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1.
Endocrine ; 77(2): 392-400, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1885495

ABSTRACT

PURPOSE: Morphometric vertebral fractures (VFs) have been recently reported as an important component of the endocrine phenotype of COVID-19 and emerging data show negative respiratory sequelae at long-term follow-up in COVID-19 survivors. The aim of this study was to evaluate the impact of VFs on respiratory function in COVID-19 survivors. METHODS: We included patients referred to our Hospital Emergency Department and re-evaluated during follow-up. VFs were detected on lateral chest X-rays on admission using a qualitative and semiquantitative assessment and pulmonary function tests were obtained by Jaeger-MasterScreen-Analyzer Unit 6 months after discharge. RESULTS: Fifty patients were included. Median age was 66 years and 66% were males. No respiratory function data were available at COVID-19 diagnosis. VFs were detected in 16 (32%) patients. No differences between fractured and non-fractured patients regarding age and sex were observed. Although no difference was observed between VF and non-VF patient groups in the severity of pneumonia as assessed by Radiological-Assessment-of-Lung-Edema score at admission, (5 vs. 6, p = 0.69), patients with VFs were characterized as compared to those without VFs by lower Forced Vital Capacity (FVC, 2.9 vs. 3.6 L, p = 0.006; 85% vs. 110% of predicted, respectively, p = 0.001), Forced Expiratory Volume 1st s (FEV1, 2.2 vs. 2.8 L, p = 0.005; 92% vs. 110% of predicted, respectively, p = 0.001) and Diffusing Capacity of the Lungs for Carbon Monoxide (DLCO 5.83 vs. 6.98 mmol/min/kPa, p = 0.036, 59% vs. 86.3% of predicted, respectively, p = 0.043) at 6-month follow up. CONCLUSIONS: VFs, expression of the endocrine phenotype of the disease, appear to influence medium-term impaired respiratory function of COVID-19 survivors which may significantly influence their recovery. Therefore, our findings suggest that a VFs assessment at baseline may help in identifying patients needing a more intensive respiratory follow-up and patients showing persistent respiratory impairment without evidence of pulmonary disease may benefit from VFs assessment to preventing the vicious circle of further fractures and respiratory deterioration.


Subject(s)
COVID-19 , Spinal Fractures , COVID-19/complications , COVID-19 Testing , Female , Follow-Up Studies , Hospitalization , Humans , Male , Spinal Fractures/diagnostic imaging , Spinal Fractures/epidemiology , Spinal Fractures/etiology , Survivors
2.
Tomography ; 8(2): 999-1004, 2022 04 02.
Article in English | MEDLINE | ID: covidwho-1776349

ABSTRACT

Thoracic spine CTs are usually performed during free breathing and with a narrow field of view; this common practice systematically excludes the assessment of lungs and other extraspinal structures, even if these have been irradiated during the examination. At our institution we perform thoracic spine CT during breath hold with additional full FOV reconstructions; this allows us to also evaluate lungs and extraspinal pathologies in the same examination with no added costs or further radiation exposure. If this simple and costless technical change is routinely applied to thoracic spine CT many concomitant extraspinal pathologies can be ruled out, from neoplasms to pneumonia; the suggested modification also allows an early diagnosis and avoids recalling and re-irradiating the patient in case these findings are partially included in the study. This practice can be further useful during the current pandemic in order to screen any lung opacities suspicious for COVID-19.


Subject(s)
COVID-19 , Spinal Fractures , Breath Holding , COVID-19/diagnostic imaging , Humans , Lung/diagnostic imaging , Spinal Fractures/diagnostic imaging , Thorax , Tomography, X-Ray Computed
3.
Bone Joint J ; 102-B(6): 671-676, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-1724736

ABSTRACT

AIMS: The current pandemic caused by COVID-19 is the biggest challenge for national health systems for a century. While most medical resources are allocated to treat COVID-19 patients, several non-COVID-19 medical emergencies still need to be treated, including vertebral fractures and spinal cord compression. The aim of this paper is to report the early experience and an organizational protocol for emergency spinal surgery currently being used in a large metropolitan area by an integrated team of orthopaedic surgeons and neurosurgeons. METHODS: An organizational model is presented based on case centralization in hub hospitals and early management of surgical cases to reduce hospital stay. Data from all the patients admitted for emergency spinal surgery from the beginning of the outbreak were prospectively collected and compared to data from patients admitted for the same reason in the same time span in the previous year, and treated by the same integrated team. RESULTS: A total of 19 patients (11 males and eight females, with a mean age of 49.9 years (14 to 83)) were admitted either for vertebral fracture or spinal cord compression in a 19-day period, compared to the ten admitted in the previous year. No COVID-19 patients were treated. The mean time between admission and surgery was 1.7 days, significantly lower than 6.8 days the previous year (p < 0.001). CONCLUSION: The structural organization and the management protocol we describe allowed us to reduce the time to surgery and ultimately hospital stay, thereby maximizing the already stretched medical resources available. We hope that our early experience can be of value to the medical communities that will soon be in the same emergency situation. Cite this article: Bone Joint J 2020;102-B(6):671-676.


Subject(s)
Coronavirus Infections , Models, Organizational , Neurosurgical Procedures , Orthopedic Procedures , Pandemics , Patient Care Team/organization & administration , Pneumonia, Viral , Spinal Cord Compression/surgery , Spinal Fractures/surgery , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19 , Critical Pathways/organization & administration , Efficiency, Organizational , Emergencies , Female , Health Care Rationing/organization & administration , Hospitals, Urban , Humans , Italy , Length of Stay/statistics & numerical data , Male , Middle Aged , Outcome and Process Assessment, Health Care , Prospective Studies , Time-to-Treatment/statistics & numerical data , Young Adult
4.
JNMA J Nepal Med Assoc ; 59(242): 1044-1047, 2021 Oct 15.
Article in English | MEDLINE | ID: covidwho-1547957

ABSTRACT

Documented re-infection of COVID-19 is uncommon and doing a major spinal surgery in an elderly patient right after the recovery from the first event is itself a major undertaking. Re-infection after successful surgery points to the possibility of COVID-19 infection being a post-surgical complication. Here, we report a case of a 72-years-old elderly female who had presented to us with features of COVID-19 infection confirmed by reverse transcription polymerase chain reaction assay and unstable spinal fracture who underwent a pedicle screw fixation for the fracture of the third and fourth thoracic vertebrae after two consecutive negative serology assays. A month after discharge from the hospital, she presented with severe symptoms of COVID-19 again confirmed by two consecutive polymerase chain reaction assays. She was managed conservatively and was discharged without significant respiratory and neurological complications. We described this case in detail in addition to reviewing the pertinent literature.


Subject(s)
COVID-19 , Pedicle Screws , Spinal Fractures , Aged , Female , Fracture Fixation, Internal/adverse effects , Humans , Lumbar Vertebrae/injuries , Lumbar Vertebrae/surgery , Pedicle Screws/adverse effects , SARS-CoV-2 , Spinal Fractures/etiology , Spinal Fractures/surgery , Thoracic Vertebrae/injuries , Thoracic Vertebrae/surgery , Treatment Outcome
6.
Int J Orthop Trauma Nurs ; 43: 100899, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1442404

ABSTRACT

INTRODUCTION: Fracture Liaison Service (FLS) managed secondary fracture prevention services have been hampered during the COVID-19 pandemic. A challenging opportunity is to use pulse-echo ultrasound (P-EU) in the plaster room. The study had two objectives: can P-EU help our decision to justly avoid DXA/VFA scans in plaster treated women (50-70 years) after fracture and whether its use can encourage or nudge all plaster treated patients (>50 years) who need DXA/VFA scans. PATIENTS AND METHODS: 1307 patients (cohort: pre-COVID-19) and 1056 patients (cohort: peri-COVID-19), each of them ≥ 50 years after recent fracture, were studied. Only in women aged 50-70 years, we used a P-EU decision threshold (DI) >= 0.896 g/cm2 to rule out further analysis by means of DXA/VFA. All other plaster patients received P-EU as part of patient information. Peri-Covid-19, all performed DXA/VFA scans were counted until three months post-study closure. By then each patient still waiting for a DXA/VFA had received a scan. RESULTS: Peri-COVID-19, 69 out of 191 plaster-treated women aged 50-70 years were ruled out (36%), for plaster and not in-plaster treated women aged 50-70 years, it was 27%. Comparing all peri-to pre-COVID-19 plaster-treated women and men, a significant P-EU nudging effect was found (difference in proportions: 8.8%) P = .001. CONCLUSION: The combination of patient information and P-EU in the plaster room is effective to reduce DXA/VFA scans and allow extra patients to undergo DXA/VFA. After all, more than a quarter of 50-70 years old women in plaster did not need to be scanned.


Subject(s)
COVID-19 , Osteoporotic Fractures , Spinal Fractures , Aged , Female , Humans , Male , Middle Aged , Osteoporotic Fractures/diagnostic imaging , Osteoporotic Fractures/epidemiology , Osteoporotic Fractures/prevention & control , Pandemics , Retrospective Studies , SARS-CoV-2 , Secondary Prevention , Spinal Fractures/epidemiology
7.
Endocrine ; 74(3): 461-469, 2021 12.
Article in English | MEDLINE | ID: covidwho-1411789

ABSTRACT

BACKGROUND AND OBJECTIVE: Bone fragility has been linked to COVID-19 severity. The objective of this study was to evaluate whether a diagnosis of vertebral fracture (VF) increased mortality risk in COVID-19 patients and whether this effect was greater than in those without COVID-19. METHODS: We assessed VFs by computed tomography (CT) in a cohort of 501 patients consecutively admitted to the emergency department (ED) for clinical suspicion of SARS-CoV-2 infection during the first wave of pandemic emergency. Of those, 239 had a confirmed diagnosis of COVID-19. RESULTS: VF prevalence was similar between COVID-19 and non-COVID-19 groups (22.2 vs. 19%; p = 0.458). Death rates were similar between COVID-19 and non-COVID-19 groups at both 30 (15.8 vs. 12.2%; p = 0.234) and 120 days (21.8 vs. 17.6%; p = 0.236). The mortality risk was higher in COVID-19 patients either with one or multiple fractures compared to those without VFs, at 30 and 120 days, but statistical significance was reached only in those with multiple VFs (30-day HR 3.03, 95% CI 1.36-6.75; 120-day HR 2.91, 95% CI 1.43-5.91). In the non-COVID-19 group, the 30-day mortality risk was significantly higher in patients either with one (HR 7.46, 95% CI 3.12-17.8) or multiple fractures (HR 6.2, 95% CI 2.75-13.98) compared to those without VFs. A similar effect was observed at 120 days. After adjustment for age, sex and bone density, mortality risk remained associated with VFs in the non-COVID-19 group only. CONCLUSIONS: VFs were not independently associated with short-term mortality in patients with COVID-19, but they strongly increased mortality risk in those without COVID-19.


Subject(s)
COVID-19 , Osteoporotic Fractures , Spinal Fractures , Bone Density , Emergency Service, Hospital , Humans , Osteoporotic Fractures/diagnostic imaging , Osteoporotic Fractures/epidemiology , Pandemics , SARS-CoV-2 , Spinal Fractures/diagnostic imaging , Spinal Fractures/epidemiology
9.
World Neurosurg ; 154: e118-e129, 2021 10.
Article in English | MEDLINE | ID: covidwho-1337002

ABSTRACT

OBJECTIVE: Neurosurgical patients are at a higher risk of having a severe course of coronavirus disease 2019 (COVID-19). The objective of this study was to determine morbidity, hospital course, and mortality of neurosurgical patients during the coronavirus disease 2019 (COVID-19) pandemic in a multicenter health care system. METHODS: A retrospective observational study was conducted to identify all hospitalized neurosurgical patients positive for COVID-19 from March 11, 2020 to November 2, 2020 at Mayo Clinic and the Mayo Clinic Health System. RESULTS: Eleven hospitalized neurosurgical patients (0.68%) were positive for COVID-19. Four patients (36.6%) were men and 7 (63.3%) were women. The mean age was 65.7 years (range, 35-81 years). All patients had comorbidities. The mean length of stay was 13.4 days (range, 4-30 days). Seven patients had a central nervous system malignancy (4 metastases, 1 meningioma, 1 glioblastoma, and 1 schwannoma). Three patients presented with cerebrovascular complications, comprising 2 spontaneous intraparenchymal hemorrhages and 1 ischemic large-vessel stroke. One patient presented with an unstable traumatic spinal burst fracture. Four patients underwent neurosurgical/neuroendovascular interventions. Discharge disposition was to home in 5 patients, rehabilitation facility in 3, and hospice in 3. Five patients had died at follow-up, 3 within 30 days from COVID-19 complications and 2 from progression of their metastatic cancer. CONCLUSIONS: COVID-19 is rare among the inpatient neurosurgical population. In all cases, patients had multiple comorbidities. All symptomatic patients from the respiratory standpoint had complications during their hospitalization. Deaths of 3 patients who died within 30 days of hospitalization were all related to COVID-19 complications. Neurosurgical procedures were performed only if deemed emergent.


Subject(s)
COVID-19/complications , Neurosurgical Procedures/methods , Adult , Aged , Aged, 80 and over , COVID-19/mortality , Central Nervous System Neoplasms/surgery , Cerebrovascular Disorders/complications , Comorbidity , Female , Hospitalization , Humans , Length of Stay , Male , Middle Aged , Neurosurgical Procedures/mortality , Pandemics , Patient Readmission/statistics & numerical data , Postoperative Complications/epidemiology , Retrospective Studies , Spinal Fractures/surgery , Treatment Outcome
10.
J Coll Physicians Surg Pak ; 31(7): S127-S129, 2021 07.
Article in English | MEDLINE | ID: covidwho-1317404

ABSTRACT

Most pregnancy-related sacral stress fractures occur after delivery. This case aims to emphasise that stress fractures can occur before delivery, and since excessive weight gain is a risk factor, pregnant women should avoid gaining excess weight, especially during quarantine. This patient, who gained 20 kgs during first pregnancy, started complaining of severe pain in the left sacral region in the 40th week of pregnancy, without any trauma. Despite conservative follow-up, her pain increased, and a caesarean section was performed. The patient continued to complain of pain in the left sacral region. Magnetic resonance imaging (MRI) identified a sacral stress fracture which was treated conservatively and resolved after 4 months. Complaints of severe back pain during the last stage of pregnancy require a detailed physical examination. When localised sensitivity is detected in the sacral region during pregnancy, a diagnosis can be made using MRI, thereby avoiding radiation exposure. Key Words: Stress fractures, COVID-19, Sacrum, Pregnancy.


Subject(s)
COVID-19 , Fractures, Stress , Low Back Pain , Spinal Fractures , Cesarean Section/adverse effects , Female , Fractures, Stress/diagnostic imaging , Fractures, Stress/epidemiology , Fractures, Stress/etiology , Humans , Magnetic Resonance Imaging , Pandemics , Pregnancy , Quarantine , SARS-CoV-2 , Sacrococcygeal Region , Sacrum/diagnostic imaging , Weight Gain
11.
J Clin Endocrinol Metab ; 106(2): e602-e614, 2021 01 23.
Article in English | MEDLINE | ID: covidwho-914177

ABSTRACT

CONTEXT AND OBJECTIVE: COVID-19 has become the most relevant medical issue globally. Despite several studies that have investigated clinical characteristics of COVID-19 patients, no data have been reported on the prevalence of vertebral fractures (VFs). Since VFs may influence cardiorespiratory function and disease outcomes, the aim of this study was to assess VFs prevalence and clinical impact in COVID-19. DESIGN AND PATIENTS: This was a retrospective cohort study performed at San Raffaele Hospital, a tertiary health care hospital in Italy. We included COVID-19 patients for whom lateral chest x-rays at emergency department were available. VFs were detected using a semiquantitative evaluation of vertebral shape on chest x-rays. RESULTS: A total of 114 patients were included in this study and thoracic VFs were detected in 41 patients (36%). Patients with VFs were older and more frequently affected by hypertension and coronary artery disease (P < 0.001, P = 0.007, P = 0.034; respectively). Thirty-six (88%) patients in VFs+ group compared to 54 (74%) in VFs- group were hospitalized (P = 0.08). Patients with VFs more frequently required noninvasive mechanical ventilation compared with those without VFs (P = 0.02). Mortality was 22% in VFs+ group and 10% in VFs- group (P = 0.07). In particular, mortality was higher in patients with severe VFs compared with those with moderate and mild VFs (P = 0.04). CONCLUSIONS: VFs may integrate the cardiorespiratory risk of COVID-19 patients, being a useful and easy to measure clinical marker of fragility and poor prognosis. We suggest that morphometric thoracic vertebral evaluation should be performed in all suspected COVID-19 patients undergoing chest x-rays.


Subject(s)
COVID-19/diagnosis , COVID-19/epidemiology , Spinal Fractures/epidemiology , Thoracic Vertebrae , Aged , COVID-19/complications , Cohort Studies , Comorbidity , Female , Humans , Italy/epidemiology , Male , Middle Aged , Prevalence , Prognosis , Radiography, Thoracic/statistics & numerical data , Retrospective Studies , SARS-CoV-2/physiology , Severity of Illness Index , Spinal Fractures/complications , Spinal Fractures/diagnosis , Spinal Fractures/diagnostic imaging , Thoracic Vertebrae/diagnostic imaging , Thoracic Vertebrae/injuries , Thoracic Vertebrae/pathology
12.
Eur Spine J ; 30(2): 468-474, 2021 02.
Article in English | MEDLINE | ID: covidwho-888202

ABSTRACT

PURPOSE: We present an organized hospital plan for the management of Coronavirus disease (COVID-19) patients requiring emergency surgical interventions. To introduce a multidisciplinary approach for the management of COVID-19-infected patients and to report the first operated patient in the Corona unit. METHODS: A detailed presentation of the hospital plan for a separate Corona unit with its intensive care unit and operating rooms. Description of the management of the first spine surgery case treated in this unit. RESULTS: The Corona unit showed a practical approach for the management of an emergency cervical spine fracture-dislocation with acute paralysis. The patient is 92-year-old female. The mechanism of injury was a simple fall during the stay in the internal medicine department where the patient was treated in the referring hospital. The patient had no other injuries and was awake and oriented. The patient did not have the clinical symptom of COVID-19, and the test result of COVID-19 done in the referring hospital was not available on admission in our emergency room. Education of the medical staff and organization of the operating theatre facilitated the management of the patient without an increased risk of spreading the infection. CONCLUSIONS: The current COVID-19 pandemic requires an extra-ordinary organization of the medical and surgical care of the patients. It is possible to manage an infected or a potentially infected patient surgically, but a multidisciplinary plan is necessary to protect other patients and the medical staff.


Subject(s)
COVID-19/prevention & control , Cervical Vertebrae/injuries , Fracture Fixation, Internal/methods , Intensive Care Units/organization & administration , Joint Dislocations/surgery , Operating Rooms/organization & administration , Spinal Fractures/surgery , Zygapophyseal Joint/injuries , Accidental Falls , Aged, 80 and over , Cervical Vertebrae/diagnostic imaging , Cervical Vertebrae/surgery , Coronavirus , Coronavirus Infections , Emergency Service, Hospital , Environment Design , Female , Fractures, Bone , Germany , Hospital Design and Construction , Humans , Joint Dislocations/diagnostic imaging , Magnetic Resonance Imaging , Pandemics , Paraplegia/etiology , Personal Protective Equipment , SARS-CoV-2 , Spinal Fractures/complications , Spinal Fractures/diagnostic imaging , Zygapophyseal Joint/diagnostic imaging , Zygapophyseal Joint/surgery
14.
Chin J Traumatol ; 23(4): 211-215, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-612746

ABSTRACT

Since December 2019, COVID-19, an acute infectious disease, has gradually become a global threat. We report a case of thoracolumbar fractures (T12 and L1) and incomplete lower limb paralysis in a patient with COVID-19. After a series of conservative treatment which did not work at all, posterior open reduction and pedicle screw internal fixation of the thoracolumbar fracture were performed in Wuhan Union Hospital. Three weeks later, the patient could stand up and the pneumonia is almost cured. We successfully performed a surgery in a COVID-19 patient, and to our knowledge it is the first operation for a COVID-19 patient ever reported.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Lumbar Vertebrae/injuries , Paralysis/surgery , Pneumonia, Viral/complications , Spinal Fractures/surgery , Thoracic Vertebrae/injuries , COVID-19 , Fracture Fixation, Internal , Humans , Lumbar Vertebrae/surgery , Male , Middle Aged , Pandemics , Pedicle Screws , SARS-CoV-2 , Thoracic Vertebrae/surgery
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