Osteoporosis: An Update on Screening, Diagnosis, Evaluation, and Treatment.

Osteoporosis screening, diagnosis, and treatment have gained much attention in the health care community over the past 2 decades. During this time, creation of multispecialty awareness programs (eg, "Own the Bone," American Orthopedic Association; "Capture the Fracture," International Osteoporosis Foundation) and improvements in diagnostic protocols have been evident. Significant advances in technology have elucidated elements of genetic predisposition for decreased bone mineral density in the aging population. Additionally, several novel drug therapies have entered the market and provide more options for primary care and osteoporosis specialists to medically manage patients at risk for fragility fractures. Despite this, adherence to osteoporosis screening and treatment protocols has been surprisingly low by health care practitioners, including orthopedic surgeons. Continued awareness and education of this skeletal disorder is crucial to effectively care for our aging population. [Orthopedics. 2023;46(1):e20-e26.].

Expectoration of anterior cervical discectomy and fusion cage: a case report.

Anterior cervical implant failure can lead to catastrophic sequalae and requires prompt evaluation and management to reduce significant morbidity. This case report describes a 51-year-old female who underwent a C2-3 and C3-4 anterior cervical discectomy and fusion (ACDF) with stand-alone, integrated plate-cage interbody devices for cervical spondylotic myelopathy (CSM). Initial procedure was performed at an outside institution. Unfortunately, no radiographic follow up was obtained by the primary surgeon during the initial post-operative period. Post-operatively she experienced persistent dysphagia and troubles swallowing. The patient was eventually seen by the ear, nose and throat (ENT) service at our institution. Eighteen months after the index procedure, a nasolaryngoscopy revealed exposure of her ACDF implant through the posterior aspect of her pharynx. The ENT service obtained radiographs and immediately contacted our Spine Surgery service. Repeat anterior approach with implant removal was planned; however, during the interim, the patient suffered a coughing fit and complete expectoration of the C2-3 implant with the locking screws in place had occurred. Patient experienced immediate relief of symptoms. Miraculously, the patient did not develop airway compromise, infection, or return of severe dysphagia symptoms. During continued follow up, no significant clinical sequelae of her anterior cervical soft tissue structures were identified. The patient chose to decline further surgical management of her cervical spine. This case report highlights a potentially catastrophic complication following ACDF. Several modifiable factors including implant design, C2-3 ACDF cage placement, use of post-operative radiographs, and patient education regarding need for consistent follow up may have prevented this complication. Implant extrusion is a rare, but potentially serious complication following ACDF. Presenting symptoms can be generalized and mild including pain, swelling, or worsening dysphagia. It is paramount to obtain orthogonal X-rays for routine follow-up of post-surgical ACDF patients, especially if dysphagia persists or worsens. Immediate surgical management in recommended if significant post-operative cage migration is encountered.

Preoperative planning for intraoperative navigation guidance.

Intraoperative navigation for spinal procedures has continued to gain popularity. Numerous platforms are currently on the market and offer a spectrum of features. Preoperative considerations when utilizing this technology begin with understanding the fundamental concepts and methods of navigation. Several key factors including patient positioning, reference array placement, and sequence of instrumentation can help improve intraoperative navigation workflow when planned appropriately. The authors review current literature to help guide surgeon decision making when utilizing navigation. Additionally, tips and techniques for use of navigation are detailed to help avoid common surgeon pitfalls. In general, navigation platforms are classified based on image acquisition and degree of surgeon motion restriction during instrumentation. Imageless platforms often require preoperative images to be uploaded into the navigation system. Image-based systems rely on intraoperative imaging to ensure accuracy of its referencing software. The system then creates a three-dimensional model that allows for visualization of the navigated instrument within the surgical field. Active and passive navigation describe the degree of surgeon free-motion restriction when utilizing navigated instruments. Active navigation platforms, such as most robotic systems, prevent the deviation of the surgeon's instrument from a predetermined trajectory. Passive navigation does not restrict surgeon motion and the projected trajectory of the instrumented can be displayed on a three-dimensional model.

Anatomic Parameters for Instrumentation of the Sacrum and Pelvis: A Systematic Review of the Literature.

INTRODUCTION: Multiple cadaver and radiographic analyses have been performed to define the surgical anatomy of the sacrum and pelvis. We provide a comprehensive review of this information, creating an accurate anatomic guide for practice and research. METHODS: A systematic review was performed to identify publications citing sacral or iliac morphometric parameters based on cadaver or radiographic anatomy. RESULTS: A total of 780 abstracts were evaluated. Fifty-six articles were included for final review and grouped into four sections: (1) bone density, (2) bony corridors, (3) screw length and trajectory, and (4) neurovascular and alimentary anatomy. CONCLUSION: A systematic analysis of the radiographic and gross anatomic features of the sacrum has yet to be published. This review includes details on the spatial arrangement of the S1 and S2 pedicle screws, sacroiliac screws, iliac screws, S2 alar iliac screws, and pelvic neurovascular anatomy. The study can be referenced by clinicians for sacral dissection, implant application, and ongoing advances in orthopaedic research. STUDY DESIGN: Systematic review. LEVEL OF EVIDENCE: Level IV.

Dietary bioflavonoids inhibit Escherichia coli ATP synthase in a differential manner.

The aim of this study was to determine if the dietary benefits of bioflavonoids are linked to the inhibition of ATP synthase. We studied the inhibitory effect of 17 bioflavonoid compounds on purified F1 or membrane bound F1Fo E. coli ATP synthase. We found that the extent of inhibition by bioflavonoid compounds was variable. Morin, silymarin, baicalein, silibinin, rimantadin, amantidin, or, epicatechin resulted in complete inhibition. The most potent inhibitors on molar scale were morin (IC50 approximately 0.07 mM)>silymarin (IC50 approximately 0.11 mM)>baicalein (IC50 approximately 0.29 mM)>silibinin (IC50 approximately 0.34 mM)>rimantadin (IC50 approximately 2.0 mM)>amantidin (IC50 approximately 2.5 mM)>epicatechin (IC50 approximately 4.0 mM). Inhibition by hesperidin, chrysin, kaempferol, diosmin, apigenin, genistein, or rutin was partial in the range of 40-60% and inhibition by galangin, daidzein, or luteolin was insignificant. The main skeleton, size, shape, geometry, and position of functional groups on inhibitors played important role in the effective inhibition of ATP synthase. In all cases inhibition was found fully reversible and identical in both F1Fo membrane preparations and isolated purified F1. ATPase and growth assays suggested that the bioflavonoid compounds used in this study inhibited F1-ATPase as well as ATP synthesis nearly equally, which signifies a link between the beneficial effects of dietary bioflavonoids and their inhibitory action on ATP synthase.