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      Feasibility of percutaneous interbody fusion as a treatment for adjacent vertebral stress fracture of ankylosing spondylitis with intervertebral pseudarthrosis formation

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          The objective of this study was to evaluate the feasibility of percutaneous interbody fusion (PIF) using bone cement for adjacent vertebral stress fracture of ankylosing spondylitis (AS) with intervertebral pseudarthrosis formation.

          Patients and methods

          From January 2010 to February 2018, eleven consecutive patients (seven men and four women; median age, 56.09±13.64 years; age range, 33–80 years) who underwent PIF as a treatment for adjacent stress fracture of AS with intervertebral pseudarthrosis formation were retrospectively analyzed. The Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) score were assessed before and after the procedure; meanwhile, the procedure duration, length of hospital stay and complications were assessed. Moreover, anterior/lateral and computed tomography (CT) scans were utilized for the assessment of bone cement distribution and interbody fusion.


          Technical success was achieved in all patients, and they experienced good interbody fusion with bone cement after PIF. Mean VAS scores declined significantly from 8.82±0.87 before the procedure to 3.36±0.67 1 day after the procedure and 2.73±0.65 1 month after the procedure, while the mean ODI scores decreased from 82.91±3.02 before treatment to 31.64 ±2.66 1 day after treatment and 30.00±3.10 1 month after treatment. The mean procedure duration was 49.73±6.12 minutes (range, 42–65 minutes). The average length of hospital stay was 7.09±1.45 days (range, 5–10 days). Extraosseous cement leakage occurred in one case without causing any clinical complications.


          PIF is a feasible therapeutic technique for adjacent vertebral stress fracture of AS with intervertebral pseudarthrosis formation, which can significantly relieve pain and stabilize the fractured spine.

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          Most cited references 15

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          Visual analog scales for interpretation of back and leg pain intensity in patients operated for degenerative lumbar spine disorders.

          A prospective observational study of visual analog scale (VAS) scores for pain in patients operated at one institution within the framework of a national registry. To describe the use of recording VAS for pain intensity in patients operated on for lumbar spine problems. There is no consensus regarding pain outcomes assessment in spine patients. Pain intensity, recorded on a VAS, is one of the most used measures. Still, many aspects of its interpretation are still debated or unclear. A total of 755 consecutive patients, mean age 50 years (range, 15-86 years), operated from 1993 to 1998 were included in the study; there were 420 males and 335 females. Diagnoses included herniated nucleus pulposus (45%), central stenosis (19%), lateral stenosis (14%), isthmic spondylolisthesis (9%), and degenerative disc disease (9%). Local pain, radiating pain, analgesic intake, and walking ability were recorded before surgery and at 4 and 12 months after surgery. The patients' opinions regarding the change in pain and satisfaction with the result were assessed separately. Correlation among variables reflecting perceived pain was sought. Preoperative VAS mean values for local and radiating pain were significantly different in the five diagnostic groups. Significant but moderate correlation between different types of pain outcomes and with patient satisfaction was present in all cases. Measuring pain intensity with VAS is a useful tool in describing spine patients. In the search for a standard in the evaluation of pain as an outcome, the differences between the various methods should be taken into account.
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            Management of cervical spinal fractures in ankylosing spondylitis with posterior fixation.

            Introduction of a posterior approach for internal fixation of fractures of the ankylosed cervical spine. To evaluate the clinical outcome of patients with ankylosing spondylitis and cervical spinal fractures treated with posterior instrumentation and a collar orthosis. Cervical spinal fractures in patients with ankylosing spondylitis almost always extend completely across the vertebral segment to include both anterior and posterior elements. Treatment with immobilization alone is often inadequate. Generalized spinal rigidity and exaggerated thoracic kyphosis may hinder anterior exposure. Posterior approaches have been described but generally require postoperative halo immobilization. In the authors' technique for patients whose spinal alignment is relatively well preserved, a posterior exposure is used that achieves three-point internal fixation along multiple segments. The complications associated with halo immobilization are avoided. Seven patients with ankylosing spondylitis and fractures of the cervical spine were stabilized with posterior instrumentation. Patients were immobilized after surgery with either a cervical collar or a sternal occipital mandibular immobilizing brace and observed for neurologic outcome, radiographic evidence of bony fusion, and complications. No patient experienced neurologic deterioration with surgery. Two patients died at acute rehabilitative facilities after discharge. Radiographic evidence of fusion was observed in the five patients available for follow-up. Patients with ankylosing spondylitis and cervical spinal fractures can be adequately treated with lateral mass plating and interspinous wiring of autologous rib graft. Adequate postoperative immobilization can be attained with a cervical collar and does not require a halo vest.
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              Osteoporosis, body composition, and bone turnover in ankylosing spondylitis.

              To study the prevalence of osteoporosis (OP) and osteopenia in ankylosing spondylitis (AS) and to investigate the relationship between symptomatic and structural severity, the indices of bone turnover, and body composition. Eighty patients with AS were enrolled prospectively: 52 men (65%) and 28 women, mean age 36.7 years +/- 11.5 (range 18-67); they were studied clinically, radiologically, and by dual energy x-ray absorptiometry. Sixty-three underwent biological assessment of bone turnover markers. OP and osteopenia as defined by the World Health Organization (T score < -2.5 SD and between -1 and -2.5 SD, respectively) were observed in 15 (18.7%) and 25 patients (31.2%) at the lumbar spine and in 11 (13.7%) and 33 patients (41.2%) at the femoral neck, respectively. Patients with OP had a lower body mass index (BMI) and fat mass percentage. There was a trend to a lower disease duration in patients with OP at the spine than in healthy subjects. Bone resorption markers (urinary D-pyridinoline or C-telopeptide concentrations) were increased in 34 patients (53.9%). Bone turnover markers were positively correlated with C-reactive protein concentration and Larsen radiological hip score; they were negatively correlated with Schober index and fat mass percentage. (1) OP is frequent in AS and can be observed in early stages of the disease. (2) Patients with AS are more susceptible to develop OP when they have low BMI, low fat mass percentage, and active and severe disease. OP was observed in parallel with increased bone resorption.

                Author and article information

                J Pain Res
                J Pain Res
                Journal of Pain Research
                Journal of Pain Research
                Dove Medical Press
                29 August 2018
                : 11
                : 1673-1678
                Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai 200233, People’s Republic of China, 649514608@ 123456qq.com ; chengyingsheng@ 123456hotmail.com
                Author notes
                Correspondence: Chun-Gen Wu; Ying-Sheng Cheng, Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, No 600 Yishan Road, Shanghai 200233, People’s Republic of China, Tel +86 189 3017 7559, Fax +86 21 3829 7739, Email 649514608@ 123456qq.com ; chengyingsheng@ 123456hotmail.com
                © 2018 Tian et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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