The Conservative Treatment of Traumatic Thoracolumbar Vertebral Fractures.

BACKGROUND: The conservative treatment of traumatic thoracolumbar vertebral fractures is often not clearly defined. METHODS: This review is based on articles retrieved by a systematic search in the PubMed and Web of Science databases for publications up to February 2018 dealing with the conservative treatment of traumatic thoracolumbar vertebral fractures. The search initially yielded 3345 hits, of which 35 were suitable for use in this review. RESULTS: It can be concluded from the available original clinical research on the subject, including three randomized controlled trials (RCTs), that the primary diagnostic evaluation should be with plain x-rays, in the standing position if possible. If a fracture is suspected on the plain films, computed tomography (CT) is indicated. Magnetic resonance imaging (MRI) is additionally advisable if there is a burst fracture. The spinal deformity resulting from the fracture should be quantified in terms of the Cobb angle. The choice of a conservative or operative treatment strategy is based on the primary stability of the fracture, the degree of deformity, the presence or absence of disc injury, and the patient's clinical state. Our analysis of the three RCTs implies that early functional therapy without a corset should be performed, although treatment in a corset may be appropriate to control pain. Follow-up x-rays should be obtained after mobilization and at one week, three weeks, six weeks, and twelve weeks. CONCLUSION: Further comparative studies of the indications for surgery and specific conservative treatment modalities would be desirable.

Validity of a basketball-specific complex test in female professional players.

The purpose of this study was to assess the validity of a new basketball-specific complex test (BBCT) based on the ascertained match performance.Fourteen female professional basketball players (ages: 23.4 ±â€Š1.8 years) performed the BBCT and a treadmill test (TT) at the beginning of pre-season training. Lactate, heart rate (HR), time, shooting precision and number of errors were measured during the four test sequences of the BBCT (short distance sprinting with direction changes, with and without a ball; fast break; lay-up parcours; sprint endurance test). In addition, lactate threshold (LT) and HR were assessed at selected times throughout the TT and the BBCT and over 6 (TT) or 10 (BBCT) minutes after the tests. The match performance score (mps) was calculated on specific parameters (e. g. points) collected during all matches during the subsequent season (22 matches). The mps served as the "gold standard" within the validation process for the BBCT and the TT.TT parameters demonstrated an explained variance (EV) between 0 % (HR recovery) and 11 % (running speed at 6 mmol/l LT). The EV from the BBCT was higher and ranged from 0 % (HR recovery 6 minutes after end of exercise) to 28 % (sprint endurance test after 8 of 10 sprints). Ten out of 21 BBCT parameters (48 %) and 2 out of 5 TT parameters (40 %) demonstrated an EV higher than 10 %. Average EV for all parameters was 12 % (BBCT) and 6 % (TT), respectively. The BBCT had a higher validity than the TT for predicting match performance. These findings suggest that coaches and scientists should consider using the BBCT testing protocol to estimate the match performance abilities of elite female players.

Evaluation of efficacy of a new hybrid fusion device: a randomized, two-centre controlled trial.

BACKGROUND: The 360° fusion of lumbar segments is a common and well-researched therapy to treat various diseases of the spine. But it changes the biomechanics of the spine and may cause adjacent segment disease (ASD). Among the many techniques developed to avoid this complication, one appears promising. It combines a rigid fusion with a flexible pedicle screw system (hybrid instrumentation, "topping off"). However, its clinical significance is still uncertain due to the lack of conclusive data. METHODS/DESIGN: The study is a randomized, therapy-controlled, two-centre trial conducted in a clinical setting at two university hospitals. If they meet the criteria, outpatients presenting with degenerative disc disease, facet joint arthrosis or spondylolisthesis will be included in the study and randomized into two groups: a control group undergoing conventional fusion surgery (PLIF - posterior lumbar intervertebral fusion), and an intervention group undergoing fusion surgery using a new flexible pedicle screw system (PLIF + "topping off"), which was brought on the market in 2013. Follow-up examination will take place immediately after surgery, after 6 weeks and after 6, 12, 24 and 36 months. An ongoing assessment will be performed every year.Outcome measurements will include quality of life and pain assessments using validated questionnaires (ODI - Ostwestry Disability Index, SF-36™ - Short Form Health Survey 36, COMI - Core Outcome Measure Index). In addition, clinical and radiologic ASD, sagittal balance parameters and duration of work disability will be assessed. Inpatient and 6-month mortality, surgery-related data (e.g., intraoperative complications, blood loss, length of incision, surgical duration), postoperative complications (e.g. implant failure), adverse events, and serious adverse events will be monitored and documented throughout the study. DISCUSSION: New hybrid "topping off" systems might improve the outcome of lumbar spine fusion. But to date, there is a serious lack of and a great need of convincing data on safety or efficacy, including benefits and harms to the patients, of these systems. Health care providers are particularly interested in such data as these implants are much more expensive than conventional implants. In such a case, randomized clinical trials are the best way to evaluate benefits and risks. TRIAL REGISTRATION: NCT01852526.

A prospective dual-energy X-ray absorptiometry study of bone remodeling after implantation of the Nanos short-stemmed prosthesis.

The aim of this study was to analyze the bone remodeling around the Nanos stem (Smith & Nephew, Marl, Germany) after primary total hip arthroplasty for coxarthrosis. In 25 patients (15 male, 10 female, mean age 59.9 years) with the diagnosis of coxarthrosis, a DEXA scan was performed immediately after surgery, 97 days (SD 6.1 days) and 368 days (SD 6.2 days) after implantation of a Nanos prosthesis. Plain radiographs were analyzed digitally for radiolucent lines, varus-valgus femoral stem alignment, measurement of stem migration and changes in varus-valgus femoral stem alignment. The position of the center of rotation (COR) and the offset were assessed pre- and postoperatively. Harris Hip Score was used to evaluate the clinical outcome. The DEXA scan showed a significant and relevant increase in BMD (Bone Mineral Density) in Gruen-Zone 6 (12%) and a decrease in Zone 1 (15%), 2 (5%) and 7 (12%), which was interpreted as reflecting a distal load transfer in the metaphysis of the femur. There was no clinically relevant migration or tilting of the Nanos stem. Radiolucent lines were noted in 12 cases, mainly at the polished tip area of the prosthesis; this was not regarded as a sign of impaired osseointegration. There was no significant difference between the position of the COR and the pre- and postoperative offset. The absence of stem migration, angulation, or relevant radiolucent lines is seen as evidence for an unimpaired osseointegration of the Nanos stem approximately 12 months after implantation. It is concluded that the Nanos prosthesis can reduce loss of BMD of the proximal femur composed with conventional stems or other short-stemmed implants.