European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Anterior cervical decompression and fusion with anterior plating of the cervical spine is a well-accepted treatment for cervical radiculopathy. Recently, to minimise the extent of surgery, anterior interbody fusion with cages has become more common. While there are numerous reports on the primary stabilising effects of the different cervical cages, little is known about the subsidence behaviour of such cages in vivo. ⋯ Her symptoms were explained by the subsidence of the cage and the subsequent foraminal stenosis observed on the magnetic resonance imaging (MRI) scan. At 15 months' follow-up, her cage was broken. Our preliminary results, so far limited in number, represent a serious warning to the proponents of stand-alone cervical cages
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Although osteoporosis is a systemic disease, vertebral fractures due to spinal bone loss are a frequent, sometimes early and often neglected complication of the disease, generally associated with considerable disability and pain. As osteoporotic vertebral fractures are an important predictor of future fracture risk, including at the hip, medical management is targeted at reducing fracture risk. A literature search for randomized, double-blind, prospective, controlled clinical studies addressing medical treatment possibilities of vertebral fractures in postmenopausal Caucasian women was performed on the leading medical databases. ⋯ Bisphosphonates have demonstrated similar efficacy in treatment and prevention of steroid-induced and male osteoporosis as in postmenopausal osteoporosis. The selection of the appropriate drug for treatment of vertebral osteoporosis from among a bisphosphonate (alendronate or risedronate), PTH, calcitonin or raloxifene will mainly depend on the efficacy, tolerability and safety profile, together with the patient's willingness to comply with a long-term treatment. Although reduction of vertebral fracture risk is an important criterion for decision making, drugs with proven additional fracture risk reduction at all clinically relevant sites (especially at the hip) should be the preferred options.
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Review Comparative Study
Recognizing and reporting osteoporotic vertebral fractures.
Vertebral fractures are the hallmark of osteoporosis, and occur with a higher incidence earlier in life than any other type of osteoporotic fractures. It has been shown that both symptomatic and asymptomatic vertebral fractures are associated with increased morbidity and mortality. Morbidity associated with these fractures includes decreased physical function and social isolation, which have a significant impact on the patient's overall quality of life. ⋯ The disadvantage of DXA use is that upper thoracic vertebrae cannot be evaluated in a substantial number of patients due to poor imaging quality. We truly believe that the that there is a major role for radiologists and clinicians alike to carefully assess and diagnose vertebral fractures using standardized grading schemes such as the one outlined in this review. Quantitative morphometry is useful in the context of epidemiological studies and clinical drug trials; however, the studies would be flawed if quantitative morphometry were to be performed in isolation without additional adjudication by a trained and highly experienced radiologist or clinician.
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The overall frequency of troublesome neck pain is estimated to be about 34%, and it was observed that the frequency of complaints lasting 1 month or longer was higher in women than in men. The prevalence increased with age, with regard to both pain duration and chronic pain. Approximately 14% of a randomly selected population meets the criterion for chronic neck pain: complaints lasting more than 6 months. ⋯ For a diagnosis of radicular and myelopathic syndromes, the functional and neurological examination is enhanced by neurophysiological assessment. Electromyography (EMG) performed with needle electrodes is the oldest method for diagnosing nerve root compression and anterior horn cell syndromes, and is claimed to have no false-positive results. For cervical myelopathy, as a routine examination sensory evoked potentials (SEPs) by stimulation of tibial nerve and motor evoked potentials (MEPs) from the upper and lower extremities are recommended.
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The costs of vertebral fractures are less well defined than the costs of hip fractures. Large studies are urgently needed. ⋯ These new data on the cost of vertebral fractures will have an impact on health economy calculations. In the future it may be be cost-effective only to prevent vertebral fractures.