Complications and safety aspects of kyphoplasty for osteoporotic vertebral fractures: a prospective follow-up study in 102 consecutive patients

<p>Abstract</p> <p>Background</p> <p>Kyphoplasty represents an established minimal-invasive method for correction and augmentation of osteoporotic vertebral fractures. Reliable data on perioperative and postoperative complications are lacking in the literature. The present study was designed to evaluate the incidence and patterns of perioperative complications in order to determine the safety of this procedure for patients undergoing kyphoplasty.</p> <p>Patients and Methods</p> <p>We prospectively enrolled 102 consecutive patients (82 women and 20 men; mean age 69) with 135 operatively treated fractured vertebrae who underwent a kyphoplasty between January 2004 to June 2006. Clinical and radiological follow-up was performed for up 6 months after surgery.</p> <p>Results</p> <p>Preoperative pain levels, as determined by the visual analogous scale (VAS) were 7.5 +/- 1.3. Postoperative pain levels were significantly reduced at day 1 after surgery (VAS 2.3 +/- 2.2) and at 6-month follow-up (VAS 1.4 +/- 0.9). Fresh vertebral fractures at adjacent levels were detected radiographically in 8 patients within 6 months. Two patients had a loss of reduction with subsequent sintering of the operated vertebrae and secondary spinal stenosis. Accidental cement extravasation was detected in 7 patients in the intraoperative radiographs. One patient developed a postoperative infected spondylitis at the operated level, which was treated by anterior corporectomy and 360 degrees fusion. Another patient developed a superficial wound infection which required surgical revision. Postoperative bleeding resulting in a subcutaneous haematoma evacuation was seen in one patient.</p> <p>Conclusion</p> <p>The data from the present study imply that percutaneous kyphoplasty can be associated with severe intra- and postoperative complications. This minimal-invasive surgical procedure should therefore be performed exclusively by spine surgeons who have the capability of managing perioperative complications.</p

Rheology of different hydrocolloids-rice starch blends. Effect of successive heating-cooling cycles

10 pages, 3 figures, 5 tables.-- Available online 25 November 2010.Hydrocolloids are frequently used for modifying starch functionality. In the present study the possible interaction of three different hydrocolloids – guar gum, hydroxypropylmethylcellulose (HPMC) and xanthan gum – with rice starch was explored by determining the pasting, viscoelastic and swelling properties of the rice starch–hydrocolloids mixtures. The impact of successive heating–cooling cycles on the pasting, viscoelasticity and swelling was also determined. Hydrocolloids tested in the range 0.2–0.8% (w/w) significantly modified the pasting, viscoelastic and swelling properties of rice starch–hydrocolloid pastes (8%, w/w) and the extent of the effect was dependent on hydrocolloid concentration. Guar and xanthan gum mixtures with rice starch had the greatest effect on the pasting properties, whereas HPMC mixtures only changed the viscosity during cooling. The starch–hydrocolloids pastes formed weaker gels compared to those of the starch alone. Rheological results suggested the formation of composite network structures with high frequency dependence. Successive multiple-heating cycles allowed the gel to rearrange resulting in altered gel viscoelasticity and release of water soluble compounds that favour phase separation at the highest hydrocolloid level tested.Financial support from University of California-Davis, Ministry of Education and Science, Spanish Research National Council (CSIC) and Spanish Ministerio de Ciencia e Innovación (Project AGL2008-00092/ALI) is gratefully acknowledged. Dr. Rosell thanks the Spanish Ministry of Education and Science for her grant.Peer reviewe

The Long-Baseline Neutrino Experiment: Exploring Fundamental Symmetries of the Universe

The preponderance of matter over antimatter in the early Universe, the dynamics of the supernova bursts that produced the heavy elements necessary for life and whether protons eventually decay --- these mysteries at the forefront of particle physics and astrophysics are key to understanding the early evolution of our Universe, its current state and its eventual fate. The Long-Baseline Neutrino Experiment (LBNE) represents an extensively developed plan for a world-class experiment dedicated to addressing these questions. LBNE is conceived around three central components: (1) a new, high-intensity neutrino source generated from a megawatt-class proton accelerator at Fermi National Accelerator Laboratory, (2) a near neutrino detector just downstream of the source, and (3) a massive liquid argon time-projection chamber deployed as a far detector deep underground at the Sanford Underground Research Facility. This facility, located at the site of the former Homestake Mine in Lead, South Dakota, is approximately 1,300 km from the neutrino source at Fermilab -- a distance (baseline) that delivers optimal sensitivity to neutrino charge-parity symmetry violation and mass ordering effects. This ambitious yet cost-effective design incorporates scalability and flexibility and can accommodate a variety of upgrades and contributions. With its exceptional combination of experimental configuration, technical capabilities, and potential for transformative discoveries, LBNE promises to be a vital facility for the field of particle physics worldwide, providing physicists from around the globe with opportunities to collaborate in a twenty to thirty year program of exciting science. In this document we provide a comprehensive overview of LBNE's scientific objectives, its place in the landscape of neutrino physics worldwide, the technologies it will incorporate and the capabilities it will possess.Comment: Major update of previous version. This is the reference document for LBNE science program and current status. Chapters 1, 3, and 9 provide a comprehensive overview of LBNE's scientific objectives, its place in the landscape of neutrino physics worldwide, the technologies it will incorporate and the capabilities it will possess. 288 pages, 116 figure

Pitfalls and complications in the treatment of cervical spine fractures in patients with ankylosing spondylitis

Patients with ankylosing spondylitis are at significant risk for sustaining cervical spine injuries following trauma predisposed by kyphosis, stiffness and osteoporotic bone quality of the spine. The risk of sustaining neurological deficits in this patient population is higher than average. The present review article provides an outline on the specific injury patterns in the cervical spine, diagnostic algorithms and specific treatment modalities dictated by the underlying disease in patients with ankylosing spondylitis. An emphasis is placed on the risks and complication patterns in the treatment of these rare, but challenging injuries

The multidimensional establishement of force-displacement-curves on human lumbar spine

Titelblatt, Inhaltsverzeichnis, Zusammenfassung Einleitung Material und Methoden Ergebnisse1 Ergebnisse2 Ergebnisse3 Referenzen Anlage Messdaten Anlage DiagrammeDie degenerative Segmentinstabilität der Lendenwirbelsäule wird sowohl in ihrer klinischen und radiologischen Objektivierbarkeit als auch in ihrer klinischen Relevanz sehr kontrovers diskutiert wird. Oftmals ist die Diagnose lumbale Segmentinstabilität Grund für aufwendige Fusionsoperationen. Das klinische Resultat dieser Operationen ist wesentlich von der korrekten Indikationsstellung abhängig. Hierzu sind vor allem objektive Daten unerlässlich. Im vorliegenden Projekt ist zunächst die Genauigkeit der heute als Goldstandard etablierten radiologischen Untersuchung untersucht worden. Anschließend wurde ein neues Messverfahren für die Aufnahme von Kraft-Weg- Kurven in vivo entwickelt. Im ersten Teil der Studie konnte gezeigt werden, dass die erreichbare prozentuale Übereinstimmung bei der mehrfachen Beurteilung von seitlichen Funktionsaufnahmen unter klinischen Alltagsbedingungen geringer als erwartet ist. Die hohe Streuung der Messwerte führte bei einer erlaubten Abweichung von +/- 1 mm bzw. +/- 1 ° zu Übereinstimmungen bei Mehrfachuntersuchungen von 38,7 % für angulatorische Verfahren und 49 % für translatorische Verfahren. Ihre zurückhaltende Bewertung im klinischen Alltag ist somit angezeigt. Im zweiten Teil der Studie wurde ein Verfahren entwickelt, welches über die Nutzung von polyaxialen Pedikelschrauben direkt an das lumbale Bewegungssegment ankoppelt. Zum gegenwärtigen Zeitpunkt können die notwendigen Voraussetzungen der Positionierung des Messgerätes nur unter Benutzung einer polyaxialen kopfverriegelnden Kombinationsschraube (MOSS-MAX, Fa. DePuy) erreicht werden. Das im dritten Teil der Studie entwickelte Messgerät realisiert die geforderte Messung von Kraft- und Wegdaten simultan. Die Erprobung des entwickelten Messgerätes erfolgte an nativen menschlichen Ganzkörperpräparaten. Es wurden simultan in Flexion, Rotation links und rechts sowie und in dorsaler Translation des kranialen und kaudalen Wirbels Kraft-Weg-Kurven erstellt. Die Auswertung der Daten zeigte reproduzierbare Messdaten für Kräfte und Wege in allen untersuchten Freiheitsgraden. Die Berechnung von segmentalen Steifigkeiten und Flexibilitätskoeffizienten im stabilen und im instabilen Zustand des Segmentes zeigte die erwartete signifikante Reduktion der Steifigkeit nach Laminektomie bzw. eine signifikante Erhöhung des Flexibilitätskoeffizienten in der instabilen Situation. Auch diese Werte sind ausreichend genau reproduzierbar. Es ist somit gelungen, ein völlig neuartiges Messverfahren zur Beurteilung segmentaler Stabilität zu entwickeln. Das Verfahren erlaubt nicht nur den intraoperativen Einsatz, sondern ist auch erstmals in der Lage, simultan Daten für Belastungen = Loads (Kräfte bzw. Momente) und Wegänderungen = Displacements (Wege bzw. Winkel) in Flexions-, Rotations- und Translationsrichtung zu erheben. Das Verfahren wurde urheberrechtlich geschützt.The clinical relevance of clinical and radiological objectivation of segment instability in the degenerative lumbar spine is very controversially discussed. The diagnosis lumbar segment instability is often the reason for complicated fusion operations. The clinical results of this surgical intervention are largely dependent on the correct diagnosis and require above all objective data. In the project presented here, we first examined the accuracy of the radiological examination currently regarded as the gold standard. Subsequently we developed a new measuring procedure for recording force-displacement curves. In part I of the study, we were able to demonstrate that the percentual agreement achieved in multiple assessments of lateral functional images under routine clinical conditions is lower than anticipated. The high scattering of the measurement values in repeated examinations resulted in 38.7% agreement for angulatory and 49% for translatory procedures with an acceptable deviation of +/- 1 mm and +/- 1°. This assessment should thus be used with caution in the clinical routine. In part II of the study, we developed a procedure that connects directly to the lumbar movement segment via polyaxial pedicle screws. At the present time, the prerequisites required for positioning the measuring device can only be achieved by using a polyaxial headlocking combination screw (MOSS-MAX, DePuy). The measuring device developed in part III of the study realizes the required measurement of force and displacement data at the same time. The measuring device was tested on native human whole-body samples. The force-displacement curves were simultaneously established in flexion, in left and right rotation as well as in dorsal translation of the cranial and caudal vertebra. Evaluation of the data showed reproducible measuring data for forces and displacements in all examined degrees of freedom. Calculation of segmental stiffnesses flexibility coefficients under stable and unstable segment conditions yielded the expected significant reduction of stiffness after laminectomy and a significantly increased flexibility coefficient in the unstable situation. These values can also be reproduced with sufficient accuracy. Thus it was possible to develop a completely novel measurement procedure for assessing segmental stability. This procedure cannot only be intraoperatively applied but enables for the first time the simultaneous recording of data for loads (forces or moments) and displacements (places or angles) in a flexional, rotational or translational direction. The procedure has been patented

Fracture care using percutaneously applied titanium mesh cages (OsseoFix®) for unstable osteoporotic thoracolumbar burst fractures is able to reduce cement- associated complications - results after 12 months

Background Despite the known demographic shift with expected doubled rate of vertebral body fractures by the year 2050, a standardized treatment concept for traumatic and osteoporotic incomplete burst fracture of the truncal spine does not exist. This study aims to determine whether minimally invasive fracture care for incomplete osteoporotic thoracolumbar burst fractures using intravertebral expandable titanium mesh cages is a suitable procedure and may provide improved safety in terms of cement-associated complications in comparison to kyphoplasty procedure. Methods In 2011/2012, 15 patients (10 women, 5 men; mean age 77) with 15 incomplete osteoporotic thoracolumbar burst fractures (T10 to L4) were stabilized using intravertebral expandable titanium mesh cages (OsseoFix®) as part of a prospective study. X-ray, MRI and bone density measurements (DXA) were performed preinterventionally. The clinical and radiological results were evaluated preoperatively, postoperatively and after 12 months according to the visual analogue scale (VAS), the Oswestry Disability Index (ODI), X-ray (Beck Index, Cobb angle) and CT analyses. Wilcoxon rank sum test, sign test and Fischer’s exact test were used for statistical evaluation. Results A significant reduction in pain intensity (VAS) from preoperative 8.0 to 1.6 after 12 months and significant improvement in activity level (ODI) from preoperative 79.0 to 30.5 % after 12 months were revealed. Radiologically, the mean kyphotic angle according to Cobb showed significant improvements from preoperative 9.1° to 8.0° after 12 months. A vertebral body subsidence was revealed in only one case (6.7 %). No changes in the position of the posterior wall were revealed. No cement leakage or perioperative complications were seen. Conclusion As a safe and effective procedure, the use of intravertebral expandable titanium mesh cages presents a valuable alternative to usual intravertebral stabilization procedures for incomplete osteoporotic burst fractures and bears the potential to reduce cement-associated complications

User requirements for a digital health self-care intervention: combining the Behaviour Change Wheel and user-centred design

Background: Heart failure is a complex syndrome that requires long-term management including self-care. The rapid advancement of mobile and digital technologies has opened new avenues for developing digital health interventions to facilitate self-care for people with heart failure. The purpose of this study is to explore what barriers people with heart failure in Australia face to self-care in their daily lives and to determine what an intervention must provide to support this. Methods: Four workshops were held with people with heart failure (n=16) and informal caregivers (n=4). These workshops had three main objectives: to explore the self-care challenges experienced by people with heart failure and their caregivers, to gain preliminary ideas for features and functions of a digital health-based intervention, and to understand the user requirements for the intervention. Analysis of the workshops was informed by a requirements analysis method and stages of intervention development outlined by the Behaviour Change Wheel (BCW), which encompasses the capability, opportunity, motivation, and behaviour (COM-B) model, the theoretical domains framework (TDF) and intervention functions. Results: All three COM-B domains and all but three TDF domains were found to be relevant to the self-care challenges experienced by people with heart failure. Analysis of participants’ ideas for possible intervention components resulted in the production of six components for the intervention and aligned with seven intervention functions (education, persuasion, incentivisation, training, environmental restructuring, modelling, and enablement). Requirements for the intervention were grouped into seven themes to describe ‘how’ the intervention must function or operate to support self-care among people with heart failure. Conclusion: User-centred design (UCD) can augment theory-based intervention development processes by providing an intermediary output for a potential intervention which then allows further consideration of solutions by multidisciplinary design teams and future intervention users

Exploring the self-care experiences of adults with heart failure in Australia: a qualitative study

Background: Heart failure is a complex, progressive syndrome that requires long-term management. This study aimed to understand the self-care experiences of community-dwelling adults with heart failure in Australia. Methods: Nine participants were recruited via social media and notifications by community heart support organisations in Australia. Participants were invited to participate in an interview via video call or telephone. Transcripts were analysed using thematic analysis. Results: Three themes were constructed, offering insight into self-care practices: 1) how participants described self-care practices as a means of adjusting the visibility of heart failure in their daily lives, 2) the significance of personal and societal understanding of self-care, and 3) the relational dynamics of self-care. Conclusion: This study contributes contextualised insights into heart failure self-care, identifying how promoting agency and social connections while challenging existing understandings of heart failure and support systems may provide potential avenues for exploration in supporting self-care. Adopting a person-centred and holistic perspective must be prioritised for effective support of people with heart failure

Diagnostik und Therapie der thorakalen Spondylodiszitis

Due to the increase in patients with multiple co-morbidities and immigration from developing countries the incidence of thoracic spondylodiscitis has not decreased. The diagnosis of thoracic spondylodiscitis is based on clinical findings, laboratory diagnostics and radiological imaging, including X-ray and MRI. Surgical therapy includes radical debridement, correction of deformity and adequate stabilisation, even though the use of titanium implants is discussed controversially. Additionally antibiotic therapy according to the resistance spectrum is necessary. Early diagnosis and therapy enable healing without severe complications