This study assesses the prevalence of major and minor discordance between hip and spine T scores using Radiofrequency Echographic Multi-spectrometry (REMS). REMS is a novel technology that uses ultrasound and radiofrequency analysis to measure bone density and bone fragility at the hip and lumbar spine. The objective was to compare the results with the existing literature on Dual-Energy X-ray Absorptiometry (DEXA) the current “gold standard” for bone densitometry. REMS and DEXA have been shown to have similar diagnostic accuracy, however, REMS has less human input when carrying out the scan, therefore the rates of discordance might be expected to be lower than for DEXA. Discordance poses a risk of misclassification of patients’ bone health status, causing diagnostic ambiguity and potentially sub-optimal management decisions. Reduction of discordance rates therefore has the potential to significantly improve treatment and patient outcomes. Results from 1,855 patients who underwent REMS investigations between 2018 and 2022 were available. Minor discordance is defined as a difference of one World Health Organisation (WHO) diagnostic classification (Normal / Osteopenia or Osteopenia / Osteoporosis). Major discordance is defined as a difference of two WHO diagnostic classifications (Normal / Osteoporosis). The results were compared with reported DEXA discordance rates.Abstract
Objective
Methods
The aim of this study was to describe the epidemiology of closed
isolated fractures of the femoral shaft in children, and to compare
the treatment and length of stay (LOS) between major trauma centres
(MTCs) and trauma units (TUs) in England. National data were obtained from the Trauma and Audit Research
Network for all isolated, closed fractures of the femoral shaft
in children from birth to 15 years of age, between 2012 and 2015.
Age, gender, the season in which the fracture occurred, non-accidental
injury, the mechanism of injury, hospital trauma status, LOS and
type of treatment were recorded.Aims
Patients and Methods
Stationary fluoroscopy has been a viable resource for determining in vivo knee kinematics, but limitations have restricted the use of this technology. Patients can only perform certain normal daily living activities while using stationary fluoroscopy and must conduct the activities at speeds that are slower than normal to avoid ghosting of the images. More recently, a Mobile Tracking Fluoroscopic (MTF) unit has been developed that can track patients in real-time as he/she performs various activities at normal speeds (Figure 1). Therefore, the objective of this study was to compare in vivo kinematics for patient's evaluated using stationary and mobile fluoroscopy to determine potential advantages and disadvantages for use of these technologies. The MTF is a unique mobile robot that can acquire real-time x-ray records of hip, knee, or ankle joint motion while a subject walks/manoeuvres naturally within a laboratory floor area. By virtue of its mechanizations, test protocols can involve many types of manoeuvres such as chair rises, stair climbing/descending, ramp crossing, walking, etc. Because the subjects are performing such actions naturally, the resulting fluoroscope images reflect the full functionality of their musculoskeletal anatomy. Patients in the study were initially fluoroscoped using a stationary unit and then using the MTF unit.INTRODUCTION:
METHODS:
The majority of spine patients present with discogenic low back pain, originating from either degenerative disc disease (DDD) or internal disc disruption (IDD). Successful treatment of this patient population relies on obtaining precision diagnosis and careful patient selection, as well as matching the pathology with reliable technology. Total disc replacement (TDR), as an alternative to spinal fusion in the treatment of DDD or IDD, has been studied and reported for several decades in long-term follow-up studies and in several randomized control trials. This prospective study presents a single surgeon experience with two-level CHARITÉ® TDR in 84 consecutive patients, with minimum follow-up of 5 years. The aims of the study were to assess the clinical outcomes of two-level TDR in patients with DDD/IDD. Based on the literature review conducted, this study is considered the largest single surgeon series experience with the two-level CHARITÉ® TDR in the treatment of lumbar DDD, with a minimum follow-up of 5 years reported to date. Between January 1997 and March 2006, n=84 consecutive patients underwent two-level TDR for the treatment of two-level DDD or IDD discogenic axial low back pain with or without radicular pain. All patients completed self-assessment outcome questionnaires pre and postoperatively (3, 6, 12 months, and yearly thereafter), including Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ) and Visual Analogue Score (VAS) for back and leg pain.Introduction
Materials and Methods
Nine patients had undergone prior surgery. When compared with those with no prior surgery, no statistical difference was detected. There was a trend for the ODI and back VAS scores of the patients with previous surgery improved more quickly in the early stages. Fourteen patients were involved in compensation claims at the time of surgery. Their results were compared with those patients without compensation claims. The numbers were too small to be statistically significant, but there was a trend suggesting recovery was delayed in the compensation group. However, at 24 months there was no difference in the outcome scores. In the patient sample, 87% of patients returned to work. No major intra-operative complications were documented. One neurological complication was documented. Two revision procedures were preformed. No prosthetic failure occurred.
Highly selective CT-guided epidural steroid injection was then carried out at the level of spondylolithesis by an experienced interventional radiologist. The pain diagram, VAS of pain severity and ODI were all completed again by the subjects themselves or by telephone at 1 and 3 months after injection in the presence of an independent assessor (nurse) and then reviewed and discussed with the treating doctor. All subjects were also asked to complete a functional questionnaire.
Up until now most spine surgery has been salvage (correcting the effects of trauma, stabilising correcting deformity, fusing degenerative segments) not restoration of normal function. As new alternatives to fusion come to fruition, we now have the ability to truly restore the spine to normal function. Spinal arthroplasty is a new concept and includes total disc replacement, nuclear replacement and there are efforts by investigators looking at posterior element reconstruction or facet replacement.
The results so far indicate good to excellent in 84% of cases. Complications have the potential to be catastrophic but attention to surgical detail results in minimal complications which will be discussed in the body of the presentation.
Pseudarthrosis – 3%–36% Graft collapse – 3%–14% Graft extrusion – 0.5%–4% These figures are regardless of the graft source and are significant. Recent studies show that the combination of graft and anterior plate fixation virtually eliminates the complication of graft extrusion, and also decreases the risk of graft collapse and development of pseudarthrosis. There are also studies that contend that plate fixation can maintain proper lordotic alignment of the spine more effectively than can ACDF without plating. I contend that the use of contemporary cervical plates significantly decreases the rate of fusion failure and graft-related complications without imparting significant implant-related complications. As a result, there is decreased overall risk to the patient. The current type of plates which are available are unicortical with locking systems that substantially decrease the risk of screw loosening or hardware migration.