Treatment of thoracolumbar fractures: comparison of the clinical and radiological outcomes of percutaneous versus open surgery.

STUDY DESIGN: Retrospective study. INTRODUCTION: Spinal fractures are common trauma that can be treated by a range of techniques, from functional to surgical. Spine surgery has been around for many years. The first procedures were done open but have been plagued by numerous complications-sometimes severe-and substantial intraoperative blood loss. Percutaneous surgery was developed to help reduce the complications while providing similar clinical and radiological outcomes to open surgery. We conducted a study to compare open and percutaneous surgery and to evaluate other complications as well as short- and medium-term clinical and radiological results. MATERIAL AND METHODS: Retrospective, single-center study comparing two cohorts of patients suffering from an isolated vertebral fracture who were operated using either an open or percutaneous technique. Included were patients who had an isolated vertebral fracture between T10 and L3 and were operated between 01/01/2016 and 31/12/2018 at the Reims university hospital. These patients were reviewed in person after a minimum of 18 months postoperative for clinical and radiological assessments. The Mercuriali and Brecher formula was used to calculate intraoperative blood loss based on pre- and postoperative hematocrit; the total blood volume was determined with the Nadler formula. RESULTS: The study cohort consisted of 79 patients operated by percutaneous surgery and 55 patients operated by open surgery. The blood loss in the percutaneous surgery group was 176 mL versus 220 mL in the open surgery group (p = 0.02). The length of hospital stay was shorter after percutaneous surgery (mean of 3.6 days) than after open surgery (mean of 5.5 days) (p < 0.001). Also, the pedicle screw placement was optimal in 88% of percutaneous procedures versus 67% of open procedures (p < 0.001). CONCLUSION: Percutaneous surgery for thoracolumbar fractures causes less blood loss than conventional open surgery. The clinical and radiological results are on par with conventional open surgery. The mean length of hospital stay is shorter and the accuracy of pedicular screw placement is higher with percutaneous surgery. Thus, we can conclude that percutaneous surgery is the preferred treatment for thoracolumbar fractures when no neurological deficit is present. LEVEL OF EVIDENCE: IV.

Percutaneous surgery for thoraco-lumbar fractures in ankylosing spondylitis: Study of 31 patients.

BACKGROUND: The risk of vertebral fracture is increased 4-fold in patients with ankylosing spondylitis (AS). Diagnostic challenges and the vulnerability associated with AS combine to generate high morbidity and mortality rates. The objective of this study was to assess the outcome of percutaneous thoraco-lumbar fracture surgery in patients with AS, in terms of quality of life, fracture healing, and complications. HYPOTHESIS: Percutaneous surgery used to treat thoraco-lumbar fractures in patients with AS reliably provides fracture healing, preserves self-sufficiency, and minimises post-operative complications. METHODS: Two centres included 31 patients with AS who were managed by percutaneous surgery for thoraco-lumbar fractures in 2013-2015. The data were reviewed retrospectively, although admission data were collected prospectively. Clinical outcomes were assessed by comparing the values at baseline and last follow-up of three variables: the Parker score, the visual analogue scale (VAS) pain score, and the EuroQol five dimensions (EQ-5D) quality-of-life score. Computed tomography was performed 1 year after surgery to evaluate bone healing, screw position, and implant loosening. Intra- and post-operative complications were recorded. RESULTS: The 31 patients had a mean age at surgery of 75.1 years, a mean follow-up of 35.6 months, and a minimum follow-up of 12 months. Three patients died during follow-up. Mean hospital stay duration was 6 days. Cemented screw fixation was used in 18 patients. At last follow-up, all patients had recovered their self-sufficiency; the mean Parker score was 7.14, compared to 6.73 at baseline, the mean VAS pain score was 1.8, and the mean EQ-5D score decrease versus baseline was 0.07 (P=0.02). Bone healing was consistently achieved. Loosening of an uncemented pedicle screw was noted in 1 patient. Of the 228 screws implanted, 6 (2.6%) were improperly positioned, including 1 within the spinal canal in a patient free of neurological manifestations. Asymptomatic cement leakage was noted in 2 patients. DISCUSSION: Percutaneous fixation of thoraco-lumbar fractures in patients with AS is a reliable method that produces a high healing rate and allows prompt patient mobilisation with preservation of self-sufficiency. The post-operative complication rate is low. LEVEL OF EVIDENCE: IV, retrospective observational study.

Posterolateral fusion versus Dynesys dynamic stabilization: Retrospective study at a minimum 5.5years' follow-up.

INTRODUCTION: Lumbar fusion is one of the most widespread techniques to treat degenerative lumbar pathology. To prevent complications such as non-union or adjacent segment degeneration, dynamic stabilization techniques were developed, but with controversial results. The aim of the present study was to compare long-term radiologic and clinical results between fusion and dynamic stabilization. MATERIAL AND METHODS: A single-center retrospective study included patients with recurrent lumbar discal hernia or lumbar canal stenosis managed by posterolateral fusion or by dynamic stabilization associated to neurologic release. Patients were seen in follow-up for radiological and clinical assessment: visual analog pain scale (VAS), Oswestry Disability Index (ODI), Short Form-12 (SF-12), adjacent segment disease (ASD), and intervertebral range of motion (ROM). RESULTS: Fifty-eight patients were included: 25 in the fusion group (FG), and 33 in the Dynesys® group (DG). VAS scores were significantly lower in DG than FG. ODI was 14.6±2.8 in DG, versus 19.4±3.3 in FG (P=0.0001). SF-12 physical subscore was significantly higher in DG. ROM was 4.1±2° in DG, vs. 0.7±0.5° in FG (P=0.001). Radiologic ASD was significantly greater in FG than DG (36% vs. 12.1%; P=0.012), without difference in clinical expression (DG, 1 case; FG, 2 cases). CONCLUSION: Dynamic stabilization provided clinical and radiological results comparable to those of posterolateral fusion in these indications (although level L5-S1 was not studied). LEVEL OF EVIDENCE: IV.

A systematic review and meta-analysis of exercise and exercise hypertension in patients with aortic coarctation.

Exercise hypertension is a common occurrence among individuals with aortic coarctation. Although exercise is known to be beneficial among the general population, the risks and benefits of exercise among those with aortic coarctation are less clear. This systematic review evaluates the benefits and risks of exercise for persons with aortic coarctation. Electronic databases were systematically searched (that is, MEDLINE and EMBASE) and key reviews cross-referenced to identify articles for inclusion. Original research articles reporting exercise among individuals with aortic coarctation were included. From 2608 individual citations, 68 eligible articles were identified. Aerobic exercise stress tests were found to be useful for determining exercise hypertension experiences post-surgical repair (N=5), and other long-term secondary findings (N=3). Experiences of exercise hypertension were associated with abnormal cardiac and/or aortic geometry and cardiac function (N=7). Exercise capacity was generally found to be similar to non-aortic coarctation controls post surgery (N=6). Exercise hypertension was experienced by 27% of participants, including 10% of adults and 43% of children/youth. Individuals who experience exercise hypertension experience greater increases in systolic blood pressure with exercise. No investigations identified evaluated forms of exercise other than aerobic stress tests and no exercise training programs have been conducted to date. Exercise stress tests can be valuable in this population for determining exercise hypertension, especially in the year post-surgical repair. Additional research is urgently needed to accurately assess the benefits and risks of exercise and exercise hypertension, and applicability of exercise restrictions for this population.

Local infiltration analgesia with ropivacaine in acute fracture of thoracolumbar junction surgery.

STUDY DESIGN: Retrospective study. INTRODUCTION: Local infiltration analgesia is effective in many surgeries as knee arthroplasty, but the analgesic efficacy of local infiltration analgesia with ropivacaine in trauma spine surgery in T10 to L2 has not been clarified. We conducted a trial to assess the analgesic efficacy of intraoperative local infiltration analgesia (LIA) with ropivacaine. OBJECTIVE: The aim of the present study was to clarify the effect of intraoperative local infiltration analgesia with ropivacaine on postoperative pain for patients undergoing thoracolumbar junction fracture surgery. METHODS: In a retrospective study, in 76 patients undergoing spine surgery for thoracolumbar junction fracture, 20ml of ropivacaine 7.5% (n R group=38) was infiltrated using a systematic technique, or no infiltration was realized (n M group=38). We assessed postoperative pain with Visual Analogue Scale (VAS) and morphine consumption in the 24 first hours. RESULTS: VAS pain score upon awakening and at 2hours postoperatively were significantly lower in the ropivacaine group (P=0.01 and P=0.002). Rescue opioid requirement during the 24 first hours were about 50% lower in the ropivacaine group (P=0.01). No local or systemic side effects were observed. CONCLUSION: Intraoperative LIA with ropivacaine in thoracolumbar junction fracture surgery may have an analgesic effect in postoperative pain control (24hours) with a reduction of VAS and morphine consumption.

The vascular health status of a population of adult Canadian Indigenous peoples from British Columbia.

Indigenous populations currently experience greater cardiovascular disease burdens. However, subclinical vascular structure and function among these populations is not well known. This investigation evaluated vascular structure and function among Canadian Indigenous populations. Blood pressure, body composition, pulse-wave velocity (PWV), baroreceptor sensitivity (BRS), arterial compliance and intima-media thickness (IMT) were measured. Vascular measures were evaluated across sexes and age groups. Vascular assessments were conducted among 55 Indigenous adults (38±18 years, 29 Female), including both First Nations (N=36) and Métis (N=19) individuals. Some differences in vascular measures were found between males and females, respectively (spectral BRS: 9.6±6.8 ms mm Hg(-1) vs 16.9±10.0 ms mm Hg(-1), P=0.01; small arterial compliance: 8.9±3.7 ml mm Hg(-1) × 100 vs 6.4±2.3 ml mm Hg(-1) × 100, P=0.004), with similar measures of overall IMT (0.61±0.14 mm vs 0.57±0.08 mm, P=0.19) and central PWV (5.7±2.5 m s(-1) vs 5.1±2.3 m s(-1), P=0.58). Greater IMT, and lower BRS and arterial compliance were identified among older adults. This relatively healthy population demonstrated healthy vascular measures, with poorer measures among older individuals.

A systematic review of physical activity levels in Native American populations in Canada and the United States in the last 50 years.

Physical activity is beneficial for many chronic conditions. However, activity levels of Native Americans are not well known. This systematic review investigated if Native American populations achieve the recommended physical activity levels, compared current and past activity levels, and assessed the ability of exercise training programmes to improve health outcomes among this population. Electronic databases (e.g. MEDLINE, EMBASE) were searched and citations were cross-referenced. Included articles reported physical activity levels or investigations among Native Americans. This search identified 89 articles: self-report (n = 61), accelerometry and pedometry (n = 10), metabolic monitoring (n = 10) and physical activity interventions (n = 17). Few adults were found to meet the physical activity recommendations (27.2% [95% confidence interval = 26.9-27.5%] self-report, 9% [4-14%] accelerometry). Among children/youth, 26.5% (24.6-28.4%) (self-report) to 45.7% (42.3-49.1%) (pedometry/accelerometry) met the recommendations. Adults and children/youth were generally identified as physically inactive (via doubly labelled water). Overall, Native American adults reported lower activity levels since 2000, compared to 1990s, although similar to 1980s. Few physical activity interventions employed strong methodologies, large sample sizes and objective outcome measures. There is a clear need to increase Native American populations' physical activity. Additional research is required to evaluate exercise training programmes among this population.

Effects of training status on arterial compliance in able-bodied persons and persons with spinal cord injury.

STUDY DESIGN: An investigation on large and small artery compliance in 36 able-bodied persons and persons with spinal cord injury (SCI). OBJECTIVE: To evaluate the effect of various training states (endurance-trained vs untrained) on arterial compliance in individuals with chronic SCI of traumatic origin and in able-bodied individuals (matched for age, sex, height, and weight). SETTING: Tertiary rehabilitation center in Canada. METHODS: Large and small artery compliance were measured at the radial artery and physical activity was assessed via questionnaire. RESULTS: There was no significant difference in large artery compliance between groups. Small artery compliance was reduced markedly (5.8±3.1 ml mm Hg(-1) × 100) in untrained persons with SCI, in comparison to all other groups. Small artery compliance of endurance-trained individuals with SCI was slightly (4%) higher than that observed in the untrained able-bodied individuals (8.6±1.5 vs. 8.2±1.4 ml mm Hg(-1) × 100, respectively). Endurance-trained, able-bodied persons had greater small artery compliance (10.6±2.3 ml mm Hg(-1) × 100) in comparison to the all other groups. CONCLUSION: Endurance training is related to increased small artery compliance in able-bodied individuals and persons with SCI (who are matched for age, sex, height and weight). Endurance training may attenuate the decline in small artery compliance seen with SCI.

Systemic arterial compliance following ultra-marathon.

There is a growing interest in training for and competing in race distances that exceed the marathon; however, little is known regarding the vascular effects of participation in such prolonged events, which last multiple consecutive hours. There exists some evidence that cardiovascular function may be impaired following extreme prolonged exercise, but at present, only cardiac function has been specifically examined following exposure to this nature of exercise. The primary purpose of this study was to characterize the acute effects of participation in an ultra-marathon on resting systemic arterial compliance. Arterial compliance and various resting cardiovascular indices were collected at rest from 26 healthy ultra-marathon competitors using applanation tonometry (HDI CR-2000) before and after participation in a mountain trail running foot race ranging from 120-195 km which required between 20-40 continuous hours (31.2±6.8 h) to complete. There was no significant change in small artery compliance from baseline to post race follow-up (8.5±3.4-7.7±8.2 mL/mmHgx100, p=0.65), but large artery compliance decreased from 16.1±4.4 to 13.5±3.8 mL/mmHgx10 (p=0.003). Participation in extreme endurance exercise of prolonged duration was associated with acute reductions in large artery compliance, but the time course of this effect remains to be elucidated.

Comparing the Finapres and Caretaker systems for measuring pulse transit time before and after exercise.

We aimed to compare the Finapres system, which is designed for accurate intra-arterial amplitude measurement, to the Caretaker system, which is designed for temporal accuracy of intra-arterial measurement, in regard to measurement of pulse transit time (PTT) at baseline and following an endurance exercise session. Pulse transit time was evaluated between the R-wave of the ECG and the foot of the arterial waveform using either the Finapres (fpPTT) or Caretaker (ctPTT). 23 participants were measured before and after completion of endurance exercise. When comparing PTT values before and after an exercise intervention within devices, ctPTT was significantly different following exercise (P=0.03); however, the Finapres obtained values did not differ significantly. Before exercise, there was no significant relationship between devices, however, after exercise a significant moderate correlation was observed (r=0.45, P=0.02). Significant differences existed between ctPTT and fpPTT (P< 0.001). The Caretaker system appears to be more accurate at detecting changes in PTT occurring as a result of a single aerobic exercise session. This may be due to the servo-controller feedback loop in the waveform contour predicting algorithm within the Finapres system, which is not present in the Caretaker unit. The Finapres system also appears to have an inherent delay in pulse contour reporting.

The prevalence of overweight and obesity in British Columbian Aboriginal adults.

Overweight and obesity among Aboriginal populations has been a growing challenge within Canada. This investigation aimed to identify the prevalence of overweight and obesity within British Columbian adult Aboriginal populations including both on and off reserve individuals through direct measurement. Further, this study stratified the variations in these rates according to age, gender and geographic region. Weight, height and waist circumference (WC) were measured via standardized procedures, and body mass index (BMI) was calculated. The mean body composition indicators were above recommended for men (BMI = 30.3 ± 5.6 kg m(-2) ; WC = 104.2 ± 14.7 cm) and women (BMI = 30.9 ± 7.2 kg m(-2); WC= 99.3 ± 17.1 cm), respectively. Rates of obesity for men and women were similar, 48.4% and 48.7%, respectively, and showed significant increases with age. Abdominal obesity (AO) was significantly greater among female participants, 69.0% compared with 52.7% in men, while both genders also demonstrated significant increases in AO with age. Both obesity and AO rates were found to be significantly greater in the Northern and Interior regions of the province in comparison to the Vancouver/Lower Mainland region. Alarmingly high rates of obesity and AO were observed in this population in men and women at every age and geographic region.

The challenge of low physical activity during the school day: at recess, lunch and in physical education.

PURPOSE: To describe physical activity (PA) intensity across a school day and assess the percentage of girls and boys achieving recommended guidelines. METHODS: The authors measured PA via accelerometry in 380 children (8-11 years) and examined data representing (1) the whole school day, (2) regular class time, (3) recess, (4) lunch and (5) scheduled physical education (PE). Activity was categorised as sedentary (SED), light physical activity (LPA) or moderate to vigorous physical activity (MVPA) using age-specific thresholds. They examined sex differences across PA intensities during each time period and compliance with recommended guidelines. RESULTS: Girls accumulated less MVPA and more SED than boys throughout the school day (MVPA -10.6 min; SED +13.9 min) recess (MVPA -1.6 min; SED +1.7 min) and lunch (MVPA -3.1 min; SED +2.9 min). Girls accumulated less MVPA (-6.2 min), less LPA (-2.5 min) and more SED (+9.4 min) than boys during regular class time. Fewer girls than boys achieved PA guidelines during school (90.9% vs 96.2%), recess (15.7% vs 34.1%) and lunch (16.7% vs 37.4%). During PE, only 1.8% of girls and 2.9% of boys achieved the PA guidelines. Girls and boys accumulated similar amounts of MVPA, LPA and SED. CONCLUSION: The MVPA deficit in girls was due to their sedentary behaviour as opposed to LPA. Physical activity strategies that target girls are essential to overcome this deficit. Only a very small percentage of children met physical activity guidelines during PE. There is a great need for additional training and emphasis on PA during PE. In addition schools should complement PE with PA models that increase PA opportunities across the school day.