Multidisciplinary and Coordinated Management of Osteoporotic Vertebral Compression Fractures: Current State of the Art.

Osteoporotic vertebral compression fractures (OVCFs) present a significant health concern, affecting a substantial portion of the older adult population worldwide. This narrative review explores the prevalence, diagnostic challenges and management strategies for OVCFs. Despite the increasing incidence and impact on morbidity and mortality, existing clinical guidelines lack consistency and clear diagnostic and therapeutic recommendations. The review addresses key questions faced by physicians dealing with older adult patients experiencing acute back pain, offering insights into triage, radiological assessments and classification systems. We propose a comprehensive algorithm for clearing OVCF, considering clinical presentation, radiological findings and morphological aspects. Emphasis is placed on the importance of medically treating osteoporosis alongside OVCF management. The review encompasses relevant literature from 1993 to 2023, provides a detailed discussion on triage issues and incorporates a clinically oriented classification system developed by the German Society for Orthopaedics and Trauma. The Material and Methods section outlines the extensive literature search carried out in PUBMED, encompassing clinical and experimental studies, systematic reviews and meta-analyses. The articles retained focused mainly on answering critical questions regarding radiological assessments, imaging modalities and the presence of a specific classification system for OVCFs. The review emphasises that the evaluation and management of OVCFs necessitates a multidisciplinary approach involving spine specialists and bone disease experts. It also addresses the role of conservative versus surgical treatments, with a focus on percutaneous vertebral augmentation. The conclusion summarises the algorithm derived for use in emergency departments and general practice, aiming to streamline OVCF management, reduce unnecessary examinations and ensure optimal patient care. The algorithm recommends primary diagnosis using computed tomography, with magnetic resonance imaging reserved for specific cases. The review advocates a holistic approach, integrating medical and surgical interventions to address the complex challenges posed by OVCFs in ageing populations.

Clinical outcomes of 3T magnetic resonance imaging-guided lumbar and sacral foraminal injections.

PURPOSE: This article evaluates the feasibility, safety, and efficacy of MRI-guided lumbar or sacral nerve root infiltration for chronic back pain. We compared the outcomes of our MRI-guided infiltrations with data from CT-guided infiltrations reported in the literature and explored the potential advantages of MRI guidance. METHOD: Forty-eight MRI-guided nerve root infiltrations were performed using a 3 T MRI machine. The optimal needle path was determined using breathhold T2-weighted sequences, and the needle was advanced under interleaved guidance based on breathhold PD-weighted images. Pain levels were assessed using a numeric rating scale (NRS) before the procedure and up to 5 months after, during follow-up. Procedure success was evaluated by comparing patients' pain levels before and after the infiltration. RESULTS: The MRI-guided infiltrations yielded pain reduction 1 week after the infiltration in 92% of cases, with an average NRS substantial change of 3.9 points. Pain reduction persisted after 5 months for 51% of procedures. No procedure-related complications occurred. The use of a 22G needle and reconstructed subtraction images from T2 FatSat sequences improved the workflow. CONCLUSION: Our study showed that MRI-guided nerve root infiltration is a feasible, safe, and effective treatment option for chronic back pain. Precise positioning of the needle tip and accurate distribution of the injected solution contributed to the effectiveness of MRI-guided infiltration, which appeared to be as accurate as CT-guided procedures. Further research is needed to explore the potential benefits of metal artifact reduction sequences to optimize chronic back pain management.

[Endoscopic lumbar surgery]. / Chirurgie lombaire endoscopique.

Spinal endoscopy is the result of an evolution of techniques and technologies in the service of an ever less invasive surgery. It allows the treatment of a large range of pathologies such as disc herniation or spinal stenosis and this range continues to increase. It has already proven its non-inferiority and cost-effectiveness compared to microsurgery despite a difficult learning curve. It has the potential to replace the microscopic «gold standard¼ as it allows a faster recovery for the patient and a shorter hospital stay.

L'endoscopie spinale est le résultat d'une évolution des techniques et des technologies au service d'une chirurgie toujours moins invasive. Elle permet de traiter un bon nombre de pathologies telles que la hernie discale ou la sténose canalaire et ce nombre continue d'augmenter. Elle a déjà prouvé sa non-infériorité et son rapport coûts-bénéfices avantageux par rapport à la microchirurgie, et ce, bien que sa courbe d'apprentissage ne soit pas toujours aisée. Elle a le potentiel de remplacer le « gold standard ¼ microscopique car elle permet une récupération plus rapide pour le patient et une hospitalisation plus courte.

Sacral Defect Reconstruction Using Double Pedicled Gracilis Muscle Flap combined with Gluteal Fasciocutaneous Rotation Flap.

Several reconstructive approaches have been described for reconstruction after sacral chordomas, classically myocutaneous flaps. Recently, postural muscle preservation techniques are preferred whenever possible. We present the case of a 70-year-old man who underwent en-bloc resection of a sacral chordoma resulting in a large three-dimensional defect. To reconstruct the pelvic floor, an acellular dermal matrix and a double pedicled muscle gracilis flap were used to avoid herniation of the abdominal cavity organs. The overlying soft tissue defect was reconstructed with a unilateral gluteal fasciocutaneous rotation flap partially deepithelialized. No surgical complications were observed. Aesthetic and functional outcomes were both satisfying at 9-months postoperative follow-up. The ambulatory functions were not compromised. This combined flap reconstruction associated with a dermal matrix offers a reliable and effective option for sacral reconstruction while minimizing the morbidity.

Sacral Chordoma: A Population-based Analysis of Epidemiology and Survival Outcomes.

BACKGROUND/AIM: Sacral chordoma is a rare primary bone neoplasm associated with high morbidity. The aim of this study is to identify demographic and clinicopathological characteristics of this tumor and evaluate their impact on survival outcomes. PATIENTS AND METHODS: The Surveillance, Epidemiology and End Results (SEER) database collecting data between 2000 and 2018 was searched for all cases of sacral chordoma. We analyzed demographic aspects, cancer stage and treatment patterns. Overall survival was calculated using the Kaplan-Meier method and compared between subgroups using the log-rank test. A multivariate Cox hazard regression analysis was conducted to identify independent predictors of overall survival. RESULTS: Four hundred and forty-two patients were identified with a mean age of 62.7 years. Most tumors presented regional invasion at diagnosis (43.2%). Mean overall survival was 124.7 months. No significant difference in terms of overall survival was found between surgery alone and surgery associated with radiotherapy. Both options provided a significantly increased survival than radiotherapy alone. Age of less than 50 years or between 50 and 69 correlated significantly with improved survival. CONCLUSION: Age and stage at diagnosis impact significantly survival outcomes. Surgery remains the mainstay treatment with the highest overall survival. Its association with radiotherapy is currently questionable and needs further research.

The SWING test: A more reliable test than passive clinical tests for assessing sagittal plane hip mobility.

BACKGROUND: Clinical assessment of sagittal plane hip mobility is usually performed using the Modified Thomas Test (for extension) and the Straight-Leg-Raise (for flexion) with a goniometer. These tests have limited reliability, however. An active swinging leg movement test (the SWING test), assessed using 3D motion analysis, could provide an alternative to these passive clinical tests. RESEARCH QUESTION: Is the SWING test a more reliable alternative to evaluate hip mobility, in comparison to the clinical extension and flexion tests? METHODS: Ten asymptomatic adult participants were evaluated by two investigators over three sessions. Participants performed 10 maximal hip extensions and flexions, with both legs straight and no trunk movement (the SWING test). Hip kinematics was assessed using a 3D motion analysis system. Maximal and minimal hip angles were calculated for each swing and represented maximal hip flexion (SWING flexion) and extension (SWING extension), respectively. The Modified Thomas Test and Straight-Leg-Raise were repeated 3 times for each leg. On the first day, both investigators performed all the tests (SWING + Modified Thomas Test + Straight-Leg-Raise). A week later, a single investigator repeated all the tests. Inter-rater, intra-rater, within-day and between-day reliability were evaluated using intra-class correlation. RESULTS: Intra-class correlation coefficients for all the tests were superior to 0.8, except for the Modified Thomas Test's intra-rater, between-day (intra-class correlation 0.673) and the Straight-Leg-Raise's inter-rater, within-day (intra-class correlation 0.294). The SWING test always showed a higher intra-class correlation coefficient than the passive clinical tests. The only significant correlation found was for the Straight-Leg-Raise and SWING flexion (r = 0.48; P < 0.001). SIGNIFICANCE: The SWING test seems to be an alternative to existing passive clinical tests, offering better reliability for assessing sagittal plane hip mobility.

Magnetic resonance imaging-guided lumbar nerve root infiltrations: optimization of an in-house protocol.

BACKGROUND: For the treatment of radicular pain, nerve root infiltrations can be performed under MRI guidance in select, typically younger, patients where repeated CT exams are not desirable due to associated radiation risk, or potential allergic reactions to iodinated contrast medium. METHODS: Fifteen 3 T MRI-guided nerve root infiltrations were performed in 12 patients with a dedicated surface coil combined with the standard spine coil, using a breathhold PD sequence. The needle artifact on the MR images and the distance between the needle tip and the infiltrated nerve root were measured. RESULTS: The distance between the needle tip and the nerve root was 2.1 ± 1.4 mm. The visual artifact width, perpendicular to the needle long axis, was 2.1 ± 0.7 mm. No adverse events were reported. CONCLUSION: This technical note describes the optimization of the procedure in a 3 T magnetic field, including reported procedure time and an assessment of targeting precision.

Cervical spine clearance after blunt trauma: current state of the art.

No definite consensus exists for the clearance of the cervical spine (C-spine) after blunt trauma, despite many validated algorithms, recommendations and guidelines. We intend to answer the most relevant questions with which physicians are confronted when clearing C-spines after blunt trauma in emergency departments (EDs). To exclude significant C-spine injuries we designed an algorithm to be compatible with clinical practice, to simplify patient management and avoid unrewarding evaluation.We conducted an exploratory PubMed search including articles published from January 2000 to October 2018. Keywords used were "cervical spine", "injury", "clearance", "Canadian C-spine Rule", "CCR" and "national emergency x-radiography utilization study". Clinical and experimental studies were included in a detailed review.We based our literature review on 33 articles. While answering fundamental triage questions from daily clinical practice, the current literature is discussed in detail. We designed an algorithm for the C-spine clearance suitable for any trauma centre with a high-quality multiplanar reconstruction computerized tomography (CT) scan continuously available.The high sensitivity of the Canadian C-spine Rule (CCR) prevents missing C-spine injuries while limiting the amount of unnecessary radiologic examinations. Plain radiographs were fully abandoned for C-spine clearance. A negative CT scan is sufficient to clear the majority of C-spine injuries and allows for collar removal. In case of motor symptoms or radio-clinical discrepancy, the advice of a specialized spine surgeon must be requested. Magnetic resonance imaging must not be routinely used. Neck pain despite negative imaging is not a reason to delay removal of stiff cervical collars. Cite this article: EFORT Open Rev 2020;5:253-259. DOI: 10.1302/2058-5241.5.190047.

Flexion-Relaxation Ratio Asymmetry and Its Relation With Trunk Lateral ROM in Individuals With and Without Chronic Nonspecific Low Back Pain.

STUDY DESIGN: A cross-sectional comparative study. OBJECTIVE: The present study aimed to investigate the relationship between the FR phenomenon asymmetry of lumbar muscles and trunk lateral range of motion (ROM) asymmetry in nonspecific chronic low back pain (NSCLBP) patients. SUMMARY OF BACKGROUND DATA: Imbalance in trunk muscle activation between right and left sides can induce pain by loading the spine incorrectly, especially in patients with NSCLBP. A previous study reported a greater asymmetry in the FR phenomenon of the erector spinae in NSCLBP patients than in asymptomatic participants (APs). Imbalance of muscle properties, such as trunk ROM, has been suggested as a possible cause of this observed asymmetry. METHODS: Twenty-eight NSCLBP patients and 22 AP performed 3 standing maximal trunk flexions. Surface electromyography was recorded bilaterally for erector spinae longissimus and lumbar multifidus. A FR ratio was calculated for each muscle. The fingertip-to-thigh test was performed to assess trunk lateral ROM. Each parameter's asymmetry was calculated as the absolute difference between right and left sides. RESULTS: NSCLBP patients present a significantly lower trunk lateral ROM than AP. FR ratio asymmetry of the erector spinae was significantly greater in NSCLBP patients than in AP (P < 0.05). FR ratio asymmetry of the multifidus and trunk lateral ROM asymmetry were not significantly different between groups. Significant correlation (r = 0.49) between FR ratio asymmetry of erector spinae and trunk lateral ROM asymmetry was observed only for patients with NSCLBP. CONCLUSION: The present findings showed that FR ratio asymmetry of erector spinae longissimus is moderately correlated with trunk lateral ROM asymmetry. In addition, the results confirmed that patients with NSCLBP present a reduced trunk lateral ROM, a FR ratio asymmetry of the erector spinae which is correlated with trunk rotation. These findings suggested an imbalance spine loading which can contribute to the persistence of pain. LEVEL OF EVIDENCE: 3.

Asymmetry of lumbar muscles fatigability with non-specific chronic low back pain patients.

PURPOSE: Non-specific chronic low back pain (NSCLBP) patients present with reduced back extensor muscle endurance which could be explained by the higher fatigability of their lumbar muscles. However, studies investigating lumbar muscle fatigability have shown contradictory findings. Furthermore, none investigated potential asymmetry in lumbar muscle fatigability, despite neuromuscular asymmetry being reported as a risk factor for NSCLBP. The present study's primary purpose was to determine whether NSCLBP patients presented with higher lumbar muscle fatigability and fatigability asymmetry than asymptomatic participants. METHODS: Thirty NSCLBP patients and 23 asymptomatic participants performed the Sorensen test. The median frequencies from the electromyographs of the right and left erector spinae longissimus (ESL) and lumbar multifidus (LMF) were measured during the test. A linear regression was performed on the median frequencies on each muscle. Slope and initial median frequency were extracted to characterize fatigability. Asymmetry was quantified by the absolute differences between right-side and left-side muscle pairs. RESULTS: NSCLBP patients presented significantly poorer back extensor muscle endurance than asymptomatic participants. No differences were found between NSCLBP patients and asymptomatic participants in terms of fatigability or fatigability asymmetry for either the ESL or LMF. The initial median frequency in both muscles was significantly lower among NSCLBP patients. CONCLUSIONS: The present study showed that NSCLBP patients did not present higher fatigability or higher fatigability asymmetry in lumbar muscles than asymptomatic participants. The heterogeneity of the NSCLBP population, due to the absence of any specific etiology, may explain these findings. These slides can be retrieved under Electronic Supplementary Material.

Identifying Subgroups of Patients With Chronic Nonspecific Low Back Pain Based on a Multifactorial Approach: Protocol For a Prospective Study.

BACKGROUND: Low back pain, especially nonspecific chronic low back pain (LBP), the leading cause of disability worldwide, represents both social and economic problems. Different therapeutic management techniques can be used, but their effects vary. Clinicians and researchers attribute the variation in the efficacy of therapeutic and management techniques to the heterogeneity of the nonspecific chronic low back pain population, and they agree that nonspecific chronic LBP must be subgrouped. OBJECTIVE: This study aims to identify nonspecific chronic LBP subgroups based on a multifactorial approach, including biomechanical, physical, and psychosocial data. METHODS: A total of 100 nonspecific chronic LBP patients and 30 healthy participants aged between 18 and 60 years will be recruited for this prospective study. A psychosocial profile will be established using questionnaires on anxiety, depression, functional disability, pain, fear of pain, avoidance belief, and physical activity. A physical capacity evaluation will be conducted. It will evaluate flexibility of the hips, lumbar spine, and lateral thoracolumbar segment, as well as trunk (extensor and flexor) muscle endurance. The subjects will perform functional daily life activities, such as walking, object lifting, forward bending, sit-to-stand, stand-to-sit, balance, and usual postures. Full body kinematics, kinetics, and surface electromyography of the trunk and hip muscles will be assessed during these tasks. The clustering classification methods for the statistical analysis will be determined according to the data and will be used to identify the subgroups of nonspecific chronic LBP patients. RESULTS: Data collection started in September 2017 and will be completed with the inclusion of all the participants (100 nonspecific chronic LBP and 30 control). The study results will be published in peer-reviewed journals and presented at relevant international conferences. CONCLUSIONS: Numerous studies have showed that the therapeutic management of nonspecific chronic LBP is difficult and has inconstant effects caused by the complexity and heterogeneity of nonspecific chronic LBP. Identifying subgroups with a multifactorial approach is more comprehensive and closer to the pathophysiology of nonspecific chronic LBP. It also represents benefit interests and a challenge both clinically and socially. The perspective of this study is expected to support clinicians for a more adapted therapeutic management for each subgroup.

[Adult scoliosis: surgical management]. / Scoliose de l'adulte : prise en charge chirurgicale.

Adult scoliosis is a common condition. Symptoms could be very debilitating. Surgical management requires a clear assessment of the functional impact of scoliosis, the failure of conservative treatments and precise analysis of radiological investigations (full spine views, dynamic X-rays and MRI). Surgical techniques (anterior and posterior approaches, minimal invasive techniques, osteotomies, all spine instrumentation) must be tailored to each patient. The main goals of surgery are treatment of symptoms, correction of deformity in coronal and sagittal plane and achievement of a solid fusion. Despite a high rate of complications, surgical treatment of adult scoliosis is associated with a better quality of life for patients.

La scoliose de l'adulte est une pathologie fréquente qui peut être très handicapante. La prise en charge chirurgicale, après échec des traitements conservateurs, nécessite une évaluation objective de l'impact fonctionnel de la scoliose pour le patient et une analyse systématique des investigations radiologiques (radiographie de colonne totale, clichés dynamiques et IRM). Les techniques chirurgicales (double abord, chirurgie mini-invasive, ostéotomies, longs montages) doivent être adaptées à chaque patient. Les buts principaux de la chirurgie sont de traiter les symptômes, corriger la déformation dans les plans coronal et sagittal, et obtenir une fusion solide. Malgré les complications potentielles, le traitement chirurgical de la scoliose permet d'offrir aux patients une meilleure qualité de vie.

Variables associated with remission in spinal surgical site infections.

BACKGROUND: There is few medical literature regarding factors associated with remission after surgical and medical treatment of postoperative spine infections. METHODS: Single-centre case-control study 2007-2014. Cluster-controlled Cox regression model with emphasis on surgical and antibiotic-related parameters. RESULTS: Overall, we found 66 episodes in 48 patients (49 episodes with metalwork) who had a median follow-up of 2.6 years (range, 0.5 to 6.8 years). The patients had a median of two surgical debridements. The median duration of antibiotic therapy was 8 weeks, of which 2 weeks parenteral. Clinical recurrence after treatment was noted in 13 episodes (20%), after a median interval of 2 months. In 53 cases (80%), the episodes were considered as in remission. By multivariate analyses, no variable was associated with remission. Especially, the following factors were not significantly related to remission: number of surgical interventions [hazard ratio (HR) 0.9; 95% confidence interval (CI), 0.8-1.1]; infection due to Staphylococcus aureus (HR 0.9; 0.8-1.1), local antibiotic therapy (HR 1.2; 0.6-2.4), and, duration of total (HR 1.0; 0.99-1.01) (or just parenteral) (HR 1.0; 0.99-1.01) antibiotic use. CONCLUSIONS: In patients with post-operative spine infections, remission is achieved in 80%. The number of surgical debridement or duration of antibiotic therapy shows no association with recurrence, suggesting that individual risk factors might be more important than the duration of antibiotic administration.

Clinical Outcomes and Development of Symptomatic Osteoarthritis 2 to 24 Years After Surgical Treatment of Tarsometatarsal Joint Complex Injuries.

BACKGROUND: Injuries to the tarsometatarsal (TMT) joint complex, or Lisfranc injuries, have been reported to result in osteoarthritis (OA) following surgical treatment. Good outcomes with respect to short and medium-term results have been reported. However, long-term results, specifically regarding clinical outcomes and the development of symptomatic OA, are limited. The objectives of this study were to assess clinical outcomes, the occurrence of symptomatic OA, and risk factors for OA at 2 to 24 years after a Lisfranc injury treated surgically with open reduction and internal fixation (ORIF) or with primary arthrodesis. METHODS: This was a retrospective study involving 61 patients treated surgically at our institution between 1988 and 2009 for an injury to the TMT joint complex. Patients underwent either ORIF with transarticular screws or primary arthrodesis when joint comminution at the TMT level was such that ORIF was not possible. Functional outcomes were assessed according to the American Orthopaedic Foot & Ankle Society (AOFAS) score, the Foot Function Index (FFI), and a visual analog scale (VAS) for pain. Global health was evaluated with the Short Form (SF)-12 Health Survey physical component summary (PCS). RESULTS: Sixty-one of the 128 patients were available for clinical evaluation, including the use of questionnaires, and radiographic assessment at a mean of 10.9 years postoperatively (range, 2.4 to 23.9 years). Mean scores were as follows: AOFAS score, 79.0; FFI, 16.9, and VAS for pain, 2.5. Radiographic evidence of OA was noted in 44 (72.1%) of the patients, and symptomatic OA, in 54.1%, the latter having worse outcomes. Risk factors for OA were nonanatomic reduction, fracture classification of Myerson type C, and a history of smoking. CONCLUSIONS: Two to 24 years following surgical treatment to restore and maintain joint anatomy for Lisfranc injuries, we found satisfactory clinical outcome scores and a large number of patients who had returned to their previous level of functioning and employment, with little need for secondary procedures. However, there was a substantial occurrence of posttraumatic OA, as evident on radiographs, albeit the occurrence of symptomatic OA was lower. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Regulation of Vacuolar H+-ATPase (V-ATPase) Reassembly by Glycolysis Flow in 6-Phosphofructo-1-kinase (PFK-1)-deficient Yeast Cells.

Yeast 6-phosphofructo-1-kinase (PFK-1) has two subunits, Pfk1p and Pfk2p. Deletion of Pfk2p alters glucose-dependent V-ATPase reassembly and vacuolar acidification (Chan, C. Y., and Parra, K. J. (2014) Yeast phosphofructokinase-1 subunit Pfk2p is necessary for pH homeostasis and glucose-dependent vacuolar ATPase reassembly. J. Biol. Chem. 289, 19448-19457). This study capitalized on the mechanisms suppressing vacuolar H(+)-ATPase (V-ATPase) in pfk2Δ to gain new knowledge of the mechanisms underlying glucose-dependent V-ATPase regulation. Because V-ATPase is fully assembled in pfk2Δ, and glycolysis partially suppressed at steady state, we manipulated glycolysis and assessed its direct involvement on V-ATPase function. At steady state, the ratio of proton transport to ATP hydrolysis increased 24% after increasing the glucose concentration from 2% to 4% to enhance the glycolysis flow in pfk2Δ. Tighter coupling restored vacuolar pH when glucose was abundant and glycolysis operated below capacity. After readdition of glucose to glucose-deprived cells, glucose-dependent V1Vo reassembly was proportional to the glycolysis flow. Readdition of 2% glucose to pfk2Δ cells, which restored 62% of ethanol concentration, led to equivalent 60% V1Vo reassembly levels. Steady-state level of assembly (100% reassembly) was reached at 4% glucose when glycolysis reached a threshold in pfk2Δ (≥40% the wild-type flow). At 4% glucose, the level of Pfk1p co-immunoprecipitated with V-ATPase decreased 58% in pfk2Δ, suggesting that Pfk1p binding to V-ATPase may be inhibitory in the mutant. We concluded that V-ATPase activity at steady state and V-ATPase reassembly after readdition of glucose to glucose-deprived cells are controlled by the glycolysis flow. We propose a new mechanism by which glucose regulates V-ATPase catalytic activity that occurs at steady state without changing V1Vo assembly.

[Surgical management of the spinal metastases]. / Métastases de la colonne vertébrale : indications au traitement chirurgical.

Seventy per cent of patients with cancer have evidence of metastases and spinal involvement may occur in up to 50 %. Pain is the most frequent symptom and it occurs in 90 % of the patients. It exist three different type of spinal pain : inflammatory, radicular and mechanical pain. Pain could be related to a neurological compromise and treatment becomes urgent. Steroids are introduced even if surgery is indicated. The Spinal Instability Neoplastic Score is a useful tool in order to determine instability in spinal metastases. Early recognition of instability could allow to minimal invasive surgery and even vertebroplasty. Tokuhashi score facilitates patient's selection during the decision-making process to the multidisciplinary team.

Septante pour cents des patients atteints de cancer souffriront de métastases, dont la localisation la plus fréquente sera la colonne vertébrale. Dans 90 % des cas, la douleur sera le symptôme d'appel. Elle pourra être inflammatoire, radiculaire ou mécanique, associée ou non à des troubles neurologiques. Si ces derniers sont présents, une prise en charge urgente est nécessaire. Une chirurgie aura plus de succès si elle est associée à un traitement par stéroïdes. Le Spinal Instability Neoplastic Score permet d'évaluer de manière objective la stabilité d'une lésion et de déterminer quelles sont celles à risque latent de fracture et de compromis neurologique. A un stade précoce, la stabilisation peut être réalisée par technique chirurgicale mini-invasive ou vertébroplastie. Le score de Tokuhashi est une aide précieuse lors du processus décisionnel, même si un travail en équipe multidisciplinaire reste la pierre angulaire de la prise en charge de ces pathologies.

Evidence showing the relationship between sagittal balance and clinical outcomes in surgical treatment of degenerative spinal diseases: a literature review.

The measure of radiographic pelvic and spinal parameters for sagittal balance analysis has gained importance in reconstructive surgery of the spine and particularly in degenerative spinal diseases (DSD). Fusion in the lumbar spine may result in loss of lumbar lordosis (LL), with possible compensatory mechanisms: decreased sacral slope (SS), increased pelvic tilt (PT) and decreased thoracic kyphosis (TK). An increase in PT after surgery is correlated with postoperative back pain. A decreased SS and/or abnormal sagittal vertical axis (SVA) after fusion have a higher risk of adjacent segment degeneration. High pelvic incidence (PI) increases the risk of sagittal imbalance after spine fusion and is a predictive factor for degenerative spondylolisthesis. Restoration of a normal PT after surgery is correlated with good clinical outcome. Therefore, there is a need for comparative prospective studies that include pre- and postoperative spinopelvic parameters and compare complication rate, degree of disability, pain and quality of life.

Prevalencia de sobrepeso y obesidad en población femenina en edad reproductiva / Overweight and obesity prevalence of the female population in childbearing age

La obesidad se ha convertido en un serio problema de salud a nivel mundial, no solo por las complicaciones cardiovasculares y metabólicas que provoca, sino también por su repercusión sobre la salud reproductiva. Se realizó una investigación para determinar la prevalencia de esta entidad en mujeres en edad reproductiva, pertenecientes al consultorio médico de la familia No.3, del área de salud del policlínico universitario Romárico Oro, municipio de Puerto Padre, provincia de Las Tunas. La muestra de estudio quedó conformada por 63 mujeres, la totalidad en edad reproductiva del consultorio estudiado. Para cumplir con los objetivos propuestos se determinaron las medidas e índices, obteniendo la valoración nutricional según estos criterios. Los resultados se presentan en tablas y se describen, interpretan y comparan con resultados de otros estudios similares. Se obtuvo que la prevalencia de obesidad, según índice de masa corporal, es de un 7,9 por ciento y de sobrepeso es de un 28,6 por ciento; según el índice cintura/cadera la prevalencia de obesidad es de un 42,8 por ciento y la circunferencia abdominal dentro de parámetros anormalmente altos se encontró en el 22,22 por ciento de la muestra. Los grupos de edades más afectados por trastornos del peso corporal por exceso, según índice cintura/cadera e índice de masa corporal, fueron el de 35 a 44 años, y el grupo de 25 a 34 años fue el más afectado según circunferencia de la cintura. Los indicadores obtenidos representan una medida de referencia para las estrategias de intervención que se realicen en un futuro (AU)

Obesity has turned into a serious health problem all over the world, not only because of the cardiovascular and metabolic complications it causes, but also for its consequences over the reproductive health. A research was carried out to determine the prevalence of this entity in women in childbearing age who belong to the family doctors office No. 3 from the health area of Romárico Oro University Policlinic, in Puerto Padre, Las Tunas province. The sample was made up of 63 women, all of them in childbearing age. To fulfill the objectives, the measures and indexes were determined, obtaining the nutritional assessment according to these criteria. The results are displayed in tables and are described, interpreted and compared to results from other similar studies. It was searched out that the obesity prevalence, according to body mass index, was of a 7, 9 percent and the overweight, of a 28, 6 percent. Depending on the waist/hip index, the prevalence of obesity is of a 42, 8 percent and the abdominal girth, within abnormally high parameters, was in the 22, 22 percent of the sample. The most affected age group due to body mass disorders by excess, according to waist/hip and body mass index, was from 35 to 44 years old; and the group from 25 to 34 years old was the most affected one in relation to abdominal girth. The indicators obtained with the study show a measurement of reference for future strategy interventions (AU)

Treatment challenges associated with bone echinococcosis.

OBJECTIVES: In this literature review, we concentrate on epidemiology and therapy of osseous echinococcosis, with an emphasis on the recurrence risk. METHODS: Literature review 1930-2012. RESULTS: We retrieved 200 publications based upon single case reports or case series, mostly from resource-poor settings. Among the 721 rural patients (22% females; median age 37 years), 60% of all reported cases were from the Mediterranean region and almost all patients were immune competent. Echinococcus granulosus was identified as the most frequent species. Most infections involved a single bone (602/721; 83%) and often the spine (321 cases; 45%). In eight cases (8/702; 1%), a secondary bacterial surgical site infection was reported. Surgical intervention was performed in 702 cases (97%), with single intervention in 687 episodes (95%). Complete excision of the lesion was possible in only 117 episodes (16%). Albendazole was by far the most frequently used agent in monotherapy with various dosages, while mebendazole in monotherapy was less frequent (32 cases). The median duration of antihelminthic therapy was 6 months (range 0.7-144 months). There were 124 recurrences (17%) after a median delay of 2 years (range 0.4-17 years). In multivariate analysis, the presence of visceral organ involvement increased the odds of recurrence by 5.4 (95% CI 3.1-9.4), whereas the number of surgical interventions, the duration of antihelminthic therapy or the use of hypertonic saline did not influence recurrence. CONCLUSIONS: Bone echinococcosis is a rare parasitic disease. While treatment modalities vary considerably, combined surgical and medical approaches are the standard of care with a 17% risk of recurrence.