A clinical profile of back pain and disability in patients with spinal osteoporosis

Ryan, P. J.; Blake, Glen; Herd, R J; Fogelman, Ignac

doi:10.1016/8756-3282(94)90887-7

Cited by 101 publications

(66 citation statements)

References 15 publications

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“…Some reports have shown a decrease in ADL and QOL in association with compression fracture and spinal deformity in osteoporosis patients [25][26][27][28][29][30][31]. Recently, Miyakoshi et al [13,32,33] investigated spinal ROM in postmenopausal patients with osteoporosis aged 50 years or older and found that a decrease in spinal ROM had negative effects on QOL, and that deterioration of back muscle strength was the most important factor decreasing spinal ROM, indicating that maintenance of back muscle strength and lumbar ROM are important for QOL.…”

Section: Discussionmentioning

confidence: 99%

Back muscle strength and spinal mobility are predictors of quality of life in middle-aged and elderly males

et al. 2010

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With aging of society, clarification of the relationship between QOL and abnormal posture in the elderly may allow improvement of QOL through any preventive methods and training. However, sagittal balance has not been studied widely and most studies have focused on postmenopausal patients with osteoporosis. In this report, we provide the first evaluation of the simultaneous effects of degenerative changes on radiograph, spinal range of motion (ROM), sagittal balance, and back muscle strength, and examine the influence of these effects on QOL of the middleaged and elderly male subjects. The subjects were 100 Japanese males who underwent a basic health checkup. Lumbar lateral radiograph, sagittal balance and spinal mobility determined with SpinalMouse Ò and back muscle strength were measured. The thoracic/lumbar angle ratio (T/L ratio) was used as an index of sagittal balance. SF-36 physical component summary (PCS) scores showed a significant negative correlation with age (r = -0.377), osteophyte score (r = -0.246) and T/L ratio (r = -0.214), and a significant positive correlation with lumbar lordosis angle (r = 0.271), thoracic ROM (r = 0.282), and back muscle strength (r = 0.549). Multiple regression analysis indicated that thoracic spinal ROM (r = 0.254, p \ 0.01) and back muscle strength (r = 0.488, p \ 0.0001) were significantly associated with SF-36 PCS (R 2 = 0.403).In conclusion, QOL of the middle-aged and elderly male subjects was related to sagittal balance, lumbar lordosis angle, spinal ROM, and back muscle strength. Exercise including muscle strength and spinal ROM may be able to influence these primary factors related to QOL. Back muscle strength and thoracic ROM impact on improvement of QOL in the middle-aged and the elderly.

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Section: Discussionmentioning

confidence: 99%

Back muscle strength and spinal mobility are predictors of quality of life in middle-aged and elderly males

et al. 2010

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“…In the United States, 25% of women over the age of 70 and 50% of women over the age of 80 show evidence of vertebral fractures, the majority of which occur in the midthoracic region and the thoracolumbar junction [16,20]. The potential sequelae include disabling pain, vertebral collapse, and progressive loss of physiologic spinal alignment [22]. Declines in physical function and changes in appearance contribute to social isolation and loss of self-esteem, thus impairing quality of life.…”

Section: Introductionmentioning

confidence: 99%

Augmentation of mechanical properties in osteoporotic vertebral bones – a biomechanical investigation of vertebroplasty efficacy with different bone cements

et al. 2001

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IntroductionOsteoporosis is a disease characterized by low bone mass, which leads to increased susceptibility to fractures. It is a common condition in the elderly, affecting predominantly women over the age of 65 [2]. The spine is the most common site of fracture in patients with osteoporosis. In the United States, 25% of women over the age of 70 and 50% of women over the age of 80 show evidence of vertebral fractures, the majority of which occur in the midthoracic region and the thoracolumbar junction [16,20]. The potential sequelae include disabling pain, vertebral collapse, and progressive loss of physiologic spinal alignment [22]. Declines in physical function and changes in appearance contribute to social isolation and loss of self-esteem, thus impairing quality of life. Significant neurological compromise due to spontaneous fracture of osteoporotic vertebrae has been described [12,19]. The morbidity associated with osteoporosis and vertebral fractures represents an enormous socio-economic cost [2].Abstract Recent clinical trials have reported favorable early results for transpedicular vertebral cement reinforcement of osteoporotic vertebral insufficiencies. There is, however, a lack of basic data on the application, safety and biomechanical efficacy of materials such as polymethylmethacrylate (PMMA) and calciumphospate (CaP) cements. The present study analyzed 33 vertebral pairs from five human cadaver spines. Thirty-nine vertebrae were osteoporotic (bone mineral density <0.75 g/cm 2 ), 27 showed nearly normal values. The cranial vertebra of each pair was augmented with either PMMA (Palacos E-Flow) or experimental brushite cement (EBC), with the caudal vertebra as a control. PMMA and EBC were easy to inject, and vertebral fillings of 20-50% were achieved. The maximal possible filling was inversely correlated to the bone mineral density (BMD) values. Cement extrusion into the spinal canal was observed in 12% of cases.All specimens were subjected to axial compression tests in a displacement-controlled mode. From loaddisplacement curves, the stiffness, S, and the maximal force before failure, F max, were determined. Compared with the native control vertebrae, a statistically significant increase in vertebral stiffness and F max was observed by the augmentation. With PMMA the stiffness increased by 174% (P=0.018) and F max by 195% (P=0.001); the corresponding augmentation with EBC was 120% (P=0.03) and 113% (P=0.002). The lower the initial BMD, the more pronounced was the augmentation effect. Both PMMA and EBC augmentation reliably and significantly raised the stiffness and maximal tolerable force until failure in osteoporotic vertebral bodies. In nonporotic specimens, no significant increase was achieved.

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“…However, it is important to distinguish the pain caused by a fracture from other causes of back pain. Patients requiring a percutaneous cement augmentation procedure are usually very fragile with multiple medical co-morbid factors [3,4,7,9,[18][19][20][21]. Thus, the differential diagnosis should include not only osteoporosis, but also malignant tumor, benign tumor endocrinopathy, autoimmune disease, blood dyscrasias, and infection [1,22,23].…”

Section: Discussionmentioning

confidence: 99%

“…Approximately 700,000 VCFs occur in the US each year and approximately one-third of them are causing chronic pain [1]. In addition to the debilitating symptoms of pain that VCFs can cause, progressive loss of sagittal posture can have a tremendous impact on quality of life [2][3][4][5][6][7][8][9][10]. New minimal invasive techniques like percutaneous vertebroplasty and percutaneous kyphoplasty proved to be an effective treatment for treating the pain and preventing further collapse at the fracture level [11][12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Routine needle biopsy during vertebral augmentation procedures. Is it necessary?

et al. 2010

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Vertebral augmentation procedures are currently widely performed to treat vertebral compression fractures. The purpose of this study was to determine the frequency of underlying previously unrecognized etiology in a consecutive series of patients undergoing kyphoplasty to treat vertebral compression fractures. A prospective histological evaluation of vertebral body biopsy specimens from presumed osteoporotic vertebral compression fractures were performed in order to identify aforementioned causes. Over a 2-year period, vertebral body biopsies from 154 vertebral levels were performed in 75 patients undergoing kyphoplasty for vertebral compression fractures. All patients received a preoperative workup that included plain radiographs, MRI, whole body bone scan, and laboratory examinations. Bone specimens were obtained from affected vertebral bodies and submitted for histologic evaluation to identify the prevalence of an underlying cause. All specimens demonstrated fragmented bone with variable amounts of unmineralised bone, signs of bone-remodeling and/or fracture-healing. In 11 patients underlying pathology other than osteoporosis was identified (prostate cancer, 1; pancreatic cancer, 1; colon cancer, 1; breast cancer, 2; multiple myeloma, 3; leukemia, 1; and lung cancer, 2). In all but one patient the results of the biopsy confirmed the diagnosis suspected from the preoperative workup. For the last patient, namely the one with pancreatic cancer, the workup did not identify the origin of the primary tumor, although the patient was considered to have a compression fracture secondary to metastatic disease of unknown origin, the vertebral biopsy suggested the presence of adenocarcinoma which eventually was proven to be pancreatic cancer. In augmentation procedures for vertebral compression fractures, bone biopsy should be reserved for the patients where the preoperative evaluation raises the suspicion of a non-osteoporotic etiology.

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A clinical profile of back pain and disability in patients with spinal osteoporosis

Cited by 101 publications

References 15 publications

Back muscle strength and spinal mobility are predictors of quality of life in middle-aged and elderly males

Back muscle strength and spinal mobility are predictors of quality of life in middle-aged and elderly males

Augmentation of mechanical properties in osteoporotic vertebral bones – a biomechanical investigation of vertebroplasty efficacy with different bone cements

Routine needle biopsy during vertebral augmentation procedures. Is it necessary?

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