SPINE20 A global advocacy group promoting evidence-based spine care of value

PURPOSE: The Global Burden of Diseases (GBD) Studies have estimated that low back pain is one of the costliest ailments worldwide. Subsequent to GBD publications, leadership of the four largest global spine societies agreed to form SPINE20. This article introduces the concept of SPINE20, the recommendations, and the future of this global advocacy group linked to G20 annual summits. METHODS: The founders of SPINE20 advocacy group coordinated with G20 Saudi Arabia to conduct the SPINE20 summit in 2020. The summit was intended to promote evidence-based recommendations to use the most reliable information from high-level research. Eight areas of importance to mitigate spine disorders were identified through a voting process of the participating societies. Twelve recommendations were discussed and vetted. RESULTS: The areas of immediate concern were "Aging spine," "Future of spine care," "Spinal cord injuries," "Children and adolescent spine," "Spine-related disability," "Spine Educational Standards," "Patient safety," and "Burden on economy." Twelve recommendations were created and endorsed by 31/33 spine societies and 2 journals globally during a vetted process through the SPINE20.org website and during the virtual inaugural meeting November 10-11, 2020 held from the G20 platform. CONCLUSIONS: This is the first time that international spine societies have joined to support actions to mitigate the burden of spine disorders across the globe. SPINE20 seeks to change awareness and treatment of spine pain by supporting local projects that implement value-based practices with healthcare policies that are culturally sensitive based on scientific evidence

SPINE20 recommendations 2021: spine care for people's health and prosperity

PURPOSE: The focus of SPINE20 is to develop evidence-based policy recommendations for the G20 countries to work with governments to reduce the burden of spine disease, and disability. METHODS: On September 17-18, 2021, SPINE20 held its annual meeting in Rome, Italy. Prior to the meeting, the SPINE20 created six proposed recommendations. These recommendations were uploaded to the SPINE20 website 10 days before the meeting and opened to the public for comments. The recommendations were discussed at the meeting allowing the participants to object and provide comments. RESULTS: In total, 27 societies endorsed the following recommendations. SPINE20 calls upon the G20 countries: (1) to expand telehealth for the access to spine care, especially in light of the current situation with COVID-19. (2) To adopt value-based interprofessional spine care as an approach to improve patient outcomes and reduce disability. (3) To facilitate access and invest in the development of a competent rehabilitation workforce to reduce the burden of disability related to spine disorders. (4) To adopt a strategy to promote daily physical activity and exercises among the elderly population to maintain an active and independent life with a healthy spine, particularly after COVID-19 pandemic. (5) To engage in capacity building with emerging countries and underserved communities for the benefit of spine patients. (6) To promote strategies to transfer evidence-based advances into patient benefit through effective implementation processes. CONCLUSIONS: SPINE20's initiatives will make governments and decision makers aware of efforts to reduce needless suffering from disabling spine pain through education that can be instituted across the globe

Can cavity-based pedicle screw augmentation decrease screw loosening? A biomechanical in vitro study

Purpose!#!In an osteoporotic vertebral body, cement-augmented pedicle screw fixation could possibly be optimized by the creation of an initial cavity. The aim of this study is to compare three test groups with regard to their loosening characteristics under cyclic loading.!##!Methods!#!Eighteen human, osteoporotic spine segments were divided in three groups. Flexibility tests and cyclic loading tests were performed with an internal fixator. The screws were fixed after creation a cavity and with cement (cavity-augmented group), without cavity and with cement (augmented group), and without cavity and without cement (control group). Cyclic loading up to 100,000 cycles was applied with a complex loading protocol. Screw loosening was measured with flexibility tests after implantation and after cyclic loading. Cement distribution was visualized from CT scans.!##!Results!#!In all groups, range of motion increased during cyclic loading, representing significant screw loosening after 100,000 cycles. In both augmented groups, screw loosening was less pronounced than in the control group. The cavity-augmented group showed only a slight tendency of screw loosening, but with smaller variations compared to both other groups. This may be explained with a trend for a more equal and homogeneous cement volume around each tip for the cavity-augmented group.!##!Conclusion!#!This study demonstrated that creating a cavity may allow a more equal fixation of all pedicle screws with slight reduction of loosening. However, augmentation only through a cannulated screw is almost equivalent, if care is taken that enough cement volume can be pushed out around the tip of the screw

Osteoid Osteoma of the Proximal Fibula: An Uncommon Location with the Indication for Open Surgery

Purpose. This is a case report of a patient with an osteoid osteoma of the proximal fibula. The objective is to illustrate a rare tumor location that requires open surgery due to closeness of neurological structures. Methods. Clinical and roentgenographic findings, treatment, and histological appearance are presented. Results. Local pain and swelling of the proximal fibula with improvement under salicylates led to the diagnosis of an osteoid osteoma, what was confirmed with an MRI scan. Due to proximity to the common peroneal nerve, we decided for open surgery. During the operation, the nerve was seen to cross the tumor site making it necessary to retract it to expose the entire tumor. Histologically, typical features of osteoid osteoma with a rather well-defined nidus surrounded by sclerotic bone were seen. A complete removal was performed. Conclusion. Osteoid osteomas of the proximal fibula are rare. When planning surgery, the common peroneal nerve must be identified, and its further distal course should be taken into account to avoid iatrogenic damage to the nerve

SPINE20 A global advocacy group promoting evidence-based spine care of value

Purpose The Global Burden of Diseases (GBD) Studies have estimated that low back pain is one of the costliest ailments worldwide. Subsequent to GBD publications, leadership of the four largest global spine societies agreed to form SPINE20. This article introduces the concept of SPINE20, the recommendations, and the future of this global advocacy group linked to G20 annual summits. Methods The founders of SPINE20 advocacy group coordinated with G20 Saudi Arabia to conduct the SPINE20 summit in 2020. The summit was intended to promote evidence-based recommendations to use the most reliable information from high-level research. Eight areas of importance to mitigate spine disorders were identified through a voting process of the participating societies. Twelve recommendations were discussed and vetted. Results The areas of immediate concern were Aging spine, Future of spine care, Spinal cord injuries, Children and adolescent spine, Spine-related disability, Spine Educational Standards, Patient safety, and Burden on economy. Twelve recommendations were created and endorsed by 31/33 spine societies and 2 journals globally during a vetted process through the SPINE20.org website and during the virtual inaugural meeting November 10-11, 2020 held from the G20 platform. Conclusions This is the first time that international spine societies have joined to support actions to mitigate the burden of spine disorders across the globe. SPINE20 seeks to change awareness and treatment of spine pain by supporting local projects that implement value-based practices with healthcare policies that are culturally sensitive based on scientific evidence

SPINE20 recommendations 2021: spine care for people's health and prosperity.

PurposeThe focus of SPINE20 is to develop evidence-based policy recommendations for the G20 countries to work with governments to reduce the burden of spine disease, and disability.MethodsOn September 17-18, 2021, SPINE20 held its annual meeting in Rome, Italy. Prior to the meeting, the SPINE20 created six proposed recommendations. These recommendations were uploaded to the SPINE20 website 10 days before the meeting and opened to the public for comments. The recommendations were discussed at the meeting allowing the participants to object and provide comments.ResultsIn total, 27 societies endorsed the following recommendations. SPINE20 calls upon the G20 countries: (1) to expand telehealth for the access to spine care, especially in light of the current situation with COVID-19. (2) To adopt value-based interprofessional spine care as an approach to improve patient outcomes and reduce disability. (3) To facilitate access and invest in the development of a competent rehabilitation workforce to reduce the burden of disability related to spine disorders. (4) To adopt a strategy to promote daily physical activity and exercises among the elderly population to maintain an active and independent life with a healthy spine, particularly after COVID-19 pandemic. (5) To engage in capacity building with emerging countries and underserved communities for the benefit of spine patients. (6) To promote strategies to transfer evidence-based advances into patient benefit through effective implementation processes.ConclusionsSPINE20's initiatives will make governments and decision makers aware of efforts to reduce needless suffering from disabling spine pain through education that can be instituted across the globe

A probabilistic finite element analysis of the stresses in the augmented vertebral body after vertebroplasty

Fractured vertebral bodies are often stabilized by vertebroplasty. Several parameters, including fracture type, cement filling shape, cement volume, elastic moduli of cement, cancellous bone and fractured region, may all affect the stresses in the augmented vertebral body and in bone cement. The aim of this study was to determine numerically the effects of these input parameters on the stresses caused. In a probabilistic finite element study, an osteoligamentous model of the lumbar spine was employed. Seven input parameters were simultaneously and randomly varied within appropriate limits for >110 combinations thereof. The maximum von Mises stresses in cancellous and cortical bone of the treated vertebral body L3 and in bone cement were calculated. The loading cases standing, flexion, extension, lateral bending, axial rotation and walking were simulated. In a subsequent sensitivity analysis, the coefficients of correlation and determination of the input parameters on the von Mises stresses were calculated. The loading case has a strong influence on the maximum von Mises stress. In cancellous bone, the median value of the maximum von Mises stresses for the different input parameter combinations varied between 1.5 (standing) and 4.5 MPa (flexion). The ranges of the stresses are large for all loading cases studied. Depending on the loading case, up to 69% of the maximum stress variation could be explained by the seven input parameters. The fracture shape and the elastic modulus of the fractured region have the highest influence. In cortical bone, the median values of the maximum von Mises stresses varied between 31.1 (standing) and 61.8 MPa (flexion). The seven input parameters could explain up to 80% of the stress variation here. It is the fracture shape, which has always the highest influence on the stress variation. In bone cement, the median value of the maximum von Mises stresses varied between 3.8 (standing) and 12.7 MPa (flexion). Up to 75% of the maximum stress variation in cement could be explained by the seven input parameters. Fracture shape, and the elastic moduli of bone cement and of the fracture region are those input parameters with the highest influence on the stress variation. In the model with no fracture, the maximum von Mises stresses are generally low. The present probabilistic and sensitivity study clearly showed that in vertebroplasty the maximum stresses in the augmented vertebral body and in bone cement depend mainly on the loading case and fracture shape. Elastic moduli of cement, fracture region and cancellous bone as well as cement volume have sometimes a moderate effect while number and symmetry of cement plugs have virtually no effect on the maximum stresses