous infusion. In conclusion, this is another interesting option for the treatment of the patients affected with osteoporosis and previous hip fractures.

  5. Jefferson fractures of the immature spine. Report of 3 cases.

    PubMed

    AuYong, Nicholas; Piatt, Joseph

    2009-01-01

    Jefferson fractures of the immature spine have received little attention in the study of pediatric spinal trauma. Fractures through synchondroses are a possibility in the immature spine, in addition to fractures through osseous portions of the vertebral ring, and they create opportunities for misinterpretation of diagnostic imaging. The authors describe 3 examples of Jefferson fractures in young children. All 3 cases featured fractures through an anterior synchondrosis in association with persistence of the posterior synchondrosis or a fracture of the posterior arch. The possibility of a Jefferson fracture should be considered for any child presenting with neck pain, cervical muscle spasm, or torticollis following a head injury, despite a seemingly normal cervical spine study. Jefferson fractures in young children are probably much more common than previously recognized.

  6. Evolution of the vertebrate epididymis.

    PubMed

    Jones, R C

    1998-01-01

    This review examines the structure and function of the extratesticular sperm ducts of vertebrates in terms of their evolutionary development and adaptive significance. The primitive extratesticular duct system of Chondrichthyes is described as an example of the vertebrate archetype. Adaptations of the duct system in higher vertebrates have involved a loss of some structures and specialization of others. The duct system probably evolved as a homeostatic mechanism to facilitate fertilization and some embryological development under conditions protected from the external environment. However, it is argued that the ducts also play an important role in the competition between males to achieve paternity. In vertebrates that practise internal fertilization the ducts are involved in post-testicular maturation and storage of spermatozoa. The biological significance of post-testicular sperm maturation has not been resolved. By contrast, sperm storage is essential in most male vertebrates because of the slow rate of spermatogenesis, particularly in ectotherms. Sperm storage is also important in the competition between males for paternity as it enables a male to mate a 'partner' a number of times during an oestrus in order to reduce the prospect of being cuckolded by another male. The extent of sperm maturation and storage in the epididymis of particular vertebrates depends on the relative roles of the testis and its extragonadal ducts in the competition between males for paternity. These roles depend on a number of factors, including allometric limitations to testis size, metabolic rate and the development of endothermy, and the reproductive strategy of females of the species.

  7. Lymphatic regulation in nonmammalian vertebrates.

    PubMed

    Hedrick, Michael S; Hillman, Stanley S; Drewes, Robert C; Withers, Philip C

    2013-08-01

    All vertebrate animals share in common the production of lymph through net capillary filtration from their closed circulatory system into their tissues. The balance of forces responsible for net capillary filtration and lymph formation is described by the Starling equation, but additional factors such as vascular and interstitial compliance, which vary markedly among vertebrates, also have a significant impact on rates of lymph formation. Why vertebrates show extreme variability in rates of lymph formation and how nonmammalian vertebrates maintain plasma volume homeostasis is unclear. This gap hampers our understanding of the evolution of the lymphatic system and its interaction with the cardiovascular system. The evolutionary origin of the vertebrate lymphatic system is not clear, but recent advances suggest common developmental factors for lymphangiogenesis in teleost fishes, amphibians, and mammals with some significant changes in the water-land transition. The lymphatic system of anuran amphibians is characterized by large lymphatic sacs and two pairs of lymph hearts that return lymph into the venous circulation but no lymph vessels per se. The lymphatic systems of reptiles and some birds have lymph hearts, and both groups have extensive lymph vessels, but their functional role in both lymph movement and plasma volume homeostasis is almost completely unknown. The purpose of this review is to present an evolutionary perspective in how different vertebrates have solved the common problem of the inevitable formation of lymph from their closed circulatory systems and to point out the many gaps in our knowledge of this evolutionary progression.

  8. Preceding and subsequent high- and low-trauma fracture patterns-a 13-year epidemiological study in females and males in Austria.

    PubMed

    Muschitz, C; Kocijan, R; Baierl, A; Dormann, R; Feichtinger, X; Haschka, J; Szivak, M; Muschitz, G K; Schanda, J; Pietschmann, P; Resch, H; Dimai, H P

    2017-01-30

    This study investigated the implication of a preceding high-trauma fracture on subsequent high- and low-trauma fractures at different skeletal sites in postmenopausal women and similarly aged men at an age range of 54 to 70 years. A preceding high-trauma fracture increases the risk of future low-trauma non-vertebral fractures including hip.

  9. Dorsal vertebral column abnormalities in dogs with disseminated idiopathic skeletal hyperostosis (DISH).

    PubMed

    Decker, S De; Volk, H A

    2014-06-21

    Although disseminated idiopathic skeletal hyperostosis (DISH) most often affects the ventral aspect of the vertebral column, this study evaluated the occurrence, nature and clinical relevance of dorsal vertebral column abnormalities in 10 dogs with DISH for which CT or MRI and a complete neurological examination were available. Dorsal vertebral column abnormalities were present in eight dogs and included articular process hypertrophy (n=7 dogs), periarticular new bone formation (n=1), pseudoarthrosis between spinous processes (n=4) and thickening of the dorsal lamina (n=4). These dorsal vertebral abnormalities caused clinically relevant vertebral canal stenosis in six dogs and were the only cause of clinical signs in four of these dogs. Although the lumbosacral joint was not affected by DISH, these six dogs demonstrated lumbosacral vertebral canal stenosis and clinical signs of cauda equina compression, which included paraparesis (n=5 dogs), lumbosacral pain (n=4), urinary incontinence (n=4), faecal incontinence (n=1) and urinary and faecal incontinence (n=1). There is a possible association between DISH and hypertrophy of dorsal vertebral structures, potentially resulting in vertebral canal stenosis. Although these changes occurred at segments fused by DISH, they predominantly affected adjacent non-affected segments.

  10. Vertebral morphology influences the development of Schmorl's nodes in the lower thoracic vertebrae.

    PubMed

    Plomp, Kimberly A; Roberts, Charlotte A; Viðarsdóttir, Una Strand

    2012-12-01

    Schmorl's nodes are the result of herniations of the nucleus pulposus into the adjacent vertebral body and are commonly identified in both clinical and archaeological contexts. The current study aims to identify aspects of vertebral shape that correlate with Schmorl's nodes. Two-dimensional statistical shape analysis was performed on digital images of the lower thoracic spine (T10-T12) of adult skeletons from the late medieval skeletal assemblages from Fishergate House, York, St. Mary Graces and East Smithfield Black Death cemeteries, London, and postmedieval Chelsea Old Church, London. Schmorl's nodes were scored on the basis of their location, depth, and size. Results indicate that there is a correlation between the shape of the posterior margin of the vertebral body and pedicles and the presence of Schmorl's nodes in the lower thoracic spine. The size of the vertebral body in males was also found to correlate with the lesions. Vertebral shape differences associated with the macroscopic characteristics of Schmorl's nodes, indicating severity of the lesion, were also analyzed. The shape of the pedicles and the posterior margin of the vertebral body, along with a larger vertebral body size in males, have a strong association with both the presence and severity of Schmorl's nodes. This suggests that shape and/or size of these vertebral components are predisposing to, or resulting in, vertically directed disc herniation.

  11. Mechanical stratigraphic controls on natural fracture spacing and penetration

    NASA Astrophysics Data System (ADS)

    McGinnis, Ronald N.; Ferrill, David A.; Morris, Alan P.; Smart, Kevin J.; Lehrmann, Daniel

    2017-02-01

    Fine-grained low permeability sedimentary rocks, such as shale and mudrock, have drawn attention as unconventional hydrocarbon reservoirs. Fracturing - both natural and induced - is extremely important for increasing permeability in otherwise low-permeability rock. We analyze natural extension fracture networks within a complete measured outcrop section of the Ernst Member of the Boquillas Formation in Big Bend National Park, west Texas. Results of bed-center, dip-parallel scanline surveys demonstrate nearly identical fracture strikes and slight variation in dip between mudrock, chalk, and limestone beds. Fracture spacing tends to increase proportional to bed thickness in limestone and chalk beds; however, dramatic differences in fracture spacing are observed in mudrock. A direct relationship is observed between fracture spacing/thickness ratio and rock competence. Vertical fracture penetrations measured from the middle of chalk and limestone beds generally extend to and often beyond bed boundaries into the vertically adjacent mudrock beds. In contrast, fractures in the mudrock beds rarely penetrate beyond the bed boundaries into the adjacent carbonate beds. Consequently, natural bed-perpendicular fracture connectivity through the mechanically layered sequence generally is poor. Fracture connectivity strongly influences permeability architecture, and fracture prediction should consider thin bed-scale control on fracture heights and the strong lithologic control on fracture spacing.

  12. Fracture risk prediction: importance of age, BMD and spine fracture status.

    PubMed

    Krege, John H; Wan, Xiaohai; Lentle, Brian C; Berger, Claudie; Langsetmo, Lisa; Adachi, Jonathan D; Prior, Jerilynn C; Tenenhouse, Alan; Brown, Jacques P; Kreiger, Nancy; Olszynski, Wojciech P; Josse, Robert G; Goltzman, David

    2013-01-01

    Our purpose was to identify factors for a parsimonious fracture risk assessment model considering morphometric spine fracture status, femoral neck bone mineral density (BMD) and the World Health Organization (WHO) clinical risk factors. Using data from 2761 subjects from the Canadian Multicentre Osteoporosis Study (CaMos), a prospective, longitudinal cohort study of randomly selected community-dwelling men and women aged ⩾50 years, we previously reported that a logistic regression model considering age, BMD and spine fracture status provided as much predictive information as a model considering these factors plus the remaining WHO clinical risk factors. The current analysis assesses morphometric vertebral fracture and/or nonvertebral fragility fracture at 5 years using data from an additional 1964 CaMos subjects who have now completed 5 years of follow-up (total N=4725). Vertebral fractures were identified from lateral spine radiographs assessed using quantititative morphometry at baseline and end point. Nonvertebral fragility fractures were determined by questionnaire and confirmed using radiographs or medical records; fragility fracture was defined as occurring with minimal or no trauma. In this analysis, a model including age, BMD and spine fracture status provided a gradient of risk per s.d. (GR/s.d.) of 1.88 and captured most of the predictive information of a model including morphometric spine fracture status, BMD and all WHO clinical risk factors (GR/s.d. 1.92). For comparison, this model provided more information than a model considering BMD and the WHO clinical risk factors (GR/s.d. 1.74). These findings confirm the value of age, BMD and spine fracture status for predicting fracture risk.

  13. Fracture risk prediction: importance of age, BMD and spine fracture status

    PubMed Central

    Krege, John H; Wan, Xiaohai; Lentle, Brian C; Berger, Claudie; Langsetmo, Lisa; Adachi, Jonathan D; Prior, Jerilynn C; Tenenhouse, Alan; Brown, Jacques P; Kreiger, Nancy; Olszynski, Wojciech P; Josse, Robert G; Goltzman, David; Goltzman, David; Kreiger, Nancy; Tenenhouse, Alan; Godmaire, Suzanne; Dumont, Silvia; Berger, Claudie; Zhou, Wei; Joyce, Carol; Kovacs, Christopher; Sheppard, Emma; Kirkland, Susan; Kaiser, Stephanie; Stanfield, Barbara; Brown, Jacques P; Bessette, Louis; Gendreau, Marc; Anastassiades, Tassos; Towheed, Tanveer; Matthews, Barbara; Josse, Bob; Jamal, Sophie; Murray, Tim; Gardner-Bray, Barbara; Adachi, Jonathan D.; Papaioannou, Alexandra; Pickard, Laura; Olszynski, Wojciech P.; Davison, K. Shawn; Thingvold, Jola; Hanley, David A.; Allan, Jane; Prior, Jerilynn C.; Patel, Millan; Vigna, Yvette; Andjelic, Nerkeza; Lentle, Brian

    2013-01-01

    Our purpose was to identify factors for a parsimonious fracture risk assessment model considering morphometric spine fracture status, femoral neck bone mineral density (BMD) and the World Health Organization (WHO) clinical risk factors. Using data from 2761 subjects from the Canadian Multicentre Osteoporosis Study (CaMos), a prospective, longitudinal cohort study of randomly selected community-dwelling men and women aged ⩾50 years, we previously reported that a logistic regression model considering age, BMD and spine fracture status provided as much predictive information as a model considering these factors plus the remaining WHO clinical risk factors. The current analysis assesses morphometric vertebral fracture and/or nonvertebral fragility fracture at 5 years using data from an additional 1964 CaMos subjects who have now completed 5 years of follow-up (total N=4725). Vertebral fractures were identified from lateral spine radiographs assessed using quantititative morphometry at baseline and end point. Nonvertebral fragility fractures were determined by questionnaire and confirmed using radiographs or medical records; fragility fracture was defined as occurring with minimal or no trauma. In this analysis, a model including age, BMD and spine fracture status provided a gradient of risk per s.d. (GR/s.d.) of 1.88 and captured most of the predictive information of a model including morphometric spine fracture status, BMD and all WHO clinical risk factors (GR/s.d. 1.92). For comparison, this model provided more information than a model considering BMD and the WHO clinical risk factors (GR/s.d. 1.74). These findings confirm the value of age, BMD and spine fracture status for predicting fracture risk. PMID:24228164

  14. Evolution of neural crest and placodes: amphioxus as a model for the ancestral vertebrate?

    NASA Technical Reports Server (NTRS)

    Holland, L. Z.; Holland, N. D.

    2001-01-01

    Recent studies of protochordates (ascidian tunicates and amphioxus) have given insights into possible ancestors of 2 of the characteristic features of the vertebrate head: neural crest and placodes. The neural crest probably evolved from cells on either side of the neural plate-epidermis boundary in a protochordate ancestral to the vertebrates. In amphioxus, homologues of several vertebrate neural crest marker genes (BMP2/4, Pax3/7, Msx, Dll and Snail) are expressed at the edges of the neural plate and/or adjacent nonneural ectoderm. Some of these markers are also similarly expressed in tunicates. In protochordates, however, these cells, unlike vertebrate neural crest, neither migrate as individuals through embryonic tissues nor differentiate into a wide spectrum of cell types. Therefore, while the protochordate ancestor of the vertebrates probably had the beginnings of a genetic programme for neural crest formation, this programme was augmented in the earliest vertebrates to attain definitive neural crest. Clear homologues of vertebrate placodes are lacking in protochordates. However, both amphioxus and tunicates have ectodermal sensory cells. In tunicates these are all primary neurons, sending axons to the central nervous system, while in amphioxus, the ectodermal sensory cells include both primary neurons and secondary neurons lacking axons. Comparisons of developmental gene expression suggest that the anterior ectoderm in amphioxus may be homologous to the vertebrate olfactory placode, the only vertebrate placode with primary, not secondary, neurons. Similarly, biochemical, morphological and gene expression data suggest that amphioxus and tunicates also have homologues of the adenohypophysis, one of the few vertebrate structures derived from nonneurogenic placodes. In contrast, the origin of the other vertebrate placodes is very uncertain.

  15. Spinal compression fractures due to pregnancy-associated osteoporosis

    PubMed Central

    Krishnakumar, R; Kumar, Arun T; Kuzhimattam, Mathew John

    2016-01-01

    Objectives: To report on unique cases of spinal compression fractures due to pregnancy-associated osteoporosis (PAO) and to suggest a satisfactory treatment modality. Materials and Methods: A single-center retrospective study. We reviewed the data of 535 patients with osteoporotic spinal compression fractures over a period of 5-year. Two patients who developed spinal compression fractures due to PAO were identified and treated. Results: The clinical presentation and blood investigations ruled out other causes of osteoporosis. Dual-energy X-ray absorptiometry was used to confirm the diagnosis. All patients improved with medical management. Conclusion: Vertebral fractures due to PAO should be considered as a differential diagnosis in patients with back pain who are in the third trimester of pregnancy or in postpartum. Early recognition and appropriate conservative management would be necessary to prevent complications such as new vertebral fractures and chronic back pain. PMID:27891031

  16. 46 CFR 148.445 - Adjacent spaces.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 5 2013-10-01 2013-10-01 false Adjacent spaces. 148.445 Section 148.445 Shipping COAST... THAT REQUIRE SPECIAL HANDLING Additional Special Requirements § 148.445 Adjacent spaces. When... following requirements must be met: (a) Each space adjacent to a cargo hold must be ventilated by...

  17. 46 CFR 148.445 - Adjacent spaces.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 5 2012-10-01 2012-10-01 false Adjacent spaces. 148.445 Section 148.445 Shipping COAST... THAT REQUIRE SPECIAL HANDLING Additional Special Requirements § 148.445 Adjacent spaces. When... following requirements must be met: (a) Each space adjacent to a cargo hold must be ventilated by...

  18. 46 CFR 148.445 - Adjacent spaces.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 5 2014-10-01 2014-10-01 false Adjacent spaces. 148.445 Section 148.445 Shipping COAST... THAT REQUIRE SPECIAL HANDLING Additional Special Requirements § 148.445 Adjacent spaces. When... following requirements must be met: (a) Each space adjacent to a cargo hold must be ventilated by...

  19. 46 CFR 148.445 - Adjacent spaces.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 5 2011-10-01 2011-10-01 false Adjacent spaces. 148.445 Section 148.445 Shipping COAST... THAT REQUIRE SPECIAL HANDLING Additional Special Requirements § 148.445 Adjacent spaces. When... following requirements must be met: (a) Each space adjacent to a cargo hold must be ventilated by...

  20. [Neural crest and vertebrate evolution].

    PubMed

    Le Douarin, Nicole M; Creuzet, Sophie

    2011-01-01

    The neural crest (NC) is a remarkable structure of the Vertebrate embryo, which forms from the lateral borders of the neural plate (designated as neural folds) during neural tube closure. As soon as the NC is formed, its constitutive cells detach and migrate away from the neural primordium along definite pathways and at precise periods of time according to a rostro-caudal progression. The NC cells aggregate in definite places in the developing embryo, where they differentiate into a large variety of cell types including the neurons and glial cells of the peripheral nervous system, the pigment cells dispersed throughout the body and endocrine cells such as the adrenal medulla and the calcitonin producing cells. At the cephalic level only, in higher Vertebrates (but along the whole neural axis in Fishes and Amphibians), the NC is also at the origin of mesenchymal cells differentiating into connective tissue chondrogenic and osteogenic cells. Vertebrates belong to the larger group of Cordates which includes also the Protocordates (Cephalocordates and the Urocordates). All Cordates are characterized by the same body plan with a dorsal neural tube and a notochord which, in Vertebrates, exists only at embryonic stages. The main difference between Protocordates and Vertebrates is the very rudimentary development of cephalic structures in the former. As a result, the process of cephalization is one of the most obvious characteristics of Vertebrates. It was accompanied by the apparition of the NC which can therefore be considered as an innovation of Vertebrates during evolution. The application of a cell marking technique which consists in constructing chimeric embryos between two species of birds, the quail and the chicken, has led to show that the vertebrate head is mainly formed by cells originating from the NC, meaning that this structure was an important asset in Vertebrate evolution. Recent studies, described in this article, have strengthened this view by showing

  1. Ankle fracture - aftercare

    MedlinePlus

    Malleolar fracture; Tri-malleolar; Bi-malleolar; Distal tibia fracture; Distal fibula fracture; Malleolus fracture ... Some ankle fractures may require surgery when: The ends of the bone are out of line with each other (displaced). The ...

  2. Vestibular blueprint in early vertebrates

    PubMed Central

    Straka, Hans; Baker, Robert

    2013-01-01

    Central vestibular neurons form identifiable subgroups within the boundaries of classically outlined octavolateral nuclei in primitive vertebrates that are distinct from those processing lateral line, electrosensory, and auditory signals. Each vestibular subgroup exhibits a particular morpho-physiological property that receives origin-specific sensory inputs from semicircular canal and otolith organs. Behaviorally characterized phenotypes send discrete axonal projections to extraocular, spinal, and cerebellar targets including other ipsi- and contralateral vestibular nuclei. The anatomical locations of vestibuloocular and vestibulospinal neurons correlate with genetically defined hindbrain compartments that are well conserved throughout vertebrate evolution though some variability exists in fossil and extant vertebrate species. The different vestibular subgroups exhibit a robust sensorimotor signal processing complemented with a high degree of vestibular and visual adaptive plasticity. PMID:24312016

  3. Hip and other fragility fracture incidence in real-world teriparatide-treated patients in the United States.

    PubMed

    Burge, R T; Disch, D P; Gelwicks, S; Zhang, X; Krege, J H

    2017-03-01

    This study demonstrates real-world effectiveness of teriparatide in reducing the risk of hip and other fragility fractures. Fracture incidence significantly decreased as adherence and persistence increased for any clinical, vertebral, nonvertebral, and hip fractures among patients who were observed for 2 years after teriparatide initiation.

  4. Evolution of the head-trunk interface in tetrapod vertebrates.

    PubMed

    Sefton, Elizabeth M; Bhullar, Bhart-Anjan S; Mohaddes, Zahra; Hanken, James

    2016-04-19

    Vertebrate neck musculature spans the transition zone between head and trunk. The extent to which the cucullaris muscle is a cranial muscle allied with the gill levators of anamniotes or is instead a trunk muscle is an ongoing debate. Novel computed tomography datasets reveal broad conservation of the cucullaris in gnathostomes, including coelacanth and caecilian, two sarcopterygians previously thought to lack it. In chicken, lateral plate mesoderm (LPM) adjacent to occipital somites is a recently identified embryonic source of cervical musculature. We fate-map this mesoderm in the axolotl (Ambystoma mexicanum), which retains external gills, and demonstrate its contribution to posterior gill-levator muscles and the cucullaris. Accordingly, LPM adjacent to the occipital somites should be regarded as posterior cranial mesoderm. The axial position of the head-trunk border in axolotl is congruent between LPM and somitic mesoderm, unlike in chicken and possibly other amniotes.

  5. Biomechanics of metastatic disease in the vertebral column.

    PubMed

    Whyne, Cari M

    2014-06-01

    Metastatic disease in the vertebral column compromises the structural stability of the spine leading to increased risk of fracture. The complex patterns of osteolytic and osteoblastic disease within the bony spine have motivated a multimodal approach to better characterize the biomechanics of tumor-involved bone. This review presents our current understanding of the biomechanical behavior of metastatically involved vertebrae, and experimental and computational image-based approaches that have been employed to quantify structural integrity in preclinical models with translation to clinical data sets.

  6. Shape regression for vertebra fracture quantification

    NASA Astrophysics Data System (ADS)

    Lund, Michael Tillge; de Bruijne, Marleen; Tanko, Laszlo B.; Nielsen, Mads

    2005-04-01

    Accurate and reliable identification and quantification of vertebral fractures constitute a challenge both in clinical trials and in diagnosis of osteoporosis. Various efforts have been made to develop reliable, objective, and reproducible methods for assessing vertebral fractures, but at present there is no consensus concerning a universally accepted diagnostic definition of vertebral fractures. In this project we want to investigate whether or not it is possible to accurately reconstruct the shape of a normal vertebra, using a neighbouring vertebra as prior information. The reconstructed shape can then be used to develop a novel vertebra fracture measure, by comparing the segmented vertebra shape with its reconstructed normal shape. The vertebrae in lateral x-rays of the lumbar spine were manually annotated by a medical expert. With this dataset we built a shape model, with equidistant point distribution between the four corner points. Based on the shape model, a multiple linear regression model of a normal vertebra shape was developed for each dataset using leave-one-out cross-validation. The reconstructed shape was calculated for each dataset using these regression models. The average prediction error for the annotated shape was on average 3%.

  7. Vertebral body recollapse without trauma after kyphoplasty with calcium phosphate cement.

    PubMed

    Piazzolla, Andrea; De Giorgi, Giuseppe; Solarino, Giuseppe

    2011-08-01

    Traditionally, immobilization and external bracing has been recommended for patients with type A traumatic and non-osteoporotic fractures that do not present neurological deficits or significant instability. Nevertheless, several authors have recently suggested the possibility to treat thoraco-lumbar and lumbar vertebral compression post-traumatic fractures using standalone balloon kyphoplasty with osteoconductive filler materials, such as calcium phosphate (CPC). Maestretti and Huang have demonstrated the advantages of this technique showing an almost immediate return to daily activities without the inconvenience of wearing a brace, pain reduction, minimal operative risks and maintenance of stability, therefore proposing this as a first-choice technique in young patient needing rapid spine stability. The authors present a case of vertebral body recollapse after kyphoplasty with calcium phosphate cement (CPC) in a 47-year-old man with an A1.2 post-traumatic L1 compression fracture.

  8. Fracture Management

    MedlinePlus

    ... to hold the fracture in the correct position. • Fiberglass casting is lighter and stronger and the exterior ... with your physician if this occurs. • When a fiberglass cast is used in conjunction with a GORE- ...

  9. Hip Fracture

    MedlinePlus

    ... make older people more likely to trip and fall — one of the most common causes of hip ... Taking steps to maintain bone density and avoid falls can help prevent hip fracture. Signs and symptoms ...

  10. Evaluation of patients with a recent clinical fracture and osteoporosis, a multidisciplinary approach

    PubMed Central

    Dumitrescu, Bianca; van Helden, Svenjhalmar; ten Broeke, Rene; Nieuwenhuijzen-Kruseman, Arie; Wyers, Caroline; Udrea, Gabriela; Linden, Sjef van der; Geusens, Piet

    2008-01-01

    The aetiology of osteoporotic fractures is multifactorial, but little is known about the way to evaluate patients with a recent clinical fracture for the presence of secondary osteoporosis. The purpose of this study was to determine the prevalence of contributors to secondary osteoporosis in patients presenting with a clinical vertebral or non-vertebral fracture. Identifying and correcting these contributors will enhance treatment effect aimed at reducing the risk of subsequent fractures. In a multidisciplinary approach, including evaluation of bone and fall-related risk factors, 100 consecutive women (n = 73) and men (n = 27) older than 50 years presenting with a clinical vertebral or non-vertebral fracture and having osteoporosis (T-score ≤-2.5) were further evaluated clinically and by laboratory testing for the presence of contributors to secondary osteoporosis. In 27 patients, 34 contributors were previously known, in 50 patients 52 new contributors were diagnosed (mainly vitamin D deficiency in 42) and 14 needed further exploration because of laboratory abnormalities (mainly abnormal thyroid stimulating hormone in 9). The 57 patients with contributors were older (71 vs. 64 yrs, p < 0.01), had more vertebral deformities (67% vs. 44%, p < 0.05) and a higher calculated absolute 10-year risk for major (16.5 vs. 9.9%, p < 0.01) and for hip fracture (6.9 vs. 2.4%, p < 0.01) than patients without contributors. The presence of contributors was similar between women and men and between patients with fractures associated with a low or high-energy trauma. We conclude that more than one in two patients presenting with a clinical vertebral or non-vertebral fracture and BMD-osteoporosis have secondary contributors to osteoporosis, most of which were correctable. Identifying and correcting these associated disorders will enhance treatment effect aimed at reducing the risk of subsequent fractures in patients older than 50 years. PMID:18680609

  11. Lisfranc fractures.

    PubMed

    Wright, Amanda; Gerhart, Ann E

    2009-01-01

    Injuries of the tarsometatarsal, or Lisfranc, joint are rarely seen. Lisfranc fractures and fracture dislocations are among the most frequently misdiagnosed foot injuries in the emergency department. A misdiagnosed injury may have severe consequences including chronic pain and loss of foot biomechanics. Evaluation of a foot injury should include a high level of suspicion of a Lisfranc injury, and a thorough work-up is needed for correct diagnosis.

  12. Colles' fracture.

    PubMed

    Altizer, Linda L

    2008-01-01

    Many people "slip and fall", especially in the icy areas of the winter season. To prevent an injury to the head, most people put their hand out to hit the ground first, so the wrist usually gets injured. The most frequent injury from this type of "intervention" is a fracture to the distal radius and/or ulna, which is frequently called a "Colles' fracture."

  13. Learning about Vertebrate Limb Development

    ERIC Educational Resources Information Center

    Liang, Jennifer O.; Noll, Matthew; Olsen, Shayna

    2014-01-01

    We have developed an upper-level undergraduate laboratory exercise that enables students to replicate a key experiment in developmental biology. In this exercise, students have the opportunity to observe live chick embryos and stain the apical ectodermal ridge, a key tissue required for development of the vertebrate limb. Impressively, every…

  14. Boxer's fracture.

    PubMed

    Altizer, Linda

    2006-01-01

    Boxer's fracture is a common name for a fracture of the distal fifth metacarpal and received its name from one of its most common causes, punching an object with a closed fist. It can occur from a fistfight or from punching a hard object. The injury of a "Boxer's Fracture" earned the name from the way in which the injury occurred, punching an immovable object with a closed fist and no boxing mitt (Figure 1). Naturally, a "Boxer" usually punches his fist into his opponent's face or body. An angry person may perform the same action into a person, or into the wall. The third person may be performing a task and strike something with his fist with forceful action accidentally. In any event, if the closed fist "punches" into an immovable or firm object with force, the most frequent injury sustained would be a fracture of the fifth metacarpal neck. Some caregivers would also call a fourth metacarpal neck fracture a boxer's fracture.

  15. The Efficacy of Bisphosphonates for Prevention of Osteoporotic Fracture: An Update Meta-analysis

    PubMed Central

    Byun, Ji-Hye; Jang, Sunmee; Lee, Sumin; Park, Suyeon; Yoon, Hyun Koo

    2017-01-01

    Background The efficacy of bisphosphonates for osteoporotic fracture has been consistently reported in recent randomized controlled trials (RCTs) enrolling hundreds of patients. The objective of this study was to update knowledge on the efficacy of available bisphosphonates in the prevention of vertebral and non-vertebral fractures. Methods An approach “using systematic reviews” on PubMed and Cochrane Library was taken. Twenty-four RCTs investigating the effects of bisphosphonates for the prevention of osteoporotic fracture were included in final analysis. A pairwise meta-analysis was conducted with a random effects model. Subgroup analysis was performed according to the type of bisphosphonate. Results The use of bisphosphonate decrease the risk of overall osteoporotic fracture (odds ratio [OR] 0.62; P<0.001), vertebral fracture (OR 0.55; P<0.001) and non-vertebral fracture (OR 0.73; P<0.001). Subgroup analysis indicated that zoledronic acid showed the lowest risk reduction (OR 0.61; P<0.001) for overall osteoporotic fractures but no significance was observed for etidronate (OR 0.34; P=0.127). Conclusions This update meta-analysis re-confirmed that bisphosphonate use can effectively reduce the risk of osteoporotic fracture. However, there is a lack of evidence regarding etidronate for the prevention of osteoporotic fracture. PMID:28326300

  16. Wrist Fracture and Risk of Subsequent Fracture: Findings from the Women’s Health Initiative Study

    PubMed Central

    Crandall, Carolyn J.; Hovey, Kathleen M.; Cauley, Jane A.; Andrews, Christopher A.; Curtis, Jeffrey R.; Wactawski-Wende, Jean; Wright, Nicole C.; Li, Wenjun; LeBoff, Meryl S.

    2015-01-01

    Wrist fractures are common in postmenopausal women and are associated with functional decline. Fracture patterns after wrist fracture are unclear. The goal of this study was to determine the frequency and types of fractures that occur after a wrist fracture among postmenopausal women. We carried out a post-hoc analysis of data from the Women’s Health Initiative Observational Study and Clinical Trials (1993–2010) carried out at 40 U.S. clinical centers. Participants were postmenopausal women aged 50–79 at baseline. Mean follow-up duration was 11.8 years. Main measures included incident wrist, clinical spine, humerus, upper extremity, lower extremity, hip, and total non-wrist fractures and bone mineral density (BMD) in a subset. Among women who experienced wrist fracture, 15.5% subsequently experienced non-wrist fracture. The hazard for non-wrist fractures was higher among women who had experienced previous wrist fracture than among women who had not experienced wrist fracture: non-wrist fracture overall (hazard ratio [HR] 1.40, 95% confidence interval [CI] 1.33–1.48), spine (HR 1.48, 95% CI 1.32–1.66), humerus (HR 1.78, 95% CI 1.57–2.02), upper extremity (non-wrist) (HR 1.88, 95% CI 1.70–2.07), lower extremity (non-hip) (HR 1.36, 95% CI 1.26–1.48), and hip (HR 1.50, 95% CI 1.32–1.71) fracture. Associations persisted after adjustment for BMD, physical activity, and other risk factors. Risk of non-wrist fracture was higher in women who were younger when they experienced wrist fracture (interaction p-value 0.02). Associations between incident wrist fracture and subsequent non-wrist fracture did not vary by baseline BMD category (normal, low bone density, osteoporosis). A wrist fracture is associated with increased risk of subsequent hip, vertebral, upper extremity, and lower extremity fractures. There may be substantial missed opportunity for intervention in the large number of women who present with wrist fractures. PMID:25990562

  17. Early development of the vertebral column.

    PubMed

    Scaal, Martin

    2016-01-01

    The segmental organization of the vertebrate body is most obviously visible in the vertebral column, which consists of a series of vertebral bones and interconnecting joints and ligaments. During embryogenesis, the vertebral column derives from the somites, which are the primary segments of the embryonic paraxial mesoderm. Anatomical, cellular and molecular aspects of vertebral column development have been of interest to developmental biologists for more than 150 years. This review briefly summarizes the present knowledge on early steps of vertebral column development in amniotes, starting from sclerotome formation and leading to the establishment of the anatomical bauplan of the spine composed of vertebral bodies, vertebral arches, intervertebral discs and ribs, and their specific axial identities along the body axis.

  18. Evolution of endothelin receptors in vertebrates.

    PubMed

    Braasch, Ingo; Schartl, Manfred

    2014-12-01

    Endothelin receptors are G protein coupled receptors (GPCRs) of the β-group of rhodopsin receptors that bind to endothelin ligands, which are 21 amino acid long peptides derived from longer prepro-endothelin precursors. The most basal Ednr-like GPCR is found outside vertebrates in the cephalochordate amphioxus, but endothelin ligands are only present among vertebrates, including the lineages of jawless vertebrates (lampreys and hagfishes), cartilaginous vertebrates (sharks, rays, and chimaeras), and bony vertebrates (ray-finned fishes and lobe-finned vertebrates including tetrapods). A bona fide endothelin system is thus a vertebrate-specific innovation with important roles for regulating the cardiovascular system, renal and pulmonary processes, as well as for the development of the vertebrate-specific neural crest cell population and its derivatives. Expectedly, dysregulation of endothelin receptors and the endothelin system leads to a multitude of human diseases. Despite the importance of different types of endothelin receptors for vertebrate development and physiology, current knowledge on endothelin ligand-receptor interactions, on the expression of endothelin receptors and their ligands, and on the functional roles of the endothelin system for embryonic development and in adult vertebrates is very much biased towards amniote vertebrates. Recent analyses from a variety of vertebrate lineages, however, have shown that the endothelin system in lineages such as teleost fish and lampreys is more diverse and is divergent from the mammalian endothelin system. This diversity is mainly based on differential evolution of numerous endothelin system components among vertebrate lineages generated by two rounds of whole genome duplication (three in teleosts) during vertebrate evolution. Here we review current understanding of the evolutionary history of the endothelin receptor family in vertebrates supplemented with surveys on the endothelin receptor gene complement of

  19. Anterior D-rod and titanium mesh fixation for acute mid-lumbar burst fracture with incomplete neurologic deficits: A prospective study of 56 consecutive patients

    PubMed Central

    Huang, Zhe-yuan; Ding, Zhen-qi; Liu, Hao-yuan; Fang, Jun; Liu, Hui; Sha, Mo

    2015-01-01

    Background: Anterior decompression and reconstruction have gained wide acceptance as viable alternatives for unstable mid-lumbar burst fracture, but there are no mid and long term prospective studies regarding clinical and radiologic results of mid-lumbar burst fractures. Materials and Methods: An Institutional Review Board-approved prospective study of 56 consecutive patients of mid-lumbar burst fractures with a load-sharing score of 7 or more treated with anterior plating was carried out. All patients were evaluated for radiologic and clinical outcomes. The fusion status, spinal canal compromise, segmental kyphotic angle (SKA), vertebral body height loss (VBHL), and adjacent segment degeneration was examined for radiologic outcome, whereas the American Spinal Injury Association scale, the visual analog scale (VAS), and the employment status were used for clinical evaluation. Results: The patients underwent clinical and radiologic followup for at least 5 years after the surgery. At the last followup, there was no case of internal fixation failure, adjacent segment degeneration, and other complications. Interbody fusion was achieved in all cases. The average fusion time was 4.5 months. No patient suffered neurological deterioration and the average neurologic recovery was 1.3 grades on final observation. Based on VAS pain scores, canal compromise, percentage of VBHL and SKA, the difference was statistically significant between the preoperative period and postoperative or final followup (P < 0.05). Results at postoperative and final followup were better than the preoperative period. However, the difference was not significant between postoperative and final followup (P > 0.05). Thirty-four patients who were employed before the injury returned to work after the operation, 15 had changed to less strenuous work. Conclusion: Good mid term clinicoradiological results of anterior decompression with D-rod and titanium mesh fixation for suitable patients with mid

  20. [Osteoporotic fractures in pregnancy - conjunction of factors?].

    PubMed

    Silva, Lígia; Sampaio, Luzia; Pinto, José; Brito, J Silva; Ventura, Francisco S

    2009-01-01

    Pregnancy-associated osteoporosis is rare and self--limiting. We report two clinical cases, with beginning of back pain during a 1st pregnancy. In the 1st case, the pain became severe after a fall, and she had other risk factors of fracture, like low calcium intake, and a treatment with thyroid hormones for weight loss. In the 2nd case, we did not find any. Both were diagnosed of osteoporosis by bone densitometry and radiology (multiple vertebral compression fractures). They had a favorable progression with life-style measures, calcium and vitamin D supplementation, and oral biphosphonate in the 2nd case. Nevertheless, both still suffer the impact.

  1. Microscale Material Properties of Bone and the Mineralized Tissues of the Intervertebral Disc-Vertebral Body Interface

    NASA Astrophysics Data System (ADS)

    Paietta, Rachel C.

    The objective of this dissertation is to understand the influences of material structure on the properties, function and failure of biological connective tissues. Biological interfaces are becoming an increasingly studied system within mechanics and tissue engineering as a model for attaching dissimilar materials. The elastic modulus of bone (≈ 20 GPa) and cartilage (≈ 0.1-1 MPa) differ over orders of magnitude, which should intuitively create high stress concentrations and failure at the interface. Yet, these natural interface systems rarely fail in vivo, and the mechanism by which loads are transferred between tissues has not yet been established. Tissue quality is one major contributor to the mechanical behavior of bone and cartilage, and is defined by properties such as collagen orientation, mineral volume fraction, porosity and tissue geometry. These properties have yet to be established at the bone-cartilage interface in the spine, and the lack of quantitative data on material microstructure and behavior limits treatments and tissue engineering construct design. In this dissertation, second harmonic generation imaging, quantitative backscattered scanning electron imaging and nanoindentation are combined to characterize micrometer scale tissue quality and modulus in both bone and calcified cartilage. These techniques are utilized to: 1) determine the hierarchical micrometer to millimeter scale properties of lamellar bone, 2) quantify changes throughout development and aging at the human intervertebral disc-vertebral body junction, and 3) explore compressive fractures at this interface. This work is the first to provide quantitative data on the mineral volume fraction, collagen orientation and modulus from the same, undecalcified sections of tissue to corroborate tissue structure and mineralization and describe quantitative parameters of the interface. The principal findings from this work indicate that the underlying matrix, or collagen, organization in

  2. Cervical vertebral bone age in girls.

    PubMed

    Mito, Toshinori; Sato, Koshi; Mitani, Hideo

    2002-10-01

    The purpose of this study was to establish cervical vertebral bone age as a new index for objectively evaluating skeletal maturation on cephalometric radiographs. Using cephalometric radiographs of 176 girls (ages 7.0-14.9 years), we measured cervical vertebral bodies and determined a regression formula to obtain cervical vertebral bone age. Next, using cephalometric and hand-wrist radiographs of another 66 girls (ages 8.0-13.9 years), we determined the correlation between cervical vertebral bone age and bone age using the Tanner-Whitehouse 2 method. The following results were obtained: (1) a regression formula was determined to obtain cervical vertebral bone age based on ratios of measurements in the third and fourth cervical vertebral bodies; (2) the correlation coefficient for the relationship between cervical vertebral bone age and bone age (0.869) was significantly (P <.05) higher than that for the relationship between cervical vertebral bone age and chronological age (0.705); and (3) the difference (absolute value) between the cervical vertebral bone age and bone age (0.75 years) was significantly (P <.001) smaller than that between cervical vertebral bone age and chronological age (1.17 years). These results suggest that cervical vertebral bone age reflects skeletal maturity because it approximates bone age, which is considered to be the most reliable method for evaluating skeletal maturation. Using cervical vertebral bone age, it might be possible to evaluate maturity in a detailed and objective manner on cephalometric radiographs.

  3. Vertebral Augmentation with Nitinol Endoprosthesis: Clinical Experience in 40 Patients with 1-Year Follow-up

    SciTech Connect

    Anselmetti, Giovanni Carlo; Manca, Antonio; Marcia, Stefano; Chiara, Gabriele; Marini, Stefano; Baroud, Gamal; Regge, Daniele; Montemurro, Filippo

    2013-05-08

    PurposeThis study was designed to assess the clinical outcomes of patients treated by vertebral augmentation with nitinol endoprosthesis (VNE) to treat painful vertebral compression fractures.MethodsForty patients with one or more painful osteoporotic VCF, confirmed by MRI and accompanied by back-pain unresponsive to a minimum 2 months of conservative medical treatment, underwent VNE at 42 levels. Preoperative and postoperative pain measured with Visual Analog Scale (VAS), disability measured by Oswestry Disability Index (ODI), and vertebral height restoration (measured with 2-dimensional reconstruction CT) were compared at last follow-up (average follow-up 15 months). Cement extravasation, subsequent fractures, and implant migration were recorded.ResultsLong-term follow-up was obtained in 38 of 40 patients. Both VAS and ODI significantly improved from a median of 8.0 (range 5–10) and 66 % (range 44–88 %) to 0.5 (range 0–8) and 6 % (range 6–66 %), respectively, at 1 year (p < 0.0001). Vertebral height measurements comparing time points increased in a statistically significant manner (ANOVA, p < 0.001). Overall cement extravasation rate was 9.5 %. Discal and venous leakage rates were 7.1 and 0 % respectively. No symptomatic extravasations occurred. Five of 38 (13.1 %) patients experienced new spontaneous, osteoporotic fractures. No device change or migration was observed.ConclusionsVNE is a safe and effective procedure that is able to provide long-lasting pain relief and durable vertebral height gain with a low rate of new fractures and cement leakages.

  4. 43 CFR 420.3 - Adjacent lands.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 43 Public Lands: Interior 1 2014-10-01 2014-10-01 false Adjacent lands. 420.3 Section 420.3 Public Lands: Interior Regulations Relating to Public Lands BUREAU OF RECLAMATION, DEPARTMENT OF THE INTERIOR OFF-ROAD VEHICLE USE § 420.3 Adjacent lands. When administratively feasible, the regulation of...

  5. 43 CFR 420.3 - Adjacent lands.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 43 Public Lands: Interior 1 2012-10-01 2011-10-01 true Adjacent lands. 420.3 Section 420.3 Public Lands: Interior Regulations Relating to Public Lands BUREAU OF RECLAMATION, DEPARTMENT OF THE INTERIOR OFF-ROAD VEHICLE USE § 420.3 Adjacent lands. When administratively feasible, the regulation of...

  6. 43 CFR 420.3 - Adjacent lands.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 43 Public Lands: Interior 1 2013-10-01 2013-10-01 false Adjacent lands. 420.3 Section 420.3 Public Lands: Interior Regulations Relating to Public Lands BUREAU OF RECLAMATION, DEPARTMENT OF THE INTERIOR OFF-ROAD VEHICLE USE § 420.3 Adjacent lands. When administratively feasible, the regulation of...

  7. 43 CFR 420.3 - Adjacent lands.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Adjacent lands. 420.3 Section 420.3 Public Lands: Interior Regulations Relating to Public Lands BUREAU OF RECLAMATION, DEPARTMENT OF THE INTERIOR OFF-ROAD VEHICLE USE § 420.3 Adjacent lands. When administratively feasible, the regulation of...

  8. 43 CFR 420.3 - Adjacent lands.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 43 Public Lands: Interior 1 2011-10-01 2011-10-01 false Adjacent lands. 420.3 Section 420.3 Public Lands: Interior Regulations Relating to Public Lands BUREAU OF RECLAMATION, DEPARTMENT OF THE INTERIOR OFF-ROAD VEHICLE USE § 420.3 Adjacent lands. When administratively feasible, the regulation of...

  9. Morphological castes in a vertebrate

    PubMed Central

    O'Riain, M. J.; Jarvis, J. U. M.; Alexander, R.; Buffenstein, R.; Peeters, C.

    2000-01-01

    Morphological specialization for a specific role has, until now, been assumed to be restricted to social invertebrates. Herein we show that complete physical dimorphism has evolved between reproductives and helpers in the eusocial naked mole-rat. Dimorphism is a consequence of the lumbar vertebrae lengthening after the onset of reproduction in females. This is the only known example of morphological castes in a vertebrate and is distinct from continuous size variation between breeders and helpers in other species of cooperatively breeding vertebrates. The evolution of castes in a mammal and insects represents a striking example of convergent evolution for enhanced fecundity in societies characterized by high reproductive skew. Similarities in the selective environment between naked mole-rats and eusocial insect species highlight the selective conditions under which queen/worker castes are predicted to evolve in animal societies. PMID:11087866

  10. Case 24: Stress Fracture of the Tibia

    DTIC Science & Technology

    2008-03-01

    strengthening was started. At six-week follow up, periosteal involvement was subsiding and a healing sclerotic band was seen across the tibial shaft on...stress fracture. Fig. 2: Axial CT showing the periosteal reaction. Female athletes have the greater tendency of acquiring tibial stress...extremity to include the vertebral body, femoral neck, tibial diaphysis, metatarsal shaft and calcaneous are most commonly affected. If the offending

  11. Fracture types (1) (image)

    MedlinePlus

    ... fracture which goes at an angle to the axis Comminuted - a fracture of many relatively small fragments Spiral - a fracture which runs around the axis of the bone Compound - a fracture (also called ...

  12. Hydraulic fracturing-1

    SciTech Connect

    Not Available

    1990-01-01

    This book contains papers on hydraulic fracturing. Topics covered include: An overview of recent advances in hydraulic fracturing technology; Containment of massive hydraulic fracture; and Fracturing with a high-strength proppant.

  13. Vertebral development and amphibian evolution.

    PubMed

    Carroll, R L; Kuntz, A; Albright, K

    1999-01-01

    Amphibians provide an unparalleled opportunity to integrate studies of development and evolution through the investigation of the fossil record of larval stages. The pattern of vertebral development in modern frogs strongly resembles that of Paleozoic labyrinthodonts in the great delay in the ossification of the vertebrae, with the centra forming much later than the neural arches. Slow ossification of the trunk vertebrae in frogs and the absence of ossification in the tail facilitate the rapid loss of the tail during metamorphosis, and may reflect retention of the pattern in their specific Paleozoic ancestors. Salamanders and caecilians ossify their centra at a much earlier stage than frogs, which resembles the condition in Paleozoic lepospondyls. The clearly distinct patterns and rates of vertebral development may indicate phylogenetic separation between the ultimate ancestors of frogs and those of salamanders and caecilians within the early radiation of ancestral tetrapods. This divergence may date from the Lower Carboniferous. Comparison with the molecular regulation of vertebral development described in modern mammals and birds suggests that the rapid chondrification of the centra in salamanders relative to that of frogs may result from the earlier migration of sclerotomal cells expressing Pax1 to the area surrounding the notochord.

  14. Effects of Interface Behavior on Fracture Spacing in Layered Rock

    NASA Astrophysics Data System (ADS)

    Chang, Xu; Wang, Jianhua; Tang, Chunan; Ru, Zhongliang

    2016-05-01

    To better understand the periodically distributed fractures in rock sequences, the effects of the layer interfaces on the evolution of the stress distribution in a fracture-bound block and on the fracture infilling process are discussed. A three-layer model is developed based on a cohesive zone model (CZM) for layer interfaces and a plastic-damaged model for rock layers. The results indicate that the interface shear strength can greatly influence the stress distribution in a fracture-bound block so that the ratio of the fracture spacing to the layer thickness ( S/ T f) is not the dominant factor in the stress state. If interface debonding occurs, the tensile stress in a fracture-bound block can decrease to zero even for a higher S/ T f ratio. If the interface shear strength is high enough, a new fracture can further infill between two adjacent preexisting fractures even if the S/ T f ratio is at a low level. The fracture process implies that there is a critical value for the interfacial shear strength that controls the fracture pattern between the central layer and its neighboring layers to be either interface debonding or layer-parallel fracture. Both interfacial debonding and layer-parallel fracture can separate the central layer from its neighboring layers and thus lead to fracture saturation. Further analysis indicates that the critical shear strength increases linearly with increasing tensile strength of the central layer.

  15. Water fluoridation and osteoporotic fracture.

    PubMed

    Hillier, S; Inskip, H; Coggon, D; Cooper, C

    1996-09-01

    Osteoporotic fractures constitute a major public health problem. These fractures typically occur at the hip, spine and distal forearm. Their pathogenesis is heterogeneous, with contributions from both bone strength and trauma. Water fluoridation has been widely proposed for its dental health benefits, but concerns have been raised about the balance of skeletal risks and benefits of this measure. Fluoride has potent effects on bone cell function, bone structure and bone strength. These effects are mediated by the incorporation of fluoride ions in bone crystals to form fluoroapatite, and through an increase in osteoblast activity. It is believed that a minimum serum fluoride level of 100 ng/ml must be achieved before osteoblasts will be stimulated. Serum levels associated with drinking water fluoridated to 1 ppm are usually several times lower than this value, but may reach this threshold at concentrations of 4 ppm in the drinking water. Animal studies suggest no effect of low-level (0-3 ppm) fluoride intake on bone strength, but a possible decrease at higher levels. Sodium fluoride has been used to treat established osteoporosis for nearly 30 years. Recent trials of this agent, prescribed at high doses, have suggested that despite a marked increase in bone mineral density, there is no concomitant reduction in vertebral fracture incidence. Furthermore, the increase in bone density at the lumbar spine may be achieved at the expense of bone mineral in the peripheral cortical skeleton. As a consequence, high dose sodium fluoride (80 mg daily) is not currently used to treat osteoporosis. At lower doses, recent trials have suggested a beneficial effect on both bone density and fracture. The majority of epidemiological evidence regarding the effect of fluoridated drinking water on hip fracture incidence is based on ecological comparisons. Although one Finnish study suggested that hip fracture rates in a town with fluoridated water were lower than those in a matching town

  16. Fragility Fractures in Patients with Psoriatic Arthritis.

    PubMed

    Del Puente, Antonio; Esposito, Antonella; Costa, Luisa; Benigno, Carla; Del Puente, Aurora; Foglia, Francesca; Oriente, Alfonso; Bottiglieri, Paolo; Caso, Francesco; Scarpa, Raffaele

    2015-11-01

    Psoriatic arthritis (PsA) can have peculiar effects on bone, including mechanisms of bone loss such as erosions, but also of bone formation, such as ankylosis or periostitis. The aim of the present study was to describe the prevalence of fractures in patients with PsA as compared to healthy controls and to investigate determinants of fractures among cases. For both cases and controls, radiographs were read to identify vertebral fractures (VF), and the presence of femoral neck or other nonvertebral fractures was obtained from patients' medical history. The prevalence of fragility fractures on radiographic readings did not differ between cases and controls. The number of subjects showing a VF was 33 (36%) among PsA patients and 36 (36%) among controls, with a prevalence of severe VF of 8% among cases and 4% among controls. Controlling for covariates in a logistic model, the only variables showing a significant correlation with the presence of nonvertebral fractures (NVF) were disease duration (p=0.02), age (p=0.03), and bone mineral density at femoral neck (inverse correlation, p=0.04). Fractures should be carefully considered when evaluating the global picture of the patient with PsA for their contribution to the "fragility" profile.

  17. Traumatic vertebral artery injury: detailed clinicopathologic and morphometric analysis of 6 cases.

    PubMed

    Lee, Carol K; Gray, Laurel; Maguire, John

    2009-06-01

    Traumatic vertebral artery injury is frequently fatal from what may often be mild trauma to the head and neck. Detailed examination of vertebral arteries is not frequently undertaken at autopsy: the structural and histologic changes that may be relevant to the development of the injury are not well known. We sampled vertebral arteries bilaterally from 6 forensic autopsies (age = 26-50 years; 3 of 6 suffered from alcohol toxicity) with documented intradural vertebral artery injuries, and 4 nonvertebral-artery-injury-related autopsies (age = 19-70 years). Intradural, dural, and extradural components from each artery were submitted for paraffin-embedded tissue processing. Multiple serial sections and special stains (hematoxylin and eosin, alcian blue pH 2.5, reticulin, Congo red) were independently examined by 2 pathologists. All 6 of 6 injured samples and 4 of 4 control samples showed degenerative changes (intimal fibrosis, focal disruption of the internal elastic lamina, and medial calcification). However, microscopic adventitial hemorrhages were only observed around peripheral nerves adjacent to the injured samples. These may be due to tracking of blood along perineural loose connective tissue regions of reduced resistance, and may be a useful finding that points to underlying vertebral artery injury. Thus, careful dissection and gross and microscopic, examination of the vertebral arteries, with particular attention to the intracranial segments, is recommended in all cases of fatal traumatic head and neck injuries.

  18. Condylar fractures.

    PubMed

    Sawhney, Raja; Brown, Ryan; Ducic, Yadranko

    2013-10-01

    The purpose of this article is to review the basic indications for different treatments of condylar and subcondylar fractures. It also reviews the steps of different surgical approaches to access the surgical area and explains the pros and cons of each procedure.

  19. Combined Measures of Dynamic Bone Quality and Postural Balance--A Fracture Risk Assessment Approach in Osteoporosis.

    PubMed

    Bhattacharya, Amit; Watts, Nelson B; Dwivedi, Alok; Shukla, Rakesh; Mani, Ashutosh; Diab, Dima

    2016-01-01

    We evaluated functional measures of neuromuscular integrity and bone's resistance to fracture as a combined tool in discriminating osteoporosis patients with and without fractures. Functional aspects of neuromuscular integrity were quantified with a noninvasive measure of static and dynamic functional postural stability (FPS), and fracture resistance was obtained with bone shock absorption in patients with osteoporosis aged 65-85 and compared our measures with dual-energy X-ray absorptiometry and Fracture Risk Assessment Tool (FRAX [World Health Organization Collaborating Center for Metabolic Bone Diseases, Sheffield, UK]) in women with osteoporosis, some with and some without vertebral fractures. Patients with vertebral fracture showed larger static FPS (postural sway excursion) in the mediolateral and anterior-posterior directions, suggesting poorer balance. Most of the variables of dynamic FPS showed significant differences between fracture and no-fracture groups (e.g., the fracture group took significantly longer during turning, implying poorer dynamic balance control). Also, compared with healthy control subjects, all 4 dynamic FPS responses for osteoporosis patients with and without fracture were significantly poorer, suggesting potential risk for falls. In summary, patients with osteoporosis who have vertebral fractures (compared with patients with similarly low bone mineral density and other nonfracture risk fractures) have not only lower bone shock absorption damping (ζ) but also increased postural imbalance.

  20. The 'Tully monster' is a vertebrate.

    PubMed

    McCoy, Victoria E; Saupe, Erin E; Lamsdell, James C; Tarhan, Lidya G; McMahon, Sean; Lidgard, Scott; Mayer, Paul; Whalen, Christopher D; Soriano, Carmen; Finney, Lydia; Vogt, Stefan; Clark, Elizabeth G; Anderson, Ross P; Petermann, Holger; Locatelli, Emma R; Briggs, Derek E G

    2016-04-28

    Problematic fossils, extinct taxa of enigmatic morphology that cannot be assigned to a known major group, were once a major issue in palaeontology. A long-favoured solution to the 'problem of the problematica', particularly the 'weird wonders' of the Cambrian Burgess Shale, was to consider them representatives of extinct phyla. A combination of new evidence and modern approaches to phylogenetic analysis has now resolved the affinities of most of these forms. Perhaps the most notable exception is Tullimonstrum gregarium, popularly known as the Tully monster, a large soft-bodied organism from the late Carboniferous Mazon Creek biota (approximately 309-307 million years ago) of Illinois, USA, which was designated the official state fossil of Illinois in 1989. Its phylogenetic position has remained uncertain and it has been compared with nemerteans, polychaetes, gastropods, conodonts, and the stem arthropod Opabinia. Here we review the morphology of Tullimonstrum based on an analysis of more than 1,200 specimens. We find that the anterior proboscis ends in a buccal apparatus containing teeth, the eyes project laterally on a long rigid bar, and the elongate segmented body bears a caudal fin with dorsal and ventral lobes. We describe new evidence for a notochord, cartilaginous arcualia, gill pouches, articulations within the proboscis, and multiple tooth rows adjacent to the mouth. This combination of characters, supported by phylogenetic analysis, identifies Tullimonstrum as a vertebrate, and places it on the stem lineage to lampreys (Petromyzontida). In addition to increasing the known morphological disparity of extinct lampreys, a chordate affinity for T. gregarium resolves the nature of a soft-bodied fossil which has been debated for more than 50 years.

  1. Vertebrate head development: segmentation, novelties, and homology.

    PubMed

    Olsson, Lennart; Ericsson, Rolf; Cerny, Robert

    2005-11-01

    Vertebrate head development is a classical topic lately invigorated by methodological as well as conceptual advances. In contrast to the classical segmentalist views going back to idealistic morphology, the head is now seen not as simply an extension of the trunk, but as a structure patterned by different mechanisms and tissues. Whereas the trunk paraxial mesoderm imposes its segmental pattern on adjacent tissues such as the neural crest derivatives, in the head the neural crest cells carry pattern information needed for proper morphogenesis of mesodermal derivatives, such as the cranial muscles. Neural crest cells make connective tissue components which attach the muscle fiber to the skeletal elements. These crest cells take their origin from the same visceral arch as the muscle cells, even when the skeletal elements to which the muscle attaches are from another arch. The neural crest itself receives important patterning influences from the pharyngeal endoderm. The origin of jaws can be seen as an exaptation in which a heterotopic shift of the expression domains of regulatory genes was a necessary step that enabled this key innovation. The jaws are patterned by Dlx genes expressed in a nested pattern along the proximo-distal axis, analogous to the anterior-posterior specification governed by Hox genes. Knocking out Dlx 5 and 6 transforms the lower jaw homeotically into an upper jaw. New data indicate that both upper and lower jaw cartilages are derived from one, common anlage traditionally labelled the "mandibular" condensation, and that the "maxillary" condensation gives rise to other structures such as the trabecula. We propose that the main contribution from evolutionary developmental biology to solving homology questions lies in deepening our biological understanding of characters and character states.

  2. EVALUATION OF TERMINAL VERTEBRAL PLATE ON CERVICAL SPINE AT DIFFERENT AGE GROUPS AND ITS CORRELATION WITH INTERVERTEBRAL DISC THICKNESS

    PubMed Central

    Luiz Vieira, Juliano Silveira; da Silva Herrero, Carlos Fernando Pereira; Porto, Maximiliano Aguiar; Nogueira Barbosa, Marcello Henrique; Garcia, Sérgio Britto; Zambelli Ramalho, Leandra Náira; Aparecido Defino, Helton Luiz

    2015-01-01

    To evaluate, by means of histomorphometry, terminal vertebral plate thickness, intervertebral disc thickness and its correlation on different age groups, seeking to identify its correlation. Methods: C4-C5 and C5-C6 cervical segments removed from human cadavers of both genders were assessed and divided into five groups of 10-year age intervals, from 21 years old. TVP and intervertebral disc thickness evaluation was made by means of histomorphometry of histological slides stained with hematoxylin and eosyn. Lower C4 TVP, upper C5 TVP, and upper C6 TVP de were compared between each other and to the interposed intervertebral disc thickness between relevant TVP. Results: The thickness of terminal vertebral plates adjacent to the same ID did not show statistic differences. However, the comparison of upper and lower vertebral plates thickness on the same cervical vertebra (C5), showed statistical difference on all age groups studied. We found a statistical correlation coefficient above 80% between terminal vertebral plate and adjacent intervertebral disc, with a proportional thickness reduction of both structures on the different cervical levels studied, and also on the different age groups assessed. Conclusion: Terminal vertebral plate shows a morphologic correlation with the intervertebral disc next to it, and does not show correlation with the terminal vertebral plate on the same vertebra. PMID:26998448

  3. Denosumab reduces the risk of osteoporotic fractures in postmenopausal women, particularly in those with moderate to high fracture risk as assessed with FRAX.

    PubMed

    McCloskey, Eugene V; Johansson, Helena; Oden, Anders; Austin, Matt; Siris, Ethel; Wang, Andrea; Lewiecki, E Michael; Lorenc, Roman; Libanati, Cesar; Kanis, John A

    2012-07-01

    Denosumab has been shown to reduce the incidence of vertebral, nonvertebral, and hip fractures. The aim of the current study was to determine whether the antifracture efficacy of denosumab was dependent on baseline fracture probability assessed by FRAX. The primary data of the phase 3 FREEDOM study of the effects of denosumab in women with postmenopausal osteoporosis were used to compute country-specific probabilities using the FRAX tool (version 3.2). The outcome variable comprised all clinical osteoporotic fractures (including clinical vertebral fractures). Interactions between fracture probability and efficacy were explored by Poisson regression. At baseline, the median 10-year probability of a major osteoporotic fracture (with bone mineral density) was approximately 15% and for hip fracture was approximately 5% in both groups. In the simplest model adjusted for age and fracture probability, treatment with denosumab over 3 years was associated with a 32% (95% confidence interval [CI] 20% to 42%) decrease in clinical osteoporotic fractures. Denosumab reduced fracture risk to a greater extent in those at moderate to high risk. For example, at 10% probability, denosumab decreased fracture risk by 11% (p = 0.629), whereas at 30% probability (90th percentile of study population) the reduction was 50% (p = 0.001). The reduction in fracture was independent of prior fracture, parental history of hip fracture, or secondary causes of osteoporosis. A low body mass index (BMI) was associated with greater efficacy. Denosumab significantly decreased the risk of clinical osteoporotic fractures in postmenopausal women. Overall, the efficacy of denosumab was greater in those at moderate to high risk of fracture as assessed by FRAX.

  4. Pseudoaneurysms Occurring as a Result of Fractures Giving Rise to the Appearance of Pseudotumors: A Short Series

    SciTech Connect

    Farquharson, Finn; Haroon, Athar; Fleet, Mustafa

    2007-09-15

    Pseudoaneurysms are focal enlargements of the vascular lumen due to partial or complete disruption of the arterial wall. These are an uncommon complication of fractures. The presence of a pseudoaneurysm adjacent to a fracture fragment can cause a pressure effect. This pressure not only impairs fracture healing but sometimes can erode the adjacent bone, producing the appearance of a pseudotumor. We present two such cases and discuss the management of these patients.

  5. Long-term investigation of nonsurgical treatment for thoracolumbar and lumbar burst fractures: an outcome analysis in sight of spinopelvic balance

    PubMed Central

    Acosta, Frank; Hempfing, Axel; Rohrmüller, David; Tauber, Mark; Lederer, Stefan; Resch, Herbert; Zenner, Juliane; Klampfer, Helmut; Schwaiger, Robert; Bogner, Robert; Hitzl, Wolfgang

    2008-01-01

    The nonsurgical treatment of thoracolumbar (TLB) and lumbar burst (LB) fractures remains to be of interest, though it is not costly and avoids surgical risks. However, a subset of distinct burst fracture patterns tend to go with a suboptimal radiographic and clinical long-term outcome. Detailed fracture pattern and treatment-related results in terms of validated outcome measures are still lacking. In addition, there are controversial data on the impact of local posttraumatic kyphosis that is associated, in particular, with nonsurgical treatment. The assessment of global spinal balance following burst fractures has not been assesed, yet. Therefore, the current study intended to investigate the radiographical and clinical long-term outcome in neurologically intact patients with special focus on the impact of regional posttraumatic kyphosis, adjacent-level compensatoric mechanisms, and global spine balance on the clinical outcome. For the purpose of a homogenous sample, strong in- and exclusion criteria were applied that resulted in a final study sample of 21 patients with a mean follow-up of 9.5 years. Overall, clinical outcome evaluated by validated measures was diminished, with 62% showing a good or excellent outcome and 38% a moderate or poor outcome in terms of the Greenough Low Back Outcome Scale. Notably, vertebral comminution in terms of the load-sharing classification, posttraumatic kyphosis, and an overall decreased lumbopelvic lordosis showed a significant effect on clinical outcome. A global and segmental curve analysis of the spine T9 to S1 revealed significant alterations as compared to normals. But, the interdependence of spinopelvic parameters was not disrupted. The patients’ spinal adaptability to compensate for the posttraumatic kyphotic deformity varied in the ranges dictated by pelvic geometry, in particular the pelvic incidence. The study substantiates the concept that surgical reconstruction and maintenance of a physiologically shaped spinal

  6. The ancestral role of nodal signalling in breaking L/R symmetry in the vertebrate forebrain.

    PubMed

    Lagadec, Ronan; Laguerre, Laurent; Menuet, Arnaud; Amara, Anis; Rocancourt, Claire; Péricard, Pierre; Godard, Benoît G; Rodicio, Maria Celina; Rodriguez-Moldes, Isabel; Mayeur, Hélène; Rougemont, Quentin; Mazan, Sylvie; Boutet, Agnès

    2015-03-30

    Left-right asymmetries in the epithalamic region of the brain are widespread across vertebrates, but their magnitude and laterality varies among species. Whether these differences reflect independent origins of forebrain asymmetries or taxa-specific diversifications of an ancient vertebrate feature remains unknown. Here we show that the catshark Scyliorhinus canicula and the lampreys Petromyzon marinus and Lampetra planeri exhibit conserved molecular asymmetries between the left and right developing habenulae. Long-term pharmacological treatments in these species show that nodal signalling is essential to their generation, rather than their directionality as in teleosts. Moreover, in contrast to zebrafish, habenular left-right differences are observed in the absence of overt asymmetry of the adjacent pineal field. These data support an ancient origin of epithalamic asymmetry, and suggest that a nodal-dependent asymmetry programme operated in the forebrain of ancestral vertebrates before evolving into a variable trait in bony fish.

  7. Low Serum DHEAS Predicts Increased Fracture Risk in Older Men: The MrOS Sweden Study.

    PubMed

    Ohlsson, Claes; Nethander, Maria; Kindmark, Andreas; Ljunggren, Östen; Lorentzon, Mattias; Rosengren, Björn E; Karlsson, Magnus K; Mellström, Dan; Vandenput, Liesbeth

    2017-03-09

    The adrenal-derived hormones dehydroepiandrosterone (DHEA) and its sulfate (DHEAS) are the most abundant circulating hormones and their levels decline substantially with age. DHEAS is considered an inactive precursor, which is converted into androgens and estrogens via local metabolism in peripheral target tissues. The predictive value of serum DHEAS for fracture risk is unknown. The aim of this study was, therefore, to assess the associations between baseline DHEAS levels and incident fractures in a large cohort of older men. Serum DHEAS levels were analyzed with mass spectrometry in the population-based Osteoporotic Fractures in Men study in Sweden (n = 2568, aged 69 to 81 years). Incident X-ray validated fractures (all, n = 594; non-vertebral major osteoporotic, n = 255; hip, n = 175; clinical vertebral, n = 206) were ascertained during a median follow-up of 10.6 years. DHEAS levels were inversely associated with the risk of any fracture (hazard ratio [HR] per SD decrease = 1.14, 95% confidence interval [CI] 1.05-1.24), non-vertebral major osteoporotic fractures (HR = 1.31, 95% CI 1.16-1.48), and hip fractures (HR = 1.18, 95% CI 1.02-1.37) but not clinical vertebral fractures (HR = 1.09, 95% CI 0.95-1.26) in Cox regression models adjusted for age, body mass index (BMI) and prevalent fractures. Further adjustment for traditional risk factors for fracture, bone mineral density (BMD), and/or physical performance variables as well as serum sex steroid levels only slightly attenuated the associations between serum DHEAS and fracture risk. Similarly, the point estimates were only marginally reduced after adjustment for FRAX estimates with BMD. The inverse association between serum DHEAS and all fractures or major osteoporotic fractures was nonlinear, with a substantial increase in fracture risk (all fractures 22%, major osteoporotic fractures 33%) for those participants with serum DHEAS levels below the median (0.60 μg/mL). In

  8. Surgery in extensive vertebral hemangioma: case report, literature review and a new algorithm proposal.

    PubMed

    Tarantino, Roberto; Donnarumma, Pasquale; Nigro, Lorenzo; Delfini, Roberto

    2015-07-01

    Hemangiomas are benign dysplasias or vascular tumors consisting of vascular spaces lined with endothelium. Nowadays, radiotherapy for vertebral hemangiomas (VHs) is widely accepted as primary treatment for painful lesions. Nevertheless, the role of surgery is still unclear. The purpose of this study is to propose a novel algorithm of treatment about VHs. This is a case report of an extensive VH and a review of the literature. A case of vertebral fracture during radiotherapy at a total dose of 30 Gy given in 10 fractions (treatment time 2 weeks) using a linear accelerator at 15 MV high-energy photons for extensive VH is reported. Using PubMed database, a review of the literature is done. The authors have no study funding sources. The authors have no conflicting financial interests. In the literature, good results in terms of pain and neurological deficits are reported. No cases of vertebral fractures are described. However, there is no consensus regarding the treatment for VHs. Radiotherapy is widely utilized in VHs determining pain. Surgery for VHs determining neurological deficit is also widely accepted. Perhaps, regarding the width of the lesion, no indications are given. We consider it important to make an evaluation before initiating the treatment for the risk of pathologic vertebral fracture, since in radiotherapy, there is no convention regarding structural changes determined in VHs. We propose a new algorithm of treatment. We recommend radiotherapy only for small lesions in which vertebral stability is not concerned. Kyphoplasty can be proposed for asymptomatic patients in which VHs are small and in patients affected by VHs determining pain without spinal canal invasion in which the VH is small. In patients affected by pain without spinal canal invasion but in which the VH is wide or presented with spinal canal invasion and in patients affected by neurological deficits, we propose surgery.

  9. Computer aided diagnosis for osteoporosis based on vertebral column structure analysis

    NASA Astrophysics Data System (ADS)

    Takahashi, Eiji; Kawata, Yoshiki; Niki, Noboru; Nakano, Yasutaka; Harada, Masafumi; Moriyama, Noriyuki

    2012-03-01

    Patients of osteoporosis are comprised of about 11 million people in Japan and it is one of the problems that have gained society. For preventing the osteoporosis, obtaining early detection and treatment are necessary. Multi-slice CT technology has been improving for three dimensional (3D) image analysis, higher body axis resolution and shorter scan time. 3D image analysis using multi-slice CT images of thoracic vertebra can be used for supporting diagnosis of osteoporosis. Simultaneously, this analysis can be used for lung cancer diagnosis which may lead to early detection. We develop automatic extraction and partitioning algorithm for spinal column by analyzing vertebral body structure, and the analysis algorithm of the vertebral body using shape analysis and a bone density measurement for the diagnosis of osteoporosis. An effective result was provided for the case including an insufficient complicated vertebral body bone fracture by the conventional method.

  10. Facial Fractures

    PubMed Central

    White, Lawrence M.; Marotta, Thomas R.; McLennan, Michael K.; Kassel, Edward E.

    1992-01-01

    Appropriate clinical radiographic investigation, together with an understanding of the normal radiographic anatomy of the facial skeleton, allows for precise delineation of facial fracutres and associated soft tissue injuries encountered in clinical practice. A combination of multiple plain radiographic views and coronal and axial computed tomographic images allow for optimal delineation of fracture patterns. This information is beneficial in the clinical and surgical management patients with facial injuries

  11. Evolutionary Specialization of Tactile Perception in Vertebrates.

    PubMed

    Schneider, Eve R; Gracheva, Elena O; Bagriantsev, Slav N

    2016-05-01

    Evolution has endowed vertebrates with the remarkable tactile ability to explore the world through the perception of physical force. Yet the sense of touch remains one of the least well understood senses at the cellular and molecular level. Vertebrates specializing in tactile perception can highlight general principles of mechanotransduction. Here, we review cellular and molecular adaptations that underlie the sense of touch in typical and acutely mechanosensitive vertebrates.

  12. Bone metabolism and fracture risk in type 2 diabetes mellitus.

    PubMed

    Yamaguchi, Toru; Sugimoto, Toshitsugu

    2012-01-01

    Osteoporosis and type 2 diabetes mellitus (T2DM), both prevalent in aging and westernized societies, adversely affect the health of elderly people by causing fractures and vascular complications, respectively. Recent experimental and clinical studies show that the disorders are etiologically related through the actions of osteocalcin and adiponectin. Meta-analyses of multiple clinical studies show that the hip fracture risk of T2DM patients is increased 1.4-1.7-fold compared with non-DM controls, even though the patients' bone mineral density (BMD) is not diminished. Vertebral fracture risk of the T2DM patients is also increased, and BMD measurement is not sensitive enough to assess this risk. These findings suggest that bone fragility in T2DM patients depends on bone quality deterioration rather than bone mass reduction. Surrogate markers are therefore needed to supplement the partial effectiveness of BMD testing in assessing the fracture risk of the T2DM patients. Markers related to advanced glycation end products may be candidates. These substances modulate bone quality in DM. Until research establishes the usefulness of surrogate markers, physicians should assess fracture risk in T2DM patients not only by measuring the BMD, but also by taking a fracture history and evaluating prior vertebral fractures using spinal X-rays.

  13. Ghrelin Receptors in Non-Mammalian Vertebrates

    PubMed Central

    Kaiya, Hiroyuki; Kangawa, Kenji; Miyazato, Mikiya

    2012-01-01

    The growth hormone secretagogue-receptor (GHS-R) was discovered in humans and pigs in 1996. The endogenous ligand, ghrelin, was discovered 3 years later, in 1999, and our understanding of the physiological significance of the ghrelin system in vertebrates has grown steadily since then. Although the ghrelin system in non-mammalian vertebrates is a subject of great interest, protein sequence data for the receptor in non-mammalian vertebrates has been limited until recently, and related biological information has not been well organized. In this review, we summarize current information related to the ghrelin receptor in non-mammalian vertebrates. PMID:23882259

  14. Vascular Plant and Vertebrate Inventory of Tuzigoot National Monument

    USGS Publications Warehouse

    Powell, Brian F.; Albrecht, E.W.; Halvorson, William Lee; Schmidt, Cecilia A.; Anning, P.; Docherty, K.

    2005-01-01

    Executive Summary From 2002 to 2004, we surveyed for plants and vertebrates (amphibians, reptiles, birds, and mammals) at Tuzigoot National Monument (NM) and adjacent areas in Arizona. This was the first effort of its kind in the area and was part of a larger effort to inventory vascular plants and vertebrates in eight National Park Service units in Arizona and New Mexico. In addition to our own surveys, we also compiled a complete list of species that have been found by previous studies. We found 330 species, including 142 that had not previously been recorded at the monument (Table 1). We found 39 species of non-native plants, 11 non-native fishes, three non-native birds, and one non-native species each of amphibian and mammal. Based on our work and that of others, there have been 597 species of plants and vertebrates found at the monument. The bird community at the monument had the highest species richness of any national park unit in central and southern Arizona. We found all other taxa to have intermediate species richness compared to other park units in the region. This extraordinary species richness observed for birds, as well as for some other taxa, is due primarily to Tavasci Marsh and the Verde River, two critical sources of perennial water, which provide habitat for many regionally rare or uncommon species. The location of the monument at the northern edge of the Sonoran Desert and at the southern edge of the Mogollon Rim also plays an important role in determining the distribution and community composition of the plant and vertebrate communities. Based on our findings, we believe the high number of non-native species, especially fish and plants, should be of particular management concern. We detail other management challenges, most notably the rapid increase in housing and associated commercial development near the monument, which will continue to impact the plant and vertebrate communities. Based on our data and a review of past studies, we believe the

  15. Application of borehole geophysics to fracture identification and characterization in low porosity limestones and dolostones

    SciTech Connect

    Haase, C.S.; King, H.L.

    1986-01-01

    Geophysical logging was conducted in exploratory core holes drilled for geohydrological investigations at three sites used for waste disposal on the US Department of Energy's Oak Ridge Reservation. Geophysical log response was calibrated to borehole geology using the drill core. Subsequently, the logs were used to identify fractures and fractured zones and to characterize the hydrologic activity of such zones. Results of the study were used to identify zones of ground water movement and to select targets for subsequent piezometer and monitoring well installation. Neutron porosity, long- and short-normal resistivity, and density logs exhibit anomalies only adjacent to pervasively fractured zones and rarely exhibit anomalies adjacent to individual fractures, suggesting that such logs have insufficient resolution to detect individual fractures. Spontaneous potential, single point resistance, acoustic velocity, and acoustic variable density logs, however, typically exhibit anomalies adjacent to both individual fractures and fracture zones. Correlation is excellent between fracture density logs prepared from the examination of drill core and fractures identified by the analysis of a suite of geophysical logs that have differing spatial resolution characteristics. Results of the study demonstrate the importance of (1) calibrating geophysical log response to drill core from a site, and (2) running a comprehensive suite of geophysical logs that can evaluate both large- and small-scale rock features. Once geophysical log responses to site-specific geological features have been established, logs provide a means of identifying fracture zones and discriminating between hydrologically active and inactive fracture zones. 9 figs.

  16. Severe thoracic spinal fracture-dislocation without neurological symptoms and costal fractures: a case report and review of the literature

    PubMed Central

    2014-01-01

    Introduction Only a high-energy force can cause thoracic spinal fracture-dislocation injuries, and such injuries should always be suspected in patients with polytrauma. The injury is usually accompanied by neurological symptoms. There are only a few cases of severe thoracic spinal fracture-dislocation without neurological symptoms in the literature, and until now, no case of severe thoracic spinal fracture-dislocation without neurological symptoms and without costal fractures has been reported. Case presentation A 30-year-old Han Chinese man had T6 to T7 vertebral fracture and anterolateral dislocation without neurological symptoms and costal fractures. The three-dimensional reconstruction by computed tomography and magnetic resonance imaging indicated the injuries in detail. A patient with thoracic spinal fracture-dislocation without neurological symptoms inclines to further dislocation of the spine and secondary neurological injury; therefore, laminectomy, reduction and internal fixations with rods and screws were done. The outcome was good. Severe spinal fracture-dislocation without neurological symptoms should be evaluated in detail, especially with three-dimensional reconstruction by computed tomography. Although treatment is individualized, reduction and internal fixation are advised for the patient if the condition is suitable for operation. Conclusions Severe thoracic spinal fracture-dislocation without neurological symptoms and costal fractures is frighteningly rare; an operation should be done if the patient's condition permits. PMID:25316002

  17. Spacing and aperture of opening-mode fractures in layered materials

    NASA Astrophysics Data System (ADS)

    Bai, Taixu

    This dissertation investigates the mechanical control on spacing and aperture of equally-spaced fractures in layered materials using the Finite Element Method, based on the theories of elasticity and linear fracture mechanics. It also investigates the effects of fracture spacing and aperture on fluid flow through the equally-spaced fractures. The results show that under a remote extension in the direction perpendicular to the fractures the normal stress acting in this direction between adjacent fractures changes from tensile to compressive as the fracture spacing to layer thickness ratio changes from greater than to less than a critical value. This stress transition precludes further infilling of fractures unless they are driven by mechanisms other than an extension, or there are significant flaws between the fractures. Hence, it defines the condition of saturation for fractures formed under extension in flawless layered materials. When flaws are present, further infilling of fractures is possible depending upon the size and locations of the flaws. The aspect ratio of equally-spaced fractures is linearly related to the average strain, the overburden stress, and the internal fluid pressure. The aspect ratio increases nonlinearly with increasing fracture spacing to layer thickness ratio because of the mechanical interaction between adjacent fractures. The interaction becomes insignificant when the spacing to layer thickness ratio is greater than about 6.0. The aspect ratio also depends on the ratio of Young's modulus of the fractured layer to that of the neighboring layers. This dependence is significant when the fracture spacing to layer thickness ratio is less than 1.3, otherwise it is negligibe. The aspect ratio is insensitive to variations in Poisson's ratios. Fluid flow rate through equally-spaced fractures does not always increases with increasing fracture density, i.e., with decreasing spacing to layer thickness ratio. There is an optimum value for the ratio

  18. On the time-course of adjacent and non-adjacent transposed-letter priming

    PubMed Central

    Ktori, Maria; Kingma, Brechtsje; Hannagan, Thomas; Holcomb, Phillip J.; Grainger, Jonathan

    2014-01-01

    We compared effects of adjacent (e.g., atricle-ARTICLE) and non-adjacent (e.g., actirle-ARTICLE) transposed-letter (TL) primes in an ERP study using the sandwich priming technique. TL priming was measured relative to the standard double-substitution condition. We found significantly stronger priming effects for adjacent transpositions than non-adjacent transpositions (with 2 intervening letters) in behavioral responses (lexical decision latencies), and the adjacent priming effects emerged earlier in the ERP signal, at around 200 ms post-target onset. Non-adjacent priming effects emerged about 50 ms later and were short-lived, being significant only in the 250-300 ms time-window. Adjacent transpositions on the other hand continued to produce priming in the N400 time-window (300-500 ms post-target onset). This qualitatively different pattern of priming effects for adjacent and non-adjacent transpositions is discussed in the light of different accounts of letter transposition effects, and the utility of drawing a distinction between positional flexibility and positional noise. PMID:25364497

  19. Distal radial fractures heal by direct woven bone formation

    PubMed Central

    2013-01-01

    Background Descriptions of fracture healing almost exclusively deal with shaft fractures and they often emphasize endochondral bone formation. In reality, most fractures occur in metaphyseal cancellous bone. Apart from a study of vertebral fractures, we have not found any histological description of cancellous bone healing in humans. Patients and methods We studied histological biopsies from the central part of 12 distal radial fractures obtained during surgery 6–28 days after the injury, using routine hematoxylin and eosin staining. Results New bone formation was seen in 6 cases. It was always in the form of fetal-like, disorganized woven bone. It seldom had contact with old trabeculae and appeared to have formed directly in the marrow. Cartilage was scarce or absent. The samples without bone formation showed only necrosis, scar, or old cancellous bone. Interpretation The histology suggests that cells in the midst of the marrow respond to the trauma by direct formation of bone, independently of trabecular surfaces. PMID:23570338

  20. What is the general action of ghrelin for vertebrates? - comparisons of ghrelin's effects across vertebrates.

    PubMed

    Kaiya, Hiroyuki; Kangawa, Kenji; Miyazato, Mikiya

    2013-01-15

    Ten years and more passed since ghrelin was discovered. Various physiological actions of ghrelin have been documented in both mammalian and nonmammalian vertebrates. Do these actions have any commonality? In this review, we focused on several effects of ghrelin, and compared the effect across vertebrates. We would like to discuss possible general function of ghrelin in vertebrates.

  1. Tracer Methods for Characterizing Fracture Creation in Engineered Geothermal Systems

    SciTech Connect

    Rose, Peter; Harris, Joel

    2014-05-08

    The aim of this proposal is to develop, through novel high-temperature-tracing approaches, three technologies for characterizing fracture creation within Engineered Geothermal Systems (EGS). The objective of a first task is to identify, develop and demonstrate adsorbing tracers for characterizing interwell reservoir-rock surface areas and fracture spacing. The objective of a second task is to develop and demonstrate a methodology for measuring fracture surface areas adjacent to single wells. The objective of a third task is to design, fabricate and test an instrument that makes use of tracers for measuring fluid flow between newly created fractures and wellbores. In one method of deployment, it will be used to identify qualitatively which fractures were activated during a hydraulic stimulation experiment. In a second method of deployment, it will serve to measure quantitatively the rate of fluid flowing from one or more activated fracture during a production test following a hydraulic stimulation.

  2. Risks of all-cause and site-specific fractures among hospitalized patients with COPD

    PubMed Central

    Liao, Kuang-Ming; Liang, Fu-Wen; Li, Chung-Yi

    2016-01-01

    Abstract Patients with chronic obstructive pulmonary disease (COPD) have a high prevalence of osteoporosis. The clinical sequel of osteoporosis is fracture. Patients with COPD who experience a fracture also have increased morbidity and mortality. Currently, the types of all-cause and site-specific fracture among patients with COPD are unknown. Thus, we elucidated the all-cause and site-specific fractures among patients with COPD. A retrospective, population-based, cohort study was conducted utilizing the Taiwan Longitudinal Health Insurance Database. Patients with COPD were defined as those who were hospitalized with an International Classification of Diseases, Ninth Revision, Clinical Modification code of 490 to 492 or 496 between 2001 and 2011. The index date was set as the date of discharge. The study patients were followed from the index date to the date when they sought care for any type of fracture, date of death, date of health insurance policy termination, or the last day of 2013. The types of fracture analyzed in this study included vertebral, rib, humeral, radial and ulnar/wrist, pelvic, femoral, and tibial and fibular fractures. The cohort consisted of 11,312 patients with COPD. Among these patients, 1944 experienced fractures. The most common site-specific fractures were vertebral, femoral, rib, and forearm fractures (radius, ulna, and wrist) at 32.4%, 31%, 12%, and 11.8%, respectively. The adjusted hazard ratios of fracture were 1.71 [95% confidence interval (95% CI) = 1.56–1.87] for female patient with COPD and 1.50 (95% CI = 1.39–1.52) for patients with osteoporosis after covariate adjustment. Vertebral and hip fractures are common among patients with COPD, especially among males with COPD. Many comorbidities contribute to the high risk of fracture among patients with COPD. PMID:27749576

  3. Building the backbone: the development and evolution of vertebral patterning.

    PubMed

    Fleming, Angeleen; Kishida, Marcia G; Kimmel, Charles B; Keynes, Roger J

    2015-05-15

    The segmented vertebral column comprises a repeat series of vertebrae, each consisting of two key components: the vertebral body (or centrum) and the vertebral arches. Despite being a defining feature of the vertebrates, much remains to be understood about vertebral development and evolution. Particular controversy surrounds whether vertebral component structures are homologous across vertebrates, how somite and vertebral patterning are connected, and the developmental origin of vertebral bone-mineralizing cells. Here, we assemble evidence from ichthyologists, palaeontologists and developmental biologists to consider these issues. Vertebral arch elements were present in early stem vertebrates, whereas centra arose later. We argue that centra are homologous among jawed vertebrates, and review evidence in teleosts that the notochord plays an instructive role in segmental patterning, alongside the somites, and contributes to mineralization. By clarifying the evolutionary relationship between centra and arches, and their varying modes of skeletal mineralization, we can better appreciate the detailed mechanisms that regulate and diversify vertebral patterning.

  4. Vertebral anomaly in fossil sea cows (Mammalia, Sirenia).

    PubMed

    Voss, Manja; Asbach, Patrick; Hilger, André

    2011-06-01

    Four incompletely preserved caudal vertebrae lacking the neural arches of two fossil sirenian individuals of Halitherium schinzii (Oligocene) from the Rhine area in Germany and northern Belgium reveal osteological alterations. The caudal vertebrae possess a transverse process with growth retardation. This asymmetry indicates that the affected transverse processes are less developed than their counterparts and, consequently, deviate from the norm. Computed tomography (CT) scans reveal osteosclerotic patterns, a morphological feature that characterizes sea cows and supports the nonpathological state of the vertebrae. Additionally, no indications of vertebral fractures or any other occurrences due to external factors are present. This is the oldest documentation of such an anomaly in any sirenian and is interpreted here as hypoplasia, the underdevelopment of an organ or parts of it that might cause a functional deficiency.

  5. Coupling between the spinal cord and cervical vertebral column under tensile loading.

    PubMed

    Kroeker, Shannon G; Ching, Randal P

    2013-02-22

    Current neck injury criteria are based on structural failure of the spinal (vertebral) column without consideration of injury to the spinal cord. Since one of the primary functions of the vertebral column is to protect the cord, it stands to reason that a more refined measure of neck injury threshold would be the onset of spinal cord injury (SCI). This study investigated the relationship between axial strains in the cervical vertebral column and the spinal cord using an in vitro primate model (n=10) under continuous tensile loading. Mean failure loads occurred at 1951.5±396N with failure strains in the vertebral column of 16±5% at the level of failure. Average tensile strains in the spinal cord at failure were 11±5% resulting in a mean coupling ratio of 0.54±0.17 between C1 and C7. The level of peak strain measured in the spinal cord did not always occur at the location of vertebral column failure. Spinal cord strains were less than spine strains and coupling ratios were not significantly different along the length of the spine. The largest coupling ratio was measured in the atlanto-occipital joint whereas the smallest coupling ratio occurred at the adjacent C1-C2 joint.

  6. Automatic lumbar vertebra segmentation from clinical CT for wedge compression fracture diagnosis

    NASA Astrophysics Data System (ADS)

    Ghosh, Subarna; Alomari, Raja'S.; Chaudhary, Vipin; Dhillon, Gurmeet

    2011-03-01

    Lumbar vertebral fractures vary greatly in types and causes and usually result from severe trauma or pathological conditions such as osteoporosis. Lumbar wedge compression fractures are amongst the most common ones where the vertebra is severely compressed forming a wedge shape and causing pain and pressure on the nerve roots and the spine. Since vertebral segmentation is the first step in any automated diagnosis task, we present a fully automated method for robustly localizing and segmenting the vertebrae for preparation of vertebral fracture diagnosis. Our segmentation method consists of five main steps towards the CAD(Computer-Aided Diagnosis) system: 1) Localization of the intervertebral discs. 2) Localization of the vertebral skeleton. 3) Segmentation of the individual vertebra. 4) Detection of the vertebrae center line and 5) Detection of the vertebrae major boundary points. Our segmentation results are promising with an average error of 1.5mm (modified Hausdorff distance metric) on 50 clinical CT cases i.e. a total of 250 lumbar vertebrae. We also present promising preliminary results for automatic wedge compression fracture diagnosis on 15 cases, 7 of which have one or more vertebral compression fracture, and obtain an accuracy of 97.33%.

  7. Denosumab. Limited efficacy in fracture prevention, too many adverse effects.

    PubMed

    2011-06-01

    The standard drug for postmenopausal osteoporotic women with a high risk of fracture is alendronic acid, used in conjunction with non-drug measures. There are no drugs with demonstrated efficacy on the risk of fracture in castrated men with prostate cancer. Denosumab, a monoclonal antibody that inhibits a cytokine acting mainly on bone cells and lymphocytes, has been authorised in the European Union for use in both these settings. There are no trials comparing denosumab versus alendronic acid for symptomatic fracture prevention. In two trials involving 1189 and 504 women, the incidence of clinical fractures, recorded as simple adverse effects, did not differ significantly between the groups. In a placebo-controlled trial in about 7900 elderly osteoporotic women, denosumab significantly reduced the incidence of symptomatic vertebral fractures (0.8% versus 2.6% after 3 years) and hip fractures (0.7% versus 1.2%). An indirect comparison, providing weak evidence, suggests that denosumab is less effective than alendronic acid. In a placebo-controlled trial in 1468 castrated men with prostate cancer, denosumab did not reduce the incidence of symptomatic fractures after 3 years. Only the incidence of vertebral fractures, detected on routine radiographs, showed a statistically significant decline (1.5% versus 3.5%). Denosumab has numerous adverse effects. In placebo-controlled trials, this monoclonal antibody was associated with a higher incidence of deep-seated infections such as endocarditis, cancer, and skin rash. More data are needed on the risk of pancreatitis, long-term bone disorders (atypical fractures, delayed fracture healing, osteonecrosis of the jaw), hypocalcaemia and cataracts, all of which were reported in clinical trials. In practice, denosumab is not sufficiently effective to outweigh its established and potential risks in postmenopausal osteoporotic women or in castrated men with prostate cancer.

  8. Fracture Mechanics

    DTIC Science & Technology

    1974-01-31

    2219 -T851 aluminum (fractures at low stresses). The parameter KF is alloy compact specimens 1 2 and demonstrate consistent a function of specimen...Congress of 20. Walker, E. K., "The Effect of Stress Ratio Applied Mechanics, 1924. During Crack Propagation and Fatigue for 2024-T3 and 7015- T6 Aluminum ...34Stress- Corrosion Cracking in 12. Kaufman, J. G., and Nelson, F. G., "More Ti-6A1-4V Titanium Alloy in Nitrogen Tetroxide," on Specimen Size Effect in 2219

  9. A complex choreography of cell movements shapes the vertebrate eye.

    PubMed

    Kwan, Kristen M; Otsuna, Hideo; Kidokoro, Hinako; Carney, Keith R; Saijoh, Yukio; Chien, Chi-Bin

    2012-01-01

    Optic cup morphogenesis (OCM) generates the basic structure of the vertebrate eye. Although it is commonly depicted as a series of epithelial sheet folding events, this does not represent an empirically supported model. Here, we combine four-dimensional imaging with custom cell tracking software and photoactivatable fluorophore labeling to determine the cellular dynamics underlying OCM in zebrafish. Although cell division contributes to growth, we find it dispensable for eye formation. OCM depends instead on a complex set of cell movements coordinated between the prospective neural retina, retinal pigmented epithelium (RPE) and lens. Optic vesicle evagination persists for longer than expected; cells move in a pinwheel pattern during optic vesicle elongation and retinal precursors involute around the rim of the invaginating optic cup. We identify unanticipated movements, particularly of central and peripheral retina, RPE and lens. From cell tracking data, we generate retina, RPE and lens subdomain fate maps, which reveal novel adjacencies that might determine corresponding developmental signaling events. Finally, we find that similar movements also occur during chick eye morphogenesis, suggesting that the underlying choreography is conserved among vertebrates.

  10. Diversity and Community Composition of Vertebrates in Desert River Habitats.

    PubMed

    Free, C L; Baxter, G S; Dickman, C R; Lisle, A; Leung, L K-P

    2015-01-01

    Animal species are seldom distributed evenly at either local or larger spatial scales, and instead tend to aggregate in sites that meet their resource requirements and maximise fitness. This tendency is likely to be especially marked in arid regions where species could be expected to concentrate at resource-rich oases. In this study, we first test the hypothesis that productive riparian sites in arid Australia support higher vertebrate diversity than other desert habitats, and then elucidate the habitats selected by different species. We addressed the first aim by examining the diversity and composition of vertebrate assemblages inhabiting the Field River and adjacent sand dunes in the Simpson Desert, western Queensland, over a period of two and a half years. The second aim was addressed by examining species composition in riparian and sand dune habitats in dry and wet years. Vertebrate species richness was estimated to be highest (54 species) in the riverine habitats and lowest on the surrounding dune habitats (45 species). The riverine habitats had different species pools compared to the dune habitats. Several species, including the agamid Gowidon longirostris and tree frog Litoria rubella, inhabited the riverine habitats exclusively, while others such as the skinks Ctenotus ariadnae and C. dux were captured only in the dune habitats. The results suggest that, on a local scale, diversity is higher along riparian corridors and that riparian woodland is important for tree-dependent species. Further, the distribution of some species, such as Mus musculus, may be governed by environmental variables (e.g. soil moisture) associated with riparian corridors that are not available in the surrounding desert environment. We conclude that inland river systems may be often of high conservation value, and that management should be initiated where possible to alleviate threats to their continued functioning.

  11. Threats from Climate Change to Terrestrial Vertebrate Hotspots in Europe

    PubMed Central

    Maiorano, Luigi; Amori, Giovanni; Capula, Massimo; Falcucci, Alessandra; Masi, Monica; Montemaggiori, Alessandro; Pottier, Julien; Psomas, Achilleas; Rondinini, Carlo; Russo, Danilo; Zimmermann, Niklaus E.

    2013-01-01

    We identified hotspots of terrestrial vertebrate species diversity in Europe and adjacent islands. Moreover, we assessed the extent to which by the end of the 21st century such hotspots will be exposed to average monthly temperature and precipitation patterns which can be regarded as extreme if compared to the climate experienced during 1950-2000. In particular, we considered the entire European sub-continent plus Turkey and a total of 1149 species of terrestrial vertebrates. For each species, we developed species-specific expert-based distribution models (validated against field data) which we used to calculate species richness maps for mammals, breeding birds, amphibians, and reptiles. Considering four global circulation model outputs and three emission scenarios, we generated an index of risk of exposure to extreme climates, and we used a bivariate local Moran’s I to identify the areas with a significant association between hotspots of diversity and high risk of exposure to extreme climates. Our results outline that the Mediterranean basin represents both an important hotspot for biodiversity and especially for threatened species for all taxa. In particular, the Iberian and Italian peninsulas host particularly high species richness as measured over all groups, while the eastern Mediterranean basin is particularly rich in amphibians and reptiles; the islands (both Macaronesian and Mediterranean) host the highest richness of threatened species for all taxa occurs. Our results suggest that the main hotspots of biodiversity for terrestrial vertebrates may be extensively influenced by the climate change projected to occur over the coming decades, especially in the Mediterranean bioregion, posing serious concerns for biodiversity conservation. PMID:24066162

  12. Diversity and Community Composition of Vertebrates in Desert River Habitats

    PubMed Central

    Free, C. L.; Baxter, G. S.; Dickman, C. R.; Lisle, A.; Leung, L. K.-P.

    2015-01-01

    Animal species are seldom distributed evenly at either local or larger spatial scales, and instead tend to aggregate in sites that meet their resource requirements and maximise fitness. This tendency is likely to be especially marked in arid regions where species could be expected to concentrate at resource-rich oases. In this study, we first test the hypothesis that productive riparian sites in arid Australia support higher vertebrate diversity than other desert habitats, and then elucidate the habitats selected by different species. We addressed the first aim by examining the diversity and composition of vertebrate assemblages inhabiting the Field River and adjacent sand dunes in the Simpson Desert, western Queensland, over a period of two and a half years. The second aim was addressed by examining species composition in riparian and sand dune habitats in dry and wet years. Vertebrate species richness was estimated to be highest (54 species) in the riverine habitats and lowest on the surrounding dune habitats (45 species). The riverine habitats had different species pools compared to the dune habitats. Several species, including the agamid Gowidon longirostris and tree frog Litoria rubella, inhabited the riverine habitats exclusively, while others such as the skinks Ctenotus ariadnae and C. dux were captured only in the dune habitats. The results suggest that, on a local scale, diversity is higher along riparian corridors and that riparian woodland is important for tree-dependent species. Further, the distribution of some species, such as Mus musculus, may be governed by environmental variables (e.g. soil moisture) associated with riparian corridors that are not available in the surrounding desert environment. We conclude that inland river systems may be often of high conservation value, and that management should be initiated where possible to alleviate threats to their continued functioning. PMID:26637127

  13. Radial head fracture - aftercare

    MedlinePlus

    Elbow fracture - radial head - aftercare ... to 2 weeks. If you have a small fracture and your bones did not move around much, ... to see a bone doctor (orthopedic surgeon). Some fractures require surgery to: Insert pins and plates to ...

  14. Hand fracture - aftercare

    MedlinePlus

    ... this page: //medlineplus.gov/ency/patientinstructions/000552.htm Hand fracture - aftercare To use the sharing features on ... need to be repaired with surgery. Types of Hand Fractures Your fracture may be in one of ...

  15. Vertebral osteomyelitis in insulin-dependent diabetics.

    PubMed

    Cooppan, R; Schoenbaum, S; Younger, M D; Freidberg, S; D'elia, J

    1976-11-20

    Vertebral osteomyelitis continues to be a diagnostically and therapeutically challenging disease with a relatively high incidence in diabetics. The clinical features, investigations and treatment of 7 insulin-dependent diabetics with vertebral osteomyelitis are presented and possible aetiological factors in this group are discussed.

  16. Spinal cord compression due to vertebral hemangioma.

    PubMed

    Aksu, Gorkem; Fayda, Merdan; Saynak, Mert; Karadeniz, Ahmet

    2008-02-01

    This article presents a case of multiple vertebral hemangiomas in a 58-year-old man with pain in the dorsal region and bilateral progressive foot numbness. Magnetic resonance imaging revealed multiple vertebral hemangiomas. One hemangioma at the T7 level demonstrated epidural extension, causing spinal cord compression. After treatment with radiotherapy, the patient's symptoms improved significantly.

  17. Vertebral architecture in the earliest stem tetrapods.

    PubMed

    Pierce, Stephanie E; Ahlberg, Per E; Hutchinson, John R; Molnar, Julia L; Sanchez, Sophie; Tafforeau, Paul; Clack, Jennifer A

    2013-02-14

    The construction of the vertebral column has been used as a key anatomical character in defining and diagnosing early tetrapod groups. Rhachitomous vertebrae--in which there is a dorsally placed neural arch and spine, an anteroventrally placed intercentrum and paired, posterodorsally placed pleurocentra--have long been considered the ancestral morphology for tetrapods. Nonetheless, very little is known about vertebral anatomy in the earliest stem tetrapods, because most specimens remain trapped in surrounding matrix, obscuring important anatomical features. Here we describe the three-dimensional vertebral architecture of the Late Devonian stem tetrapod Ichthyostega using propagation phase-contrast X-ray synchrotron microtomography. Our scans reveal a diverse array of new morphological, and associated developmental and functional, characteristics, including a possible posterior-to-anterior vertebral ossification sequence and the first evolutionary appearance of ossified sternal elements. One of the most intriguing features relates to the positional relationships between the vertebral elements, with the pleurocentra being unexpectedly sutured or fused to the intercentra that directly succeed them, indicating a 'reverse' rhachitomous design. Comparison of Ichthyostega with two other stem tetrapods, Acanthostega and Pederpes, shows that reverse rhachitomous vertebrae may be the ancestral condition for limbed vertebrates. This study fundamentally revises our current understanding of vertebral column evolution in the earliest tetrapods and raises questions about the presumed vertebral architecture of tetrapodomorph fish and later, more crownward, tetrapods.

  18. The evolution of adaptive immunity in vertebrates.

    PubMed

    Hirano, Masayuki; Das, Sabyasachi; Guo, Peng; Cooper, Max D

    2011-01-01

    Approximately 500 million years ago, two types of recombinatorial adaptive immune systems (AISs) arose in vertebrates. The jawed vertebrates diversify their repertoire of immunoglobulin domain-based T and B cell antigen receptors mainly through the rearrangement of V(D)J gene segments and somatic hypermutation, but none of the fundamental AIS recognition elements in jawed vertebrates have been found in jawless vertebrates. Instead, the AIS of jawless vertebrates is based on variable lymphocyte receptors (VLRs) that are generated through recombinatorial usage of a large panel of highly diverse leucine-rich-repeat (LRR) sequences. Whereas the appearance of transposon-like, recombination-activating genes contributed uniquely to the origin of the AIS in jawed vertebrates, the use of activation-induced cytidine deaminase for receptor diversification is common to both the jawed and jawless vertebrates. Despite these differences in anticipatory receptor construction, the basic AIS design featuring two interactive T and B lymphocyte arms apparently evolved in an ancestor of jawed and jawless vertebrates within the context of preexisting innate immunity and has been maintained since as a consequence of powerful and enduring selection, most probably for pathogen defense purposes.

  19. Cellular automata segmentation of the boundary between the compacta of vertebral bodies and surrounding structures

    NASA Astrophysics Data System (ADS)

    Egger, Jan; Nimsky, Christopher

    2016-03-01

    Due to the aging population, spinal diseases get more and more common nowadays; e.g., lifetime risk of osteoporotic fracture is 40% for white women and 13% for white men in the United States. Thus the numbers of surgical spinal procedures are also increasing with the aging population and precise diagnosis plays a vital role in reducing complication and recurrence of symptoms. Spinal imaging of vertebral column is a tedious process subjected to interpretation errors. In this contribution, we aim to reduce time and error for vertebral interpretation by applying and studying the GrowCut - algorithm for boundary segmentation between vertebral body compacta and surrounding structures. GrowCut is a competitive region growing algorithm using cellular automata. For our study, vertebral T2-weighted Magnetic Resonance Imaging (MRI) scans were first manually outlined by neurosurgeons. Then, the vertebral bodies were segmented in the medical images by a GrowCut-trained physician using the semi-automated GrowCut-algorithm. Afterwards, results of both segmentation processes were compared using the Dice Similarity Coefficient (DSC) and the Hausdorff Distance (HD) which yielded to a DSC of 82.99+/-5.03% and a HD of 18.91+/-7.2 voxel, respectively. In addition, the times have been measured during the manual and the GrowCut segmentations, showing that a GrowCutsegmentation - with an average time of less than six minutes (5.77+/-0.73) - is significantly shorter than a pure manual outlining.

  20. Whole Genome Duplications Shaped the Receptor Tyrosine Kinase Repertoire of Jawed Vertebrates

    PubMed Central

    Brunet, Frédéric G.; Volff, Jean-Nicolas; Schartl, Manfred

    2016-01-01

    The receptor tyrosine kinase (RTK) gene family, involved primarily in cell growth and differentiation, comprises proteins with a common enzymatic tyrosine kinase intracellular domain adjacent to a transmembrane region. The amino-terminal portion of RTKs is extracellular and made of different domains, the combination of which characterizes each of the 20 RTK subfamilies among mammals. We analyzed a total of 7,376 RTK sequences among 143 vertebrate species to provide here the first comprehensive census of the jawed vertebrate repertoire. We ascertained the 58 genes previously described in the human and mouse genomes and established their phylogenetic relationships. We also identified five additional RTKs amounting to a total of 63 genes in jawed vertebrates. We found that the vertebrate RTK gene family has been shaped by the two successive rounds of whole genome duplications (WGD) called 1R and 2R (1R/2R) that occurred at the base of the vertebrates. In addition, the Vegfr and Ephrin receptor subfamilies were expanded by single gene duplications. In teleost fish, 23 additional RTK genes have been retained after another expansion through the fish-specific third round (3R) of WGD. Several lineage-specific gene losses were observed. For instance, birds have lost three RTKs, and different genes are missing in several fish sublineages. The RTK gene family presents an unusual high gene retention rate from the vertebrate WGDs (58.75% after 1R/2R, 64.4% after 3R), resulting in an expansion that might be correlated with the evolution of complexity of vertebrate cellular communication and intracellular signaling. PMID:27260203

  1. Whole Genome Duplications Shaped the Receptor Tyrosine Kinase Repertoire of Jawed Vertebrates.

    PubMed

    Brunet, Frédéric G; Volff, Jean-Nicolas; Schartl, Manfred

    2016-06-03

    The receptor tyrosine kinase (RTK) gene family, involved primarily in cell growth and differentiation, comprises proteins with a common enzymatic tyrosine kinase intracellular domain adjacent to a transmembrane region. The amino-terminal portion of RTKs is extracellular and made of different domains, the combination of which characterizes each of the 20 RTK subfamilies among mammals. We analyzed a total of 7,376 RTK sequences among 143 vertebrate species to provide here the first comprehensive census of the jawed vertebrate repertoire. We ascertained the 58 genes previously described in the human and mouse genomes and established their phylogenetic relationships. We also identified five additional RTKs amounting to a total of 63 genes in jawed vertebrates. We found that the vertebrate RTK gene family has been shaped by the two successive rounds of whole genome duplications (WGD) called 1R and 2R (1R/2R) that occurred at the base of the vertebrates. In addition, the Vegfr and Ephrin receptor subfamilies were expanded by single gene duplications. In teleost fish, 23 additional RTK genes have been retained after another expansion through the fish-specific third round (3R) of WGD. Several lineage-specific gene losses were observed. For instance, birds have lost three RTKs, and different genes are missing in several fish sublineages. The RTK gene family presents an unusual high gene retention rate from the vertebrate WGDs (58.75% after 1R/2R, 64.4% after 3R), resulting in an expansion that might be correlated with the evolution of complexity of vertebrate cellular communication and intracellular signaling.

  2. [Fall risk and fracture. Aging and fall/fracture].

    PubMed

    Kozaki, Koichi

    2013-05-01

    Fall deteriorates QOL and ADL of elderly people, especially when they suffer from hip and vertebral fractures. It is not easy to identify the cause of falling, because falling usually result from multiple factors. Among various potential causes, osteoporosis, osteoarthritis, medication of hypnotic drugs, and environmental factors are important, because they are frequent and can be modifiable. When evaluating fall risks, grasping power, one-leg standing time, timed up&go test, are useful. On the other hand, fall risk index, 22-item self-assessment test, is easy and even better in predicting future falls. In the Cochrane systematic review article 2009, exercise such as Tai-Chi, withdrawal of hypnotic drugs, and vitamin D supplementation are shown to prevent falls in community-dwelling elderly.

  3. Computer-aided tissue engineering of a human vertebral body.

    PubMed

    Wettergreen, M A; Bucklen, B S; Sun, W; Liebschner, M A K

    2005-10-01

    Tissue engineering is developing into a less speculative science involving the careful interplay of numerous design parameters and multidisciplinary professionals. Problem solving abilities and state of the art research tools are required to develop solutions for a wide variety of clinical issues. One area of particular interest is orthopedic biomechanics, a field that is responsible for the treatment of over 700,000 vertebral fractures in the United States alone last year. Engineers are currently lacking the technology and knowledge required to govern the subsistence of cells in vivo, let alone the knowledge to create a functional tissue replacement for a whole organ. Despite this, advances in computer-aided tissue engineering are continually growing. Using a combinatory approach to scaffold design, patient-specific implants may be constructed. Computer-aided design, optimization of geometry using voxel finite element models or other optimization routines, creation of a library of architectures with specific material properties, rapid prototyping, and determination of a defect site using imaging modalities highlight the current availability of design resources. This study proposes a novel methodology from start to finish which could, in the future, be used to design a tissue-engineered construct for the replacement of an entire vertebral body.

  4. Lamprey: a model for vertebrate evolutionary research

    PubMed Central

    XU, Yang; ZHU, Si-Wei; LI, Qing-Wei

    2016-01-01

    Lampreys belong to the superclass Cyclostomata and represent the most ancient group of vertebrates. Existing for over 360 million years, they are known as living fossils due to their many evolutionally conserved features. They are not only a keystone species for studying the origin and evolution of vertebrates, but also one of the best models for researching vertebrate embryonic development and organ differentiation. From the perspective of genetic information, the lamprey genome remains primitive compared with that of other higher vertebrates, and possesses abundant functional genes. Through scientific and technological progress, scientists have conducted in-depth studies on the nervous, endocrine, and immune systems of lampreys. Such research has significance for understanding and revealing the origin and evolution of vertebrates, and could contribute to a greater understanding of human diseases and treatments. This review presents the current progress and significance of lamprey research. PMID:27686784

  5. Chopart fractures.

    PubMed

    Klaue, Kaj

    2004-09-01

    The Chopart articular space was described by François Chopart (1743-1795) as a practical space for amputations in cases of distal foot necrosis. It corresponds to the limit between the anatomical hind-foot and the mid-foot. The bones involved are the talus and the calcaneus proximally, and the navicular and the cuboid distally. This space thus holds two functionally distinct entities, the anterior part of the coxa pedis (an essential functional joint) and the calcaneo-cuboidal joint,which can be considered to be an "adaptive joint" within a normal foot. Trauma to this region may cause fractures and/or dislocations and, in high energy trauma,compartment syndromes. Principles of treatment are immediate reduction of dislocations and realignment of the medial and lateral column of the foot in length and orientation. Open reduction and internal fixation of talus and navicular fractures are often indicated to restore the "coxa pedis". Open reconstruction or fusion in correct length of the calcaneo-cuboidal joint is occasionally indicated. Salvage procedures in malunions include navicular osteotomies and calcaneo-cuboidal bone block fusions. Treatment of joint destructions, especially involving the talo-navicular joint, include triple arthrodesis.

  6. The Epidemiology of Incident Fracture from Cradle to Senescence.

    PubMed

    Pasco, Julie A; Lane, Stephen E; Brennan-Olsen, Sharon L; Holloway, Kara L; Timney, Elizabeth N; Bucki-Smith, Gosia; Morse, Amelia G; Dobbins, Amelia G; Williams, Lana J; Hyde, Natalie K; Kotowicz, Mark A

    2015-12-01

    To reduce the burden of fracture, not only does bone fragility need to be addressed, but also injury prevention. Thus, fracture epidemiology irrespective of degree of trauma is informative. We aimed to determine age-and-sex-specific fracture incidence rates for the Barwon Statistical Division, Australia, 2006-2007. Using radiology reports, incident fractures were identified for 5342 males and 4512 females, with incidence of 210.4 (95 % CI 204.8, 216.2) and 160.0 (155.3, 164.7)/10,000/year, respectively. In females, spine (clinical vertebral), hip (proximal femoral) and distal forearm fractures demonstrated a pattern of stable incidence through early adult life, with an exponential increase beginning in postmenopausal years for fractures of the forearm followed by spine and hip. A similar pattern was observed for the pelvis, humerus, femur and patella. Distal forearm, humerus, other forearm and ankle fractures showed incidence peaks during childhood and adolescence. For males, age-related changes mimicked the female pattern for fractures of the spine, hip, ribs, pelvis and humerus. Incidence at these sites was generally lower for males, particularly among the elderly. A similar childhood-adolescent peak was seen for the distal forearm and humerus. For ankle fractures, there was an increase during childhood and adolescence but this extended into early adult life; in contrast to females, there were no further age-related increases. An adolescent-young adult peak incidence was observed for fractures of the face, clavicle, carpal bones, hand, fingers, foot and toe, without further age-related increases. Examining patterns of fracture provides the evidence base for monitoring temporal changes in fracture burden, and for identifying high-incidence groups to which fracture prevention strategies could be directed.

  7. Influence of Vertebral Bone Marrow Edema on Outcome in Non-Acute Osteoporotic Patients Treated with Percutaneous Vertebroplasty

    PubMed Central

    2016-01-01

    Study Design Prospective cohort study. Purpose To prospectively investigate the influence of presence of bone marrow edema (BME) in non acute osteoporotic verterbral compression fractures on postoperative clinical outcome in patients treated by percutaneous vertebroplasty (PV). Overview of Literature Although PV is widely used to treat osteoporotic collapsed vertebral compression fractures (VCF); little is known about the influence of BME in osteoporotic VCF or about its relation with relief of pain. Methods Sixty seven patients with non acute osteoporotic verterbral compression fractures treated with PV. They were divided into edema group (56 patients with apparent vertebral BME in their magnetic resonance [MR] images), and non edema group (11 patients with no vertebral BME detected in their MR images). Pain was evaluated one week, one month, six months, and one year post procedure using visual analogue scale. Statistical analysis including a 2-tailed t test comparing postoperative data with preoperative values was done. Results A good clinical response to PV procedure was seen in all patients. Significant difference was seen between two groups in one week, and one month follow up periods. Regarding pain relief in the other periods of follow up, no significant difference was seen between two groups. Conclusions PV resulted in significantly clinical improvement in patients with BME pattern than in those without in one week and one month follow up periods. But the absence of vertebral BME did not influence pain relief in patients with osteoporotic VCFs in six months, and one year post procedure. PMID:27340521

  8. Temporal Trends in Fracture Rates and Postdischarge Outcomes among Hemodialysis Patients

    PubMed Central

    Beaubrun, Anne C.; Kilpatrick, Ryan D.; Freburger, Janet K.; Bradbury, Brian D.; Wang, Lily

    2013-01-01

    Patients with ESRD have a substantially increased risk of bone fractures, but the burden of fractures has not been sufficiently characterized in this population. Here, we analyzed fracture rates and postdischarge outcomes using Medicare data from hemodialysis patients in the United States between 2000 and 2009. We assessed adjusted quarterly fracture rates (inpatient and outpatient) and consequences of postfracture hospitalization for seven categories of fracture location. Pelvis/hip, vertebral, and lower leg fractures were the most prevalent fracture types. Pelvis/hip fractures declined slightly from 29.6 to 20.6 per 1000 patient-years between early 2000 and late 2009, but the incidence rates for all other fracture types remained relatively constant. Median lengths of stay for the primary fracture hospitalization ranged from 5 days (interquartile range [IQR], 3–9 days) for forearm/wrist fractures to 8 days (IQR, 5–12 days) for femur fractures. The proportion of patients discharged from the primary hospitalization to a skilled-nursing facility ranged from 28% (ribs/sternum) to 47% (pelvis/hip). A negative binomial regression model suggested that patients had an adjusted mean of 3.8–5.2 additional hospitalizations during the year after discharge from the index hospitalization, varying by fracture type, comprising a mean of 33–52 inpatient days. Case-mix–adjusted mortality rates after discharge ranged from 0.43 to 0.91 per patient-year and were highest for vertebral, pelvis/hip, and femur fractures. In conclusion, fractures in the dialysis population are common and are associated with a substantially increased risk for death and hospitalization. PMID:23744885

  9. Evolution of the head-trunk interface in tetrapod vertebrates

    PubMed Central

    Sefton, Elizabeth M; Bhullar, Bhart-Anjan S; Mohaddes, Zahra; Hanken, James

    2016-01-01

    Vertebrate neck musculature spans the transition zone between head and trunk. The extent to which the cucullaris muscle is a cranial muscle allied with the gill levators of anamniotes or is instead a trunk muscle is an ongoing debate. Novel computed tomography datasets reveal broad conservation of the cucullaris in gnathostomes, including coelacanth and caecilian, two sarcopterygians previously thought to lack it. In chicken, lateral plate mesoderm (LPM) adjacent to occipital somites is a recently identified embryonic source of cervical musculature. We fate-map this mesoderm in the axolotl (Ambystoma mexicanum), which retains external gills, and demonstrate its contribution to posterior gill-levator muscles and the cucullaris. Accordingly, LPM adjacent to the occipital somites should be regarded as posterior cranial mesoderm. The axial position of the head-trunk border in axolotl is congruent between LPM and somitic mesoderm, unlike in chicken and possibly other amniotes. DOI: http://dx.doi.org/10.7554/eLife.09972.001 PMID:27090084

  10. Mitotic chromosome condensation in vertebrates

    SciTech Connect

    Vagnarelli, Paola

    2012-07-15

    Work from several laboratories over the past 10-15 years has revealed that, within the interphase nucleus, chromosomes are organized into spatially distinct territories [T. Cremer, C. Cremer, Chromosome territories, nuclear architecture and gene regulation in mammalian cells, Nat. Rev. Genet. 2 (2001) 292-301 and T. Cremer, M. Cremer, S. Dietzel, S. Muller, I. Solovei, S. Fakan, Chromosome territories-a functional nuclear landscape, Curr. Opin. Cell Biol. 18 (2006) 307-316]. The overall compaction level and intranuclear location varies as a function of gene density for both entire chromosomes [J.A. Croft, J.M. Bridger, S. Boyle, P. Perry, P. Teague,W.A. Bickmore, Differences in the localization and morphology of chromosomes in the human nucleus, J. Cell Biol. 145 (1999) 1119-1131] and specific chromosomal regions [N.L. Mahy, P.E. Perry, S. Gilchrist, R.A. Baldock, W.A. Bickmore, Spatial organization of active and inactive genes and noncoding DNA within chromosome territories, J. Cell Biol. 157 (2002) 579-589] (Fig. 1A, A'). In prophase, when cyclin B activity reaches a high threshold, chromosome condensation occurs followed by Nuclear Envelope Breakdown (NEB) [1]. At this point vertebrate chromosomes appear as compact structures harboring an attachment point for the spindle microtubules physically recognizable as a primary constriction where the two sister chromatids are held together. The transition from an unshaped interphase chromosome to the highly structured mitotic chromosome (compare Figs. 1A and B) has fascinated researchers for several decades now; however a definite picture of how this process is achieved and regulated is not yet in our hands and it will require more investigation to comprehend the complete process. From a biochemical point of view a vertebrate mitotic chromosomes is composed of DNA, histone proteins (60%) and non-histone proteins (40%) [6]. I will discuss below what is known to date on the contribution of these two different classes of

  11. Type 2 diabetes mellitus and fracture risk.

    PubMed

    Dede, Anastasia D; Tournis, Symeon; Dontas, Ismene; Trovas, George

    2014-12-01

    Increased fracture risk, traditionally associated with type 1 diabetes, has lately been of great concern in patients with type 2 diabetes. A variable increase in fracture risk has been reported, ranging from 20% to 3-fold, depending on skeletal site, diabetes duration and study design. Longer disease duration, the presence of diabetic complications, inadequate glycemic control, insulin use and increased risk for falls are all reported to increase fracture risk. Patients with type 2 diabetes display a unique skeletal phenotype with either normal or more frequently increased, bone mineral density and impaired structural and geometric properties. Recently, alterations in bone material properties seem to be the predominant defect leading to increased bone fragility. Accumulation of advanced glycation end-products and changes in collagen cross-linking along with suppression of bone turnover seem to be significant factors impairing bone strength. FRAX score has been reported to underestimate fracture risk and lumbar spine BMD is inadequate in predicting vertebral fractures. Anti-diabetic medications, apart from thiazolidinediones, appear to be safe for the skeleton, although more data are needed. Optimal strategies to reduce skeletal fragility in type 2 diabetic patients are yet to be determined.

  12. Older men with low serum IGF-1 have an increased risk of incident fractures: the MrOS Sweden study.

    PubMed

    Ohlsson, Claes; Mellström, Dan; Carlzon, Daniel; Orwoll, Eric; Ljunggren, Osten; Karlsson, Magnus K; Vandenput, Liesbeth

    2011-04-01

    Osteoporosis-related fractures constitute a major health concern not only in women but also in men. Insulin-like growth factor 1 (IGF-1) is a key determinant of bone mass, but the association between serum IGF-1 and incident fractures in men remains unclear. To determine the predictive value of serum IGF-1 for fracture risk in men, older men (n = 2902, mean age of 75 years) participating in the prospective, population-based Osteoporotic Fractures in Men (MrOS) Sweden study were followed for a mean of 3.3 years. Serum IGF-1 was measured at baseline by radioimmunoassay. Fractures occurring after the baseline visit were validated. In age-adjusted hazards regression analyses, serum IGF-1 associated inversely with risk of all fractures [hazard ratio (HR) per SD decrease = 1.23, 95% confidence interval (CI) 1.07-1.41], hip fractures (HR per SD decrease = 1.45, 95% CI 1.07-1.97), and clinical vertebral fractures (HR per SD decrease = 1.40, 95% CI 1.10-1-78). The predictive role of serum IGF-1 for fracture risk was unaffected by adjustment for height, weight, prevalent fractures, falls, and major prevalent diseases. Further adjustment for bone mineral density (BMD) resulted in an attenuated but still significant association between serum IGF-1 and fracture risk. Serum IGF-1 below but not above the median was inversely related to fracture incidence. The population-attributable risk proportion was 7.5% for all fractures and 22.9% for hip fractures. Taken together, older men with low serum IGF-1 have an increased fracture risk, especially for the two most important fracture types, hip and vertebral fractures. The association between serum IGF-1 and fracture risk is partly mediated via BMD.

  13. Two Rare Variants of Left Vertebral Artery.

    PubMed

    Singh, Rajani

    2017-02-15

    Though the variations of vertebral artery are clinically asymptomatic yet abnormalities are of diagnostic importance either prior to vascular surgery in the neck region or in patients of intravascular diseases such as arteriovenous malformations or cerebral aneurysms. Therefore, the aim of the study is to bring out 2 variations in the configuration of vertebral artery and their clinical implication. During dissection of thorax of 2 female cadavers, 2 different variants of configurations of left vertebral arteries were observed. In 1 patient, the left vertebral artery arose aberrantly from arch of aorta between left common carotid artery and left subclavian artery. This artery then, following oblique course, abnormally entered into foramen transversarium of C4 vertebra. In the second patient, the left common stump emerged from arch of aorta in the left side of left common carotid artery and then instantly bifurcated into vertebral artery and subclavian artery. Then following the usual oblique course, the left vertebral artery anomalously entered into foramen transversarium of C3 vertebra at the level of upper border of thyroid cartilage. The knowledge of these rare variations in the origin of vertebral artery is of paramount importance to surgeons performing surgery in neck region, radiologist performing angiography to avoid misinterpretation of radiographs and to anatomists for rare variations in academics and research.

  14. Can a fractured caprock self-heal?

    NASA Astrophysics Data System (ADS)

    Elkhoury, Jean E.; Detwiler, Russell L.; Ameli, Pasha

    2015-05-01

    The ability of geologic seals to prevent leakage of fluids injected into the deep subsurface is critical for mitigating risks associated with greenhouse-gas sequestration and natural-gas production. Fractures caused by tectonic or injection-induced stresses create potential leakage pathways that may be further enhanced by mineral dissolution. We present results from reactive-flow experiments in fractured caprock (dolomitic anhydrite), where additional dissolution occurs in the rock matrix adjacent to the fracture surfaces. Preferential dissolution of anhydrite left a compacted layer of dolomite in the fractures. At lower flow rate, rock-fluid reactions proceeded to near equilibrium within the fracture with preferential flow paths persisting over the 6-month duration of the experiment and a negligible change in permeability. At higher flow rate, permeability decreased by a dramatic two orders of magnitude. This laboratory-scale observation of self-healing argues against the likelihood of runaway permeability growth in fractured porous caprock composed of minerals with different solubilities and reaction kinetics. However, scaling arguments suggest that at larger length scales this self-healing process may be offset by the formation of dissolution channels. Our results have relevance beyond the greenhouse-gas sequestration problem. Chemical disequilibrium at waste injection sites and in hydrothermal reservoirs will lead to reactive flows that may also significantly alter formation permeability.

  15. Vertebral augmentation by kyphoplasty and vertebroplasty: 8 years experience outcomes and complications

    PubMed Central

    Yaltirik, Kaan; Ashour, Ahmed M; Reis, Conner R; Özdoğan, Selçuk; Atalay, Başar

    2016-01-01

    Background and Context: Minimally invasive percutaneous vertebral augmentation techniques; vertebroplasty, and kyphoplasty have been treatment choices for vertebral compression fractures (VCFs). The purpose of this study is to evaluate the outcomes of the patients who underwent vertebroplasty or kyphoplasty regarding complications, correction of vertebral body height, kyphosis angle and pain relief assessment using visual analog score (VAS) for pain. Materials and Methods: A retrospective review of the hospital records for 100 consecutive patients treated with kyphoplasty or vertebroplasty in our department database. Patients with osteoporotic compression fractures, traumatic compressions, and osteolytic vertebral lesions, including metastases, hemangiomas, and multiple myeloma, were included in the study. Preoperative and postoperative VAS pain scores, percentages of vertebral compression and kyphotic angles were measured and compared as well as demographic characteristics and postoperative complications. Mobilization and length of stay (LOS) were recorded. Results: One hundred patients were treated by 110 procedures. 64 patients were operated on due to osteoporosis (72 procedures). Twelve patients were operated on because of metastasis (13 procedures), 8 patients were operated on because of multiple myeloma (9 procedures). Five patients had two surgeries, 1 patient had 3 surgeries, and 1 patient had 5 surgeries. The mean preoperative VAS was 74.05 ± 9.8. In total, 175 levels were treated, 46 levels by kyphoplasty and 129 by vertebroplasty. The mean postoperative VAS was 20.94 ± 11.8. Most of the patients were mobilized in the same day they of surgery. Mean LOS was 1.83 days. Six patients had nonsymptomatic leakage of polymethlymethacrylate, and patient had epidural hematoma, which was operated on performing hemi-laminectomy. Conclusions: Percutaneous vertebroplasty and balloon kyphoplasty are both effective and safe minimally invasive procedures for the

  16. System for fracturing an underground geologic formation

    DOEpatents

    Mace, Jonathan L.; Tappan, Bryce C.; Seitz, Gerald J.; Bronisz, Lawrence E.

    2017-03-14

    An explosive system for fracturing an underground geologic formation adjacent to a wellbore can comprise a plurality of explosive units comprising an explosive material contained within the casing, and detonation control modules electrically coupled to the plurality of explosive units and configured to cause a power pulse to be transmitted to at least one detonator of at least one of the plurality of explosive units for detonation of the explosive material. The explosive units are configured to be positioned within a wellbore in spaced apart positions relative to one another along a string with the detonation control modules positioned adjacent to the plurality of explosive units in the wellbore, such that the axial positions of the explosive units relative to the wellbore are at least partially based on geologic properties of the geologic formation adjacent the wellbore.

  17. Land-Surface Subsidence and Open Bedrock Fractures in the Tully Valley, Onondaga County, New York

    USGS Publications Warehouse

    Hackett, William R.; Gleason, Gayle C.; Kappel, William M.

    2009-01-01

    Open bedrock fractures were mapped in and near two brine field areas in Tully Valley, New York. More than 400 open fractures and closed joints were mapped for dimension, orientation, and distribution along the east and west valley walls adjacent to two former brine fields. The bedrock fractures are as much as 2 feet wide and over 50 feet deep, while linear depressions in the soil, which are 3 to 10 feet wide and 3 to 6 feet deep, indicate the presence of open bedrock fractures below the soil. The fractures are probably the result of solution mining of halite deposits about 1,200 feet below the land surface.

  18. Developmental control of segment numbers in vertebrates.

    PubMed

    Gomez, Céline; Pourquié, Olivier

    2009-09-15

    Segmentation or metamery in vertebrates is best illustrated by the repetition of the vertebrae and ribs, their associated skeletal muscles and blood vessels, and the spinal nerves and ganglia. The segment number varies tremendously among the different vertebrate species, ranging from as few as six vertebrae in some frogs to as many as several hundred in some snakes and fish. In vertebrates, metameric segments or somites form sequentially during body axis formation. This results in the embryonic axis becoming entirely segmented into metameric units from the level of the otic vesicle almost to the very tip of the tail. The total segment number mostly depends on two parameters: (1) the control of the posterior growth of the body axis during somitogenesis-more same-size segments can be formed in a longer axis and (2) segment size--more smaller--size segments can be formed in a same-size body axis. During evolution, independent variations of these parameters could explain the huge diversity in segment numbers observed among vertebrate species. These variations in segment numbers are accompanied by diversity in the regionalization of the vertebral column. For example, amniotes can exhibit up to five different types of vertebrae: cervical, thoracic, lumbar, sacral and caudal, the number of which varies according to the species. This regionalization of the vertebral column is controlled by the Hox family of transcription factors. We propose that during development, dissociation of the Hox- and segmentation-clock-dependent vertebral patterning systems explains the enormous diversity of vertebral formulae observed in vertebrates.

  19. Developmental control of segment numbers in vertebrates

    PubMed Central

    Gomez, Céline; Pourquié, Olivier

    2011-01-01

    Segmentation or metamery in vertebrates is best illustrated by the repetition of the vertebrae and ribs, their associated skeletal muscles and blood vessels, and the spinal nerves and ganglia. The segment number varies tremendously among the different vertebrate species, ranging from as few as six vertebrae in some frogs to as many as several hundred in some snakes and fish. In vertebrates, metameric segments or somites form sequentially during body axis formation. This results in the embryonic axis becoming entirely segmented into metameric units from the level of the otic vesicle almost to the very tip of the tail. The total segment number mostly depends on two parameters: (1) the control of the posterior growth of the body axis during somitogenesis—more same-size segments can be formed in a longer axis and (2) segment size—more smaller-size segments can be formed in a same-size body axis. During evolution, independent variations of these parameters could explain the huge diversity in segment numbers observed among vertebrate species. These variations in segment numbers are accompanied by diversity in the regionalization of the vertebral column. For example, amniotes can exhibit up to five different types of vertebrae: cervical, thoracic, lumbar, sacral and caudal, the number of which varies according to the species. This regionalization of the vertebral column is controlled by the Hox family of transcription factors. We propose that during development, dissociation of the Hox- and segmentation-clock-dependent vertebral patterning systems explains the enormous diversity of vertebral formulae observed in vertebrates. PMID:19621429

  20. Heterogeneity of vertebrate brain tubulins.

    PubMed Central

    Field, D J; Collins, R A; Lee, J C

    1984-01-01

    We have examined the extent of brain tubulin heterogeneity in six vertebrate species commonly used in tubulin research (rat, calf, pig, chicken, human, and lamb) using isoelectric focusing, two-dimensional electrophoresis, and peptide mapping procedures that provide higher resolution than previously available. The extent of heterogeneity is extremely similar in all of these organisms, as judged by number, range of isoelectric points, and distribution of the isotubulins. A minimum of 6 alpha and 12 beta tubulins was resolved from all sources. Even the pattern of spots on two-dimensional peptide maps is remarkably similar. These similarities suggest that the populations of tubulin in all of these brains should have similar overall physical properties. It is particularly interesting that chicken, which has only four or five beta-tubulin genes, contains approximately 12 beta tubulins. Thus, post-translational modification must generate at least some of the tubulin heterogeneity. Mammalian species, which contain 15-20 tubulin DNA sequences, do not show any more tubulin protein heterogeneity than does chicken. This suggests that expression of only a small number of the mammalian genes may be required to generate the observed tubulin heterogeneity. Images PMID:6588378

  1. Rotations in a Vertebrate Setting

    NASA Astrophysics Data System (ADS)

    McCollum, Gin

    2003-05-01

    Rotational movements of the head are often considered to be measured in a single three dimensional coordinate system implemented by the semicircular canals of the vestibular system of the inner ear. However, the vertebrate body -- including the nervous system -- obeys rectangular symmetries alien to rotation groups. At best, nervous systems mimic the physical rotation group in a fragmented way, only partially reintegrating physical movements in whole organism responses. The vestibular canal reference frame is widely used in nervous systems, for example by eye movements. It is used to some extent even in the cerebrum, as evidenced by the remission of hemineglect -- in which half of space is ignored -- when the vestibular system is stimulated. However, reintegration of space by the organism remains incomplete. For example, compensatory eye movements (which in most cases aid visual fixation) may disagree with conscious self-motion perception. In addition, movement-induced nausea, illusions, and cue-free perceptions demonstrate symmetry breaking or incomplete spatial symmetries. As part of a long-term project to investigate rotation groups in nervous systems, we have analyzed the symmetry group of a primary vestibulo-spinal projection.

  2. Antibody Isotype Switching in Vertebrates.

    PubMed

    Senger, Kate; Hackney, Jason; Payandeh, Jian; Zarrin, Ali A

    2015-01-01

    The humoral or antibody-mediated immune response in vertebrates has evolved to respond to diverse antigenic challenges in various anatomical locations. Diversification of the immunoglobulin heavy chain (IgH) constant region via isotype switching allows for remarkable plasticity in the immune response, including versatile tissue distribution, Fc receptor binding, and complement fixation. This enables antibody molecules to exert various biological functions while maintaining antigen-binding specificity. Different immunoglobulin (Ig) classes include IgM, IgD, IgG, IgE, and IgA, which exist as surface-bound and secreted forms. High-affinity autoantibodies are associated with various autoimmune diseases such as lupus and arthritis, while defects in components of isotype switching are associated with infections. A major route of infection used by a large number of pathogens is invasion of mucosal surfaces within the respiratory, digestive, or urinary tract. Most infections of this nature are initially limited by effector mechanisms such as secretory IgA antibodies. Mucosal surfaces have been proposed as a major site for the genesis of adaptive immune responses, not just in fighting infections but also in tolerating commensals and constant dietary antigens. We will discuss the evolution of isotype switching in various species and provide an overview of the function of various isotypes with a focus on IgA, which is universally important in gut homeostasis as well as pathogen clearance. Finally, we will discuss the utility of antibodies as therapeutic modalities.

  3. The Fracture Risk Assessment Tool (FRAX®): applications in clinical practice.

    PubMed

    Watts, Nelson B

    2011-04-01

    Osteoporosis is a serious health concern affecting millions of Americans, with many patients going undiagnosed and untreated. Fractures due to osteoporosis and fracture-related complications are the most clinically relevant and costly consequences of this disorder. The Fracture Risk Assessment Tool (FRAX®), released by the World Health Organization (WHO) in February 2008, is a major achievement in helping determine which patients may be candidates for pharmacological therapy for osteoporosis. This Web-based algorithm, which has been incorporated into some dual x-ray absorptiometry (DXA) reporting software, calculates the 10-year probability of major osteoporotic fracture (clinical vertebral, hip, forearm, or humerus) and the 10-year probability of hip fracture in men and women based on easily obtained clinical risk factors and bone mineral density (BMD) of the femoral neck (optional). The National Osteoporosis Foundation updated its U.S. guidelines in February 2008 to incorporate FRAX and recommends that all postmenopausal women and men aged ≥50 years with a hip or vertebral fracture, a T-score ≤-2.5 at the femoral neck or spine (excluding secondary causes), or low bone mass (T-score between -1.0 and -2.5) and a 10-year probability of hip fracture ≥3% or of major osteoporosis-related fracture ≥20% (based on FRAX) should be considered candidates for drug therapy. Despite its demonstrated clinical utility, FRAX has limitations and should not be used in all situations. Acceptance and clinical use of FRAX may help identify men and women at increased risk for osteoporotic fracture, but implementing the tool into clinical practice may be a challenge for busy physicians.

  4. Alteration-weakening leading to localized deformation in a damage aureole adjacent to a dormant shear zone

    NASA Astrophysics Data System (ADS)

    Backeberg, Nils R.; Rowe, Christie D.; Barshi, Naomi

    2016-09-01

    Deformation adjacent to faults and shear zones is traditionally thought to correlate with slip. Inherited structures may control damage geometry, localizing fluid flow and deformation in a damage aureole around structures, even after displacement has ceased. In this paper we document a post-shearing anastomosing foliation and fracture network that developed to one side of the Mesoarchean Marmion Shear Zone. This fracture network hosts the low-grade, disseminated Hammond Reef gold deposit. The shear zone juxtaposed a greenstone belt against tonalite gneiss and was locked by an intrusion that was emplaced during the final stages of suturing. After cessation of activity, fluids channeled along fault- and intrusion-related fractures led to the pervasive sericitization of feldspars. Foliated zones resulted from flattening in the weaker sericite-rich tonalite during progressive alteration without any change in the regional NW-SE shortening direction. The anastomosing pattern may have been inherited from an earlier ductile fabric, but sericite alteration and flattening fabrics all formed post-shearing. Thus, the apparent foliated fracture network adjacent to the Marmion Shear Zone is a second-order effect of shear-related damage, distinct in time from shear activity, adjacent to an effectively dormant shear zone. This phenomenon has implications for understanding the relative timing of fault zone activity, alteration and (in this case) gold mineralization related to long-term fault zone permeability.

  5. Treatment of C2 body fracture with unusual distractive and rotational components resulting in gross instability.

    PubMed

    Lau, Darryl; Shin, Samuel S; Patel, Rakesh; Park, Paul

    2013-01-01

    Cervical fractures can result in severe neurological compromise and even death. One of the most commonly injured segments is the C2 vertebrae, which most frequently involves the odontoid process. In this report, we present the unusual case of a 28-year-old female who sustained a C2 vertebral body fracture (comminuted transverse fracture through the body and both transverse processes) that had both a significant distractive and rotational component, causing the fracture to be highly unstable. Application of halo bracing was unsuccessful. The patient subsequently required a C1-C4 posterior spinal fusion. Follow-up computer tomography imaging confirmed fusion and the patient did well clinically thereafter.

  6. Effect of Natural Fractures on Hydraulic Fracturing

    NASA Astrophysics Data System (ADS)

    Ben, Y.; Wang, Y.; Shi, G.

    2012-12-01

    Hydraulic Fracturing has been used successfully in the oil and gas industry to enhance oil and gas production in the past few decades. Recent years have seen the great development of tight gas, coal bed methane and shale gas. Natural fractures are believed to play an important role in the hydraulic fracturing of such formations. Whether natural fractures can benefit the fracture propagation and enhance final production needs to be studied. Various methods have been used to study the effect of natural fractures on hydraulic fracturing. Discontinuous Deformation Analysis (DDA) is a numerical method which belongs to the family of discrete element methods. In this paper, DDA is coupled with a fluid pipe network model to simulate the pressure response in the formation during hydraulic fracturing. The focus is to study the effect of natural fractures on hydraulic fracturing. In particular, the effect of rock joint properties, joint orientations and rock properties on fracture initiation and propagation will be analyzed. The result shows that DDA is a promising tool to study such complex behavior of rocks. Finally, the advantages of disadvantages of our current model and future research directions will be discussed.

  7. Fracture channel waves

    NASA Astrophysics Data System (ADS)

    Nihei, Kurt T.; Yi, Weidong; Myer, Larry R.; Cook, Neville G. W.; Schoenberg, Michael

    1999-03-01

    The properties of guided waves which propagate between two parallel fractures are examined. Plane wave analysis is used to obtain a dispersion equation for the velocities of fracture channel waves. Analysis of this equation demonstrates that parallel fractures form an elastic waveguide that supports two symmetric and two antisymmetric dispersive Rayleigh channel waves, each with particle motions and velocities that are sensitive to the normal and tangential stiffnesses of the fractures. These fracture channel waves degenerate to shear waves when the fracture stiffnesses are large, to Rayleigh waves and Rayleigh-Lamb plate waves when the fracture stiffnesses are low, and to fracture interface waves when the fractures are either very closely spaced or widely separated. For intermediate fracture stiffnesses typical of fractured rock masses, fracture channel waves are dispersive and exhibit moderate to strong localization of guided wave energy between the fractures. The existence of these waves is examined using laboratory acoustic measurements on a fractured marble plate. This experiment confirms the distinct particle motion of the fundamental antisymmetric fracture channel wave (A0 mode) and demonstrates the ease with which a fracture channel wave can be generated and detected.

  8. Calcium intake and risk of fracture: systematic review

    PubMed Central

    Leung, William; Tai, Vicky; Bastin, Sonja; Gamble, Greg D; Grey, Andrew; Reid, Ian R

    2015-01-01

    Objective To examine the evidence underpinning recommendations to increase calcium intake through dietary sources or calcium supplements to prevent fractures. Design Systematic review of randomised controlled trials and observational studies of calcium intake with fracture as an endpoint. Results from trials were pooled with random effects meta-analyses. Data sources Ovid Medline, Embase, PubMed, and references from relevant systematic reviews. Initial searches undertaken in July 2013 and updated in September 2014. Eligibility criteria for selecting studies Randomised controlled trials or cohort studies of dietary calcium, milk or dairy intake, or calcium supplements (with or without vitamin D) with fracture as an outcome and participants aged >50. Results There were only two eligible randomised controlled trials of dietary sources of calcium (n=262), but 50 reports from 44 cohort studies of relations between dietary calcium (n=37), milk (n=14), or dairy intake (n=8) and fracture outcomes. For dietary calcium, most studies reported no association between calcium intake and fracture (14/22 for total, 17/21 for hip, 7/8 for vertebral, and 5/7 for forearm fracture). For milk (25/28) and dairy intake (11/13), most studies also reported no associations. In 26 randomised controlled trials, calcium supplements reduced the risk of total fracture (20 studies, n=58 573; relative risk 0.89, 95% confidence interval 0.81 to 0.96) and vertebral fracture (12 studies, n=48 967. 0.86, 0.74 to 1.00) but not hip (13 studies, n=56 648; 0.95, 0.76 to 1.18) or forearm fracture (eight studies, n=51 775; 0.96, 0.85 to 1.09). Funnel plot inspection and Egger’s regression suggested bias toward calcium supplements in the published data. In randomised controlled trials at lowest risk of bias (four studies, n=44 505), there was no effect on risk of fracture at any site. Results were similar for trials of calcium monotherapy and co-administered calcium and vitamin D. Only one trial

  9. Mortality associated with bone fractures in COPD patients

    PubMed Central

    Yamauchi, Yasuhiro; Yasunaga, Hideo; Sakamoto, Yukiyo; Hasegawa, Wakae; Takeshima, Hideyuki; Urushiyama, Hirokazu; Jo, Taisuke; Matsui, Hiroki; Fushimi, Kiyohide; Nagase, Takahide

    2016-01-01

    Background and objective COPD is well known to frequently coexist with osteoporosis. Bone fractures often occur and may affect mortality in COPD patients. However, in-hospital mortality related to bone fractures in COPD patients has been poorly studied. This retrospective study investigated in-hospital mortality of COPD patients with bone fractures using a national inpatient database in Japan. Methods Data of COPD patients admitted with bone fractures, including hip, vertebra, shoulder, and forearm fractures to 1,165 hospitals in Japan between July 2010 and March 2013, were extracted from the Diagnosis Procedure Combination database. The clinical characteristics and mortalities of the patients were determined. Multivariable logistic regression analysis was also performed to determine the factors associated with in-hospital mortality of COPD patients with hip fractures. Results Among 5,975 eligible patients, those with hip fractures (n=4,059) were older, had lower body mass index (BMI), and had poorer general condition than those with vertebral (n=1,477), shoulder (n=281), or forearm (n=158) fractures. In-hospital mortality was 7.4%, 5.2%, 3.9%, and 1.3%, respectively. Among the hip fracture group, surgical treatment was significantly associated with lower mortality (adjusted odds ratio, 0.43; 95% confidence interval, 0.32–0.56) after adjustment for patient backgrounds. Higher in-hospital mortality was associated with male sex, lower BMI, lower level of consciousness, and having several comorbidities, including pneumonia, lung cancer, congestive heart failure, chronic liver disease, and chronic renal failure. Conclusion COPD patients with hip fractures had higher mortality than COPD patients with other types of fracture. Surgery for hip fracture was associated with lower mortality than conservative treatment. PMID:27703343

  10. Borehole sampling of fracture populations - compensating for borehole sampling bias in crystalline bedrock aquifers, Mirror Lake, Grafton County, New Hampshire

    USGS Publications Warehouse

    McDonald, G.D.; Paillet, Frederick L.; Barton, C.C.; Johnson, C.D.

    1997-01-01

    The clustering of orientations of hydraulically conductive fractures in bedrock at the Mirror Lake, New Hampshire fractured rock study site was investigated by comparing the orientations of fracture populations in two subvertical borehole arrays with those mapped on four adjacent subvertical roadcuts. In the boreholes and the roadcuts, the orientation of fracture populations appears very similar after borehole data are compensated for undersampling of steeply dipping fractures. Compensated borehole and pavement fracture data indicate a northeast-striking population of fractures with varying dips concentrated near that of the local foliation in the adjacent rock. The data show no correlation between fracture density (fractures/linear meter) and distance from lithologic contacts in both the boreholes and the roadcuts. The population of water-producing borehole fractures is too small (28 out of 610 fractures) to yield meaningful orientation comparisons. However, the orientation of large aperture fractures (which contains all the producing fractures) contains two or three subsidiary clusters in orientation frequency that are not evident in stereographic projections of the entire population containing all aperture sizes. Further, these subsidiary orientation clusters do not coincide with the dominant (subhorizontal and subvertical) regional fracture orientations.

  11. Hydrocarbon provinces and productive trends in Libya and adjacent areas

    SciTech Connect

    Missallati, A.A. Ltd., Tripoli )

    1988-08-01

    According to the age of major reservoirs, hydrocarbon occurrences in Libya and adjacent areas can be grouped into six major systems which, according to their geographic locations, can be classified into two major hydrocarbon provinces: (1) Sirte-Pelagian basins province, with major reservoirs ranging from middle-late Mesozoic to early Tertiary, and (2) Murzog-Ghadames basins province, with major reservoirs ranging from early Paleozoic to early Mesozoic. In the Sirte-Pelagian basins province, hydrocarbons have been trapped in structural highs or in stratigraphic wedge-out against structural highs and in carbonate buildups. Here, hydrocarbon generation is characterized by the combined effect of abundant structural relief and reservoir development in the same hydrocarbon systems of the same age, providing an excellent example of hydrocarbon traps in sedimentary basins that have undergone extensive tensional fracturing in a shallow marine environment. In the Murzog-Ghadames basins province, hydrocarbons have been trapped mainly in structural highs controlled by paleostructural trends as basement arches which acted as focal points for oil migration and accumulation.

  12. Adjacent Segment Pathology after Anterior Cervical Fusion

    PubMed Central

    Chung, Jae Yoon; Park, Jong-Beom; Seo, Hyoung-Yeon

    2016-01-01

    Anterior cervical fusion has become a standard of care for numerous pathologic conditions of the cervical spine. However, subsequent development of clinically significant disc disease at levels adjacent to fused discs is a serious long-term complication of this procedure. As more patients live longer after surgery, it is foreseeable that adjacent segment pathology (ASP) will develop in increasing numbers of patients. Also, ASP has been studied more intensively with the recent popularity of motion preservation technologies like total disc arthroplasty. The true nature and scope of ASP remains poorly understood. The etiology of ASP is most likely multifactorial. Various factors including altered biomechanical stresses, surgical disruption of soft tissue and the natural history of cervical disc disease contribute to the development of ASP. General factors associated with disc degeneration including gender, age, smoking and sports may play a role in the development of ASP. Postoperative sagittal alignment and type of surgery are also considered potential causes of ASP. Therefore, a spine surgeon must be particularly careful to avoid unnecessary disruption of the musculoligamentous structures, reduced risk of direct injury to the disc during dissection and maintain a safe margin between the plate edge and adjacent vertebrae during anterior cervical fusion. PMID:27340541

  13. A Case of Aerococcus Urinae Vertebral Osteomyelitis

    PubMed Central

    Jerome, Michael; Slim, Jihad; Sison, Raymund; Marton, Randy

    2015-01-01

    Aerococcus urinae is an aerobic, alpha hemolytic gram positive coccus bacterium that grows in pairs or clusters. We report the first case of vertebral osteomyelitis due to A. urinae. This has not been previously reported in the literature. PMID:26069429

  14. Sleep and orexins in nonmammalian vertebrates.

    PubMed

    Volkoff, Hélène

    2012-01-01

    Although a precise definition of "sleep" has yet to be established, sleep-like behaviors have been observed in all animals studied to date including mammals and nonmammalian vertebrates. Orexins are hypothalamic neuropeptides that are involved in the regulation of many physiological functions, including feeding, thermoregulation, cardiovascular control, as well as the control of the sleep-wakefulness cycle. To date, the knowledge on the functions of orexins in nonmammalian vertebrates is still limited, but the similarity of the structures of orexins and their receptors among vertebrates suggest that they have similar conserved physiological functions. This review describes our current knowledge on sleep in nonmammalian vertebrates (birds, reptiles, amphibians, and fish) and the possible role of orexins in the regulation of their energy homeostasis and arousal states.

  15. [Vertebral osteomyelitis associated with epidural block].

    PubMed

    Carrillo Esper, R; Cruz-Bautista, I

    2001-01-01

    Infectious complications after epidural anesthesia are infrequent and the most common are epidural and subdural abscess. We report one rare case of vertebral osteomyelitus associated with an epidural catheter and review the literature.

  16. [Osteocyte-network in various vertebrates].

    PubMed

    Yamaguchi, Akira

    2012-05-01

    Since aquatic and land vertebrates live in different habitats,the morphology and function of bone might be greatly affected by the habitats of each vertebrate. We histologically investigated the bones of various vertebrates including teleost fishes, amphibians, reptiles, and mammals. Teleost fishes exhibited either bones contained many osteocytes (cellular bone) or bones have few osteocytes (acellular bone) . The development of osteocyte lacunocanalicular system in the cellular bone of the fish is poor compared to those in amphibians, reptiles, and mammals. Bones in Xenopus laevis, a freshwater species, exhibited well-developed lacunocanalicular systems as well as those in reptiles and mammals. These studies indicates that the osteocyte lacunocanalicular system differs between teleost fishes and land vertebrates, but this is not directly related to aquatic habitat.

  17. Cervicobrachialgia with congenital vertebral anomalies and diastematomyelia.

    PubMed

    Roosen, N; De Moor, J

    1984-05-01

    A case of diastematomyelia in an adult female patient is reported. The relationship of the cervicobrachialgia, which was the presenting sign, to the diastematomyelia and the congenital vertebral anomalies is discussed.

  18. RFamide Peptides in Early Vertebrate Development

    PubMed Central

    Sandvik, Guro Katrine; Hodne, Kjetil; Haug, Trude Marie; Okubo, Kataaki; Weltzien, Finn-Arne

    2014-01-01

    RFamides (RFa) are neuropeptides involved in many different physiological processes in vertebrates, such as reproductive behavior, pubertal activation of the reproductive endocrine axis, control of feeding behavior, and pain modulation. As research has focused mostly on their role in adult vertebrates, the possible roles of these peptides during development are poorly understood. However, the few studies that exist show that RFa are expressed early in development in different vertebrate classes, perhaps mostly associated with the central nervous system. Interestingly, the related peptide family of FMRFa has been shown to be important for brain development in invertebrates. In a teleost, the Japanese medaka, knockdown of genes in the Kiss system indicates that Kiss ligands and receptors are vital for brain development, but few other functional studies exist. Here, we review the literature of RFa in early vertebrate development, including the possible functional roles these peptides may play. PMID:25538682

  19. Recombination Drives Vertebrate Genome Contraction

    PubMed Central

    Nam, Kiwoong; Ellegren, Hans

    2012-01-01

    Selective and/or neutral processes may govern variation in DNA content and, ultimately, genome size. The observation in several organisms of a negative correlation between recombination rate and intron size could be compatible with a neutral model in which recombination is mutagenic for length changes. We used whole-genome data on small insertions and deletions within transposable elements from chicken and zebra finch to demonstrate clear links between recombination rate and a number of attributes of reduced DNA content. Recombination rate was negatively correlated with the length of introns, transposable elements, and intergenic spacer and with the rate of short insertions. Importantly, it was positively correlated with gene density, the rate of short deletions, the deletion bias, and the net change in sequence length. All these observations point at a pattern of more condensed genome structure in regions of high recombination. Based on the observed rates of small insertions and deletions and assuming that these rates are representative for the whole genome, we estimate that the genome of the most recent common ancestor of birds and lizards has lost nearly 20% of its DNA content up until the present. Expansion of transposable elements can counteract the effect of deletions in an equilibrium mutation model; however, since the activity of transposable elements has been low in the avian lineage, the deletion bias is likely to have had a significant effect on genome size evolution in dinosaurs and birds, contributing to the maintenance of a small genome. We also demonstrate that most of the observed correlations between recombination rate and genome contraction parameters are seen in the human genome, including for segregating indel polymorphisms. Our data are compatible with a neutral model in which recombination drives vertebrate genome size evolution and gives no direct support for a role of natural selection in this process. PMID:22570634

  20. MULTI-PHASE FRACTURE-MATRIX INTERACTIONS UNDER STRESS CHANGES

    SciTech Connect

    A.S. Grader; D. Elsworth; P.M. Halleck; F. Alvarado; H. Yasuhara; A. Alajmi; Z. Karpyn

    2002-10-28

    present time, we are developing an inverse process using a simulation model to understand the fluid flow patterns in the presence of a fracture, and the interactions between fluid flow in the fracture and the adjacent matrix. Preliminary results demonstrate that the flow patterns are significantly impacted by the presence of the fracture. Bypassing is quantified and we expect to be able to extract from the modeling the distribution of properties in the fracture and the adjacent matrix.

  1. Irradiation of Spinal Metastases: Should We Continue to Include One Uninvolved Vertebral Body Above and Below in the Radiation Field?

    SciTech Connect

    Klish, Darren S.; Grossman, Patricia; Allen, Pamela K.; Rhines, Laurence D.; Chang, Eric L.

    2011-12-01

    Purpose: Historically, the appropriate target volume to be irradiated for spinal metastases is 1-2 vertebral bodies above and below the level of involvement for three reasons: (1) to avoid missing the correct level in the absence of simulation or (2) to account for the possibility of spread of disease to the adjacent level, and (3) to account for beam penumbra. In this study, we hypothesized that isolated failures occurring in the level adjacent to level treated with stereotactic body radiosurgery (SBRS) were infrequent and that with improved localization techniques with image-guided radiation therapy, treatment of only the involved level of spinal metastases may be more appropriate. Methods and Materials: Patients who had received SBRS treatments to only the involved level of the spine as part of a prospective trial for spinal metastases comprised the study population. Follow-up imaging with spine MRI was performed at 3-month intervals following initial treatment. Failures in the adjacent (V{+-}1, V{+-}2) and distant spine were identified and classified accordingly. Results: Fifty-eight patients met inclusion criteria for this study and harbored 65 distinct spinal metastases. At 18-month median follow-up, seven (10.7%) patients failed simultaneously at adjacent levels V{+-}1 and at multiple sites throughout the spine. Only two (3%) patients experienced isolated, solitary adjacent failures at 9 and 11 months, respectively. Conclusion: Isolated local failures of the unirradiated adjacent vertebral bodies may occur in <5% of patients with isolated spinal metastasis. On the basis of the data, the current practice of irradiating one vertebral body above and below seems unnecessary and could be revised to irradiate only the involved level(s) of the spine metastasis.

  2. Oldest Pathology in a Tetrapod Bone Illuminates the Origin of Terrestrial Vertebrates

    PubMed Central

    Bishop, Peter J.; Walmsley, Christopher W.; Phillips, Matthew J.; Quayle, Michelle R.

    2015-01-01

    The origin of terrestrial tetrapods was a key event in vertebrate evolution, yet how and when it occurred remains obscure, due to scarce fossil evidence. Here, we show that the study of palaeopathologies, such as broken and healed bones, can help elucidate poorly understood behavioural transitions such as this. Using high-resolution finite element analysis, we demonstrate that the oldest known broken tetrapod bone, a radius of the primitive stem tetrapod Ossinodus pueri from the mid-Viséan (333 million years ago) of Australia, fractured under a high-force, impact-type loading scenario. The nature of the fracture suggests that it most plausibly occurred during a fall on land. Augmenting this are new osteological observations, including a preferred directionality to the trabecular architecture of cancellous bone. Together, these results suggest that Ossinodus, one of the first large (>2m length) tetrapods, spent a significant proportion of its life on land. Our findings have important implications for understanding the temporal, biogeographical and physiological contexts under which terrestriality in vertebrates evolved. They push the date for the origin of terrestrial tetrapods further back into the Carboniferous by at least two million years. Moreover, they raise the possibility that terrestriality in vertebrates first evolved in large tetrapods in Gondwana rather than in small European forms, warranting a re-evaluation of this important evolutionary event. PMID:25938463

  3. Oldest pathology in a tetrapod bone illuminates the origin of terrestrial vertebrates.

    PubMed

    Bishop, Peter J; Walmsley, Christopher W; Phillips, Matthew J; Quayle, Michelle R; Boisvert, Catherine A; McHenry, Colin R

    2015-01-01

    The origin of terrestrial tetrapods was a key event in vertebrate evolution, yet how and when it occurred remains obscure, due to scarce fossil evidence. Here, we show that the study of palaeopathologies, such as broken and healed bones, can help elucidate poorly understood behavioural transitions such as this. Using high-resolution finite element analysis, we demonstrate that the oldest known broken tetrapod bone, a radius of the primitive stem tetrapod Ossinodus pueri from the mid-Viséan (333 million years ago) of Australia, fractured under a high-force, impact-type loading scenario. The nature of the fracture suggests that it most plausibly occurred during a fall on land. Augmenting this are new osteological observations, including a preferred directionality to the trabecular architecture of cancellous bone. Together, these results suggest that Ossinodus, one of the first large (>2m length) tetrapods, spent a significant proportion of its life on land. Our findings have important implications for understanding the temporal, biogeographical and physiological contexts under which terrestriality in vertebrates evolved. They push the date for the origin of terrestrial tetrapods further back into the Carboniferous by at least two million years. Moreover, they raise the possibility that terrestriality in vertebrates first evolved in large tetrapods in Gondwana rather than in small European forms, warranting a re-evaluation of this important evolutionary event.

  4. Vertebral osteomyelitis: clinical features and diagnosis.

    PubMed

    Eren Gök, S; Kaptanoğlu, E; Celikbaş, A; Ergönül, O; Baykam, N; Eroğlu, M; Dokuzoğuz, B

    2014-10-01

    We aimed to describe clinical and diagnostic features of vertebral osteomyelitis for differential diagnosis and treatment. This is a prospective observational study performed between 2002 and 2012 in Ankara Numune Education and Research Hospital in Ankara, Turkey. All the patients with vertebral osteomyelitis were followed for from 6 months to 3 years. In total, 214 patients were included in the study, 113 out of 214 (53%) were female. Out of 214 patients, 96 (45%) had brucellar vertebral osteomyelitis (BVO), 63 (29%) had tuberculous vertebral osteomyelitis (TVO), and 55 (26%) had pyogenic vertebral osteomyelitis (PVO). Mean number of days between onset of symptoms and establishment of diagnosis was greater with the patients with TVO (266 days) than BVO (115 days) or PVO (151 days, p <0.001). In blood cultures, Brucella spp. were isolated from 35 of 96 BVO patients (35%). Among 55 PVO patients, the aetiological agent was isolated in 11 (20%) patients. For tuberculin skin test >15 mm, sensitivity was 0.66, specificity was 0.97, positive predictive value was 0.89, negative predictive value was 0.88, and receiver operating characteristics area was 0.8. Tuberculous and brucellar vertebral osteomyelitis remained the leading causes of vertebral osteomyelitis with delayed diagnosis. In differential diagnosis of vertebral osteomyelitis, consumption of unpasteurized cheese, dealing with husbandry, sweating, arthralgia, hepatomegaly, elevated alanine transaminase, and lumbar involvement in magnetic resonance imaging were found to be predictors of BVO, thoracic involvement in magnetic resonance imaging and tuberculin skin test > 15 mm were found to be predictors of TVO, and history of spinal surgery and leucocytosis were found to be predictors of PVO.

  5. Cervical vertebral fusion with anterior meningocele

    PubMed Central

    Chavredakis, Emmanuel; Carter, David; Bhojak, Manesh; Jenkinson, Michael D; Clark, Simon R

    2015-01-01

    We present the first described case of cervical vertebral fusion associated with anterior meningocele and syringomyelia. A 45-year-old woman presented with minor trauma, and plain cervical spine radiographs highlighted a congenital deformity of the cervical vertebral bodies. She had a normal neurological examination; however, further imaging revealed a meningocele and syringomyelia. This case highlights the importance of thorough imaging investigation when presented with a congenital deformity in order to detect and prevent development of degenerative spinal cord pathologies. PMID:25923673

  6. Radiotherapy in the treatment of vertebral hemangiomas

    SciTech Connect

    Faria, S.L.; Schlupp, W.R.; Chiminazzo, H. Jr.

    1985-02-01

    Symptomatic vertebral hemangiomas are not common. Although radiotherapy has been used as treatment, the data are sparse concerning total dose, fractionation and results. The authors report nine patients with vertebral hemangioma treated with 3000-4000 rad, 200 rad/day, 5 fractions per week, followed from 6 to 62 months. Seventy-seven percent had complete or almost complete disappearance of the symptoms. Radiotherapy schedules are discussed.

  7. Geothermal energy enhancement by thermal fracture. [REX (Rock Energy Extraction)

    SciTech Connect

    Demuth, R.B.; Harlow, F.H.

    1980-12-01

    A large, vertical, circular fracture created deep within hot rock is connected to the surface through two holes. The inlet provides a source of cold water and the outlet extracts heated water. Cooling of the rock produces thermal stresses that fracture the rock adjacent to the primary crack, thereby enhancing the heat extraction rate by means of convective transport. The properties of the thermal fracture network vary with position and time. The REX code for high-speed computer was written and used to study the coupled processes of primary-crack flow and lateral thermal fracture heat transport. Calculations for elapsed times of 100 y show that thermal fracture enhancement can double the heat extraction rate over the results from conduction alone. Long-term enhancement predictions depend on data from rock-mechanics studies, which the REX code is prepared to accept as they become available.

  8. Ibandronate dose response is associated with increases in bone mineral density and reductions in clinical fractures: results of a meta-analysis.

    PubMed

    Sebba, Anthony I; Emkey, Ronald D; Kohles, Joseph D; Sambrook, Philip N

    2009-03-01

    This meta-analysis pooled data from the four phase III clinical trials of ibandronate to assess the relationship between ibandronate dose, changes in bone mineral density, and rates of both clinical and non-vertebral fractures. Individual patient data from the intent-to-treat population of the BONE, IV fracture prevention, MOBILE, and DIVA studies were included for analysis. The relationship between ibandronate dose and bone mineral density at both the lumbar spine and at the total hip was assessed qualitatively. The relationship between lumbar spine bone mineral density and clinical fracture rate, and the relationship between total hip bone mineral density and non-vertebral fracture rate, were assessed both qualitatively and using mathematical models. A total of 8710 patients were included in this analysis. Both lumbar spine and total hip bone mineral density were observed to increase with increasing ibandronate dose. The incidence of all clinical fractures was observed to decrease as lumbar spine bone mineral density increased. A statistically significant inverse linear relationship was observed between percent change in lumbar spine bone mineral density and the rate of clinical fractures (P=0.005). A non-significant curvilinear relationship was observed between percent change in total hip bone mineral density and non-vertebral fracture rate. Increased ibandronate exposure is associated with increasing gains in the lumbar spine bone mineral density and decreasing clinical fracture rates. A non-linear relationship may exist between increases in the total hip bone mineral density and non-vertebral fracture rate.

  9. [Periprosthetic Acetabulum Fractures].

    PubMed

    Schreiner, A J; Stuby, F; de Zwart, P M; Ochs, B G

    2016-12-01

    In contrast to periprosthetic fractures of the femur, periprosthetic fractures of the acetabulum are rare complications - both primary fractures and fractures in revision surgery. This topic is largely under-reported in the literature; there are a few case reports and no long term results. Due to an increase in life expectancy, the level of patients' activity and the number of primary joint replacements, one has to expect a rise in periprosthetic complications in general and periprosthetic acetabular fractures in particular. This kind of fracture can be intra-, peri- or postoperative. Intraoperative fractures are especially associated with insertion of cementless press-fit acetabular components or revision surgery. Postoperative periprosthetic fractures of the acetabulum are usually related to osteolysis, for example, due to polyethylene wear. There are also traumatic fractures and fractures missed intraoperatively that lead to some kind of insufficiency fracture. Periprosthetic fractures of the acetabulum are treated conservatively if the implant is stable and the fracture is not dislocated. If surgery is needed, there are many possible different surgical techniques and challenging approaches. That is why periprosthetic fractures of the acetabulum should be treated by experts in pelvic surgery as well as revision arthroplasty and the features specific to the patient, fracture and prosthetic must always be considered.

  10. Evolution and development of the vertebrate neck

    PubMed Central

    Ericsson, Rolf; Knight, Robert; Johanson, Zerina

    2013-01-01

    Muscles of the vertebrate neck include the cucullaris and hypobranchials. Although a functional neck first evolved in the lobe-finned fishes (Sarcopterygii) with the separation of the pectoral/shoulder girdle from the skull, the neck muscles themselves have a much earlier origin among the vertebrates. For example, lampreys possess hypobranchial muscles, and may also possess the cucullaris. Recent research in chick has established that these two muscles groups have different origins, the hypobranchial muscles having a somitic origin but the cucullaris muscle deriving from anterior lateral plate mesoderm associated with somites 1–3. Additionally, the cucullaris utilizes genetic pathways more similar to the head than the trunk musculature. Although the latter results are from experiments in the chick, cucullaris homologues occur in a variety of more basal vertebrates such as the sharks and zebrafish. Data are urgently needed from these taxa to determine whether the cucullaris in these groups also derives from lateral plate mesoderm or from the anterior somites, and whether the former or the latter represent the basal vertebrate condition. Other lateral plate mesoderm derivatives include the appendicular skeleton (fins, limbs and supporting girdles). If the cucullaris is a definitive lateral plate-derived structure it may have evolved in conjunction with the shoulder/limb skeleton in vertebrates and thereby provided a greater degree of flexibility to the heads of predatory vertebrates. PMID:22697305

  11. Colles' fracture - is it a signal of osteoporosis?

    PubMed

    Hossain, M; Hoq, M F; Fatima, N; Laskar, M H; Emran, M A; Asaduzzaman, K M; Alam, M

    2011-10-01

    Asymptomatic post-menopausal osteoporosis is common but some-times associated with pain and deformity. Symptomatic osteoporosis is usually associated with fracture. A 59 years old post-menopausal woman presented with a history of acute low-back-pain. She had menopause for 12 years. She gave history of colles' fracture at about two years back. Her mother died as consequences of femoral neck fracture. MRI of vertebral spine showed demineralization with partial collapse of D6,7,12 and L1 vertebra. Dual energy X-ray absorptiometry of vertebra showed BMD T-score of -4.5. Patient was managed with IV infusion of zoledronic acid, oral intake of vitamin D and calcium supplements and with regular non-weight-bearing exercises. Her condition improved gradually. During post-menopausal period, every women must be aware of osteoporosis and any fracture in that time must be evaluated to rule out osteoporosis.

  12. Expression of growth differentiation factor 6 in the human developing fetal spine retreats from vertebral ossifying regions and is restricted to cartilaginous tissues.

    PubMed

    Wei, Aiqun; Shen, Bojiang; Williams, Lisa A; Bhargav, Divya; Gulati, Twishi; Fang, Zhimin; Pathmanandavel, Sarennya; Diwan, Ashish D

    2016-02-01

    During embryogenesis vertebral segmentation is initiated by sclerotomal cell migration and condensation around the notochord, forming anlagen of vertebral bodies and intervertebral discs. The factors that govern the segmentation are not clear. Previous research demonstrated that mutations in growth differentiation factor 6 resulted in congenital vertebral fusion, suggesting this factor plays a role in development of vertebral column. In this study, we detected expression and localization of growth differentiation factor 6 in human fetal spinal column, especially in the period of early ossification of vertebrae and the developing intervertebral discs. The extracellular matrix proteins were also examined. Results showed that high levels of growth differentiation factor 6 were expressed in the nucleus pulposus of intervertebral discs and the hypertrophic chondrocytes adjacent to the ossification centre in vertebral bodies, where strong expression of proteoglycan and collagens was also detected. As fetal age increased, the expression of growth differentiation factor 6 was decreased correspondingly with the progress of ossification in vertebral bodies and restricted to cartilaginous regions. This expression pattern and the genetic link to vertebral fusion suggest that growth differentiation factor 6 may play an important role in suppression of ossification to ensure proper vertebral segmentation during spinal development.

  13. Paratrooper's Ankle Fracture: Posterior Malleolar Fracture

    PubMed Central

    Young, Ki Won; Cho, Jae Ho; Kim, Hyung Seuk; Cho, Hun Ki; Lee, Kyung Tai

    2015-01-01

    Background We assessed the frequency and types of ankle fractures that frequently occur during parachute landings of special operation unit personnel and analyzed the causes. Methods Fifty-six members of the special force brigade of the military who had sustained ankle fractures during parachute landings between January 2005 and April 2010 were retrospectively analyzed. The injury sites and fracture sites were identified and the fracture types were categorized by the Lauge-Hansen and Weber classifications. Follow-up surveys were performed with respect to the American Orthopedic Foot and Ankle Society ankle-hindfoot score, patient satisfaction, and return to preinjury activity. Results The patients were all males with a mean age of 23.6 years. There were 28 right and 28 left ankle fractures. Twenty-two patients had simple fractures and 34 patients had comminuted fractures. The average number of injury and fractures sites per person was 2.07 (116 injuries including a syndesmosis injury and a deltoid injury) and 1.75 (98 fracture sites), respectively. Twenty-three cases (41.07%) were accompanied by posterior malleolar fractures. Fifty-five patients underwent surgery; of these, 30 had plate internal fixations. Weber type A, B, and C fractures were found in 4, 38, and 14 cases, respectively. Based on the Lauge-Hansen classification, supination-external rotation injuries were found in 20 cases, supination-adduction injuries in 22 cases, pronation-external rotation injuries in 11 cases, tibiofibular fractures in 2 cases, and simple medial malleolar fractures in 2 cases. The mean follow-up period was 23.8 months, and the average follow-up American Orthopedic Foot and Ankle Society ankle-hindfoot score was 85.42. Forty-five patients (80.36%) reported excellent or good satisfaction with the outcome. Conclusions Posterior malleolar fractures occurred in 41.07% of ankle fractures sustained in parachute landings. Because most of the ankle fractures in parachute injuries were

  14. Experimental assessment of the sealing effectiveness of rock fracture grouting

    SciTech Connect

    Schaffer, A.; Daemen, J.J.K.

    1987-03-01

    The objective of this investigation is to determine the effectiveness of cement grouts as sealants of fractures in rock. Laboratory experiments have been conducted on seven 15-cm granite cubes containing saw cuts, three 23-cm diameter andesite cores containing induced tension cracks, and one 15-cm diameter marble core containing a natural fracture. Prior to grouting, the hydraulic conductivity of the fractures is determined under a range of normal stresses, applied in loading and unloading cycles, from 0 to 14 MPa (2000 psi). Grout is injected through an axial borehole, at a pressure of 1.2 to 8.3 MPa (180 to 1200 psi), pressure selected to provide a likely groutable fracture aperture, while the fracture is stressed at a constant normal stress. The fracture permeability is measured after grouting. Flow tests on the ungrouted samples confirm the inverse relation between normal stress and fracture permeability. The equivalent aperture determined by these tests is a reliable indicator of groutability. Postgrouting permeability measurements as performed here, and frequently in practice, can be misleading, since incomplete grouting of fractures can result in major apparent reductions in permeability. The apparent permeability reduction is caused by grouting of a small area of a highly preferential flowpath directly adjacent to the hole used for grouting and for permeability testing. Experimental results confirm claims in the literature that ordinary portland cement inadequately penetrates fine fractures.

  15. [Fractures of the forefoot].

    PubMed

    Richter, M

    2011-10-01

    Fractures of the forefoot are common and comprise approximately two thirds of all foot fractures. Forefoot fractures are caused by direct impact or the effect of indirect force. The forces exerted can range from repetitive minor load (stress fractures) to massive destructive forces (complex trauma). The clinical course in forefoot fractures is typically more favourable than in fractures of the mid- and hindfoot. The incidence of complications like infection or pseudarthrosis is low. Exceptions are rare fractures of the proximal shaft of the fifth metatarsal and the sesamoids with higher pseudarthrosis rates. Malunited metatarsal fractures can cause painful conditions that should even be treated operatively. Differences in structure and function of the different forefoot areas and specific fracture types require an adapted management of these special injuries.

  16. Management of metacarpal fractures.

    PubMed

    McNemar, Thomas B; Howell, Julianne Wright; Chang, Eric

    2003-01-01

    Fractures of the hand are the most common fractures of the human skeleton. Metacarpal fractures account for 30% to 50% of all of hand fractures. The mechanisms of these injuries vary from axial loading forces to direct blows to the dorsal hand. Resulting deformities include malrotation, angulation, and shortening. Treatment modalities vary from nonoperative reduction to open reduction and internal fixation. The treatment algorithm is guided by the location of the fracture, the stability of the fracture, and the resultant deformity. Operative procedures, although they may lead to excellent radiographic reduction of fractures, often lead to debilitating stiffness from the inflammatory reaction of the surgical procedure. Operative fixation must be employed judiciously and offered only when confident that non-operative therapy can be improved on with operative intervention. This article reviews the various types of metacarpal fractures, with the treatment options available for each fracture. The indications for each treatment modality, postoperative care, and rehabilitation are presented.

  17. Hyponatremia and Fractures: Findings from the Osteoporotic Fractures in Men Study

    PubMed Central

    Jamal, Sophie A; Arampatzis, Spyridon; Harrison, Stephanie Litwack; Bucur, Roxana C; Ensrud, Kristine; Orwoll, Eric S; Bauer, Douglas C

    2015-01-01

    Hyponatremia may be a risk factor for fracture. To determine the relationship between hyponatremia and fracture we conducted cross-sectional and longitudinal analyses using data from the Osteoporotic Fractures in Men Study (MrOS). The MrOS study enrolled 5122 community dwelling men aged ≥ 65 years from six centers across the United States. We excluded men taking bisphosphonates, those with unknown medication history, those without serum sodium measures, or those with out of range assays for serum sodium. Serum sodium was measured at study entry. Subjects were followed for fractures (nonspine (including hip), hip, and incident and prevalent morphometric) for up to 9 years. We used cox proportional hazards models to analyze the association between serum sodium levels (<135mmol/L versus ≥135mmol/L) and risk of nonspine and hip fractures, with results presented as hazard ratios (HR) and 95% confidence intervals (CI). We examined the association between morphometric vertebral fractures and serum sodium using logistic regression models, presented as odds ratios (OR) and 95% CI. Hyponatremia was observed in 64 men (1.2% of the cohort). After adjusting for age, BMI, study center, and other covariates, we found that, compared to men with serum sodium ≥ 135mmol/L, those with serum sodium <135mmol/L, had an increased risk hip fracture (HR=3.04; 95% CI: 1.37 to 6.75), prevalent (OR=2.46; 95% CI: 1.22 to 4.95) and incident (OR=3.53; 95% CI: 1.35 to 9.19) morphometric spine fractures but not nonspine fractures (OR=1.44; 95% CI: 0.85 to 2.44). Adjusting for bone mineral density did not change our findings. Our data demonstrate that hyponatremia is associated with up to a doubling in the risk of hip and morphometric spine fractures, independent of BMD. Further studies, to determine how hyponatremia causes fractures and if correction of hyponatremia decreases fractures, are needed. PMID:25294595

  18. Strategies for treatment to prevent fragility fractures in postmenopausal women.

    PubMed

    Geusens, Piet

    2009-12-01

    The objective of treatment of osteoporosis is to decrease the risk of fractures in patients at high risk for a first or subsequent fracture. The efficacy of treatment will depend on the efficiency and level of implementation of clinical case finding to select patients at risk, the results of additional investigations, the efficacy, tolerance and safety of medical intervention and the adherence to treatment during follow-up. Each of these steps is critical in treatment in daily practice. Failure to consider one or another step can result in suboptimal fracture prevention or overtreatment. The aim of case finding is to identify patients for treatment, who have disease characteristics of patients in whom fracture prevention has been demonstrated in randomised controlled trials (RCTs). These include patients with a low-trauma hip or vertebral fracture, with a low bone mineral density (BMD) or with a high risk of fracture based on the presence of clinical risk factors (CRFs) for osteoporosis and fractures such as included in the FRAX case-finding algorithm, with or without BMD. Case finding starts clinically, with systematic or opportunistic doctor- and/or patient-driven evaluation for the presence of CRFs, but its implementation is low. Further investigations aim to assess the risk of fracture(s) and to have baseline measurements for the subsequent monitoring of treatment, to exclude diseases that mimic osteoporosis, to identify the cause of osteoporosis and contributory factors and to select the most appropriate treatment. Medical intervention consists of providing information about osteoporosis to the patient, lifestyle advice, optimalisation of calcium intake and vitamin D status, fall prevention to reduce fall risk, correction of reversible contributors to secondary osteoporosis and a wide array of drugs for prevention of a first or subsequent vertebral, hip and non-vertebral, non-hip fracture. Drug treatment is based on manipulation of bone remodelling by

  19. The early origin of vertebral anomalies, as illustrated by a 'butterfly vertebra'.

    PubMed Central

    Müller, F; O'Rahilly, R; Benson, D R

    1986-01-01

    An anomalous (butterfly) eleventh thoracic vertebra in a fetus of 63 mm greatest length is described and graphic reconstructions (together with normal controls) are provided. The cartilaginous hemicentra are separated by disc-like material. Cartilaginous bars to adjacent vertebrae are present. The neural arch is complete. The notochord is not duplicated. Only one comparable case in the embryonic period has been described previously. After a discussion of cleft vertebrae in the human and in experimental animals, a developmental timetable of the appearance of several vertebral anomalies is provided. The sensitive period for butterfly vertebrae, depending on the mode of origin, seems to be 3-6 postovulatory weeks. More severe anomalies, such as the split notochord syndrome, appear earlier. It is concluded that most of the vertebral anomalies discussed arise during the embryonic period proper, although the timing of a few, such as spina bifida occulta, extends into the early fetal period. Images Fig. 1 Fig. 3 Fig. 5 PMID:3693103

  20. MULTI-PHASE FRACTURE-MATRIX INTERACTIONS UNDER STRESS CHANGES

    SciTech Connect

    A.S. Grader; D. Elsworth; P.M. Halleck; F. Alvarad; H. Yasuhara; A. Alajmi

    2002-04-20

    the presence of a fracture, and the interactions between fluid flow in the fracture and the adjacent matrix. Preliminary results demonstrate that the flow patterns are significantly impacted by the presence of the fracture. Bypassing is quantified and we expect to be able to extract from the modeling the distribution of properties in the fracture and the adjacent matrix.

  1. Techniques to reduce adjacent bed heating in electric reservoir heating processes

    SciTech Connect

    Harvey, A.H.

    1980-12-01

    The feasibility of several enhanced recovery techniques that employ an alternating electric current to heat an oil reservoir, which would act as a resistance heating element, was examined. In these processes, the flow of electric current in formations adjacent to the reservoir could be reduced either by displacing most of the connate water with a more saline water prior to heating, or by establishing a horizontal, electrically conductive fracture within the reservoir. Radial models are proposed for approximating the distribution of resistance heating which would occur.

  2. Use of Oral Bisphosphonates in Primary Prevention of Fractures in Postmenopausal Women: A Population-Based Cohort Study

    PubMed Central

    Real, Jordi; Galindo, Gisela; Galván, Leonardo; Lafarga, María Antonia; Rodrigo, María Dolors; Ortega, Marta

    2015-01-01

    Oral bisphosphonates are first-line drugs in the treatment of osteoporosis under most guidelines, and have been shown to decrease risk of first fracture only in asymptomatic vertebral fractures and in clinical trial populations that are generally very different from the general population. Objective To compare incidence of first osteoporotic fracture in two cohorts of postmenopausal women, one treated with bisphosphonates and the other only with calcium and vitamin D. Design Retrospective population cohort study with paired matching based on data from electronic health records. Setting Women aged 60 years and older in 2005, from 21 primary care centers in a healthcare region of Spain. Participants Two groups of women aged 60 years and older (n = 1208), prescribed either calcium and vitamin D (CalVitD) or bisphosphonates (BIPHOS) with or without calcium and vitamin D, were compared for the end point of first recorded osteoporotic-related fracture, with 5-years follow-up. Main Outcome Measure Incidence of first fracture: Vertebral fracture, osteoporosis with pathological fracture, fracture of the upper humeral epiphysis, fracture of the lower radial epiphysis, or femur fracture. Results Estimated 10-year risk of fracture was 11.4% (95% confidence interval: 9.6 to 13.2), 11.8% (9.2 to 14.3) in the BIPHOS group and 11.1% (8.6 to 13.6) in the CalVitD group. No significant differences were found between groups in total fractures (Hazard ratio = 0.934 (0.67 to 1.31)) or location (vertebral, femoral, radial or humeral). Conclusions In postmenopausal women, bisphosphonates have not been shown to better decrease risk of first fracture compared with calcium and vitamin D therapy alone. PMID:25861000

  3. On material fracture criteria

    NASA Astrophysics Data System (ADS)

    Kremnev, L. S.

    2017-01-01

    Based on the nonlinear mechanics of material fracture, a model of the fracture of materials with actual (discrete) structures has been constructed. The model is supported by proofs that crack resistance K 1 c and fracture toughness G 1 c obtained from the energy conservation law without using the assumptions adopted in the linear material fracture mechanics serve as the force and energy criteria in the nonlinear fracture mechanics. It has been shown that energy criterion G 1 c in the nonlinear mechanics is much greater than G 1 c in the linear fracture mechanics.

  4. Vertebral artery dissecting aneurysm treated by internal trapping via the contralateral vertebral artery: A case report

    PubMed Central

    2015-01-01

    A 42-year-old man with a history of sudden onset of severe headache followed by consciousness disturbance was brought to our hospital. Radiological examinations revealed subarachnoid hemorrhage, associated with rupture of a left vertebral artery dissecting aneurysm. Initially, internal trapping was attempted via the ipsilateral vertebral artery. However, the microcatheter could not be navigated through the true lumen to the distal side of the vertebral artery. Subsequently, therefore, the guiding catheter was placed in the right vertebral artery, and the microcatheter was retrogradely navigated successfully through the lesion to the proximal side of the left vertebral artery. Finally, the lesion was completely embolized with electrodetachable coils without complications. However, the patient died after the operation because of deterioration of the general condition. The postmortem examination revealed how an intimal flap had interfered with the antegrade navigation of the microcatheter in the lesion. The present case showed that endovascular treatment for a vertebral artery dissecting aneurysm via the contralateral vertebral artery may be a useful option in cases where antegrade navigation of the microcatheter via the ipsilateral vertebral artery is found to be difficult. PMID:26116649

  5. Vertebral artery dissecting aneurysm treated by internal trapping via the contralateral vertebral artery: A case report.

    PubMed

    Kojima, Atsuhiro

    2015-10-01

    A 42-year-old man with a history of sudden onset of severe headache followed by consciousness disturbance was brought to our hospital. Radiological examinations revealed subarachnoid hemorrhage, associated with rupture of a left vertebral artery dissecting aneurysm. Initially, internal trapping was attempted via the ipsilateral vertebral artery. However, the microcatheter could not be navigated through the true lumen to the distal side of the vertebral artery. Subsequently, therefore, the guiding catheter was placed in the right vertebral artery, and the microcatheter was retrogradely navigated successfully through the lesion to the proximal side of the left vertebral artery. Finally, the lesion was completely embolized with electrodetachable coils without complications. However, the patient died after the operation because of deterioration of the general condition. The postmortem examination revealed how an intimal flap had interfered with the antegrade navigation of the microcatheter in the lesion. The present case showed that endovascular treatment for a vertebral artery dissecting aneurysm via the contralateral vertebral artery may be a useful option in cases where antegrade navigation of the microcatheter via the ipsilateral vertebral artery is found to be difficult.

  6. Biomechanics of Thoracolumbar Burst and Chance-Type Fractures during Fall from Height

    PubMed Central

    Ivancic, Paul C.

    2014-01-01

    Study Design In vitro biomechanical study. Objective To investigate the biomechanics of thoracolumbar burst and Chance-type fractures during fall from height. Methods Our model consisted of a three-vertebra human thoracolumbar specimen (n = 4) stabilized with muscle force replication and mounted within an impact dummy. Each specimen was subjected to a single fall from an average height of 2.1 m with average velocity at impact of 6.4 m/s. Biomechanical responses were determined using impact load data combined with high-speed movie analyses. Injuries to the middle vertebra of each spinal segment were evaluated using imaging and dissection. Results Average peak compressive forces occurred within 10 milliseconds of impact and reached 40.3 kN at the ground, 7.1 kN at the lower vertebra, and 3.6 kN at the upper vertebra. Subsequently, average peak flexion (55.0 degrees) and tensile forces (0.7 kN upper vertebra, 0.3 kN lower vertebra) occurred between 43.0 and 60.0 milliseconds. The middle vertebra of all specimens sustained pedicle and endplate fractures with comminution, bursting, and reduced height of its vertebral body. Chance-type fractures were observed consisting of a horizontal split fracture through the laminae and pedicles extending anteriorly through the vertebral body. Conclusions We hypothesize that the compression fractures of the pedicles and vertebral body together with burst fracture occurred at the time of peak spinal compression, 10 milliseconds. Subsequently, the onset of Chance-type fracture occurred at 20 milliseconds through the already fractured and weakened pedicles and vertebral body due to flexion-distraction and a forward shifting spinal axis of rotation. PMID:25083357

  7. Osteopenia and bone fractures in a man with anorexia nervosa and hypogonadism

    SciTech Connect

    Rigotti, N.A.; Neer, R.M.; Jameson, L.

    1986-07-18

    Women with anorexia nervosa have reduced skeletal mass. Both anorexia and osteopenia are less common in men. We describe a 22-year-old man with anorexia nervosa and severe osteopenia involving both cortical and trabecular bone who developed a pelvic fracture and multiple vertebral compression fractures. He was found to have secondary hypogonadotropic hypogonadism that was reversible with weight gain. This case illustrates the need to consider osteopenia as a potential complication of anorexia nervosa in males as well as females.

  8. Biomechanics of Thoracolumbar Burst and Chance-Type Fractures during Fall from Height.

    PubMed

    Ivancic, Paul C

    2014-08-01

    Study Design In vitro biomechanical study. Objective To investigate the biomechanics of thoracolumbar burst and Chance-type fractures during fall from height. Methods Our model consisted of a three-vertebra human thoracolumbar specimen (n = 4) stabilized with muscle force replication and mounted within an impact dummy. Each specimen was subjected to a single fall from an average height of 2.1 m with average velocity at impact of 6.4 m/s. Biomechanical responses were determined using impact load data combined with high-speed movie analyses. Injuries to the middle vertebra of each spinal segment were evaluated using imaging and dissection. Results Average peak compressive forces occurred within 10 milliseconds of impact and reached 40.3 kN at the ground, 7.1 kN at the lower vertebra, and 3.6 kN at the upper vertebra. Subsequently, average peak flexion (55.0 degrees) and tensile forces (0.7 kN upper vertebra, 0.3 kN lower vertebra) occurred between 43.0 and 60.0 milliseconds. The middle vertebra of all specimens sustained pedicle and endplate fractures with comminution, bursting, and reduced height of its vertebral body. Chance-type fractures were observed consisting of a horizontal split fracture through the laminae and pedicles extending anteriorly through the vertebral body. Conclusions We hypothesize that the compression fractures of the pedicles and vertebral body together with burst fracture occurred at the time of peak spinal compression, 10 milliseconds. Subsequently, the onset of Chance-type fracture occurred at 20 milliseconds through the already fractured and weakened pedicles and vertebral body due to flexion-distraction and a forward shifting spinal axis of rotation.

  9. Depression of the Thoracolumbar Posterior Vertebral Body on the Estimation of Cement Leakage in Vertebroplasty and Kyphoplasty Operations

    PubMed Central

    Chen, Hao; Jia, Pu; Bao, Li; Feng, Fei; Yang, He; Li, Jin-Jun; Tang, Hai

    2015-01-01

    Background: The cross-section of thoracolumbar vertebral body is kidney-shaped with depressed posterior boundary. The anterior wall of the vertebral canal is separated from the posterior wall of the vertebral body on the lateral X-ray image. This study was designed to determine the sagittal distance between the anterior border of the vertebral canal and the posterior border of the vertebral body (DBCV) and to analyze the potential role of DBCV in the estimation of cement leakage during percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP). Methods: We retrospectively recruited 233 patients who had osteoporotic vertebral compression fractures and were treated with PVP or PKP. Computed tomography images of T11–L2 normal vertebrae were measured to obtain DBCV. The distance from cement to the posterior wall of the vertebral body (DCPW) of thoracolumbar vertebrae was measured from C-arm images. The selected vertebrae were divided into two groups according to DCPW, with the fracture levels, fracture grades and leakage rates of the two groups compared. A relative operating characteristic (ROC) curve was applied to determine whether the DCPW difference can be used to estimate the degree of cement leakage. The data were processed by statistical software SPSS version 21.0 using independent sample t-test and Chi-square tests. Results: The maximum DBCV was 6.40 mm and the average DBCV was 3.74 ± 0.95 mm. DBCV appeared to be longer in males than in females, but the difference was not statistically significant. The average DCPW of type-B leakage vertebrae (2.59 ± 1.20 mm) was shorter than that of other vertebrae (7.83 ± 2.38 mm, P < 0.001). The leakage rate of group DCPW ≤6.40 mm was lower than that of group DCPW >6.40 mm for type-C and type-S, but much higher for type-B. ROC curve revealed that DCPW only has a predictive value for type-B leakage (area under the curve: 0.98, 95% confidence interval: 0.95–0.99, P < 0.001), and when the cut-off value was 4

  10. Evolution of innate and adaptive immune systems in jawless vertebrates.

    PubMed

    Kasamatsu, Jun

    2013-01-01

    Because jawless vertebrates are the most primitive vertebrates, they have been studied to gain understanding of the evolutionary processes that gave rise to the innate and adaptive immune systems in vertebrates. Jawless vertebrates have developed lymphocyte-like cells that morphologically resemble the T and B cells of jawed vertebrates, but they express variable lymphocyte receptors (VLRs) instead of the T and B cell receptors that specifically recognize antigens in jawed vertebrates. These VLRs act as antigen receptors, diversity being generated in their antigen-binding sites by assembly of highly diverse leucine-rich repeat modules. Therefore, jawless vertebrates have developed adaptive immune systems based on the VLRs. Although pattern recognition receptors, including Toll-like receptors (TLRs) and Rig-like receptors (RLRs), and their adaptor genes are conserved in jawless vertebrates, some transcription factor and inflammatory cytokine genes in the TLR and RLR pathways are not present. However, like jawed vertebrates, the initiation of adaptive immune responses in jawless vertebrates appears to require prior activation of the innate immune system. These observations imply that the innate immune systems of jawless vertebrates have a unique molecular basis that is distinct from that of jawed vertebrates. Altogether, although the molecular details of the innate and adaptive immune systems differ between jawless and jawed vertebrates, jawless vertebrates have developed versions of these immune systems that are similar to those of jawed vertebrates.

  11. Vertebrate extracellular preovulatory and postovulatory egg coats.

    PubMed

    Menkhorst, Ellen; Selwood, Lynne

    2008-11-01

    Extracellular egg coats deposited by maternal or embryonic tissues surround all vertebrate conceptuses during early development. In oviparous species, the time of hatching from extracellular coats can be considered equivalent to the time of birth in viviparous species. Extracellular coats must be lost during gestation for implantation and placentation to occur in some viviparous species. In the most recent classification of vertebrate extracellular coats, Boyd and Hamilton (Cleavage, early development and implantation of the egg. In: Parkes AS (ed.), Marshall's Physiology of Reproduction, vol. 2, 3rd ed. London: Longmans, Green & Co; 1961:1-126) defined the coat synthesized by the oocyte during oogenesis as primary and the coat deposited by follicle cells surrounding the oocyte as secondary. Tertiary egg coats are those synthesized and deposited around the primary or secondary coat by the maternal reproductive tract. This classification is difficult to reconcile with recent data collected using modern molecular biological techniques that can accurately establish the site of coat precursor synthesis and secretion. We propose that a modification to the classification by Boyd and Hamilton is required. Vertebrate egg coats should be classed as belonging to the following two broad groups: the preovulatory coat, which is deposited during oogenesis by the oocyte or follicle cells, and the postovulatory coats, which are deposited after fertilization by the reproductive tract or conceptus. This review discusses the origin and classification of vertebrate extracellular preovulatory and postovulatory coats and illustrates what is known about coat homology between the vertebrate groups.

  12. Chemical and Mechanical Alteration of Fractured Caprock Under Reactive Flow

    NASA Astrophysics Data System (ADS)

    Elkhoury, J. E.; Ameli, P.; Detwiler, R. L.

    2013-12-01

    Permeability evolution of fractures depends on chemical and mechanical processes. Stress perturbations lead to mechanical deformation and fracture propagation that can increase formation permeability. Chemical disequilibrium between fluids and resident minerals leads to dissolution and precipitation that further alter fracture porosity and permeability. The ability to predict whether these coupled chemical and mechanical processes will enhance or diminish fracture permeability remains elusive. Here, we present results from reactive-transport experiments in fractured anhydrite cores, with significant alteration of the rock matrix, where only the flow rate differed. For high flow rate, the transformation of anhydrite to gypsum occurred uniformly within the fracture leading to compaction and a two-order-of-magnitude decrease in permeability. For low flow rate, rock-fluid reactions proceeded to near equilibrium within the fracture with preferential flow paths persisting over the 6-month duration of the experiment and a negligible change in permeability. Anticipating such permeability evolution is critical for successful geologic CO2 sequestration and waste injection. Additionally, reactive alteration of the porous matrix bounding fractures will influence the strength of earthquake fault zones. Comparison of the aperture field before (a) and after (b) the reactive flow-through experiment at low flow rate. a) Aperture field from optical profilometry measurements of the fracture surfaces. b) Inferred aperture from x-ray computed tomography scans. Color scale I (blue) denotes mainly unaltered regions of the fracture and/or aperture < 200 μm. Color scale II (green/yellow) denotes reacted regions of the fracture surfaces and the matrix adjacent to the fracture. Persistent flow paths are clearly observed in panel (b) (color scale III corresponds to aperture > 200 μm) leading to negligible change in permeability after a 6-month run.

  13. The lamina propria of vertebrate seminiferous tubules: a comparative light and electron microscopic investigation.

    PubMed

    Christl, H W

    1990-01-01

    The lamina propria of the seminiferous tubules was compared by means of light and electron microscopy in specimens obtained from the following vertebrates: Mute swan, northern mallard, blackbird, grey short-tailed opossum, north american opossum, european rabbit, mouse, rat, golden hamster, mini pig, bull, llama, roebuck, horse, coati, cat, dog, java monkey, orang utan. The lamina propria consists of basal lamina, ground substance, collagen fibers, fibroblasts and myofibroblasts. Myofibroblasts are characterized by myofilaments, dense patches and a basal lamina covering their plasmalemma. The layers of myofibroblasts always lie adjacent to the germinal epithelium, while the surrounding fibroblast layers are located peripherally.

  14. Fractures in anisotropic media

    NASA Astrophysics Data System (ADS)

    Shao, Siyi

    Rocks may be composed of layers and contain fracture sets that cause the hydraulic, mechanical and seismic properties of a rock to be anisotropic. Coexisting fractures and layers in rock give rise to competing mechanisms of anisotropy. For example: (1) at low fracture stiffness, apparent shear-wave anisotropy induced by matrix layering can be masked or enhanced by the presence of a fracture, depending on the fracture orientation with respect to layering, and (2) compressional-wave guided modes generated by parallel fractures can also mask the presence of matrix layerings for particular fracture orientations and fracture specific stiffness. This report focuses on two anisotropic sources that are widely encountered in rock engineering: fractures (mechanical discontinuity) and matrix layering (impedance discontinuity), by investigating: (1) matrix property characterization, i.e., to determine elastic constants in anisotropic solids, (2) interface wave behavior in single-fractured anisotropic media, (3) compressional wave guided modes in parallel-fractured anisotropic media (single fracture orientation) and (4) the elastic response of orthogonal fracture networks. Elastic constants of a medium are required to understand and quantify wave propagation in anisotropic media but are affected by fractures and matrix properties. Experimental observations and analytical analysis demonstrate that behaviors of both fracture interface waves and compressional-wave guided modes for fractures in anisotropic media, are affected by fracture specific stiffness (controlled by external stresses), signal frequency and relative orientation between layerings in the matrix and fractures. A fractured layered medium exhibits: (1) fracture-dominated anisotropy when the fractures are weakly coupled; (2) isotropic behavior when fractures delay waves that are usually fast in a layered medium; and (3) matrix-dominated anisotropy when the fractures are closed and no longer delay the signal. The

  15. Metatarsal stress fractures - aftercare

    MedlinePlus

    ... page: //medlineplus.gov/ency/patientinstructions/000553.htm Metatarsal stress fractures - aftercare To use the sharing features on ... that connect your ankle to your toes. A stress fracture is a break in the bone that ...

  16. Infant skull fracture (image)

    MedlinePlus

    Skull fractures may occur with head injuries. Although the skull is both tough and resilient and provides excellent ... or blow can result in fracture of the skull and may be accompanied by injury to the ...

  17. Rib fracture - aftercare

    MedlinePlus

    ... page: //medlineplus.gov/ency/patientinstructions/000539.htm Rib fracture - aftercare To use the sharing features on this page, please enable JavaScript. A rib fracture is a crack or break in one or ...

  18. Forearm Fractures in Children

    MedlinePlus

    .org Forearm Fractures in Children The forearm is the part of the arm between the wrist and the elbow. It is ... two bones: the radius and the ulna. Forearm fractures are common in childhood, accounting for more than ...

  19. Pediatric Thighbone (Femur) Fracture

    MedlinePlus

    .org Thighbone (Femur) Fractures In Children Page ( 1 ) The thighbone (femur) is the largest and strongest bone in the body. It can break ... Cause Statistics The most common cause of thighbone fractures in infants under 1 year old is child ...

  20. Nasal fracture (image)

    MedlinePlus

    A nasal fracture is a break in the bone over the ridge of the nose. It usually results from a blunt ... and is one of the most common facial fracture. Symptoms of a broken nose include pain, blood ...

  1. Bone fracture repair - slideshow

    MedlinePlus

    ... page: //medlineplus.gov/ency/presentations/100077.htm Bone fracture repair - series—Indications To use the sharing features ... Go to slide 4 out of 4 Overview Fractures of the bones are classified in a number ...

  2. Femur fracture repair - discharge

    MedlinePlus

    ... page: //medlineplus.gov/ency/patientinstructions/000166.htm Femur fracture repair - discharge To use the sharing features on this page, please enable JavaScript. You had a fracture (break) in the femur in your leg. It ...

  3. Lisfranc (Midfoot) Fractures

    MedlinePlus

    ... that disrupts multiple different joints and includes multiple fractures. Lisfranc injuries tend to damage the cartilage of ... include ligament strains and tears, as well as fractures and dislocations of bone (far right). (Le ) This ...

  4. Growth Plate Fractures

    MedlinePlus

    .org Growth Plate Fractures Page ( 1 ) The bones of children and adults share many of the same risks for injury. But because they ... to a unique injury called a growth plate fracture. Growth plates are areas of cartilage located near ...

  5. Hip fracture surgery

    MedlinePlus

    ... neck fracture repair; Trochanteric fracture repair; Hip pinning surgery; Osteoarthritis-hip ... You may receive general anesthesia before this surgery. This means ... spinal anesthesia. With this kind of anesthesia, medicine is ...

  6. Static histomorphometry of human iliac crest and vertebral trabecular bone: a comparative study.

    PubMed

    Thomsen, J S; Ebbesen, E N; Mosekilde, Li

    2002-01-01

    We recently developed a new, rapid method for conducting static histomorphometry on large histologic sections. This method has now been applied on both iliac crest and lumbar vertebral bone to compare the age-related changes at these two skeletal sites and to investigate the correlation between the histomorphometric measures at the iliac crest and the vertebral body. The material comprised matched sets of unilateral transiliac crest bone biopsies and lumbar vertebral bodies (L-2) from 24 women (19-96 years) and 24 men (23-95 years) selected from a larger autopsy material. Three female subjects (80, 88, and 90 years) had a known vertebral fracture of L-2. The iliac crest biopsies and 9-mm-thick mediolateral slices of half the entire vertebral bodies were embedded in methylmetacrylate, stained with aniline blue, and scanned into a computer with a flatbed image scanner at a high resolution. With a custom-made computer program the following static histomorphometric measures were determined: trabecular bone volume; marrow and bone space star volume; node-strut analysis; trabecular bone pattern factor; trabecular thickness; trabecular number; trabecular separation; and anisotropy of bone and marrow phase. In addition, connectivity density was measured (ConnEulor method). The results showed that the age-related changes in the static histomorphometric measures are generally similar in the iliac crest and the vertebral body, and that these age-related changes are independent of gender. An exception, however, is connectivity density, where the age-related changes are similar for women and men in the vertebral body but significantly different in the iliac crest. Furthermore, the results showed that the histomorphometric measures were weakly intercorrelated between the iliac crest and the vertebral body, despite the generally similar pattern in age-related changes at these two skeletal sites. The highest correlation coefficient was found for trabecular separation (Tb.Sp; r = 0

  7. Protective effect of total and supplemental vitamin C intake on the risk of hip fracture - A 17-year follow-up from the Framingham Osteoporosis Study

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Dietary antioxidants such as vitamin C may play a role in bone health. We evaluated associations of vitamin C intake (total, dietary and supplemental) with incident hip fracture and non-vertebral osteoporotic fracture, over a 15 to 17-y follow-up, in the Framingham Osteoporosis Study. 366 men and 59...

  8. [Drug therapy for prevention of falls and fractures].

    PubMed

    Ringe, Johann D

    2006-06-01

    The primary goal in the practical management of osteoporosis is to prevent first or subsequent fractures and thereby to avoid acute or chronic pain and progressive skeletal deformity. Therapeutic strategies should always take the complex pathogenetic mechanisms of fractures into account, especially the fact that mechanical impacts and falls play an important role in the majority of fracture events. Accordingly, recommendations to patients and the selection of drugs should aim at both, falls and fractures. In this context there is an increasing interest in the dual effects of vitamin D on bone and muscle. Controlled studies proved that adequate vitamin D supplementation is able to improve muscle strength, coordination and body sway and thereby reduce the risk of falls and fractures. Alendronate has been studied extensively by large trials of high quality and its efficacy to reduce the risk of vertebral and nonvertebral fractures is in line with the criteria of evidence-based medicine. The innovative combination of 70 mg alendronate with 2,800 IU vitamin D in a once-weekly tablet guarantees a basic supply with this important prohormone for bone and muscle. Due to a regular combined intake an improved compliance can be anticipated which will be followed by better therapeutic results in osteoporosis patients with increased fracture risk.

  9. The importance of loading the periphery of the vertebral endplate

    PubMed Central

    Sutterlin, Chester; Dabirrahmani, Danè; Appleyard, Richard

    2016-01-01

    Background Commercial fusion cages typically provide support in the central region of the endplate, failing to utilize the increased compressive strength around the periphery. This study demonstrates the increase in compressive strength that can be achieved if the bony periphery of the endplate is loaded. Methods Sixteen cadaveric lumbar vertebrae (L1–L5) were randomly divided into two even groups. A different commercial mass produced implant (MPI) was allocated to each group: (I) a Polyether-ether-ketone (PEEK) anterior lumber inter-body fusion (ALIF) MPI; and (II) a titanium ALIF MPI. Uniaxial compression at a displacement rate of 0.5 mm/sec was applied to all vertebrae during two phases: (I) with the allocated MPI situated in the central region of the endplate; (II) with an aluminum plate, designed to load the bony periphery of the endplate. The failure load and mode of failure was recorded. Results From phase 1 to phase 2, the failure load increased from 1.1±0.4 to 2.9±1.4 kN for group 1; and from 1.3±1.0 to 3.0±1.9 kN for group 2. The increase in strength from phase 1 to phase 2 was statistically significant for each group (group 1: P<0.01, group 2: P<0.05, paired t-test). There was no significant difference between the groups in either phase (P>0.05, t-test). The mode of failure in phase 1 was the implant being forced through the endplate for both groups. In phase 2, the mode of failure was either a fracture of the epiphyseal rim or buckling of the side wall of the vertebral body. Conclusions Loading the periphery of the vertebral endplate achieved significant increase in compressive load capacity compared to loading the central region of the endplate. Clinically, this implies that patient-specific implants which load the periphery of the vertebral endplate could decrease the incidence of subsidence and improve surgical outcomes. PMID:27757430

  10. Finite element analysis predicts experimental failure patterns in vertebral bodies loaded via intervertebral discs up to large deformation.

    PubMed

    Clouthier, Allison L; Hosseini, Hadi S; Maquer, Ghislain; Zysset, Philippe K

    2015-06-01

    Vertebral compression fractures are becoming increasingly common. Patient-specific nonlinear finite element (FE) models have shown promise in predicting yield strength and damage pattern but have not been experimentally validated for clinically relevant vertebral fractures, which involve loading through intervertebral discs with varying degrees of degeneration up to large compressive strains. Therefore, stepwise axial compression was applied in vitro on segments and performed in silico on their FE equivalents using a nonlocal damage-plastic model including densification at large compression for bone and a time-independent hyperelastic model for the disc. The ability of the nonlinear FE models to predict the failure pattern in large compression was evaluated for three boundary conditions: healthy and degenerated intervertebral discs and embedded endplates. Bone compaction and fracture patterns were predicted using the local volume change as an indicator and the best correspondence was obtained for the healthy intervertebral discs. These preliminary results show that nonlinear finite element models enable prediction of bone localisation and compaction. To the best of our knowledge, this is the first study to predict the collapse of osteoporotic vertebral bodies up to large compression using realistic loading via the intervertebral discs.

  11. Orbital fractures: a review

    PubMed Central

    Joseph, Jeffrey M; Glavas, Ioannis P

    2011-01-01

    This review of orbital fractures has three goals: 1) to understand the clinically relevant orbital anatomy with regard to periorbital trauma and orbital fractures, 2) to explain how to assess and examine a patient after periorbital trauma, and 3) to understand the medical and surgical management of orbital fractures. The article aims to summarize the evaluation and management of commonly encountered orbital fractures from the ophthalmologic perspective and to provide an overview for all practicing ophthalmologists and ophthalmologists in training. PMID:21339801

  12. The vertebral column of Australopithecus sediba.

    PubMed

    Williams, Scott A; Ostrofsky, Kelly R; Frater, Nakita; Churchill, Steven E; Schmid, Peter; Berger, Lee R

    2013-04-12

    Two partial vertebral columns of Australopithecus sediba grant insight into aspects of early hominin spinal mobility, lumbar curvature, vertebral formula, and transitional vertebra position. Au. sediba likely possessed five non-rib-bearing lumbar vertebrae and five sacral elements, the same configuration that occurs modally in modern humans. This finding contrasts with other interpretations of early hominin regional vertebral numbers. Importantly, the transitional vertebra is distinct from and above the last rib-bearing vertebra in Au. sediba, resulting in a functionally longer lower back. This configuration, along with a strongly wedged last lumbar vertebra and other indicators of lordotic posture, would have contributed to a highly flexible spine that is derived compared with earlier members of the genus Australopithecus and similar to that of the Nariokotome Homo erectus skeleton.

  13. Three Distinct Glutamate Decarboxylase Genes in Vertebrates

    PubMed Central

    Grone, Brian P.; Maruska, Karen P.

    2016-01-01

    Gamma-aminobutyric acid (GABA) is a widely conserved signaling molecule that in animals has been adapted as a neurotransmitter. GABA is synthesized from the amino acid glutamate by the action of glutamate decarboxylases (GADs). Two vertebrate genes, GAD1 and GAD2, encode distinct GAD proteins: GAD67 and GAD65, respectively. We have identified a third vertebrate GAD gene, GAD3. This gene is conserved in fishes as well as tetrapods. We analyzed protein sequence, gene structure, synteny, and phylogenetics to identify GAD3 as a homolog of GAD1 and GAD2. Interestingly, we found that GAD3 was lost in the hominid lineage. Because of the importance of GABA as a neurotransmitter, GAD3 may play important roles in vertebrate nervous systems. PMID:27461130

  14. Chitin is endogenously produced in vertebrates.

    PubMed

    Tang, W Joyce; Fernandez, Javier G; Sohn, Joel J; Amemiya, Chris T

    2015-03-30

    Chitin, a biopolymer of N-acetylglucosamine, is abundant in invertebrates and fungi and is an important structural molecule [1, 2]. There has been a longstanding belief that vertebrates do not produce chitin; however, we have obtained compelling evidence to the contrary. Chitin synthase genes are present in numerous fishes and amphibians, and chitin is localized in situ to the lumen of the developing zebrafish gut, in epithelial cells of fish scales, and in at least three different cell types in larval salamander appendages. Chitin synthase gene knockdowns and various histochemical experiments in zebrafish further authenticated our results. Finally, a polysaccharide was extracted from scales of salmon that exhibited all the chemical hallmarks of chitin. Our data and analyses demonstrate the existence of endogenous chitin in vertebrates and suggest that it serves multiple roles in vertebrate biology.

  15. The origin of the vertebrate skeleton

    NASA Astrophysics Data System (ADS)

    Pivar, Stuart

    2011-01-01

    The anatomy of the human and other vertebrates has been well described since the days of Leonardo da Vinci and Vesalius. The causative origin of the configuration of the bones and of their shapes and forms has been addressed over the ensuing centuries by such outstanding investigators as Goethe, Von Baer, Gegenbauer, Wilhelm His and D'Arcy Thompson, who sought to apply mechanical principles to morphogenesis. However, no coherent causative model of morphogenesis has ever been presented. This paper presents a causative model for the origin of the vertebrate skeleton, based on the premise that the body is a mosaic enlargement of self-organized patterns engrained in the membrane of the egg cell. Drawings illustrate the proposed hypothetical origin of membrane patterning and the changes in the hydrostatic equilibrium of the cytoplasm that cause topographical deformations resulting in the vertebrate body form.

  16. Chitin is endogenously produced in vertebrates

    PubMed Central

    Sohn, Joel J.; Amemiya, Chris T.

    2015-01-01

    Chitin, a biopolymer of N-acetylglucosamine, is abundant in invertebrates and fungi, and is an important structural molecule. There has been a longstanding belief that vertebrates do not produce chitin, however, we have obtained compelling evidence to the contrary. Chitin synthase genes are present in numerous fishes and amphibians, and chitin is localized in situ to the lumen of the developing zebrafish gut, in epithelial cells of fish scales, and in at least three different cell types in larval salamander appendages. Chitin synthase gene knockdowns and various histochemical experiments in zebrafish further authenticated our results. Finally, a polysaccharide was extracted from scales of salmon that exhibited all the chemical hallmarks of chitin. Our data and analyses demonstrate the existence of endogenous chitin in vertebrates and suggest that it serves multiple roles in vertebrate biology. PMID:25772447

  17. Percutaneous Vertebroplasty in a Broken Vertebral Titanium Implant (Titanium Mesh Cage)

    SciTech Connect

    Bierry, G.; Buy, X.; Mohan, P. Chandra; Cupelli, J.; Steib, J.P.; Gangi, A.

    2006-08-15

    We report the case of a percutaneous consolidation of a broken vertebral implant (Surgical Titanium Mesh Implants; DePuy Spine, Raynham, MA, USA) by vertebroplasty. Four years after anterior spondylectomy with cage implantation and stabilization with posterior instrumentation, the patient was admitted for excruciating back pain. Radiographs showed fracture of the cage, screw, and rod. An anterior surgical approach was deemed difficult and a percutaneous injection of polymethyl methacrylate into the cage was performed following posterior instrumentation replacement. This seems to be an interesting alternative to the classical anterior surgical approach, which is often difficult in postoperative conditions.

  18. Method and apparatus for determining two-phase flow in rock fracture

    DOEpatents

    Persoff, Peter; Pruess, Karsten; Myer, Larry

    1994-01-01

    An improved method and apparatus as disclosed for measuring the permeability of multiple phases through a rock fracture. The improvement in the method comprises delivering the respective phases through manifolds to uniformly deliver and collect the respective phases to and from opposite edges of the rock fracture in a distributed manner across the edge of the fracture. The improved apparatus comprises first and second manifolds comprising bores extending within porous blocks parallel to the rock fracture for distributing and collecting the wetting phase to and from surfaces of the porous blocks, which respectively face the opposite edges of the rock fracture. The improved apparatus further comprises other manifolds in the form of plenums located adjacent the respective porous blocks for uniform delivery of the non-wetting phase to parallel grooves disposed on the respective surfaces of the porous blocks facing the opposite edges of the rock fracture and generally perpendicular to the rock fracture.

  19. [Epidemiological view of fracture risk].

    PubMed

    Fujiwara, Saeko

    2010-09-01

    Incidence of hip fracture increases exponentially with age. Women had two times higher hip fracture incidence than men. Major risk factors for the hip fracture are age, sex, bone mineral density, and previous fracture and others, but each risk factor contributes differently to development of the fracture by sites. Factors related to fall are important role in developing hip fracture.

  20. The evolution of early vertebrate photoreceptors

    PubMed Central

    Collin, Shaun P.; Davies, Wayne L.; Hart, Nathan S.; Hunt, David M.

    2009-01-01

    Meeting the challenge of sampling an ancient aquatic landscape by the early vertebrates was crucial to their survival and would establish a retinal bauplan to be used by all subsequent vertebrate descendents. Image-forming eyes were under tremendous selection pressure and the ability to identify suitable prey and detect potential predators was thought to be one of the major drivers of speciation in the Early Cambrian. Based on the fossil record, we know that hagfishes, lampreys, holocephalans, elasmobranchs and lungfishes occupy critical stages in vertebrate evolution, having remained relatively unchanged over hundreds of millions of years. Now using extant representatives of these ‘living fossils’, we are able to piece together the evolution of vertebrate photoreception. While photoreception in hagfishes appears to be based on light detection and controlling circadian rhythms, rather than image formation, the photoreceptors of lampreys fall into five distinct classes and represent a critical stage in the dichotomy of rods and cones. At least four types of retinal cones sample the visual environment in lampreys mediating photopic (and potentially colour) vision, a sampling strategy retained by lungfishes, some modern teleosts, reptiles and birds. Trichromacy is retained in cartilaginous fishes (at least in batoids and holocephalans), where it is predicted that true scotopic (dim light) vision evolved in the common ancestor of all living gnathostomes. The capacity to discriminate colour and balance the tradeoff between resolution and sensitivity in the early vertebrates was an important driver of eye evolution, where many of the ocular features evolved were retained as vertebrates progressed on to land. PMID:19720654

  1. [Osteoporosis and Colles' fracture].

    PubMed

    Hindsø, K; Lauritzen, J B

    2001-10-01

    We describe the connection between osteoporosis and Colles' fractures of the distal radius from an epidemiological and aetiological point of view. In addition, the value of these fractures as markers of osteoporosis and future risk of fracture is assessed. Several studies have clearly shown an epidemiological association between osteoporosis and fractures of the distal radius, with the association strongest for women up to 65 years of age and for osteoporosis located in the forearm. The association weakens for other locations and for older women. Osteoporosis may have some aetiologic significance for the development of Colles' fractures, but several extraskeletal factors are of equal or further importance. The occurrence of a Colles' fracture in the first 10-15 years after the postmenopause indicates an increased relative risk of sustaining another fracture in the future. However the relative risk approaches one after a few years and, because of the comparatively low absolute risk in this age-group, Colles' fracture as a risk factor contributes little to an assessment of the lifetime fracture risk. In a few longitudinal studies, Colles' fractures could not predict the long-term risk of osteoporosis. The presence of a Colles' fracture should lead to considerations concerning the skeletal and extraskeletal causes of the fracture for the purpose of initiating preventive and therapeutic measures.

  2. Elbow fractures and dislocations.

    PubMed

    Little, Kevin J

    2014-07-01

    Elbow fractures are common in pediatric patients. Most injuries to the pediatric elbow are stable and require simple immobilization; however, more severe fractures can occur, often requiring operative stabilization and/or close monitoring. This article highlights the common fractures and dislocations about the pediatric elbow and discusses the history, evaluation, and treatment options for specific injuries.

  3. Complex osteotomies vertebral column resection and decancellation.

    PubMed

    Obeid, Ibrahim; Bourghli, Anouar; Boissière, Louis; Vital, Jean-Marc; Barrey, Cédric

    2014-07-01

    Pedicle subtraction osteotomy (PSO) is nowadays widely used to treat sagittal imbalance. Some complex malalignment cases cannot be treated by a PSO, whereas the imbalance is coronal or mixed or the sagittal imbalance is major and cannot be treated by a single PSO. The aim of this article was to review these complex situations--coronal imbalance, mixed imbalance, two-level PSO, vertebral column resection, and vertebral column decancellation, and to focus on their specificities. It wills also to evoke the utility of navigation in these complex cases.

  4. Scenarios for the making of vertebrates.

    PubMed

    Holland, Nicholas D; Holland, Linda Z; Holland, Peter W H

    2015-04-23

    Over the past 200 years, almost every invertebrate phylum has been proposed as a starting point for evolving vertebrates. Most of these scenarios are outdated, but several are still seriously considered. The short-range transition from ancestral invertebrate chordates (similar to amphioxus and tunicates) to vertebrates is well accepted. However, longer-range transitions leading up to the invertebrate chordates themselves are more controversial. Opinion is divided between the annelid and the enteropneust scenarios, predicting, respectively, a complex or a simple ancestor for bilaterian animals. Deciding between these ideas will be facilitated by further comparative studies of multicellular animals, including enigmatic taxa such as xenacoelomorphs.

  5. Renal-vertebral index in normal children.

    PubMed Central

    Bacopoulos, C; Papahatzi-Kalmadi, M; Karpathios, T; Thomaidis, T; Matsaniotis, N

    1981-01-01

    The renal-vertebral index is a simple method of evaluating the renal length in children and is convenient for everyday clinical work. The results of 822 normal children aged between 3 days and 14 years are reported. Infants of up to 1 year were found to have an index of about 4 to 5, pre-school children are an index of 3 1/2 to 4 1/2, and schoolchildren an index of 3 1/2 to 4. There was no significant difference in renal-vertebral index between boys and girls. Images Fig. 1 PMID:7259261

  6. 30 CFR 56.9103 - Clearance on adjacent tracks.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Clearance on adjacent tracks. 56.9103 Section..., Hauling, and Dumping Traffic Safety § 56.9103 Clearance on adjacent tracks. Railcars shall not be left on side tracks unless clearance is provided for traffic on adjacent tracks....

  7. 30 CFR 57.9103 - Clearance on adjacent tracks.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Clearance on adjacent tracks. 57.9103 Section..., Hauling, and Dumping Traffic Safety § 57.9103 Clearance on adjacent tracks. Railcars shall not be left on side tracks unless clearance is provided for traffic on adjacent tracks....

  8. 49 CFR 236.404 - Signals at adjacent control points.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ..., INSPECTION, MAINTENANCE, AND REPAIR OF SIGNAL AND TRAIN CONTROL SYSTEMS, DEVICES, AND APPLIANCES Traffic Control Systems Standards § 236.404 Signals at adjacent control points. Signals at adjacent controlled... 49 Transportation 4 2011-10-01 2011-10-01 false Signals at adjacent control points....

  9. 49 CFR 236.404 - Signals at adjacent control points.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ..., INSPECTION, MAINTENANCE, AND REPAIR OF SIGNAL AND TRAIN CONTROL SYSTEMS, DEVICES, AND APPLIANCES Traffic Control Systems Standards § 236.404 Signals at adjacent control points. Signals at adjacent controlled... 49 Transportation 4 2010-10-01 2010-10-01 false Signals at adjacent control points....

  10. 33 CFR 80.1395 - Puget Sound and adjacent waters.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Puget Sound and adjacent waters... INTERNATIONAL NAVIGATION RULES COLREGS DEMARCATION LINES Thirteenth District § 80.1395 Puget Sound and adjacent waters. The 72 COLREGS shall apply on all waters of Puget Sound and adjacent waters, including Lake...

  11. 33 CFR 80.1395 - Puget Sound and adjacent waters.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 33 Navigation and Navigable Waters 1 2014-07-01 2014-07-01 false Puget Sound and adjacent waters... INTERNATIONAL NAVIGATION RULES COLREGS DEMARCATION LINES Thirteenth District § 80.1395 Puget Sound and adjacent waters. The 72 COLREGS shall apply on all waters of Puget Sound and adjacent waters, including Lake...

  12. 33 CFR 80.1395 - Puget Sound and adjacent waters.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 33 Navigation and Navigable Waters 1 2013-07-01 2013-07-01 false Puget Sound and adjacent waters... INTERNATIONAL NAVIGATION RULES COLREGS DEMARCATION LINES Thirteenth District § 80.1395 Puget Sound and adjacent waters. The 72 COLREGS shall apply on all waters of Puget Sound and adjacent waters, including Lake...

  13. 33 CFR 80.1395 - Puget Sound and adjacent waters.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 33 Navigation and Navigable Waters 1 2011-07-01 2011-07-01 false Puget Sound and adjacent waters... INTERNATIONAL NAVIGATION RULES COLREGS DEMARCATION LINES Thirteenth District § 80.1395 Puget Sound and adjacent waters. The 72 COLREGS shall apply on all waters of Puget Sound and adjacent waters, including Lake...

  14. 33 CFR 80.1395 - Puget Sound and adjacent waters.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 33 Navigation and Navigable Waters 1 2012-07-01 2012-07-01 false Puget Sound and adjacent waters... INTERNATIONAL NAVIGATION RULES COLREGS DEMARCATION LINES Thirteenth District § 80.1395 Puget Sound and adjacent waters. The 72 COLREGS shall apply on all waters of Puget Sound and adjacent waters, including Lake...

  15. Fusion angle affects intervertebral adjacent spinal segment joint forces-Model-based analysis of patient specific alignment.

    PubMed

    Senteler, Marco; Weisse, Bernhard; Rothenfluh, Dominique A; Farshad, Mazda T; Snedeker, Jess G

    2017-01-01

    This study addresses the hypothesis that adjacent segment intervertebral joint loads are sensitive to the degree of lordosis that is surgically imposed during vertebral fusion. Adjacent segment degeneration is often observed after lumbar fusion, but a causative mechanism is not yet clearly evident. Altered kinematics of the adjacent segments and potentially nonphysiological mechanical joint loads have been implicated in this process. However, little is known of how altered alignment and kinematics influence loading of the adjacent intervertebral joints under consideration of active muscle forces. This study investigated these effects by simulating L4/5 fusions using kinematics-driven musculoskeletal models of one generic and eight sagittal alignment-specific models. Models featured different spinopelvic configurations but were normalized by body height, masses, and muscle properties. Fusion of the L4/5 segment was implemented in an in situ (22°), hyperlordotic (32°), and hypolordotic (8°) fashion and kinematic input parameters were changed accordingly based on findings of an in vitro investigation. Bending motion from upright standing to 45° forward flexion and back was simulated for all models in intact and fused conditions. Joint loads at adjacent levels and moment arms of spinal muscles experienced changes after all types of fusion. Hypolordotic configuration led to an increase of adjacent segment (L3/4) shear forces of 29% on average, whereas hyperlordotic fusion reduced shear by 39%. Overall, L4/5 in situ fusion resulted in intervertebral joint forces closest to intact loading conditions. An artificial decrease in lumbar lordosis (minus 14° on average) caused by an L4/5 fusion lead to adverse loading conditions, particularly at the cranial adjacent levels, and altered muscle moment arms, in particular for muscles in the vicinity of the fusion. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:131-139, 2017.

  16. Seismicity in Azerbaijan and Adjacent Caspian Sea

    SciTech Connect

    Panahi, Behrouz M.

    2006-03-23

    So far no general view on the geodynamic evolution of the Black Sea to the Caspian Sea region is elaborated. This is associated with the geological and structural complexities of the region revealed by geophysical, geochemical, petrologic, structural, and other studies. A clash of opinions on geodynamic conditions of the Caucasus region, sometimes mutually exclusive, can be explained by a simplified interpretation of the seismic data. In this paper I analyze available data on earthquake occurrences in Azerbaijan and the adjacent Caspian Sea region. The results of the analysis of macroseismic and instrumental data, seismic regime, and earthquake reoccurrence indicate that a level of seismicity in the region is moderate, and seismic event are concentrated in the shallow part of the lithosphere. Seismicity is mostly intra-plate, and spatial distribution of earthquake epicenters does not correlate with the plate boundaries.

  17. Significant forefoot varus deformity resulting in progressive stress fractures of all lesser metatarsal bones.

    PubMed

    van der Vlies, Cornelis H; Ponsen, Kees J; Besselaar, Philip P; Goslings, J Carel

    2007-01-01

    Stress fractures may occur in any bone, but appear most frequently in the metatarsal bones. Consecutive stress fractures of all lesser metatarsals in a short period are rare, and only a few cases have been described in the literature. We report an unusual case of a young man with consecutive stress fractures of four adjacent lesser metatarsal bones. The etiology was in all probability the fixed forefoot varus deformity. This foot deformity may impose increased mechanical loads across the lateral aspect of the foot that, in turn, may result in stress fractures involving the lesser metatarsals. In our patient conservative treatment finally resulted in a satisfactory outcome.

  18. Bone-Muscle Indices as Risk Factors for Fractures in Men: The Osteoporotic Fractures in Men (MrOS) Study

    PubMed Central

    Wong, A.K.O.; Cawthon, P.M.; Peters, K.W.; Cummings, S.R.; Gordon, C.L; Sheu, Y.; Ensrud, K.; Petit, M.; Zmuda, J.M.; Orwoll, E.; Cauley, J.

    2014-01-01

    Objective To assess bone-muscle (B-M) indices as risk factors for incident fractures in men. Methods Participants of the Osteoporotic Fractures in Men (MrOS) Study completed a peripheral quantitative computed tomography scan at 66% of their tibial length. Bone macrostructure, mechanical properties and muscle area were computed. Areal bone mineral density (aBMD) and body composition was assessed with dual-energy X-ray absorptiometry. Four year incident non-spine and clinical vertebral fractures were ascertained. B-M indices were expressed as bone-to-muscle ratios for: strength, mass and area. Discriminative power and hazards ratios (HR) for fractures were reported. Results In 1163 men (age: 77.2 ± 5.2 years, BMI: 28.0 ± 4.0 kg/m2, 7.7% ≥ 1 fracture), B-M indices were smaller in fractured men except for bending and areal indices. Smaller B-M indices were associated with increased fracture risk (HR: 1.30 to 1.74) independent of age and body mass index. Strength and mass indices remained significant after accounting for lumbar spine aBMD. B-M indices did not improve fracture discrimination beyond total hip aBMD. However, aBMD already explains part of the variance in B-M indices. Conclusion Mass and bending B-M indices are risk factors for fractures men, but may not improve fracture risk prediction beyond that provided by total hip aBMD. PMID:25198219

  19. On Water Flow in Hot Fractured Rock -- A Sensitivity Study on theImpact of Fracture-Matrix Heat Transfer

    SciTech Connect

    Birkholzer, Jens T.; Zhang, Yingqi

    2005-06-01

    Dual-continuum models have been widely used in modeling flowand transport in fractured porous rocks. Among many other applications,dual-continuum approaches were utilized in predictive models of thethermal-hydrological conditions near emplacement tunnels (drifts) atYucca Mountain, Nevada, the proposed site for a radioactive wasterepository in the U.S. In unsaturated formations such as those at YuccaMountain, the magnitude of mass and heat exchange between the twocontinua fracture network and matrix is largely dependent on the flowcharacteristics in the fractures, because channelized finger-type flowstrongly reduces the interface area between the matrix surfaces and theflowing liquid. This effect may have important implications, for example,during the time period that the fractured rock near the repository driftswould be heated above the boiling point of water. Depending on themagnitude of heat transfer from the matrix, water percolating down thefractures will either boil off in the hot rock region above drifts or maypenetrate all the way to the drift walls and possibly seep into the opencavities. In this paper, we describe a sensitivity analysis using avariety of approaches to treat fracture-matrix interaction in athree-dimensional dual-continuum setting. Our simulation example is alaboratory heater experiment described in the literature that providesevidence of rapid water flow in fractures, leading to drift seepagedespite above-boiling conditions in the adjacent fractured rock. Theexperimental finding can only be reproduced when the interface area forheat transfer between the matrix and fracture continua is reduced toaccount for flow channeling.

  20. Proximal humerus fractures.

    PubMed

    Price, Matthew C; Horn, Pamela L; Latshaw, James C

    2013-01-01

    Proximal humerus fractures are among the most common fractures associated with osteoporosis. With an aging population, incidence of these fractures will only increase. The proximal humerus not only forms the lateral portion of the shoulder articulation but also has significant associations with musculoskeletal and neurovascular structures. As a result, fractures of the proximal humerus can significantly impact not only the function of the shoulder joint, but the health and function of the entire upper extremity as well. Understanding of these fractures, the management options, and associated nursing care, can help reduce morbidity rate and improve functional outcomes.

  1. Stress fractures in runners.

    PubMed

    McCormick, Frank; Nwachukwu, Benedict U; Provencher, Matthew T

    2012-04-01

    Stress fractures are a relatively common entity in athletes, in particular, runners. Physicians and health care providers should maintain a high index of suspicion for stress fractures in runners presenting with insidious onset of focal bone tenderness associated with recent changes in training intensity or regimen. It is particularly important to recognize “high-risk” fractures, as these are associated with an increased risk of complication. A patient with confirmed radiographic evidence of a high-risk stress fracture should be evaluated by an orthopedic surgeon. Runners may benefit from orthotics, cushioned sneakers, interval training, and vitamin/calcium supplementation as a means of stress fracture prevention.

  2. Fracture toughness of silicon