Abstract Background The management of older adults with back pain in GP surgery practices is currently not well understood. We aimed to describe this and investigate if there are factors associated with variability in treatment. Methods Using primary care records from UK Clinical Practice Research Datalink Aurum, we observed 594,559 adults aged 50 years and older with an index consultation for back pain between 1 January 2015 to 31 July 2018 over 18-months follow-up. Main outcome measures were time to first referral to (i) radiology, (ii) physiotherapy, (iii) exercise, physical activity programmes and musculoskeletal clinics and services, (iv) other clinics and services for further assessment, and (v) pain medication prescriptions. Results The majority of patients received pain medication prescriptions following a back pain diagnosis (n = 381,829; 64.2%), but not referrals to radiology (n = 23,712; 4.0%), physiotherapy (n = 2,856; 0.5%), exercise, physical activity programmes and musculoskeletal clinics and services (n = 22,182; 3.7%) or other clinics and services for further assessment (n = 20,755; 3.5%). The probability of referrals or prescriptions at index consultation were (i) 2.6%, (ii) 0.3%, (iii) 1.7%, (iv) 1.3% and (v) 56.4% respectively. Opioids in combination with paracetamol or ibuprofen were most commonly prescribed (n = 151,390, 25.5%), followed by non-topical non-steroidal anti-inflammatory drugs (n = 127,164, 21.4%) and non-combination opioids dosage forms (n = 101,713, 17.1%). We observed large variability in the management of back pain within practice regions, age groups and socioeconomic status for all outcomes with the exception of pain medication prescriptions which showed little variation within factors of interest. Conclusions Older patients presenting to GP surgery practices with back pain are typically prescribed pain medications, with few referred for imaging, further therapy or assessment. Among non-pharmacological treatments, there exist differences by practice region, age, and socioeconomic status. Future work is needed to explore reasons for these differences, and to develop new clinical guidelines or tools to facilitate the standardisation of managing back pain in older adults within GP surgery practices in the UK.
Zidong Zhang, German Nudelman, Hanna Pincas
et al.
Abstract The diverse health benefits of exercise are associated with multi-organ molecular responses. Alternative RNA splicing (AS) is an important determinant of transcriptome and proteome diversity. We profiled the temporal effects of acute endurance and resistance exercise on the AS landscape of human skeletal muscle, adipose tissue, and blood, and studied regulatory mechanisms through integrated multi-omic analyses. We identified 5102 distinct differential AS (DAS) events, with the majority modifying protein-coding sequence (89%) and being independent of altered RNA expression (67%). Endurance and resistance exercise induced differing patterns of AS alterations with divergent temporal trajectories. We inferred the DAS-associated RNA-binding and DNA-binding proteins. In skeletal muscle, where DAS events were the most abundant, DAS genes were enriched for muscle structure- and RNA splicing-related processes, and splicing machinery components were regulated at the protein phosphorylation, RNA, and AS levels. These findings implicate AS regulation as a major mediator of the responses to exercise.
Abstract Background Dual fluoroscopic imaging system (DFIS) was employed to identify the Center of Rotation(COR) in the lower lumbar spine and determine its relationship with weight bearing. Methods In this study, twenty participants were recruited. A 3D model of each participant’s lumbar spine was created using CT images, and their relative positions were determined through DFIS. By integrating CT imaging with DFIS, the kinematic data of the participants’ spines during movement were captured. The lower lumbar spine’s COR was calculated using the method of perpendicular bisectors. Results While flexing and extending, the Center of Rotation (COR) initially moved downward with increasing load, followed by upward movement as the load further increased. During flexion and extension, the COR coordinates of L3-4 at 0 kg, 5 kg and 10 kg are(0.3549 ± 0.2176,0.0177 ± 0.1317),(0.0598 ± 0.2095,-0.1806 ± 0.1719),(0.1427 ± 0.1440,-0.0911 ± 0.2722); The center of rotation coordinates of L4-5 at 0 kg, 5 kg and 10 kg are(0.0566 ± 0.2693,-0.0727 ± 0.2132),(0.0964 ± 0.2671,-0.2037 ± 0.2299),(0.1648 ± 0.1520,-0.0049 ± 0.1641). The anterior-posterior position of the COR shifted posteriorly with increasing weight-bearing. During lateral bending, the center of rotation coordinates of L3-4 at 0 kg, 5 kg and 10 kg are(0.0745 ± 0.1229,0.0966 ± 0.3403) (-0.0438 ± 0.1281,0.1161 ± 0.1584), (-0.0464 ± 0.1517,0.1320 ± 0.2730); The center of rotation coordinates of L4-5 at 0 kg, 5 kg and 10 kg are(-0.0314 ± 0.1411,-0.0355 ± 0.2088), (-0.0764 ± 0.3135,0.0105 ± 0.3230),(-0.0376 ± 0.1701,0.0285 ± 0.2395). Throughout the lateral bending exercises, the upper and lower COR positions increased as the load increased, while the left and right COR positions remained unaffected by the load increment. The COR height differed between flexion and lateral bending. We observed variations in the COR position of the lumbar spine during lateral bending and flexion-extension movements. This enhanced our comprehension of coupled motion patterns within the lumbar spine. Conclusions Position of the lumbar spine COR changes with variations in the load. During different movements, the COR location of the lower lumbar spine varied. This finding suggests the presence of distinct motion patterns in the lower lumbar spine. As the load increases, the lumbar COR position changes significantly. Abnormal movement patterns of the lower lumbar spine under different loads may be one of the factors that accelerate lumbar disc degeneration.
Abstract Objective This study aimed to assess the bone ingrowth and in vivo safety of a novel designed 3D-printed porous stand-alone cage (PSAC) for Cervical Fusion in a Sheep Model. Methods PASC was designed and fabricated by 3D-printing technology. We implanted the PSAC at the C2/C3 level and control cages at the C3/C4 level in 18 sheep. After 4, 12, and 24 weeks, X-ray was used to assess DSH, Micro-CT to evaluate bone volume fraction (BV/TV), biomechanical testing to determine bone-implant interface strength, and toluidine blue staining to assess bone ingrowth depth and new bone formation. Sheep health, blood markers, vital organ pathology and local tissue reaction (HE staining) were monitored to evaluate its safety. Results (1) X-ray results showed that both cages maintained stable DSH. (2) Micro-CT revealed greater bone volume within the porous structure of the PSAC group compared to the control group (BV1/TV1(%): 50.37 ± 4.79 vs. 43.98 ± 6.27, p = 0.076). (3) In terms of bone ingrowth, toluidine blue staining showed that new bone formation in the PSAC group was higher to the control at 4 and 12 weeks (1.64 ± 0.85 mm² vs. 2.86 ± 1.81 mm², p = 0.35) and was not inferior at 24 weeks. The bone ingrowth depth was consistent between the PSAC and control groups (24 weeks: 1116.28 ± 152.28 μm vs. 1161.36 ± 368.45 μm, p = 0.85). (4) The bone-implant interface strength of the PSAC was not inferior to the control group (24 weeks: maximum failure load 309.65 ± 47.13 vs. 302.93 ± 43.33 N, p = 0.88; failure displacement 2.20 ± 0.30 mm vs. 2.05 ± 0.40 mm, p = 0.70). (5) Safety: Blood tests and HE staining showed no significant toxic or inflammatory pathological changes. All animals remained in good health, with no infections or deaths. Conclusion Our findings suggest that the intervertebral PSAC are safe and effective for cervical fixation, showing no adverse effects on the cervical spine or animal bodies, and demonstrating equivalent fixation and healing capabilities compared to control devices.
Orthopedic surgery, Diseases of the musculoskeletal system
Helal El-Zaatari, Liubov Arbeeva, Amanda E. Nelson
Data used to understand knee osteoarthritis (KOA) often involves knee-level, rather than person-level information. Failure to account for the correlation between joints within a person may lead to inaccurate inferences. The aim of this study was to develop a flexible, data-driven framework for predicting knee pain outcomes, incorporating the advantages of both random forest (RF) and mixed effects models for correlated data. Specifically, we utilized data from the baseline visit of the Osteoarthritis Initiative (OAI) and applied the Binary Mixed Models (BiMM) algorithm to predict two binary dependent variables. 1) presence of knee pain, stiffness or aching in the past 12 months and 2) presence of knee pain indicated by a KOOS pain score > 85. This novel approach was compared to standard random forests (RF), which do not account for correlations among knees. This study demonstrates the potential of BiMM as a predictive tool for KOA pain, achieving a comparable or slightly improved performance over traditional RF models while simultaneously accounting for within-person correlation among knees. This is a significant advancement, as most machine learning models to date have only considered each knee individually. These findings support the integration of BiMM in KOA outcome prediction, providing a nuanced alternative to existing models and advancing our understanding of important KOA outcomes on the person level. Although demonstrated here for KOA, this method is relevant to any situation where within-person correlations are relevant, including other joints and other musculoskeletal conditions.
Chemotherapy is a widely used treatment for a variety of solid and hematological malignancies. Despite its success in improving the survival rate of cancer patients, chemotherapy causes significant toxicity to multiple organs, including the skeleton, but the underlying mechanisms have yet to be elucidated. Using tumor-free mouse models, which are commonly used to assess direct off-target effects of anti-neoplastic therapies, we found that doxorubicin caused massive bone loss in wild-type mice, a phenotype associated with increased number of osteoclasts, leukopenia, elevated serum levels of danger-associated molecular patterns (DAMPs; e.g. cell-free DNA and ATP) and cytokines (e.g. IL-1β and IL-18). Accordingly, doxorubicin activated the absent in melanoma (AIM2) and NLR family pyrin domain containing 3 (NLRP3) inflammasomes in macrophages and neutrophils, causing inflammatory cell death pyroptosis and NETosis, which correlated with its leukopenic effects. Moreover, the effects of this chemotherapeutic agent on cytokine secretion, cell demise, and bone loss were attenuated to various extent in conditions of AIM2 and/or NLRP3 insufficiency. Thus, we found that inflammasomes are key players in bone loss caused by doxorubicin, a finding that may inspire the development of a tailored adjuvant therapy that preserves the quality of this tissue in patients treated with this class of drugs.
Surgeons are exposed to a high prevalence of work-related musculoskeletal disorders (WMSDs). The scientific issues surrounding this problem are generating a growing body of work. The aim of this study is to obtain quantitative and visual information from articles about WMSDs and surgeons through bibliometric analysis. The keywords “surgeon” and “work-related musculoskeletal disorders” were searched in the PubMed/Medline database until March 2024. Data extraction and visualization were performed using VOSviewer version 1.6.20. and Microsoft Excel on the overall distribution of publications by year, sources, articles, authors and keywords. A total of 173 English-language publications were extracted between 1982 and 2024. The number of publications has increased over the years. A significant increase was observed from 2016. America is the leader with 82/173 publications (47.4%) and 3,276 citations. Work [impact factor (IF): 2.3] is the first top source which has 7 articles followed by Surgical Endoscopy (IF: 3.1) with 5 publications. Journal of Occupational Rehabilitation (IF: 3.3) is the top journal with 681 citations for 2 publications. Hallbeck MS, Yu D, and Vijendern A are the most productive authors with 23 publications. The analysis showed that the United States and the UK are the two most productive countries (journals, authors, citations). The most frequently used keywords were “ergonomics”, “musculoskeletal disorders”, “work-related musculoskeletal disorders”, and “surgeons”. Bibliometric analysis has shown that the prevalence of WMSDs in surgeons is a topic showing significant growth, particularly since 2016, dominated by American researchers. A synthesis of the WMSD prevalence by body area has been made based on the most cited articles. This field has evolved considerably. From a rather subjective analysis of prevalence based on questionnaires, work has moved towards a more ergonomic assessment using objective evaluation tools.
Aurora Catalina Estrada Rodríguez, Nathalia Rodríguez Suárez, Steve Fernando Pedraza Vargas
Introducción. Las personas con síndrome de carga del cuidador requieren una intervención sobre sus alteraciones físicas y emocionales; una alternativa terapéutica en neurorehabilitación son los aceites esenciales.
Objetivo. Identificar el efecto de la terapia con aceites esenciales sobre la calidad de vida en un grupo de pacientes con síndrome de carga del cuidador a través de su percepción fenomenológica.
Métodos. Estudio mixto con triangulación concurrente o DITRIAC. En lo cuantitativo, se realizó un estudio de diseño preexperimental con medición pre y post intervención con un solo grupo del grado de carga del cuidador por medio de la escala de Zarit y el cuestionario SF36 con el fin de conocer la percepción de la calidad de vida relacionada con la salud. En lo cualitativo, se llevó a cabo un estudio fenomenológico con recolección de información por medio de un diario de campo y una entrevista semiestructurada.
Resultados. En la fase cuantitativa se evidenció disminución de los síntomas de carga y mejoría en los niveles de calidad de vida con el uso de los aceites esenciales, mientras que en la fase cualitativa las narrativas refirieron mejor desempeño en sus roles asociado a una representación diferente del estado sintomatológico.
Conclusión. Los aceites esenciales se perciben como una terapia de efecto positivo que modifica los síntomas psicosomáticos y emocionales de los sujetos con carga del cuidador, lo cual impacta positivamente su calidad de vida. Existe un valor no reconocido de las narrativas del paciente en el conocimiento de los efectos de los tratamientos que se realizan, en especial en los procesos de enfermedad que alteran la mente.
Abstract Introduction Inflammatory bowel disease (IBD)-related arthritis is recognized as the most prevalent extraintestinal manifestation (EIM) of IBD. The objective of this study was to determine the prevalence and characteristics of undiagnosed IBD-related arthritis and to compare two screening questionnaires, DETection of Arthritis in Inflammatory boweL diseases (DETAIL) and IBd Identification of Spondyloarthritis Questionnaire (IBIS-q), for early disease detection. Methods Between April and October 2023, both the DETAIL and IBIS-q questionnaires were administered to consecutive IBD outpatients visiting the University Hospital of Udine, Italy. During routine gastroenterology evaluations, patients aged > 18 years with Crohn’s disease (CD) or ulcerative colitis (UC) were requested to complete both questionnaires. Subsequently, all patients who completed the questionnaires underwent a blinded rheumatological evaluation within 2 weeks. Patients with a previous diagnosis of IBD-related SpA were then excluded. Results Overall, 203 patients were enrolled, of whom 26 were excluded because of a prior diagnosis of inflammatory arthritis. Among the remaining 177 patients, 10/177 (5.6%) received a new diagnosis of IBD-related arthritis. The median duration of symptoms before diagnosis was 4 (IQR 1.8–10.5) months. Imaging-confirmed enthesitis was the predominant pattern in 8 out 10 cases (80%, with 8 out 8 lacking concomitant peripheral arthritis), axial involvement in 1 out 10 cases (10%), and peripheral arthritis in 1 out 10 cases (10%). The DETAIL questionnaire exhibited higher specificity, but lower sensitivity compared to the IBIS-q, with a sensitivity of 40.0% (12.2–73.8) and specificity of 84.4% (78.0–89.6) versus a sensitivity of 70.0% (34.8–93.3) and specificity of 74.3% (66.9–80.7). Both questionnaires performed less effectively than in other studies. Conclusion This study highlights a significant proportion of undiagnosed IBD-related arthritis (5.6%). Enthesitis emerged as the predominant pattern of newly diagnosed arthritis in our cohort, likely due to the recent onset of symptoms. Our study underscores the importance of entheseal involvement in early IBD-related arthritis and the importance of incorporating entheseal involvement into screening questionnaires.
Abstract Objective This study aimed at constructing a network of competing endogenous RNA (ceRNA) in the synovial tissues of rheumatoid arthritis (RA). It seeks to discern potential biomarkers and explore the long non-coding RNA (lncRNA)-microRNA (miRNA)-messenger RNA (mRNA) axes that are intricately linked to the pathophysiological mechanisms underpinning RA, and providing a scientific basis for the pathogenesis and treatment of RA. Methods Microarray data pertaining to RA synovial tissue, GSE103578, GSE128813, and GSE83147, were acquired from the Gene Expression Omnibus (GEO) database ( http://www.ncbi.nlm.nih.gov/geo ). Conducted to discern both differentially expressed lncRNAs (DELncRNAs) and differentially expressed genes (DEGs). A ceRNA network was obtained through key lncRNAs, key miRNAs, and key genes. Further investigations involved co-expression analyses to uncover the lncRNA-miRNA-mRNA axes contributing to the pathogenesis of RA. To delineate the immune-relevant facets of this axis, we conducted an assessment of key genes, emphasizing those with the most substantial immunological correlations, employing the GeneCards database. Finally, gene set enrichment analysis (GSEA) was executed on the identified key lncRNAs to elucidate their functional implications in RA. Results The 2 key lncRNAs, 7 key miRNAs and 6 key genes related to the pathogenesis of RA were obtained, as well as 2 key lncRNA-miRNA-mRNA axes (KRTAP5-AS1-hsa-miR-30b-5p-PNN, XIST-hsa-miR-511-3p/hsa-miR-1277-5p-F2RL1). GSEA of two key lncRNAs obtained biological processes and signaling pathways related to RA synovial lesions. Conclusion The findings of this investigation hold promise in furnishing a foundational framework and guiding future research endeavors aimed at comprehending the etiology and therapeutic interventions for RA.
Bader A. Alqahtani, Aqeel M. Alenazi, Ragab K. Elnaggar
et al.
Abstract Background Normative values for hand grip and pinch strength among children in Saudi Arabia has not been well established. Therefore, the main aim of this study is to establish normative values for hand grip and pinch strength in children aged 6 to 18 years in Saudi Arabia. Methods A cross-sectional study was conducted from different 5 regions in Saudi Arabia. Participants between the age of 6 years and 18 years old were recruited through different primary and secondary schools in Saudi Arabia. Data for age, gender, Body Mass Index, and preferred hand were collected. Hand grip strength was measured using digital hand dynamometer and the tip pinch, palmar pinch, and key pinch strength were measured using the hydraulic pinch gauge. Results A total of 616 participants included in this study (318 boys and 298 girls). Participants were stratified into 5 chronological age groups of 6–7 years, 8–9, 10–11, 12–13, 14–15, 16–17, and 18 years. The results showed an overall trend of increasing hand grip strength and pinch strength with age regardless of hand preference. Boys had significantly higher grip strength than girls in all age groups (P < 0.05). Conclusion This study established normative values for hand grip and pinch strength in the healthy Saudi pediatric and adolescent population, using boys and girls aged 6 to 18. The outcomes of this study also demonstrated that gender, age, and hand preference can all have an impact on how strong a handgrip develops.
Systemic vasculitis is a heterogeneous group of disorders characterized by inflammation and necrosis in the vessel wall. Patients usually present a quite broad spectrum of manifestations which vary in terms of vessels’ size affected, organs involvement, and the extent of inflammatory process as well as an immunological diversity, including autoantibodies profile. Though, the diagnosis is based on clinical features, tissue biopsy, imaging investigations, and serologic tests. The main autoantibodies, important not only in the diagnosis but also in monitoring and prognosis of systemic vasculitides, are anti-neutrophil cytoplasmic antibodies (ANCA), anti-glomerular basement membrane antibodies (anti-GBM), anti-complement component C1q antibodies (anti-C1q), and cryoglobulins. Although other autoantibodies have been analyzed, their clinical utility still needs further investigation. The current work aimed to review the clinical associations of main autoantibodies in systemic vasculitis.
AimsThe involvement of cyclin D1 in the proliferation of microglia, and the generation and maintenance of bone cancer pain (BCP), have not yet been clarified. We investigated the expression of microglia and cyclin D1, and the influences of cyclin D1 on pain threshold.MethodsFemale Sprague Dawley (SD) rats were used to establish a rat model of BCP, and the messenger RNA (mRNA) and protein expression of ionized calcium binding adaptor molecule 1 (IBA1) and cyclin D1 were detected by reverse transcription-polymerase chain reaction (RT-PCR) and western blot, respectively. The proliferation of spinal microglia was detected by immunohistochemistry. The pain behaviour test was assessed by quantification of spontaneous flinches, limb use, and guarding during forced ambulation, mechanical paw withdrawal threshold, and thermal paw withdrawal latency.ResultsIBA1 and cyclin D1 in the ipsilateral spinal horn increased in a time-dependent fashion. Spinal microglia proliferated in BCP rats. The microglia inhibitor minocycline attenuated the pain behaviour in BCP rats. The cyclin-dependent kinase inhibitor flavopiridol inhibited the proliferation of spinal microglia, and was associated with an improvement in pain behaviour in BCP rats.ConclusionOur results revealed that the inhibition of spinal microglial proliferation was associated with a decrease in pain behaviour in a rat model of BCP. Cyclin D1 acts as a key regulator of the proliferation of spinal microglia in a rat model of BCP. Disruption of cyclin D1, the restriction-point control of cell cycle, inhibited the proliferation of microglia and attenuated the pain behaviours in BCP rats. Cyclin D1 and the proliferation of spinal microglia may be potential targets for the clinical treatment of BCP.Cite this article: Bone Joint Res 2022;11(11):803–813.
Kaoru Suseki, Masaomi Yamashita, Yoshiaki Kojima
et al.
Objectives: Many patients with osteoporotic fragile fracture often suffer from dysphagia that results in malnutrition, further deterioration of physical strength, and rehabilitation difficulties. This study aims to investigate the risk factors for dysphagia in hospitalized patients with osteoporotic vertebral and/or hip fractures. Methods: Between January 2020 and December 2021, 569 inpatients were managed for osteoporotic vertebral or hip fractures. Of these, 503 patients were analyzed and 66 were excluded as the required data could not be obtained or dysphagia with causative diseases such as cerebrovascular disease. The patients were divided into 2 groups: patients with dysphagia (P-group) and patients without dysphagia (N-group). We investigated gender, fracture site, age, systemic skeletal muscle mass index (SMI), bone mineral density (BMD), and body mass index (BMI) in early stage of hospitalization and studied their relationship with dysphagia. Results: There were no significant differences in gender and fracture site between the 2 groups. A significant difference was observed in age, SMI, BMD, and BMI (P < 0.01). We performed a logistic regression analysis with the P-group as the objective variable and age, SMI, BMD, and BMI as explanatory variables. We divided objective groups into all patients, patients with vertebral fracture, patients with hip fracture, men, and women. SMI was an independent risk factor in all groups. Conclusions: Lower SMI was a risk factor for dysphagia in hospitalized patients with osteoporotic vertebral and hip fractures. We carefully observed swallowing function of patients with decreased SMI to maintain the nutritional status and prevent rehabilitation difficulties.
Direnç Şerif Çelik, Koray Ayar, Selime Ermurat
et al.
Abstract Background There is limited and conflicting information on Fgf23 levels and their relationship with bone loss and disease activity in rheumatoid arthritis (RA). The aim of this study was to compare Fgf23 levels in RA patients with a healthy population and to evaluate the relationship between Fgf23 levels in RA with disease activity, bone mineral density (BMD), and radiological damage score. Results The median Fgf23 levels in patients with RA and in hospital staff were 20.06 (11.2–51.0) and 26.40 (12.6–49.5) pg/ml (P < 0.001), respectively. RA patients were divided into active (DAS28 > 3.2) and inactive (DAS28 ≤ 3.2) subgroups. The median Fgf23 levels in active and inactive RA patients were 22.12 (13.90–51.02) and 17.71 (11.20–31.19) pg/ml, respectively (P = 0.001). BMD of RA patients was evaluated with dual-energy X-ray absorptiometry and radiological damage scores were evaluated independently by two investigators using the modified Sharp score (MSS). In RA patients, Fgf23 values correlated with DAS28 and with erosion score of observer-2 (r = 0.297, P = 0.036), but not with erosion score of observer-1 (r = 0.252, P = 0.077). No correlation was found between DAS28 and femur and lumbar vertebra BMD. Conclusion In RA, Fgf23 is not associated with BMD but may be associated with local bone loss and disease activity.
Ernest R. Vina, Philip H. Tsoukas, Shahrzad Abdollahi
et al.
Background: Racial and ethnic disparities in osteoarthritis (OA) patients’ disease experience may be related to marked differences in the utilization and prescription of pharmacologic treatments. Objectives: The main objective of this rapid systematic review was to evaluate studies that examined race/ethnic differences in the use of pharmacologic treatments for OA. Data sources and methods: A literature search (PubMed and Embase) was ran on 25 February 2022. Studies that evaluated race/ethnic differences in the use of OA pharmacologic treatments were included. Two reviewers independently screened titles and abstracts and abstracted data from full-text articles. Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Results: The search yielded 3880 titles, and 17 studies were included in this review. African Americans and Hispanics were more likely than non-Hispanic Whites to use prescription non-selective non-steroidal anti-inflammatory drugs (NSAIDs) for OA. However, compared to non-Hispanic Whites with OA, African Americans and Hispanics with OA were less likely to receive a prescription for cyclooxygenase-2-selective NSAIDs and less likely to report the use of joint health supplements (i.e. glucosamine and chondroitin sulfate). There were minimal/no significant race/ethnic differences in the patient-reported use of the following OA therapies: acetaminophen, opioids, and other complementary/alternative medicines (vitamins, minerals, and herbs). There were also no significant race differences in the receipt of intra-articular therapies (i.e. glucocorticoid or hyaluronic acid). However, there is limited evidence to suggest that African Americans may be less likely than Whites to receive opioids and intra-articular therapies in some OA patient populations. Conclusion: This systematic review provides an overview of the current pharmacologic options for OA, with a focus on race and ethnic differences in the use of such medical therapies.
Muzammil Mumtaz, Justin Mendoza, Sudharshan Tripathi
et al.
Introduction: The correlation between cervical alignment and clinical outcome of total disc replacement (TDR) surgery is arguable. We believe that this conflict exists because the parameters that influence the biomechanics of the cervical spine are not well understood, specifically the effect of TDR on different cervical alignments.
Methods: A validated osseo-ligamentous model from C2-C7 was used in this study. The C2-C7 Cobb angle of the base model was modified to represent: lordotic (−10°), straight (0°), and kyphotic (+10°) cervical alignment. The TDR surgery was simulated at the C5-C6 segment. The range of motion (ROM), intradiscal pressure, annular stresses, and facet loads were computed for all the models.
Results: The ROM results demonstrated kyphotic alignment after TDR surgery to be the most mobile when compared to intact base model (41% higher in flexion–extension, 51% higher in lateral bending, and 27% higher in axial rotation) followed by straight and lordotic alignment, respectively. The annular stresses for the kyphotic alignment when compared to intact base model were higher at the index level (33% higher in flexion–extension and 48% higher in lateral bending) compared to other alignments. The lordotic model demonstrated higher facet contact forces at the index level (75% higher in extension than kyphotic alignment, 51% higher in lateral bending than kyphotic alignment, and 78% higher in axial rotation than kyphotic alignment) when compared among the three alignment models.
Conclusion: Preoperative cervical alignment should be an integral part of surgical planning for TDR surgery as different cervical alignments may significantly alter the postsurgical outcomes.